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The public in southwestern Taiwan’s Kaohsiung City have expressed concern over risk of arsenic (As) to people living in six villages of that city nearby a coastal heavy-industrial area. To investigate, we first analyzed urinary total As (TAs) levels in 328 adult subjects from the Nutrition and Health Survey in Taiwan in 2005-2008 (NAHSIT 2005-8). We found the top three highest median urinary TAs levels in residents from the Penghu islands (150.90 µg/L, n = 21) and the upper northern region (78.04 µg/L, n = 56) and the southern region (75.21 µg/L, n = 33) of Taiwan. Then, urinary TAs levels in 1,801 and 1,695 voluntary adult residents of the above-mentioned six villages in 2016 and 2018 respectively were compared with those from the top three highest TAs levels of NAHSIT 2005-8. Median urinary As levels were 84.60 µg/L in 2016 and 73.40 µg/L in 2018, similar to those in the southern region of Taiwan, but far below those in the Penghu islands (p < 0.05). Finally, in 2020, we interviewed 116 healthy adult residents from the same six villages and analyzed one-spot urine samples of total inorganic-related As (TiAs), a summation of As3+, As5+, monomethylarsonic acid, and dimethylarsinic acid. Subjects consuming seafood 2 days before urine sampling (n = 15) were significantly higher TiAs levels than those not (n = 101, p = 0.028). These findings suggest that seafood consumption is probably the main source of urinary TAs and TiAs in people residing close to that coastal heavy-industrial area.

Background/Purpose: The FUT2 gene is a histo-blood group antigen (HBGA) that determines the susceptibility to Norovirus (NoV) infection. This study investigated the clinical significance of the FUT2 gene profile and HBGA expression in NoV infection. Methods: Fecal specimens were collected from children in Chang-Gung Children's Hospital with acute gastroenteritis (AGE). The medical records were reviewed for clinical data. The viral etiology of gastroenteritis was validated using molecular methods. Genomic DNA was isolated from saliva or whole blood with the Puregene B Kit, according to the manufacturers' instructions. Single-nucleotide polymorphisms (SNPs) were determined by real-time PCR assays. Results: FUT2 gene DNA was examined in 98 children with AGE. NoV was detected by RT-PCR in 44 patients (44.8%), while 54 (55.2%) had non-NoV AGE. Of the 44 NoV patients, 38 (86.3%) were secretors (no G428A mutation) and six (13.7%) were non-secretors (G428A mutation). Of the 54 non-NoV AGE patients, 28 (51.9%) were secretors and 20 (48.1%) were non-secretors. NoV-infected patients who were secretors had more frequent vomiting (P

Introduction In this study, the combination of TEMPO-oxidized sacchachitin nanofibers (TOSCNFs) with chitosan-activated platelet-rich plasma (cPRP) was evaluated for remedying dry eye syndrome (DES). Methods TOSCNFs, designated T050SC, were generated. T050SC combined with chitosan-activated (cPRP) was formulated as eye drops for application for severe DES. To evaluate the effects of cPRP and TOSCNFs on the repair of corneal injury, in vitro studies were conducted using Statens Seruminstitut rabbit corneal (SIRC) epithelial cells for cell proliferation and cell migration assays, and a severe DES animal model using rabbits was established with benzalkonium chloride (BAC) treatment for the evaluation. Results Results showed that the optimal eye formulation contained PRP activated by 350 μg/mL of the low-molecular-weight chitosan group (L3) combined with 300 μg/mL TO50SC (L3+T050SC). In the WST-1 cell-proliferation assay, L3 and L3+TO50SC significantly increased Statens SIRC cell proliferation after 24 hrs of incubation. In the SIRC cell migration assay, the L3+TO50SC group showed a wound-healing efficiency of 89% after 24-hr treatment. After 5 days of treatment, Schirmer's test results did not simulate the dry eye animal model. Typical cornea appearance and eye fluorescein staining results showed that the L3 group had the best effect on improving cornea haze and epithelial damage. Conclusion This study has determined that TOSCNFs effectively promoted the healing effect on severe cases of corneal damage, and also might enhance the clinical application and medical potential of PRP in ophthalmology.

There is controversial evidence on the best choice for root-end filling materials in follow-up periods and treatment protocols. The purpose of this study was to evaluate the effectiveness of different root-end filling materials in modern surgical endodontic treatment.A total of 16 studies with a minimum follow-up of 12-months were qualified to be reviewed, involving randomized control trials and observational studies in PubMed, Cochrane library and Scopus until September 1, 2021. The outcome of modern surgical endodontic treatment was assessed based on clinical and radiographic success. Direct comparisons were combined to estimate indirect comparisons, and the estimated effect size was analyzed using the odds ratio (OR). The comparative effectiveness of all materials for target outcomes were shown as P-score.Within this network meta-analysis, mineral trioxide aggregate (MTA) had superior effects among all root-end filling materials at 12-months follow-up. (MTA: OR, 2.03; 95% CI, 0.84-4.91; P-score, 0.86; reference material, gutta-percha). In further sensitivity analyses, MTA, calcium silicate-based root repair material (RRM) and super EBA cement (Super EBA) were associated with significantly higher success rates at 12-months follow-up. (MTA: OR, 5.62; 95% CI, 1.58-19.99; P-score, 0.88; RRM: OR, 5.23; 95% CI, 1.05-25.98; P-score, 0.74; Super EBA: OR, 3.99; 95% CI, 1.06-15.04; P-score, 0.54; reference material, gutta-percha).MTA remains the best choice for root-end filling materials of modern surgical endodontic treatment at the 12-month follow-up. Comparative randomized clinical trials in the long-term follow-up are warranted in future investigations.

Two decades have passed since the September 11 attacks by Islamist militants that shocked the world. Despite this, Islamophobia remains a common phenomenon. In Taiwan, the 2014 12-year Basic Education Curriculum amendments emphasize cultural and global understanding as core competencies. With more than 6 years of implementation, it would be therefore interesting to learn what elementary school students think of Islam. Anchoring on the concepts of intercultural competency development, stereotypes are said to be related to cognitive knowledge, intercultural behavioral abilities, and attitudes. A survey instrument was developed and validated to collect information on stereotypes, skills in intercultural interaction, and attitudes toward Islam. Additionally, cognitive knowledge of Islam was also tested. A total of 712 students participated in the study. Structural equation modelling was used to test the mediating role of cognitive knowledge and intercultural behavioral skills within the relationship between cultural stereotypes and intercultural affects. Findings show that behavioral skills alone are not enough to diminish the negative aspects of stereotypes. Importantly, it is only with the help of cognitive knowledge that the relationship between stereotypes and intercultural affects are improved. It is hoped that by understanding the importance of proper curriculum content, more sustainable coexistence can be established.

Alzheimer’s disease (AD) is the most common age-related neurodegenerative disease. It presents with progressive memory loss, worsens cognitive functions to the point of disability, and causes heavy socioeconomic burdens to patients, their families, and society as a whole. The underlying pathogenic mechanisms of AD are complex and may involve excitotoxicity, excessive generation of reactive oxygen species (ROS), aberrant cell cycle reentry, impaired mitochondrial function, and DNA damage. Up to now, there is no effective treatment available for AD, and it is therefore urgent to develop an effective therapeutic regimen for this devastating disease. Sestrin2, belonging to the sestrin family, can counteract oxidative stress, reduce activity of the mammalian/mechanistic target of rapamycin (mTOR), and improve cell survival. It may therefore play a crucial role in neurodegenerative diseases like AD. However, only limited studies of sestrin2 and AD have been conducted up to now. In this article, we discuss current experimental evidence to demonstrate the potential roles of sestrin2 in treating neurodegenerative diseases, focusing specifically on AD. Strategies for augmenting sestrin2 expression may strengthen neurons, adapting them to stressful conditions through counteracting oxidative stress, and may also adjust the autophagy process, these two effects together conferring neuronal resistance in cases of AD.

Aim: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis. Methods: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24–36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings. Results: For enrolled 1845 patients, SICH rates were ≥ 2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281–0.846], p = 0.0106), the ECASS II (adjusted RR: 0.318 [0.130–0.776], p = 0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048–0.957], p = 0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of < 130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24–36 h. Conclusions: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of < 130 mg/dL is supposed to a candidate marker for predicting SICH within 24–36 h.

PurposeWhen the speech motor system encounters errors, it generates adaptive responses to compensate for the errors. We previously showed that adaptive responses to task-irrelevant errors are significantly smaller than responses to task-relevant errors when errors are introduced gradually. The current study aimed to examine responses to task-irrelevant and task-relevant errors when errors are introduced suddenly.MethodWe used an adaptation paradigm in which participants experienced task-relevant errors (induced by formant-shift perturbations) and task-irrelevant errors (induced by formant-clamp perturbations). For one group of participants (N = 30), we applied the perturbations gradually. The second group of participants (N = 30) received the perturbations suddenly. We designed the perturbations based on participant-specific vowel configurations such that a participant’s first and second formants of /ε/ were perturbed toward their /æ/. To estimate adaptive responses, we measured formant changes (within 0–100 ms of the vowel onset) in response to the formant perturbations.ResultsWe found that (1) the difference between adaptive responses to formant-shift and formant-clamp perturbations was the smallest for the suddenly introduced perturbations, and (2) responses to formant-shift perturbations positively correlated with responses to formant-clamp perturbations for the suddenly (but not gradually) introduced perturbations.ConclusionsThese results showed that the speech motor system responds to task-relevant errors and task-irrelevant errors more differently when errors are introduced gradually than suddenly. Overall, the speech motor system evaluates the relevance of errors and uses its evaluation to modulate its adaptive responses to errors.

Background Huntington's disease (HD) is a neurodegenerative disorder caused by the expansion of trinucleotide CAG repeat in the Huntingtin (Htt) gene. The major pathogenic pathways underlying HD involve the impairment of cellular energy homeostasis and DNA damage in the brain. The protein kinase ataxia-telangiectasia mutated (ATM) is an important regulator of the DNA damage response. ATM is involved in the phosphorylation of AMP-activated protein kinase (AMPK), suggesting that AMPK plays a critical role in response to DNA damage. Herein, we demonstrated that expression of polyQ-expanded mutant Htt (mHtt) enhanced the phosphorylation of ATM. Ginsenoside is the main and most effective component of Panax ginseng. However, the protective effect of a ginsenoside (compound K, CK) in HD remains unclear and warrants further investigation. Methods This study used the R6/2 transgenic mouse model of HD and performed behavioral tests, survival rate, histological analyses, and immunoblot assays. Results The systematic administration of CK into R6/2 mice suppressed the activation of ATM/AMPK and reduced neuronal toxicity and mHTT aggregation. Most importantly, CK increased neuronal density and lifespan and improved motor dysfunction in R6/2 mice. Conversely, CK enhanced the expression of Bcl2 protected striatal cells from the toxicity induced by the overactivation of mHtt and AMPK. Conclusions Thus, the oral administration of CK reduced the disease progression and markedly enhanced lifespan in the transgenic mouse model (R6/2) of HD.

Purpose We continuously monitor our speech output to detect potential errors in our productions. When we encounter errors, we rapidly change our speech output to compensate for the errors. However, it remains unclear whether we adjust the magnitude of our compensatory responses based on the characteristics of errors. Method Participants ( N = 30 adults) produced monosyllabic words containing /ɛ/ (/hɛp/, /hɛd/, /hɛk/) while receiving perturbed or unperturbed auditory feedback. In the perturbed trials, we applied two different types of formant perturbations: (a) the F1 shift, in which the first formant of /ɛ/ was increased, and (b) the F1–F2 shift, in which the first formant was increased and the second formant was decreased to make a participant's /ɛ/ sound like his or her /æ/. In each perturbation condition, we applied three participant-specific perturbation magnitudes (0.5, 1.0, and 1.5 ɛ–æ distance). Results Compensatory responses to perturbations with the magnitude of 1.5 ɛ–æ were proportionally smaller than responses to perturbation magnitudes of 0.5 ɛ–æ. Responses to the F1–F2 shift were larger than responses to the F1 shift regardless of the perturbation magnitude. Additionally, compensatory responses for /hɛd/ were smaller than responses for /hɛp/ and /hɛk/. Conclusions Overall, these results suggest that the brain uses its error evaluation to determine the extent of compensatory responses. The brain may also consider categorical errors and phonemic environments (e.g., articulatory configurations of the following phoneme) to determine the magnitude of its compensatory responses to auditory errors.

Human norovirus (NoV) is the leading cause of acute gastroenteritis and the rapid transmission of NoV renders infection control problematic. Our study aimed to investigate viral shedding in gastroenteritis in children caused by variants of emerging norovirus strains infections.We used RNA-dependent RNA polymerase (RdRp) sequencing to measure NoV genome copies in stool to understand the relationship between the clinical manifestations and viral shedding in hospitalized patients. The near full-length NoV genome sequence was amplified via reverse transcription-polymerase chain reaction (RT-PCR) and NoV recombination was analyzed using the Recombination Analysis Tool (RAT).From January 2015 to March 2018, 77 fecal specimens were collected from hospitalized pediatric patients with confirmed NoV gastroenteritis. The NoV genotypes were GII.4 (n = 22), non-GII.4 (n = 14), GII.4 Sydney (n = 21), and GII.P16-GII.2 (n = 20). Viral load increased from days 2 to 9 from the illness onset, resulting in an irregular plateau without peaks. After day 9, the viral load declined gradually and most viral shedding in feces ceased by day 15. The average viral load was highest in GII.4 Sydney followed by GII.P16-GII.2 infections and lowest in non-GII.4 infections. GII.4 unclassified infections showed the longest viral shedding time, followed by GII.4 Sydney infections, GII.P16-GII.2 recombinant infection resulted in the shortest duration. NoVs evolved to form a group of GII.P16-GII.2 variants during the 2017 to 2018 period.The viral load and shedding period and was different in variants of NoV infections in children. High mutation rate of emerging and re-emerging variants was observed to an enhanced epidemic risk rendering continuous surveillance.

Inhibitor of DNA-binding/differentiation (Id) proteins, a family of helix-loop-helix (HLH) proteins that includes four members of Id1 to Id4 in mammalian cells, are critical for regulating cell growth, differentiation, senescence, cell cycle progression, and increasing angiogenesis and vasculogenesis, as well as accelerating the ability of cell migration. Alzheimer’s disease (AD), the most common neurodegenerative disease in the adult population, manifests the signs of cognitive decline, behavioral changes, and functional impairment. The underlying mechanisms for AD are not well-clarified yet, but the aggregation of amyloid-beta peptides (Aβs), the major components in the senile plaques observed in AD brains, contributes significantly to the disease progression. Emerging evidence reveals that aberrant cell cycle reentry may play a central role in Aβ-induced neuronal demise. Recently, we have shown that several signaling mediators, including Id1, hypoxia-inducible factor-1 (HIF-1), cyclin-dependent kinases-5 (CDK5), and sonic hedgehog (Shh), may contribute to Aβ-induced cell cycle reentry in postmitotic neurons; furthermore, Id1 and CDK5/p25 mutually antagonize the expression/activity of each other. Therefore, Id proteins may potentially have clinical applications in AD. In this review article, we introduce the underlying mechanisms for cell cycle dysregulation in AD and present some examples, including our own studies, to show different aspects of Id1 in terms of cell cycle reentry and other signaling that may be crucial to alter the neuronal fates in this devastating neurodegenerative disease. A thorough understanding of the underlying mechanisms may provide a rationale to make an earlier intervention before the occurrence of cell cycle reentry and subsequent apoptosis in the fully differentiated neurons during the progression of AD or other neurodegenerative diseases.

Dynein transport along the cytoskeletal microtubules towards the minus end is essential for cell division, cell migration and other basic cellular functions. Dynein cytoplasmic 1 light intermediate chain 1 (DYNC1LI1) has been previously associated with pancreatic ductal adenocarcinoma, hepatocellular carcinoma and prostate cancer. Cytoskeletal structures are involved in the regulation of the mucosal barrier integrity. Thus, improving our understanding of the molecular mechanisms that regulate the mucosal barrier is critical for cancer management and treatment. The present study aimed to investigate DYNC1LI1 expression in colorectal cancer (CRC) tissues. The American Joint Committee on Cancer Stage II CRC cell line LS 174T was used to determine the association between the cellular expression levels of DYNC1LI1 and different types of mucin (MUC) by reverse transcription‑quantitative PCR. The role of DYNC1LI1 in cell chemosensitivity and proliferation was also evaluated in the presence of the DNA analog 5‑fluorouracil (5‑FU) or the platinum‑based drug, oxaliplatin by the MTT assay. LS 174T cells with decreased expression levels of DYNC1LI1 were discovered to be more sensitive to 5‑FU compared with LS 174T cells with endogenous DYNC1LI1 expression levels. Moreover, LS 174T cells transfected with short hairpin RNA targeting DYNC1LI1 were associated with low MUC1 and high MUC2, MUC4 and MUC5AC expression levels. Notably, the CRC cells with low MUC1 expression levels and high expression levels of the other MUCs (MUC2, MU4 and MUC5AC) were shown to benefit from 5‑FU treatment. In conclusion, the findings of the present study have suggested that DYNC1LI1 expression may be significantly associated with MUC expression levels and may be used to predict the chemotherapeutic efficiency. However, additional functional studies and clinical reports are required for an improved understanding of the significance of these molecular interactions in tumorigenesis.

Background/Purpose: Rotavirus vaccines were launched in Taiwan since early 2006. Our study was aimed to figure out long-term extended molecular epidemiology in acute gastroenteritis (AGE) in hospitalized young children after rotavirus vaccination in Taiwan. Methods: During the 10-year period from January 2007 to December 2016, fecal samples from children under 5 years old with AGE hospitalized in Chang Gung Children's Hospital (CGCH) were examined for enteric pathogens and they were divided into two time intervals: early post-vaccine (Jan. 2007 to Dec. 2011; EPV) and late post-vaccine (Jan. 2012 to Dec. 2016; LPV). Results: In total, 837 patients with AGE were enrolled with complete study. In the EPV period, 106 (26.7%) rotavirus and 65 (16.4%) norovirus infections were identified as major pathogens. In the LPV period, 79 (17.9%) rotavirus and 98 (22.2%) norovirus infections were diagnosed. Statistical analyses showed a significantly decreased prevalence of rotavirus infection (P = 0.002) and a significantly increased prevalence of norovirus (P = 0.034) and enteric bacterial infections (P

瞭解選擇數學領域的原因，可讓學生評估自己、教師鼓勵學生，以此達到適性發展的目的。本研究以國際數學與科學教育成就趨勢調查2011 年八年級5,042 位學生資料，進行社會認知生涯理論驗證，接著加入學校、教師和父母情境影響變項，採取部分最小平方法結構方程式模型進行分析。研究結果顯示：符合社會認知生涯理論的興趣模型和選擇模型主要路徑假設，數學職業選擇意圖受結果期待與學習興趣的直接影響，而自我效能則是產生較多間接影響；加入情境因素後，只有教師教學對自我效能具中等重要性，但要透過學習興趣、自我效能或結果期待來對數學職業意圖產生影響，直接影響的效果量偏低；其他如「學校氣氛」和「父母協助」等因素，其直接或間接影響效果也都微乎其微。本研究依據研究結果，提出 相關建議。 Understanding the reasons for selecting mathematics as their intended career can help students become familiar with their own goals and help teachers encourage their students to achieve “talent development.” By using data from TIMSS 2011 (2011 Trends in International Mathematics and Science) on 5,042 eighth-grade students from Taiwan, the current study confirmed the Social Cognitive Career Theory (SCCT) and accounted for situational variables, such as school, teacher, and parent characteristics. The partial least squares structural equation modeling results confirmed the main path hypotheses of SCCT and demonstrated that math outcome expectations and interests have a direct effect on the students’ career-choice intention, whereas self-efficacy has an indirect effect. SCCT included situational variables to demonstrate that teacher instruction had moderate implications on self-efficacy and an indirect effect on the career-choice intention, with regard to student interests, self-efficacy, and outcome expectations. Other situational variables, such as school atmosphere and parental support, had little-to-no effect on the career-choice intention. Finally, some conclusions and suggested applications were stated.

This study examined the relationship between intercultural social efficacy (ISE), coping strategies, Mandarin Chinese and English language proficiency, and depression. In total, 1870 foreign students in Taiwan participated in the study. Study results indicated that aspects of background demographics may influence depression levels. Participants with an immigrant background and those who are older are more likely to suffer from depression; however, gender and length of stay do not seem to affect depression. The moderating effects of Mandarin Chinese and English language proficiency and ISE on the relationship between coping strategies and depression were examined. Based on the results, the moderating role of Mandarin Chinese and English language proficiency was not supported, suggesting that coping strategies are independent of linguistic proficiency. However, knowing both languages is an important factor in reducing the stress of studying abroad. Additionally, the results confirmed the moderating effects of ISE, suggesting that a higher level of social effectiveness reinforces the negative association between coping strategies and depression. Students who are better able to interact with other cultures may be able to develop effective coping strategies. Moreover, this study found that although most of the study abroad students were not depressed, early intervention and prevention measures could help alleviate possible mental health crises.

Despite the development of vaccines in 2006, rotavirus is still a major cause of acute gastroenteritis worldwide. This study was performed to analyze the presence of circulating rotaviruses before and after the introduction of rotavirus vaccines to allow phylogenetic comparisons of vaccine strains in northern Taiwan. Rotavirus genotyping and sequencing of rotavirus VP7 and VP4 PCR products were performed by Reverse Transcriptase Polymerase Chain Reaction and DNA autosequencing. Phylogenies were constructed by the neighbor-joining and maximum-likelihood methods using CLUSTAL W software included in the MEGA software package (version 6.0). Between April 2004 and December 2012, a total of 101 rotavirus specimens from pediatric patients with acute gastroenteritis hospitalized in Chang Gung Children's Hospital were amplified, and their VP4 and VP7 sequences were determined. These 101 specimens consisted of 55 pre-vaccine strains (G1 [13, 23.6%], G2 [12, 21.8%], G3 [16, 29.1%], and G9 [14, 25.5%]) and 46 post-vaccine strains (G1 [25, 54.3%], G2 [12, 26.1%], G3 [5, 10.9%], and G9 [4, 8.7%]). The most common combination of the G and P types was G2P[4], accounting for 36% cases, followed by G9P[8] (25%), G1P[8] (20%), G3P[4] (15%), G3P[8] (10%), G1P[4] (5%), and G2P[8] (5%). Phylogenetic analysis showed that only the G1 and P[8] genotypes clustered in the same lineages with the rotavirus vaccine strains. Based on our results, the inclusion of G9, modified G2 and G3 with target lineages, and the combination G2P[4] and G9P[8] in the rotavirus vaccines in Taiwan is warranted as a vaccination strategy.

Sensorimotor adaptation experiments are commonly used to examine motor learning behavior and to uncover information about the underlying control mechanisms of many motor behaviors, including speech production. In the speech and voice domains, aspects of the acoustic signal are shifted/perturbed over time via auditory feedback manipulations. In response, speakers alter their production in the opposite direction of the shift so that their perceived production is closer to what they intended. This process relies on a combination of feedback and feedforward control mechanisms that are difficult to disentangle. The current study describes and tests a simple 3-parameter mathematical model that quantifies the relative contribution of feedback and feedforward control mechanisms to sensorimotor adaptation. The model is a simplified version of the DIVA model, an adaptive neural network model of speech motor control. The three fitting parameters of SimpleDIVA are associated with the three key subsystems involved in speech motor control, namely auditory feedback control, somatosensory feedback control, and feedforward control. The model is tested through computer simulations that identify optimal model fits to six existing sensorimotor adaptation datasets. We show its utility in (1) interpreting the results of adaptation experiments involving the first and second formant frequencies as well as fundamental frequency; (2) assessing the effects of masking noise in adaptation paradigms; (3) fitting more than one perturbation dimension simultaneously; (4) examining sensorimotor adaptation at different timepoints in the production signal; and (5) quantitatively predicting responses in one experiment using parameters derived from another experiment. The model simulations produce excellent fits to real data across different types of perturbations and experimental paradigms (mean correlation between data and model fits across all six studies = 0.95 ± 0.02). The model parameters provide a mechanistic explanation for the behavioral responses to the adaptation paradigm that are not readily available from the behavioral responses alone. Overall, SimpleDIVA offers new insights into speech and voice motor control and has the potential to inform future directions of speech rehabilitation research in disordered populations. Simulation software, including an easy-to-use graphical user interface, is publicly available to facilitate the use of the model in future studies.

Background The ingestion of multiple magnets may lead to severe complications including bowel obstruction, perforation, fistula, peritonitis, short bowel syndrome, life-threatening injuries, and even death. The annual case number of high-powered neodymium magnets ingestion has been increasing in the western world and the dearth of available data demonstrates that this issue has been neglected in Taiwan. Methods We searched the electronic medical records of our institution for patients younger than 18 years old who were diagnosed with, who had ever visited our emergency department, or been hospitalized for magnetic foreign body ingestion between January 2009 and March 2018. Demographic data including the number, shape, and size of magnets ingested, the clinical presentation, type of intervention, and complications were reviewed. Results Thirteen patients who met the enrollment criteria were analyzed. One patient was documented between 2009 and 2013, and twelve were documented between January 2014 and March 2018. Five of the cases documented between 2014 and 2018 had ingested Buckyballs. The median age of the patients was 5 years. All of the patients with clinical symptoms had ingested more than one magnet and required endoscopic or surgical intervention. Bowel perforation or deep ulcer with impending perforation was found in three patients during surgery. Conclusion The number of children who visited our emergency department or were hospitalized due to the ingestion of magnets has increased recently. The presence of high power of neodymium magnets in many products increases the risk of ingesting multiple magnets resulting in serious complications. Therefore, stricter policies are needed to prevent children from obtaining products that contain magnets.

Prediabetes increased risk of diabetes and diabetes‐related macrovascular and microvascular complication. Glycohemoglobin (HbA1c) is clinically used as the gold standard for glycemic control of diabetes. Glycated albumin (GA) is an early Amadori‐type glycation protein between glucose and serum albumin, which changes in a shorter period of time than HbA1c and is superior to HbA1c in reflecting fluctuations in blood glucose. In this study, we aim to assess the predictive value of GA and glycohemoglobin (HbA1c) on a progression of diabetic retinopathy (DR) in prediabetic patients in Taiwan. This study was conducted at the outpatient department of a regional hospital in Southern Taiwan, and recruited 291 patients with prediabetes from January 2016 to February 2017. Blood and urine samples were obtained from all patients after fasting for 12 hours within 1 month of enrollment. The mean age is 62.5 ± 13.0 years and there are 161 males and 130 females. A total of 24.1% of patients have DR. The average value of GA and HbA1c are 14.6% ± 2.8% and 6.0% ± 0.4%, respectively. Old age, male, high systolic blood pressure, high HbA1C, and low total cholesterol are significantly associated with DR in patients with pre‐DM. Therefore, in the prediabetic populations, high HbA1C, but not GA nor GA/HbA1C ratio, is significantly associated with DR.

Sarcopenia is prevalent in postmenopausal women but is inconclusive in total thyroidectomy and under levothyroxine replacement. We aim to analyze the determinants of sarcopenia and investigate the early detection of sarcopenia in this group. Fifty postmenopausal women with total thyroidectomy were measured for body composition via Dual-energy X-ray Absorptiometry (DXA) and Appendicular Skeletal Muscle mass divided by the height square (ASM/ht2). Handgrip strength and gait speed and Geriatric Nutritional Risk Index (GNRI) were calculated. Eight determinants associated with sarcopenia include GNRI (β, 0.042, 95% confidence interval (CI), 0.021 to 0.064), femoral neck BMD (β, 0.989, 95% CI, 0.049 to 1.929), TSH (β, 0.192, 95% CI, 0.027 to 0.357), and thyroglobulin Ab (0.657, 95% CI, 0.210 to 1.103) for ASM/height2, menopausal years (β, −3.112, 95% CI, −5.661 to −0.563) and ASM/height2 (β, 2.669, 95% CI, 1.073 to 4.265) for handgrip strength, and GNRI (β, 0.062, 95% CI, 0.019 to 0.105), T3 (β, −3.541, 95% CI, −7.019 to −0.063), and age (β, 0.043, 95% CI, 0.003 to 0.084) for gait speed. Our study confirmed a high prevalence of low skeletal muscle mass index in postmenopausal women with total thyroidectomy and revealed a number of determinants that could help early diagnosis and management this disease in daily clinical practice.

Prediabetes should be viewed as an increased risk for diabetes and cardiovascular disease. In this study, we investigated its prevalence among the relatives and spouses of patients with type 2 diabetes or risk factors for prediabetes, insulin resistance, and β-cell function. A total of 175 individuals were included and stratified into three groups: controls, and relatives and spouses of type 2 diabetic patients. We compared clinical characteristics consisting of a homeostatic model assessment for insulin resistance (HOMA-IR) and beta cell function (HOMA-β), a quantitative insulin sensitivity check index (QUICKI), and triglyceride glucose (TyG) index. After a multivariable linear regression analysis, the relative group was independently correlated with high fasting glucose, a high TyG index, and low β-cell function, the relatives and spouses were independently associated with a low QUICKI. The relatives and spouses equally had a higher prevalence of prediabetes. These study also indicated that the relatives had multiple factors predicting the development of diabetes mellitus, and that the spouses may share a number of common environmental factors associated with low insulin sensitivity.

Isolation of high-purity, label-free, and viable circulating tumour cells (CTCs) from cancer patients is crucial for subsequent analyses. To address this issue, a two-step CTC isolation scheme was proposed, wherein a spheroid cell culture was used to further purify viable CTCs after conventional negative selection-based CTC isolation methods. Our results from a cancer cell line model revealed that the survival of leukocytes in spheroid cell cultures was significantly decreased with time, whereas OECM-1 cells maintained viability and proliferated. Therefore, such a cell culture operation was expected to increase cancer cell purity in the cell spheroids. This assumption was confirmed by our results, which showed that cancer cell purities were 10.6 to 80.3-fold increased after spheroid cell culture for 8 days. In the following clinical tests, CTC-related cells were observed in 6 of 13 blood samples. Furthermore, the average purity of CTC-related cells was 34.8 ± 14.0%. By utilizing a second-step spheroid cell culture operation, the purity of CTC-related cells was greatly improved when compared with that (less than 10%) achievable by conventional negative selection-based CTC isolation. Overall, this study proposed a two-step process for the isolation of high-purity, label-free, and viable CTCs.

服務學習在教育改革中漸形一股潮流，臺灣教育部也訂定相關辦法與方案，鼓勵相關單位開設相關課程與活動。為求教師可以評估自己的服務學習課程成效，將從服務學習相關文獻確立核心學習內涵，再歸納檢核方法。本文以自編問卷調查詢問大專院校有帶領 服務學習活動或課程的教師，發現教師認為服務學習的公民意識與素養執行不易，且服務學習的概念尚待釐清；而且教師在服務學習的「認知」和「行為」有差距，凸顯結構化與機制化的重要。最後，針對不同服務學習核心學習內涵，教師有建議和實際採用的 檢核機制，而教師較建議者，實際採用程度也會比較頻繁。據此，未來或許可以有具體有效的服務學習操作手冊或藍圖，增加教師信心與採用頻繁度，也讓學生從中獲益。 Service learning has become a popular trend in current educational reform, and to maintain the pace, the Taiwan Ministry of Education has adopted various strategies and plans in promoting service learning courses and activities within schools. In order to help teachers evaluate the effects of their service learning classes, the author reviewed service learning literature in order to establish its core learning contents and evaluation methods. A survey questionnaire was also used to collect relevant data from teachers. Findings of the study indicate that teachers perceived that the civic consciousness and literacy of service learning are difficult to develop, and that the concept of service learning must be clarified. In addition, there are discrepancies between teachers’ “knowledge” and “practice” of service learning, suggesting the need for a basic framework and system for service learning. Finally, regarding the different core contents of service learning, it is noticed that teachers suggested and adopted a number of evaluation methods, with the more often suggested methods being adopted more often in practice. All in all, for the benefit of the students, this study recommends the development of a concrete and effective service learning manual or blueprint, in order to strengthen teachers’ confidence and adoption frequency.