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Abstract Transcranial temporal interference stimulation (tTIS) is a promising brain stimulation method that can target deep brain regions by delivering an interfering current from surface electrodes. Most instances of tTIS stimulate the brain with a single-frequency sinusoidal waveform generated by wave interference. Theta burst stimulation is an effective stimulation scheme that can modulate neuroplasticity by generating long-term potentiation- or depression-like effects. To broaden tTIS application, we developed a theta burst protocol using tTIS technique to modulate neuroplasticity in rats. Two cannula electrodes were unilaterally implanted into the intact skull over the primary motor cortex. Electrical field of temporal interference envelopes generated by tTIS through cannula electrodes were recorded from primary motor cortex. Theta burst schemes were characterized, and motor activation induced by the stimulation was also evaluated simultaneously by observing electromyographic signals from the corresponding brachioradialis muscle. After validating the stimulation scheme, we further tested the modulatory effects of theta burst stimulation delivered by tTIS and by conventional transcranial electrical stimulation on primary motor cortex excitability. Changes in the amplitude of motor evoked potentials, elicited when the primary motor cortex was activated by electrical pulses, were measured before and after theta burst stimulation by both techniques. Significant potentiation and suppression were found at 15 to 30 min after the intermittent and continuous theta burst stimulation delivered using tTIS, respectively. However, comparing to theta burst stimulations delivered using conventional form of transcranial electrical stimulation, using tTIS expressed no significant difference in modulating motor evoked potential amplitudes. Sham treatment from both methods had no effect on changing the motor evoked potential amplitude. The present study demonstrated the feasibility of using tTIS to achieve a theta burst stimulation scheme for motor cortical neuromodulation. These findings also indicated the future potential of using tTIS to carry out theta burst stimulation protocols in deep-brain networks for modulating neuroplasticity.

Abstract Anelloviruses are nonpathogenic viruses that comprise a major portion of the human virome. Despite being ubiquitous in the human population, anelloviruses (ANVs) remain poorly understood. Basic features of the virus, such as the identity of its capsid protein and the structure of the viral particle, have been unclear until now. Here, we use cryogenic electron microscopy to describe the first structure of an ANV-like particle. The particle, formed by 60 jelly roll domain-containing ANV capsid proteins, forms an icosahedral particle core from which spike domains extend to form a salient part of the particle surface. The spike domains come together around the 5-fold symmetry axis to form crown-like features. The base of the spike domain, the P1 subdomain, shares some sequence conservation between ANV strains while a hypervariable region, forming the P2 subdomain, is at the spike domain apex. We propose that this structure renders the particle less susceptible to antibody neutralization by hiding vulnerable conserved domains while exposing highly diverse epitopes as immunological decoys, thereby contributing to the immune evasion properties of anelloviruses. These results shed light on the structure of anelloviruses and provide a framework to understand their interactions with the immune system.

Abstract To reduce the use of antibiotics and chemicals in aquaculture, an edible herb, Bidens pilosa, has been selected as a multifunctional feed additive. Although there has been considerable research into the effects of B. pilosa on poultry, the wider effects of B. pilosa, particularly on the growth and gut microbiota of fish, remain largely unexplored. We aimed to investigate the interactive effects between the host on growth and the gut microbiota using transcriptomics and the gut microbiota in B. pilosa-fed tilapia. In this study, we added 0.5% and 1% B. pilosa to the diet and observed that the growth performance of tilapia significantly increased over 8 weeks of feeding. Comparative transcriptome analysis was performed on RNA sequence profiles obtained from liver and muscle tissues. Functional enrichment analysis revealed that B. pilosa regulates several pathways and genes involved in amino acid metabolism, lipid metabolism, carbohydrate metabolism, endocrine system, signal transduction, and metabolism of other amino acids. The expression of the selected growth-associated genes was validated by qRT–PCR. The qRT–PCR results indicated that B. pilosa may enhance growth performance by activating the expression of the liver igf1 and muscle igf1rb genes and inhibiting the expression of the muscle negative regulator mstnb. Both the enhancement of liver endocrine IGF1/IGF1Rb signaling and the suppression of muscle autocrine/paracrine MSTN signaling induced the expression of myogenic regulatory factors (MRFs), myod1, myog and mrf4 in muscle to promote muscle growth in tilapia. The predicted function of the gut microbiota showed several significantly different pathways that overlapped with the KEGG enrichment results of differentially expressed genes in the liver transcriptomes. This finding suggested that the gut microbiota may influence liver metabolism through the gut–liver axis in B. pilosa-fed tilapia. In conclusion, dietary B. pilosa can regulate endocrine IGF1 signaling and autocrine/paracrine MSTN signaling to activate the expression of MRFs to promote muscle growth and alter the composition of gut bacteria, which can then affect liver amino acid metabolism, carbohydrate metabolism, endocrine system, lipid metabolism, metabolism of other amino acids, and signal transduction in the host, ultimately enhancing growth performance. Our results suggest that B. pilosa has the potential to be a functional additive that can be used as an alternative to reduce antibiotic use as a growth promoter in aquaculture.

Abstract Objectives In this study, we aimed to validate the performance of the PAX1 and JAM3 methylation (PAX1 m /JAM3 m ) test as a triage tool for detecting cervical intraepithelial neoplasia grade 3 or worse (CIN3 +) in non-16/18 high-risk human papillomavirus-positive patients (non-16/18 hrHPV +). Methods The triage performance of liquid-based cytology (LBC) and the PAX1 m /JAM3 m test for detecting CIN3 + were compared. Results In total, 1851 participants had cervical histological outcomes and were included in the analysis. The sensitivity/specificity of the LBC test results with atypical squamous cells of undetermined significance or worse (LBC ≥ ASCUS) and the PAX1 m /JAM3 m test were 90.1%/26.7% and 84.8%/88.5%, respectively. PAX1 m /JAM3 m ( +) had the highest diagnostic AUC (0.866, 95% confidence interval (CI) 0.837–0.896) in the whole cohort. All cancers (n = 20) were detected by PAX1 m /JAM3 m (+). Compared with LBC ≥ ASCUS, PAX1 m /JAM3 m (+) reduced the number of patients who needed referral for colposcopy by 57.21% (74.66% vs. 17.45%). The odds ratios for detecting CIN3 + by LBC ≥ ASCUS and PAX1 m /JAM3 m (+) were 3.3 (95% CI 2.0–5.9) and 42.6 (27.1–69.6), respectively (p

Objective: Robotic thoracic surgery provides another minimally invasive approach in addition to video-assisted thoracoscopic surgery (VATS) that yields less pain and faster recovery compared with open surgery. However, robotic incisions are generally placed more inferiorly, which may increase the risk of intercostal nerve injury that affects the abdominal wall. We hypothesized that a robotic approach causes greater ipsilateral rectus muscle atrophy compared with open and VATS approaches. Methods: The cross-sectional area and density of bilateral rectus abdominis muscles were measured on computed tomography scans in patients who underwent lobectomy in 2018. The differences between the contralateral and ipsilateral muscles were compared between preoperative and 6-month surveillance scans. Changes were compared among the open, VATS, and robotic approaches through a mixed effects model after adjustments of correlation and covariates. Results: Of 99 lobectomies, 25 (25.3%) were open, 56 (56.6%) VATS, and 18 (18.1%) robotic. The difference between the contralateral and ipsilateral rectus muscle cross-sectional area was significantly larger at 6 months after robotic surgery compared with open (31.4% vs 9.5%, P = .049) and VATS (31.4% vs 14.1%, P = .021). There were no significant differences in the cross-sectional area between the open and VATS approach. Conclusions: In this retrospective analysis, there was greater ipsilateral rectus muscle atrophy associated with robotic thoracic surgery compared with open or VATS approaches. These findings should be correlated with clinical symptoms and followed to assess for resolution or persistence.

Abstract The deep ultraviolet (DUV) micro-light emitting diode (μLED) has serious electron leakage and low hole injection efficiency. Meanwhile, with the decrease in the size of the LED chip, the plasma-assisted dry etching process will cause damage to the side wall of the mesa, which will form a carrier leakage channel and produce non-radiative recombination. All of these will reduce the photoelectric performance of μLED. To this end, this study introduces polarized bulk charges into the hole supply layer (p-HSL) and the electron supply layer (n-ESL) respectively (dual-polarized structure) of the DUV μLED at an emission wavelength of 279 nm to enhance the binding of carriers and increase the injection efficiency of carriers. This is because the polarization-induced bulk charge can shield the polarized sheet charge on the interface and reduce the polarization electric field. The reduced polarization electric field in p-HSL can increase the effective barrier height of the conduction band in the p-type region and reduce the effective barrier height of the valence band. The decrease in the polarized electric field of n-HSL can reduce the thermal velocity of electrons, thereby enhancing the electron injection efficiency, reducing the Shockley–Read–Hall (SRH) recombination, and increasing the effective barrier height of the valence band. The study results indicate that the electron concentration and hole concentration of a μLED with dual polarization were increased by 77.93% and 93.6%, respectively. The optical power and maximum external quantum efficiency of μLED reached 31.04 W/cm2 and 2.91% respectively, and the efficiency droop is only 2.06% at 120 A/cm2. These results provide a new approach to solving the problem of insufficient carrier injection and SRH recombination in high-performance DUV μLEDs.

OBJECTIVE: This study evaluated the impact of local treatment modalities in the management of large non-small cell lung cancer (NSCLC) tumors using a nationwide population-based dataset. MATERIAL AND METHODS: Patients with NSCLC tumors >7 cm that were cN0-1M0 in the Surveillance, Epidemiology, and End Results (SEER) registry from 2010 to 2015 were stratified by local management strategy (surgery, radiation therapy, no local treatment) and evaluated using Kaplan–Meier survival analyses, Cox proportional-hazard methods, and propensity-matched analysis. RESULTS: A total of 3156 patients were identified, of which 1580 (50.1%) underwent surgical resection, 920 (29.2%) received radiation only, 655 (20.7%) received no local treatment. Overall, the 5-year survival of patients undergoing surgical resection was 40.7%, compared to 14.7% and 5.3% for the radiation only and no local treatment groups, respectively (P < .001). Surgery with or without radiation continued to have an independent association with improved survival in multivariable analysis (HR 0.23, P < .0001). Other factors associated with improved survival included younger age, negative nodal disease, and chemotherapy use. In propensity-matched sub-analyses, 5-year survival remained significantly better after surgery alone compared to radiation alone (38.5% vs. 13.6%, P < .001), while survival after radiation alone was better than no local treatment, though both were largely poor (12.4% vs. 7.5%, P < .001). CONCLUSIONS: Survival of patients with large NSCLC managed non-surgically is very poor. Despite the significant long-term survival benefit with surgical intervention, nearly half of the study cohort did not undergo surgery. Patients and clinicians can use these results to estimate specific potential benefits when considering possible treatment strategies for large NSCLC tumors.

Abstract Introduction Seizures are common reasons to call an ambulance, and this study aims to analyze the burden of seizures in the prehospital setting based on incidence, hospital admission rate, and costs. Methods This was a population-based, cross-sectional analysis of prehospital emergency medical services (EMS) data on suspected seizure cases from the federal state of Hesse, Germany, in 2019. Results A total of 6534 suspected seizure cases were identified, of which most were those with a known seizure disorder. Incidence rate for epilepsy-related seizures (ES; pediatric epilepsy, first seizure [1stS], seizure with known seizure disorder [SEPI]) was 205.7 per 100,000 inhabitants and incidence rate for pediatric febrile seizures (PFS) was 36.7 per 100,000 inhabitants, corresponding to 171,275 ES and 28,500 PFS (99.3%

Abstract In this study, we conducted an in-depth exploration of Alzheimer's Disease (AD) by integrating state-of-the-art methodologies, including single-cell RNA sequencing (scRNA-seq), weighted gene co-expression network analysis (WGCNA), and a convolutional neural network (CNN) model. Focusing on the pivotal role of microglia in AD pathology, our analysis revealed 11 distinct microglial subclusters, with 4 exhibiting obviously alterations in AD and HC groups. The investigation of cell–cell communication networks unveiled intricate interactions between AD-related microglia and various cell types within the central nervous system (CNS). Integration of WGCNA and scRNA-seq facilitated the identification of critical genes associated with AD-related microglia, providing insights into their involvement in processes such as peptide chain elongation, synapse-related functions, and cell adhesion. The identification of 9 hub genes, including USP3, through the least absolute shrinkage and selection operator (LASSO) and COX regression analyses, presents potential therapeutic targets. Furthermore, the development of a CNN-based model showcases the application of deep learning in enhancing diagnostic accuracy for AD. Overall, our findings significantly contribute to unraveling the molecular intricacies of microglial responses in AD, offering promising avenues for targeted therapeutic interventions and improved diagnostic precision.

Abstract This retrospective study investigated the incidence, medication use, and outcomes in pediatric autosomal-dominant polycystic kidney disease (ADPKD) using Taiwan's National Health Insurance Research Database (NHIRD). A 1:4 matched control group of individuals included in the NHIRD during the same period was used for comparative analyses. A total of 621 pediatric patients were identified from 2009 to 2019 (mean age, 9.51 ± 6.43 years), and ADPKD incidence ranged from 2.32 to 4.45 per 100,000 individuals (cumulative incidence, 1.26–1.57%). The incidence of newly developed hypertension, anti-hypertensive agent use, nephrolithiasis, and proteinuria were significantly higher in the ADPKD group than the non-ADPKD group (0.7 vs. 0.04, 2.26 vs. 0.30, 0.4 vs. 0.02, and 0.73 vs. 0.05 per 100 person-years, respectively). The adjusted hazard ratios for developing hypertension, proteinuria, nephrolithiasis and anti-hypertensive agent use in cases of newly-diagnosed pediatric ADPKD were 12.36 (95% CI 4.92–31.0), 13.49 (95% CI 5.23–34.79), 13.17 (95% CI 2.48–69.98), and 6.38 (95% CI 4.12–9.89), respectively. The incidence of congenital cardiac defects, hematuria, urinary tract infections, gastrointestinal diverticulosis, dyslipidemia, and hyperuricemia were also higher in the ADPKD group. Our study offers valuable insights into the epidemiology of pediatric ADPKD in Taiwan and could help in formulating guidelines for its appropriate management.

Abstract The evidence for the impact of renal dysfunction in patients with diabetes mellitus (DM) and first cardiovascular diseases on mid-term adverse outcomes remain scarce. This study included the data of patients with DM having first atherosclerotic cardiovascular disease (ASCVD) or congestive heart failure (CHF) from the Taipei Medical University Clinical Research Database. A Cox proportional hazards regression model was used to assess the impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on the 1-year mortality and recurrent ASCVD/CHF outcomes. We enrolled 21,320 patients with DM hospitalized for ASCVD or CHF; of them, 18,185, 2639, and 496 were assigned to the non-CKD, CKD, and ESRD groups, respectively. After propensity score matching, compared with the non-CKD group, the CKD and ESRD groups had higher mid-term all-cause mortality (adjusted hazard ratio 1.72 [95% confidence interval 1.48–1.99] and 2.77 [2.05–3.73], respectively), cardiovascular death (1.84 [1.44–2.35] and 1.87 [1.08–3.24], respectively), and recurrent hospitalization for ASCVD (1.44 [1.24–1.68] and 2.33 [1.69–3.23], respectively) and CHF (2.08 [1.75–2.47] and 1.50 [1.04–2.17], respectively). The advancing age was associated with mortality in CKD/ESRD groups. In CKD group, male sex was associated with all-cause mortality and recurrent ASCVD risk; the diuretics usage was associated with mortality and recurrent CHF risks. Our findings suggest that CKD and ESRD are significant risk factors for mid-term adverse outcomes in patients with DM and established cardiovascular diseases. Additionally, old age, male sex and diuretics usage requires attention. Further good quality studies are needed in the future.

Abstract Malnutrition is a frequently underdiagnosed condition leading to increased morbidity, mortality, and healthcare costs. The Mount Sinai Health System (MSHS) deployed a machine learning model (MUST-Plus) to detect malnutrition upon hospital admission. However, in diverse patient groups, a poorly calibrated model may lead to misdiagnosis, exacerbating health care disparities. We explored the model’s calibration across different variables and methods to improve calibration. Data from adult patients admitted to five MSHS hospitals from January 1, 2021 - December 31, 2022, were analyzed. We compared MUST-Plus prediction to the registered dietitian’s formal assessment. Hierarchical calibration was assessed and compared between the recalibration sample (N = 49,562) of patients admitted between January 1, 2021 - December 31, 2022, and the hold-out sample (N = 17,278) of patients admitted between January 1, 2023 - September 30, 2023. Statistical differences in calibration metrics were tested using bootstrapping with replacement. Before recalibration, the overall model calibration intercept was −1.17 (95% CI: −1.20, −1.14), slope was 1.37 (95% CI: 1.34, 1.40), and Brier score was 0.26 (95% CI: 0.25, 0.26). Both weak and moderate measures of calibration were significantly different between White and Black patients and between male and female patients. Logistic recalibration significantly improved calibration of the model across race and gender in the hold-out sample. The original MUST-Plus model showed significant differences in calibration between White vs. Black patients. It also overestimated malnutrition in females compared to males. Logistic recalibration effectively reduced miscalibration across all patient subgroups. Continual monitoring and timely recalibration can improve model accuracy.

Background: This study aimed to investigate the influence of immunonutritional factors on treatment-related toxicities and survival outcomes in patients with cervical cancer undergoing definitive radiochemotherapy. Methods: Patients with cervical cancer who received curative radiochemotherapy between 2016 and 2021 were retrospectively investigated. Pretreatment prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) were measured. Survival outcomes, acute and late toxicities were evaluated. Results: Among the 138 patients, those with larger tumor diameters had significantly lower pre-treatment PNI (p = 0.005). Pre-treatment immunonutritional factors were predictive of clinical survival, whereas post-treatment factors did not correlate with prognosis. Patients with low pre-treatment PNI (2.4) had shorter progression-free survival (PFS, HR: 1.86, p = 0.045 for PNI; HR: 3.15, p = 0.002 for NLR) and overall survival (OS, HR: 1.80, p = 0.048 for PNI; HR: 3.83, p = 0.015 for NLR). High pre-treatment NLR was associated with an increased risk of acute diarrhea (p = 0.049) and late severe toxicities (p = 0.046). Combined analysis revealed that pre-treatment good nutritional status and low systemic inflammation were linked to longer PFS (p = 0.007) and OS (p = 0.002), and poor nutritional status and substantial systemic inflammation were associated with higher rates of late severe toxicities (p = 0.036), with higher prognostic value in advanced stage patients. Conclusion: Pretreatment immunonutritional measures serve as quantitative biomarkers for predicting survivals and treatment toxicities in patients with cervical cancer treated with definitive radiochemotherapy.

A hotly debated topic is the effectiveness of inquiry-based instructional practice in science classrooms on student achievement and motivation. Numerous studies based on multinational large-scale education data show such student-centered instructional practice positively led to students' motivational beliefs but was negatively associated with science achievement. Current literature, however, drew such a conclusion based on the measures of instructional practice from students' perceptions, not teachers, despite teachers being the subject matter experts and actual implementers of classroom activities. Thus, this study examined the relationships between teacher-perceived instructional practice, science motivational beliefs, and science achievement. Specifically, this study investigated the predictive effects of instructional practices on aggregated student motivational beliefs (i.e., self-concept, utility value, and intrinsic value) and science achievement in the classroom context. Moreover, the study explored the contextual effects of student motivational beliefs on science achievement. We examined 3861 eighth graders' data nested within 168 science classrooms in the Korean portion of the latest "Trends in International Mathematics and Science Study" using multilevel structural equation modeling. The results showed that the inquiry-based instructional approach did not predict science achievement or motivational beliefs at the classroom level. On the other hand, student self-concept and utility value positively predicted individual achievement, while classroom-level utility value statistically predicted average classroom achievement. In other words, the significant effect of classroom-level utility value on achievement was beyond the effect of individual utility value. The unique contributions of the study lie in advancing the science education literature with a fresh reflection on such relationships by using a less examined data source (i.e., teacher perceptions), focusing on the classroom context (i.e., classroom-level science motivational beliefs and achievement), and situating in an underrepresented country (i.e., Korea) in the literature. The results shed light on the discrepancies in the effectiveness of instructional practice perceived by teachers versus students on desired educational outcomes in a learning context. This study also discusses the practical and methodological implications for instructional and motivational research.

While existing literature supports the use of smartphones to teach English vocabulary, limited studies have addressed how learned words can be transferred to college students' writing. This action research study designed pretest, treatment on mobile phones, posttest, and out-of-class pair-work, followed by a delayed posttest after three weeks to promote academic vocabulary use in writing. In the four-week treatment, academic words and collocations were designed using Quizlet units, combined with in-class writing practice. In the pair-work stage, the participants were allowed freedom to choose words they desired to learn and to exchange each other's word logs with recycling of taught vocabulary designed in the treatment. Assessment of the pretest, posttest, and the delayed posttest involved (a) a general academic vocabulary test (receptive knowledge), (b) a vocabulary test of target words (gap-filling), and (c) an in-class writing task. Results show that our mobile-assisted language learning (MALL) project helped participants remember more words after their MALL experiences and apply them in their writing; meanwhile, such improvement could be maintained. Pair work was more favored than individual work as the participants indicated a stronger preference and endorsed collaborative learning. We argue that mobile devices should be combined with new learning strategies for both in-class and out-of-class learning.

Background: The latest guidelines discourage the use of long-acting beta 2 -agonists/inhaled corticosteroids (LABA/ICS) for chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence regarding the optimal subsequent treatment after discontinuing LABA/ICS. Objectives: To compare the effectiveness and safety of switching from LABA/ICS to triple therapy (LABA/long-acting muscarinic antagonists (LAMA)/ICS) or to dual bronchodilators (LABA/LAMA) in COPD patients. Design: This was a new-user, active-comparator, and propensity score-matched cohort study analyzing the Taiwanese nationwide healthcare insurance claims. Methods: We recruited COPD patients switching from LABA/ICS to triple therapy or to dual bronchodilators from 2015 to 2019. The primary effectiveness outcome was the annual rate of exacerbations, and safety outcomes included severe pneumonia and all-cause mortality. Stratification by prior exacerbations was conducted. Results: After matching, each group comprised 1892 patients, 55% of whom experienced no exacerbations in the prior year. Treatment with LABA/LAMA/ICS versus LABA/LAMA showed comparable annual rate of moderate-to-severe exacerbations (incidence rate ratio, 1.04; 95% confidence interval (CI), 0.91–1.19). However, switching to LABA/LAMA/ICS was associated with increased risks of severe pneumonia (hazard ratio (HR), 1.65; 95% CI, 1.30–2.09) and all-cause death (HR, 1.39; 95% CI, 1.09–1.78). In patients with⩾2 prior exacerbations, LABA/LAMA/ICS versus LABA/LAMA was related to a 21% reduced rate of exacerbations but with a twofold increased pneumonia risk and a 49% elevated risk of all-cause mortality. Conclusion: Switching from LABA/ICS to triple therapy versus dual bronchodilators in COPD patients was associated with similar rates of annual exacerbations but was related to elevated risks of severe pneumonia and all-cause mortality. Among frequent exacerbators, triple therapy was associated with lower rates of exacerbation but was accompanied by increased risks of pneumonia and mortality compared to LABA/LAMA. Careful consideration of the examined safety events is necessary when switching from LABA/ICS to triple therapy in COPD management.

Abstract Aim This cross‐sectional study investigates the factors that contribute to academic resilience among nursing students during COVID‐19 pandemic. Design A cross‐sectional study. Methods A survey was conducted in a general hospital between November and December 2022. The Nursing Student Academic Resilience Inventory (NSARI) model was used to assess the academic resilience of 96 nursing students. The Boruta method was then used to identify the core factors influencing overall academic resilience, and rough set analysis was used to analyse the behavioural patterns associated with these factors. Results Attributes were categorised into three importance levels. Three statistically significant attributes were identified (“I earn my patient's trust by making suitable communication,” “I receive support from my instructors,” and “I try to endure academic hardship”) based on comparison with shadow attributes. The rough set analysis showed nine main behavioural patterns. Random forest, support vector machines, and backpropagation artificial neural networks were used to test the performance of the model, with accuracies ranging from 73.0% to 76.9%. Conclusion Our results provide possible strategies for improving academic resilience and competence of nursing students.

Core binding factor acute myeloid leukemia (CBF-AML) stands out as the most common type of adult AML, characterized by specific chromosomal rearrangements involving CBF genes, particularly t(8;21). Shikonin (SHK), a naphthoquinone phytochemical widely employed as a food colorant and traditional Chinese herbal medicine, exhibits antioxidant, anti-inflammatory, and anti-cancer activities. In this study, we aim to investigate the antileukemic effects of SHK and its underlying mechanisms in human CBF-AML cells and zebrafish xenograft models. Our study revealed that SHK reduced the viability of CBF-AML cells. SHK induced cell cycle arrest, promoted cell apoptosis, and induced differentiation in Kasumi-1 cells. Additionally, SHK downregulated the gene expression of AML1-ETO and c-KIT in Kasumi-1 cells. In animal studies, SHK showed no toxic effects in zebrafish and markedly inhibited the growth of leukemia cells in zebrafish xenografts. Transcriptomic analysis showed that differentially expressed genes (DEGs) altered by SHK are linked to key biological processes like DNA repair, replication, cell cycle regulation, apoptosis, and division. Furthermore, KEGG pathways associated with cell growth, such as the cell cycle and p53 signaling pathway, were significantly enriched by DEGs. Analysis of AML-associated genes in response to SHK treatment using DisGeNET and the STRING database indicated that SHK downregulates the expression of cell division regulators regarding AML progression. Finally, we found that SHK combined with cytarabine synergistically reduced the viability of Kasumi-1 cells. In conclusion, our findings provide novel insights into the mechanisms of SHK in suppressing leukemia cell growth, suggesting its potential as a chemotherapeutic agent for human CBF-AML.

Accurate interpretation of in vivo wide-field fluorescent imaging (WFFI) data requires precise separation of raw fluorescence signals into neural and hemodynamic components. The classical Beer-Lambert law-based approach, which uses concurrent 530-nm illumination to estimate relative changes in cerebral blood volume (CBV), fails to account for the scattering and reflection of 530-nm photons from non-neuronal components leading to biased estimates of CBV changes and subsequent misrepresentation of neural activity. This study introduces a novel linear regression approach designed to overcome this limitation. This correction provides a more reliable representation of CBV changes and neural activity in fluorescence data. Our method is validated across multiple datasets, demonstrating its superiority over the classical approach.

Study region: Taiwan Study focus: This study examines the relationship between typhoon parameters and droughts in Taiwan, particularly following the severe drought of 2020–2021. Using tropical cyclone best-track and satellite-based precipitation datasets from 1981 to 2020, we analyzed anomalies, correlation matrices, and wavelet coherence. Seasonal variations and long-term trends were also detected. New hydrological insights for the region: We found a positive correlation between typhoon characteristics (count, duration, length, wind speed) in Taiwan and drought occurrence and severity, especially over 2–4 year periods. Conversely, negative relationships were observed between typhoon duration and length in the Western North Pacific (WNP) and drought indices in Taiwan, influenced by large-scale atmospheric patterns. Typhoon duration and length in the WNP had a greater impact on Taiwan's drought than typhoon quantity, showing significant coherence with long-term drought over multi-year to decadal timescales. Seasonally, drought intensity peaked in central and southeastern Taiwan during late winter and early spring when typhoons were absent, in contrast to the rainy summer typhoon season. Spatially, increasing drought trends were identified in central and southern Taiwan, while northern regions exhibited decreasing dryness, potentially linked to the concentration of typhoon landing points in the north. This study underscores the complex relationships between drought severity in Taiwan and typhoon behavior in both the vicinity of Taiwan and the WNP.

BackgroundInternational Classification of Diseases codes are widely used to describe diagnosis information, but manual coding relies heavily on human interpretation, which can be expensive, time consuming, and prone to errors. With the transition from the International Classification of Diseases, Ninth Revision, to the International Classification of Diseases, Tenth Revision (ICD-10), the coding process has become more complex, highlighting the need for automated approaches to enhance coding efficiency and accuracy. Inaccurate coding can result in substantial financial losses for hospitals, and a precise assessment of outcomes generated by a natural language processing (NLP)–driven autocoding system thus assumes a critical role in safeguarding the accuracy of the Taiwan diagnosis related groups (Tw-DRGs). ObjectiveThis study aims to evaluate the feasibility of applying an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), autocoding system that can automatically determine diagnoses and codes based on free-text discharge summaries to facilitate the assessment of Tw-DRGs, specifically principal diagnosis and major diagnostic categories (MDCs). MethodsBy using the patient discharge summaries from Kaohsiung Medical University Chung-Ho Memorial Hospital (KMUCHH) from April 2019 to December 2020 as a reference data set we developed artificial intelligence (AI)–assisted ICD-10-CM coding systems based on deep learning models. We constructed a web-based user interface for the AI-assisted coding system and deployed the system to the workflow of the certified coding specialists (CCSs) of KMUCHH. The data used for the assessment of Tw-DRGs were manually curated by a CCS with the principal diagnosis and MDC was determined from discharge summaries collected at KMUCHH from February 2023 to April 2023. ResultsBoth the reference data set and real hospital data were used to assess performance in determining ICD-10-CM coding, principal diagnosis, and MDC for Tw-DRGs. Among all methods, the GPT-2 (OpenAI)-based model achieved the highest F1-score, 0.667 (F1-score 0.851 for the top 50 codes), on the KMUCHH test set and a slightly lower F1-score, 0.621, in real hospital data. Cohen κ evaluation for the agreement of MDC between the models and the CCS revealed that the overall average κ value for GPT-2 (κ=0.714) was approximately 12.2 percentage points higher than that of the hierarchy attention network (κ=0.592). GPT-2 demonstrated superior agreement with the CCS across 6 categories of MDC, with an average κ value of approximately 0.869 (SD 0.033), underscoring the effectiveness of the developed AI-assisted coding system in supporting the work of CCSs. ConclusionsAn NLP-driven AI-assisted coding system can assist CCSs in ICD-10-CM coding by offering coding references via a user interface, demonstrating the potential to reduce the manual workload and expedite Tw-DRG assessment. Consistency in performance affirmed the effectiveness of the system in supporting CCSs in ICD-10-CM coding and the judgment of Tw-DRGs.

Online banking not merely enables customers to make transactions within a short time and access transactional information anywhere but also facilitates financial institutions to simplify transaction procedures and reduce their operating expenses. Common concerns by both customers and financial institutions are the secure authentication measures for protecting sensitive financial information from cybersecurity threats and maintaining their trust in a secure environment. This paper presents a blockchain-supported scheme to establish secure authentication and mutual trust for handling online banking processes. The proposed solution’s model design, inference process, proof method, security analysis, and performance evaluation are included in this study. With the decentralized applications and smart contracts, that benefit from disruptive innovations in blockchain technology, the proposed scheme enables financial institutions to provide efficient, immutable, transparent, and secure online financial services for customers. In addition, the computational efforts of the proposed solution show that high performance can be achieved in executing financial transactions while safeguarding sensitive data and retaining trust in a decentralized environment which is some of the most significant weak security of the existing authentication schemes for online banking platforms.

The Kelvin-Helmholtz Instability (KHI) is a large scale convective instability which occurs anywhere the velocity shear between two fluids is large, such as Earth’s magnetopause where the fast flowing magnetosheath abuts the relatively stagnant outer magnetosphere. The KHI was initially believed to contribute only to energy and momentum transfer from the solar wind to the magnetosphere, but was eventually shown to support mass transport and plasma heating. Recent advancements in in-situ observational capabilities and high scale computer modeling have once again shifted our understanding of the KHI from a large scale process, to an active environment which connects the global and kinetic scales through a variety of multi-scale processes and phenomena. In this mini-review, we provide an update on the latest findings in Kelvin-Helmholtz (KH) related processes at kinetic scales and the effects of the global environment on KH development.

ObjectiveThis study investigated the relationship between years of employment and cognitive health among older non-Latinx Black, Latinx, and non-Latinx White women. We hypothesized that women who had never been formally employed (i.e., zero years of formal work experience) would exhibit a pronounced cognitive decline.MethodsOur study included 5,664 older adult women from the Health and Retirement Study (2010–2016) aged 65–101 (M = 75.41). Out of 5,664 participants, 850 identified as non-Latinx Black, 475 identified as Latinx, and 4,339 identified as non-Latinx White. Furthermore, 5,292 women indicated having a professional employment history of at least one year, whereas 372 women reported no formal work experience. The Telephone Interview for Cognitive Status-27 (TICS-27) was used to assess cognitive performance. Linear mixed effects models were conducted to assess whether employment history was associated with the rate of cognitive decline.ResultsIn all three racial and ethnic groups, lower age, higher education, greater number of years worked, fewer chronic conditions, and greater household income were associated with better cognitive performance at baseline (p

Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments’ impacts.

Background: This study aimed to determine whether a cognitive test the Mini-Mental State Examination (MMSE) and the Ascertain Dementia 8 (AD8) instrument applied in combination could improve the accuracy of dementia detection in a community setting. Methods: Study participants were recruited from a community-based integrated screening program in Tainan, Taiwan. Participants completed the AD8 and were administered the Chinese version of the MMSE by psychologists. In addition, the presence of dementia was determined by neurologists based on the 2011 National Institute on Aging–Alzheimer's Association guidelines. Logistic regression analysis determined whether the combination of these two tests provided any additional information for dementia detection than either test alone. Receiver operating characteristic (ROC) curve analyses were conducted to explore the performances of different screening modalities in detecting dementia. Result: In total, 282 participants with an average age of 69.31 ± 10.27 years were enrolled. The prevalence of dementia among participants aged ≥65 years was 9.29 %. The sensitivity and specificity of the AD8 applied alone for detecting dementia were 64.71 % and 87.89 %, respectively, and of the MMSE applied alone, after adjusting for education level, were 41.18 % and 84.50 %, respectively. Using a cutoff score of 21 for the MMSE resulted in sensitivity of 77.78 % and specificity of 73.58 %. The AD8 and MMSE when combined in parallel yielded 88.89 % sensitivity and 70.16 % specificity. The serial use of the AD8 followed by the MMSE yielded 50 % sensitivity and 93.02 % specificity. Except for when an MMSE cutoff value of 26 was applied, the sensitivity of all examined modalities was poor and specificity was moderate for detecting mild cognitive impairment. ROC curve analysis revealed that the parallel application of the MMSE and AD8 (area under the ROC curve [AUC]: 82.3 % [75.1 %–89.4 %]) resulted in better dementia detection accuracy than the AD8 alone (AUC: 73.3 % [60.7 %–85.9 %]), the MMSE alone (AUC: 77.4 % [67.6 %–87.3 %]), or serial test administration (AUC: 67.6 % [53.4 %–81.8 %]). Conclusion: This study successfully demonstrated that the MMSE and AD8 combination for dementia screening could improve detection accuracy in a community setting.