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Simple Summary Conventional serum markers such as carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), and tissue polypeptide antigen (TPA) have a low sensitivity in predicting the prognosis of locoregional esophageal squamous cell carcinoma cell (ESCC). In our clinical study, we found high serum elafin to be an independent outcome predictor for stage I-IIIA ESCC, considering T, N, overall stage, and treatment. In vitro experiments showed that adding recombinant elafin drove ESCC cell proliferation, migration and invasion, while shRNA attenuated elafin levels, abrogating those effects. Our results suggested serum elafin might be a noninvasive biomarker to predict the outcome of locoregional ESCC and could potentially be used as a therapeutic target. Abstract Esophageal squamous cell carcinoma (ESCC) is a highly aggressive tumor known to have locally advanced and metastatic features which cause a dismal prognosis. We sought to determine whether elafin, a non-invasive and secretory small-molecule marker, could be used to predict prognosis in locoregional ESCC patients in human and in vitro studies. In our human study, 119 subjects were identified as having incident and pathologically-proved ESCC with stage I-IIIA tumors from southern Taiwan between 2000 and 2016. We measured their serum elafin levels at baseline and followed them until the date of cancer death or until January 2020, the end of this study. Those with high serum elafin levels were found to have a 1.99-fold risk (95% confidence interval: 1.17–3.38) shorter survival than those who did not. In our in vitro experiments, elevated elafin levels were found to drive ESCC cell proliferation, migration and invasion, while attenuation of elafin level by shRNA abrogated those effects. We concluded that elafin promotes ESCC motility and invasion and leads to a worse clinical prognosis in ESCC patients without distant metastasis.

ObjectiveIt is unclear whether endoscopic assessment of scars after colorectal endoscopic mucosal resection (EMR) has to include biopsies, even if endoscopy is negative. Vice versa, endoscopic diagnosis of recurrent adenoma may not require biopsy before endoscopic reinterventions. We prospectively analysed various endoscopic modalities in the diagnosis of recurrence following EMR.DesignWe conducted a prospective study of patients undergoing colonoscopy after EMR of large (≥20 mm) colorectal neoplasia. Endoscopists predicted recurrence and confidence level with four imaging modes: high-definition white light (WL) and narrow-band imaging (NBI) with and without near focus (NF). Separately, 26 experienced endoscopists assessed offline images.ResultsTwo hundred and thirty patients with 255 EMR scars were included. The prevalence of recurrent adenoma was 24%. Diagnostic values were high for all modes (negative predictive value (NPV) ≥97%, positive predictive value (PPV) ≥81%, sensitivity ≥90%, specificity ≥93% and accuracy ≥93%). In high-confidence cases, NBI with NF had NPV of 100% (95% CI 98% to 100%) and sensitivity of 100% (95% CI 93% to 100%). Use of clips at initial EMR increased diagnostic inaccuracy (adjusted OR=1.68(95% CI 1.01 to 2.75)). In offline assessment, specificity was high for all imaging modes (mean: ≥93% (range: 55%–100%)), while sensitivity was significantly higher for NBI-NF (82%(72%–93%)%)) compared with WL (69%(38%–86%); pConclusionOur study demonstrates very high sensitivity and accuracy for all four imaging modalities, especially NBI with NF, for diagnosis of recurrent neoplasia after EMR. Our data strongly suggest that in cases of high confidence negative optical diagnosis based on NBI-NF, no biopsy is needed to confirm absence of recurrence during colorectal EMR follow-up. A high confidence positive optical diagnosis can lead to immediate resection of any suspicious area. In all cases of low confidence, biopsy is still required.Trial registration numberNCT02668198.

To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke.The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure.The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.

Today, the most serious threat to global health is the continuous outbreak of respiratory diseases, which is called Coronavirus Disease 2019 (COVID-19). The outbreak of COVID-19 has brought severe challenges to public health and has attracted great attention from the research and medical communities. Most patients infected with COVID-19 will have fever. Therefore, the monitoring of body temperature has become one of the most important basis for pandemic prevention and testing. Among them, the measurement of body temperature is the most direct through the Forehead Thermometer, but the measurement speed is relatively slow. The cost of fast-checking body temperature measurement equipment, such as infrared body temperature detection and face recognition temperature machine, is too high, and it is difficult to build Disease Surveillance System (DSS). To solve the above-mentioned problems, the Intelligent pandemic prevention Temperature Measurement System (ITMS) and Pandemic Prevention situation Analysis System (PPAS) are proposed in this study. ITMS is used to detect body temperature. However, PPAS uses big data analysis techniques to prevent pandemics. In this study, the campus field is used as an example, in which ITMS and PPAS are used. In the research, Proof of Concept (PoC), Proof of Service (PoS), and Proof of Business (PoB) were carried out for the use of ITMS and PPAS in the campus area. From the verification, it can be seen that ITMS and PPAS can be successfully used in campus fields and are widely recognized by users. Through the verification of this research, it can be determined that ITMS and PPAS are indeed feasible and capable of dissemination. The ITMS and PPAS are expected to give full play to their functions during the spread of pandemics. All in all, the results of this research will provide a wide range of applied thinking for people who are committed to the development of science and technology.

The organic light-emitting transistors (OLETs) with a novel tri-layer organic semiconducting heterostructure architecture and good performance, including record high EQE, is presented. In addition, an active-matrix display based on OLETs, without driving TFTs, will be demonstrated on a plastic substrate. The potential advantages of such technologies will be discussed.

The dynamic bootstrap voltage (DBV) technique is proposed to keep high efficiency over wide ranges of load currents for high-power universal serial bus devices. The silicon area of the embedded power management with the DBV technique in the system-on-a-chip can be effectively reduced to 50% of the conventional design with a P-type high-side power MOSFET. Test chips fabricated in 0.25-μm CMOS process showed a 92% peak efficiency from 1 mA to 1 A. The maximum driving current was higher than 5 A, and the efficiency was 88%. Compared with the efficiency of the converter without the DBV technique, the efficiency of the converter with DBV technique was improved by about 28%.

Development of 2.1D package with organic interposer in panel size based on the high resolution dry film photo resist and the ultra-thin electro-less copper seed layer will be reported in this paper. The aim of 2.1D technology is to focus on the reducing of production cost and increase I/O counts simultaneously. Compare to the wafer level lithography process, substrate-based process leads to the benefit in cost reduction and risk elusion form chip first process. Dry film photo resist and electro-less copper seed layer processes can significantly save the equipment and material cost compared to the wafer patterning process. High density interconnection routings are integrated on an organic film in 25 µm thickness. Micro-bump is designed as 25 µm size with 40 µm pitch. Embedded trace substrate (ETS) also reported here by using plated nickel seed layer as etching resistance, copper trace with 3 µm width and spacing embedded in the organic film can be achieved. This designed 2.1D organic interposer substrate has passed MSL3 (Moisture Soaking Level 3) standard and TCT (Thermal Cycling Test) reliability test with 1000 cycles. In terms of electrical property study, the electrical measurement including DC resistance and S-parameter is performed to tell apart the different performance of dielectric and photo resist materials, and the result show agreement with the formed appearance of copper traces.

The thickness of thin liquid films is of great interest to industrial processes and life science. Here we propose a holographic system for the evaluation of the 3D topography and thickness of evolving thin liquid film.

Development of 2.1D package with organic interposer in panel size based on the high resolution dry film photoresist and the ultra-thin electro-less copper seed layer will be reported in this paper. The aim of 2.1D technology is focus on the reducing of production cost and increase I/O counts simultaneously. Compare to the wafer level lithography process, substrate-based process leads to the benefit in cost reduction and risk elusion form chip first process. The high resolution photolithography semi-additive processes (SAP) can achieve 3 µm copper line width and 25 µm laser drilled vias in panel size (510*408mm). On the other hand, the sputtered metal seed layer can be replaced by electro-less copper plating seed layer (approximately 0.1 µm). When it comes to cost, dry film photoresist and electro-less copper seed layer processes can significantly save the equipment and material cost compared to the wafer patterning process. These high density interconnection lines, micro-bump pads and vias are integrated and demonstrated on an organic film in the thickness of 25 µm. Micro-bump pads designed for the copper pillar bond are with a 25 µm diameter and a 40 µm pitch. Flip chip bond alignment is verified by the x-ray examination. The embedded trace substrate (ETS) by using plating nickel thin layer for etching resistance, copper trace with 3 µm width and spacing embedded in the organic film can be formed with very good flatness performance. Moreover, this designed 2.1D organic interposer substrate has passed the MSL3 (Moisture Soaking Level 3) standard and the TCT (Thermal Cycling Test) reliability test with 1000 cycles. In terms of electrical property study, kinds of dielectric materials and high resolution photoresists are employed in this study. The electrical measurement including DC resistance and S-parameter is performed to tell apart the different performance of dielectric and photoresist materials, and the result show agreement with the formed appearance of copper traces.

Can a robot think like a human being? Scientists in recent years have been trying to achieve this dream, and we are also committed to this same goal. In this paper, we use an example of throwing the ball into the basket to make the robots process with human-like thinking behavior. Such thinking behavior adopted in this paper is divided into two modes: fast and slow. The fast mode belongs to the intuitional reaction, and the slow mode represents the complicated cogitation in human brain. This fascinating human thinking concept is inspired by the book, Thinking, Fast and Slow , which explains the process of the human brain. In addition, the psychology theories proposed in this book are also adopted to realize the thinking algorithms, and our experiments verify that the thinking mode of human beings is reasonable and effective in robots.

With the increasing role of endoscopy in patient evaluation, more mucosal lesions, including gastric, duodenal and colonic polyps, are encountered during routine examinations. It is imperative for gastroenterologists to become familiar with the endoscopic management of these various gastrointestinal lesions. In this article, various resection techniques will be discussed, including hot/cold forceps polypectomy, hot/cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. The article will also discuss the evidence regarding the efficacy and safety of these techniques and the future direction of endoscopic management of mucosal lesions in the gastrointestinal tract.

System-on-a-chip (SoC) applications require multiple power supply voltages with the features of low noise for analog circuits and high efficiency for digital circuits. Thus, this paper proposes the priority-scheduled program (PSP) for the single-inductor quad-output (SIQO) switching converter. This technique manages energy delivery to multiple outputs, facilitates fast transient response, and reduces cross-regulation simultaneously. Moreover, a level bypass detector (LBD) is used to overcome the limitation of significant loading differences among quad outputs in conventional designs because the PSP technique cantransfer additional energy to low-priority outputs to avoid overshoot voltage at high-priority outputs. Furthermore, voltage disturbance can be filtered out using two additional low-dropout regulators that operate as buffers cascaded at two low-priority outputs. Therefore, the SIQO converter that is fabricated in 40 nm CMOS technology satisfies the power requirements in portable electronics given its low cross-regulation of 0.2%, fast transient response of 15 $\mu\hbox{s}$ , and an output voltage ripple that is smaller than 30 mV.

Four power stages for voltage regulator module (VRM) are adopted to provide high current driving capability and low output ripple in cloud computing. Thus, the time-shift current balance (TSCB) technique is proposed to achieve high performance power supply for servers. In addition, the power request, which includes the number of active phases and voltage identification, is acknowledged by servers for high driving capability during high throughput and high efficiency during standby mode. Furthermore, to equally distribute the current in each phase, the proposed TSCB technique in either voltage-mode or peak current-mode control improves the current balance performance and solves the stability problem. In the scale-down clouding computing prototype, the efficiency can be kept higher than 90% over a wide load current range of 2 A. In addition, the performance and operating frequency of the servers in stable operation are not limited by the VRM with the TSCB technique.

2.1D package technology (chip on substrate) as a potential low cost solution for 2.5D silicon interposer package (chip on wafer on substrate), we develop here a panel type manufacture organic interposer (scheme 1). 2.1D technology focus on the production cost and the ball count range which defined by line/space. We presents the demonstration of high resolution photolithography semi-additive processes (SAP) to achieve 3 μm copper line widths and 25 μm laser drilled vias with panel-based processes by using large field projection lithography equipment and advanced dry film photoresists. Furthermore, electro-less copper plating seed layer (∼0.1 μm) was chosen to replace sputtered metal seed layer. Compare to wafer pattering process, dry film photoresist and elctro-less copper seed layer processes can save significant equipment and material cost to reaches 3 μm level line width and gap. A metal layer redistribution layer (RDL) structure integrating high density lines and vias was demonstrated on 25 μm organic film. The organic interposer also consists of micro-bump pad of 25 μm diameter (40 μm pitch). The designed 2.1D organic interposer substrate has passed the reliability test with MSL3 (Moisture Soaking Level 3) standard and TCT (Thermal Cycling Test) 1000 cycles. The electrical performance of the substrate/organic interposer combination has also been tested.

To cope with monolithic controller replicas and the current unbalance situation in multiphase converters, a pseudo-ramp current balance technique is proposed to achieve time-multiplexing current balance in voltage-mode multiphase DC-DC buck converter. With only one modulation controller, silicon area and power consumption caused by the replicas of controller can be reduced significantly. Current balance accuracy can be further enhanced since the mismatches between different controllers caused by process, voltage, and temperature variations are removed. Moreover, the offset cancellation control embedded in the current matching unit is used to eliminate intrinsic offset voltage existing at the operational transconductance amplifier for improved current balance. An explicit model, which contains both voltage and current balance loops with non-ideal effects, is derived for analyzing system stability. Experimental results show that current difference between each phase can be decreased by over 83% under both heavy and light load conditions.

Dual dynamic voltage scaling (DVS) techniques employed in single-inductor dual-output (SIDO) converters are used to improve the efficiency of the system-on-a-chip (SoC). One DVS technique for digital circuits is controlled by the SoC processor. This paper presents the analog DVS (ADVS) technique for analog circuits to scale voltage across the power MOSFET of the switchable digital-analog (D/A) low-dropout (LDO) regulator which is the post-regulator cascaded in series with the SIDO converter. The ADVS determines the tradeoff between voltage suppression and efficiency. Furthermore, because of the digital operation of the D/A LDO regulator, the quiescent current is further reduced at light loads while the load current requirement is minimized. In addition, the limitation of the capacitor-free LDO is significantly reduced by a few microamperes. The test chip was fabricated using a 40-nm CMOS process. Experimental results demonstrated switchable D/A LDO regulator operation with peak efficiency at 96.7% in analog operation and a 5-mV output voltage ripple at 120-mA load resulting from the advantage of ripple suppression. The power efficiency could be sustained at a value over 92.57% even when the load current decreased to 1 μA.

Alcohol is an important risk factor for the development of second esophageal squamous-cell carcinoma (ESCC) in head and neck squamous-cell carcinoma (HNSCC) patients. However, the influence of tea consumption is uncertain. We prospectively performed endoscopic screening in incident HNSCC patients to identify synchronous esophageal neoplasm. In total, 987 patients enrolled between October 2008 and December 2017 and were analyzed. In vitro studies were conducted to investigate the effect of epigallocatechin gallate (EGCG) on the betel alkaloid, arecoline-stimulated carcinogenesis in two ESCC cell lines. There were 151 patients (15.3%) diagnosed to have synchronous esophageal neoplasm, including 88 low-grade dysplasia, 30 high-grade dysplasia and 33 squamous-cell carcinoma (SCC). Tea consumption was associated with a significantly lower risk of having esophageal high-grade dysplasia or SCC in HNSCC patients, especially those who were betel nut chewers, alcohol drinkers or cigarette smokers (all adjusted odds ratio were 0.5, p-values: 0.045, 0.045 and 0.049 respectively). In vitro studies indicated that EGCG suppressed arecoline-induced ESCC cell proliferation and colony formation through the inhibition of the Akt and ERK1/2 pathway in a reactive oxygen species-independent manner. In conclusion, tea consumption may protect against the development of second esophageal neoplasms among HNSCC patients, especially those who regularly consume betel nuts, alcohol and cigarettes.

In this paper, we propose a video summarization system for analyzing basketball game videos. In contrast to previous video analysis technologies employing only visual and motion features to do video filtering, we add audio features to do video summarization in the system. First, we extract replay highlights by special effect detection. Next, we filter landscape shots using color range pixel and fast motion activity. Then, the corresponding audio features extracted from these landscape shots are used to identify landscape shot highlights by an SVM. Finally, we integrate the replay highlights and landscape shot highlights to complete the video summarization. From the experimental results, we find that the accuracy on the special effect detection, landscape shot extraction, and landscape shot highlight detection is very high. Thus, the final video summarization has high recall values on highlight extraction.

The stability of conventional constant on-time control buck converter is constrained by the time constant, which is the product of the output capacitor and its equivalent series resistance (ESR). Specialty polymer capacitor which is mostly used as output capacitor for such a consideration although it limits the performance of converter. On the other hand, the multilayer ceramic capacitors are widely used in commercial power management ICs due to the advantages of low cost and ESR. However, the stability often confronts with the subharmonic problem caused by small time constant. A differential-zero compensator with the noise margin enhancement (DZC-NME) technique in constant on-time control buck dc-dc converter with output ceramic capacitor is proposed in this paper. Thus, the proposed DZC-NME technique not only eliminates the limit of large time constant but also tolerates the existence of equivalent series inductor (ESL) effect. Experiment results demonstrate small output ripple of 10 mV and high efficiency of 91% when ESR is smaller than 1 mΩ and large interference from ESL effect is 40 mV.

Tradeoff between power efficiency and transient performance usually comes out during the design consideration of a power module. A configurable power supplying implementation named as the power cloud system (PCS) is proposed to handle different load conditions for simultaneously improving the power efficiency and the transient response in order to meet the system-on-chip (SoC) requirements. At heavy loads, the switching regulator takes over the energy delivery scheme in the PCS with the fast transient technique. An auxiliary power unit, which activates hybrid operation in both medium and light loads, can realize the low-dropout (LDO) regulator to provide a supplementary energy immediately in transient duration and be the high-side power switches of the switching regulator to minimize the power loss. Besides, owing to its low quiescent current of an LDO regulator, it can directly operate under the ultralight-load condition. Therefore, the satisfactory power conversion efficiency and the load transient response can be derived over a wide load range, which will certainly meet the power requirement for different operated functions in the SoC. The chip was fabricated by a 0.25-μm CMOS process, and the experimental results show the improvements of 56% transient dip voltage and 25% transient recovery time in hybrid operation, as well as a peak efficiency of 94%.

We have demonstrated a Cu2O/ZnO nanorods (NRs) array p-n heterostructures photoelectrochemical biosensor. The electrodeposition of Cu2O at pH 12 acquired the preferably (111) lattice planes, resulting in the largest interfacial electric field between Cu2O and ZnO, which finally led to the highest separation efficiency of photogenerated charge carriers. High verticality ZnO nanorods by seed layer and thermal annealing assist the hydrothermal growth. The optimized Cu2O/ZnO NRs array p-n heterostructures exhibited enhanced PEC performance, such as elevated photocurrent and photoconversion efficiency, as well as excellent sensing performance for the sensitive detection of four strains of different races and different degree of cancer cell which made the device self-powered. We got spectral response characteristics and operating wavelength range of biosensor, and to verify the biological characteristics of cancer cells wafer react with different stages of cancer characterized by a cancer measured reaction experiment.

This study presents a method to identify early esophageal cancer within endoscope using hyperspectral imaging technology. The research samples are three kinds of endoscopic images including white light endoscopic, chromoendoscopic, and narrow-band endoscopic images with different stages of pathological changes (normal, dysplasia, dysplasia - esophageal cancer, and esophageal cancer). Research is divided into two parts: first, we analysis the reflectance spectra of endoscopic images with different stages to know the spectral responses by pathological changes. Second, we identified early cancerous lesion of esophagus by principal component analysis (PCA) of the reflectance spectra of endoscopic images. The results of this study show that the identification of early cancerous lesion is possible achieve from three kinds of images. In which the spectral characteristics of NBI endoscopy images of a gray area than those without the existence of the problem the first two, and the trend is very clear. Therefore, if simply to reflect differences in the degree of spectral identification, chromoendoscopic images are suitable samples. The best identification of early esophageal cancer is using the NBI endoscopic images. Based on the results, the use of hyperspectral imaging technology in the early endoscopic esophageal cancer lesion image recognition helps clinicians quickly diagnose. We hope for the future to have a relatively large amount of endoscopic image by establishing a hyperspectral imaging database system developed in this study, so the clinician can take this repository more efficiently preliminary diagnosis.

Ingestion of mushrooms from the genus Amanita can present detrimental consequences to the human body. The mushroom is frequently found in the coastal Pacific Northwest, Pennsylvania, New Jersey, and Ohio. Amanitin, one of the two distinct toxins isolated from the Amanita mushroom, is responsible for the majority of symptoms and signs seen with mushroom poisoning. Clinically, ingestion of these mushrooms can result in a wide range of clinical symptoms including nausea, vomiting, crampy abdominal pain, and diarrhea. There have been several case reports of patients who developed severe hepatic failure that required liver transplantation. Thus, it is important to recognize the symptoms early and treat the patients with the available agents including multidose activated charcoal, N-acetylcysteine, penicillin G, and Silybum. Through an extensive literature search, we found no published literature on amatoxin poisoning in the state of Texas. With new cases of amatoxin poisoning emerging in the state, it is important for healthcare providers and workers to have a better awareness and early recognition of the detrimental effects of Amanita species poisoning and to be educated to provide the proper care for this group of patients.

Typical atrial flutter (AFL) is a common atrial arrhythmia that may cause significant symptoms and serious adverse effects including embolic stroke, myocardial ischemia and infarction, and rarely a tachycardia-induced cardiomyopathy as a result of rapid atrioventricular conduction. As a result of the well-defined anatomic and electrophysiological substrate, and the relative pharmacologic resistance of typical AFL, radiofrequency catheter ablation has emerged in the past decade as a safe and effective first-line treatment. This article reviews the electrophysiology of typical AFL and the techniques currently used for its diagnosis and management.

// I-Chen Wu 1, 2, * , Yu-Kuei Chen 3, * , Chun-Chieh Wu 4 , Yu-Jen Cheng 5 , Wei-Chung Chen 6 , Huey-Jiun Ko 1 , Yu-Peng Liu 7, 8 , Chee-Yin Chai 4 , Hung-Shun Lin 9 , Deng-Chyang Wu 1, 2 , Ming-Tsang Wu 7, 10, 11 1 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 3 Department of Food Science and Nutrition, Meiho University, Pingtung, Taiwan 4 Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 5 Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan 6 Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 7 Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 8 Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan 9 Department of Laboratory Medicine & Department of Research, Education & Training, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 10 Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 11 Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan * These authors have contributed equally to this work Correspondence to: Ming-Tsang Wu, email: 960021@ms.kmuh.org.tw Keywords: ATPase Na+/K+ transporting alpha 1 polypeptide, microarray-based screening, arecoline, F344, esophageal squamous cell carcinoma Received: December 30, 2015 Accepted: October 14, 2016 Published: November 10, 2016 ABSTRACT This study aims to identify new upregulated genes related to secretory or membranous proteins to help detect esophageal squamous cell carcinoma (ESCC). First, we performed microarray-based screening of esophageal tumors from both N-nitrosomethylbenzylamine- and arecoline-induced F344 rats and seventeen human ESCC specimens. Candidate genes were validated by quantitative PCR (qPCR) and immunohistochemical (IHC) staining of ESCC tissues. Among the paired cancer and adjacent normal tissues from 14 ESCC patients, 10 pairs (71.4%) had overexpression of ATP1A1 (ATPase Na+/K+ transporting alpha 1 polypeptide) by qPCR (P = 0.0052). ATP1A1 protein expression was re-confirmed by tissue arrays in 243 ESCC tissues and 126 adjacent normal tissues and by ELISA in 78 serum specimens of ESCC patients. ATP1A1 was 12.3 times (adjusted odds ratio=12.3, 95% CI = 7.2-21.0) more likely to be overexpressed in cancer tissues than in normal tissues. ATP1A1 expression was also correlated to tumor stage. Patients with higher serum ATP1A1 levels had a 2.9-fold (95% CI = 1.1-7.4) risk of late-stage disease (stages III-IV vs . I-II). Downregulation of ATP1A1 expression inhibited the migration and invasion ability of ESCC cell lines in vitro . We concluded that the overexpression of ATP1A1 is strongly associated with the presence and severity of ESCC.

Recent case series have shown that enteroscopy is safe and effective to remove entrapped small bowel foreign bodies. However, the optimal timing for the foreign body retrieval in terms of duration of entrapment and when to consider surgical intervention are unknown. In this case series, we report that antegrade and retrograde enteroscopy can be used safely to retrieve foreign bodies entrapped in the small bowel for longer than 70 days. In total, 20 patients (mean age, 48 years; 11 females) with entrapped foreign bodies in the small intestine underwent antegrade, retrograde, or combined double balloon enteroscopy for retrieval of objects. Symptoms prompted removal of entrapped, nonsharp objects in all patients and included abdominal pain, nausea, and vomiting. The mean time of entrapment was 83 days (range, 4-272 days). There were 15 cases of retained video capsule endoscopy (VCE) with a mean entrapment time of 106 days (range, 7-272 days). Two VCEs could not be removed safely with enteroscopy. Other retained small bowel objects included in this study were nails and fish hooks. Their average entrapment time was 13 days (range, 4-43 days). Of the 30 enteroscopies, there was only 1 case (3%) with a complication (perforation). According to this case series, experienced endoscopists can safely and effectively retrieve foreign bodies in the small bowel, particularly VCE, that are retained for extended periods of time.

The p-n heterojunction photoelectrochemical biosensor, which comprises a p-type Cu2O film formed by electrochemical deposition and n-type ZnO nanorods formed by the hydrothermal method, is prone to photoelectrochemical reactions and self-powered. Four types of human esophageal cancer cells (ECCs) were detected by this biosensor without requiring an extra bias voltage. The measured photocurrent values of high invasion capacity cancer cells was consistently 2 times higher than those measured by a slight invasion capacity cancer cells. The response time, which was about 0.5 s, allowed repeated measurement.

Compact size wearable devices require multiple supplies with relative large loading difference, which causes serious cross regulation, large ripple and oscillation in single-inductor multiple-output (SIMO) DC-DC converter. Thus, a continuous conduction mode/green mode (CCM/GM) relative skip energy control (RSEC) in single-inductor multiple-output (SIMO) is proposed for wearable device power solution. Different from conventional absolute skip method, the RSEC eliminates unnecessary skip-induced voltage ripple and cross regulation with well regulation performance over wide load and voltage ranges. Optimization between efficiency and voltage ripple achieves low noise supply and reduced switching loss. Moreover, smooth transition between CCM and GM provides high power and longer usage time in wearable devices. The test chip fabricated in 0.18μm CMOS process occupies 2.24mm2 active area. Maximum output ripple, overshoot/undershoot and cross regulation are kept below 17mV, 27mV and 0.0432mV/mA, respectively.

System-on-a-chip (SoC) applications need multiple power supplies with low noise for analog circuits and high efficiency for digital circuits. Thus, this paper proposes the priority-scheduled program (PSP) for single inductor quad output (SIQO) switching converter to manage energy delivery for four outputs. Consequently, SIQO converter with PSP can provides fast transient response and reduce cross-regulation. Besides, the level bypass detector (LBD) provides unlimited load range between each output through the shared inductor. The PSP cooperates with the LDB to transfer energy to low priority outputs to avoid overshoot at high priority outputs. With the two low-dropout regulator (LDR) working as buffers at low priority outputs, voltage disturbance can be filtered out. The SIQO converter fabricated in 40nm CMOS technology satisfies power requirements in portable electronics with 0.2% low noise, 15µs fast transient response, and cross-regulation smaller than 30mV.

Supplying a regulated 0.6V to biomedical systems requires a low dropout (LDO) regulator with a maximum driving current capability of 10mA. One sub-1V voltage reference circuit is commonly used in the conventional LDO design to generate the reference voltage VREF with a low temperature coefficient (TC), as shown in Fig. 17.10.1. VREF is sent to the inverting terminal of the error amplifier (EA) to regulate the output voltage VOUT. The critical path of the voltage headroom exists between VREF and VIN through the inverting terminal and the tail current of the EA. That is, VIN>VSG+VOV+VREF ≈|Vtp|+2VOV+VREF, where VIN is the input supply voltage, Vtp is the threshold voltage of the p-type MOSFET and VOV is the overdrive voltage. If the minimum value of VIN is reduced to 0.65V, the derived VREF should be smaller than 50mV when |Vtp| is 0.4V and |VOV| is 0.1V. Such a sub-1V voltage reference circuit is difficult to design [1]-[4]. Even if VREF can be derived, the offset voltage in the EA will seriously affect the exact value of VREF (≤50mV). In addition, the low noise immunity is another disadvantage that severely affects the performance of the biomedical system.

For high power universal serial bus (USB) devices, the dynamic bootstrap voltage (DBV) technique is proposed to keep high efficiency over a wide load range, including light and heavy loads. Besides, the silicon area of power management of the system-on-a-chip (Soc) can be effectively reduced to 50% of conventional design with P-type high-side power MOSFET. The test chip fabricated in 0.25μm CMOS process shows 92% peak efficiency from 1mA to 1A. The maximum driving current is higher than 3A with 88 % efficiency. Compared to that without the DBV technique, the efficiency is improved about 28%.