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Purpose: Carotid artery web (CaW) is a rare focal fibromuscular dysplasia that can lead to embolic strokes with large vessel occlusion. This condition can be effectively treated with endovascular thrombectomy (EVT). Our study aims to assess the prevalence of CaW among patients with acute ischemic stroke (AIS) who underwent EVT and to compare the clinical characteristics of CaW with other carotid artery pathologies. Methods: We enrolled consecutive patients with AIS who underwent EVT at a single medical center and two regional teaching hospitals in Taiwan from September 2014 to December 2021. We compared CaW with carotid dissection (CaD) and carotid large artery atherosclerosis (CaLAA) in terms of patient demographics and thrombus histological findings. Results: Of the 576 AIS patients who underwent EVT, four (mean age: 50 years) were diagnosed with CaW, resulting in a prevalence of 0.69%. Among these four patients, three experienced successful reperfusion after EVT and achieved functional independence (defined as a modified Rankin Scale score ≤2) three months post-stroke. Importantly, none of the CaW patients suffered a recurrent stroke within one year. Patients with CaW were younger than those with CaD or CaLAA, and exhibited fewer vascular risk factors. Additionally, CaW was associated with distal occlusion sites. The thrombus composition in CaW patients was similar to that in CaD patients. Conclusion: In conclusion, CaW is a rare finding among Asian patients with carotid artery disease who undergo for AIS. It is more prevalent in younger patients with a limited number of vascular risk factors.

Abstract Background Chronic cerebral ischemia (CCI) is a significant health issue characterized by hypoperfusion due to damage or occlusion of the cerebral or carotid arteries. CCI may lead to progressive cognitive impairment that is considered as a prelude to neurodegenerative diseases, including dementia and Alzheimer's disease (AD). Endothelial progenitor cells (EPCs) have been implicated in vascular repair in ischemic cerebrovascular diseases, primarily by differentiating into endothelial cells (ECs) or through paracrine effects. However, the clinical transplantation of stem cell therapies remains limited. In this study, we investigated the effects of EPC-derived conditioned medium (EPC-CM) on the impaired vasculature and neurological function in a rodent model of CCI and the mechanism involved. Methods EPC-CM was analyzed by cytokine array to identify key factors involved in angiogenesis and cellular senescence. The effects and mechanism of the candidate factors in the EPC-CM were validated in vitro using oxygen–glucose deprivation (OGD)-injured ECs and EPCs. The therapeutic effects of EPC-CM and the identified key factor were further examined in a rat model of CCI, which was induced by bilateral internal carotid artery ligation (BICAL). EPC-CM was administered via intracisternal injection one week post BICAL. The cerebral microvasculature and neurobehavior of the rats were examined three weeks after BICAL. Results Macrophage migration inhibitory factor (MIF) was identified as a key factor in the EPC-CM. Recombinant MIF protein promoted angiogenesis and prevented senescence in the injured EPCs and ECs. The effect was similar to that of the EPC-CM. These therapeutic effects were diminished when the EPC-CM was co-treated with MIF-specific antibody (Ab). Additionally, the vascular, motor, and cognitive improvements observed in the BICAL rats treated with EPC-CM were abolished by co-treated with MIF Ab. Furthermore, we found MIF promoted angiogenesis and anti-senescence via activating the AKT pathway. Inhibition of the AKT pathway diminished the protective effects of MIF in the in vitro study. Conclusions We demonstrated that EPC-CM protected the brain from chronic ischemic injury and promoted functional recovery through MIF-mediated AKT pathway. These findings suggest EPC-CM holds potential as a novel cell-free therapeutic approach for treating CCI through the actions of MIF.

Working memory (WM) supports future behavior by retaining perceptual information obtained in the recent past. The present study tested the hypothesis that WM recodes sensory information in a format that better supports behavioral goals. We recorded EEG while participants performed color delayed-estimation tasks where the colorwheel for the response was either randomly rotated or held fixed across trials. Accordingly, observers had to remember the exact colors in the Rotation condition, whereas they could prepare for a response based on the fixed mapping between the colors and their corresponding locations on the colorwheel in the No-Rotation condition. Results showed that the color reports were faster and more precise in the No-Rotation condition even when exactly the same set of colors were tested in both conditions. To investigate how the color information was maintained in the brain, we decoded the color using a multivariate EEG classification method. The decoding was limited to the stimulus encoding period in the Rotation condition, whereas it continued to be significant during the maintenance period in the No-Rotation condition, indicating that the color information was actively maintained in the condition. Follow-up analyses suggested that the prolonged decoding was not merely driven by the covert shift of attention but rather by the recoding of sensory information into an action-oriented response format. Together, these results provide converging evidence that WM flexibly recodes sensory information depending on the specific task context to optimize subsequent behavioral performance.

This study utilized unplugged computational thinking learning material named Robot City as the instructional material. The board game corresponds to structural programming, including sequential structure, conditional structure, repetitive structure, and the modeling concept of calling a procedure in programming languages. According to the different task assignment methods, the aim of playing the board game is to help instruct the seventh-grade students in computational thinking, and to explore its impact on students' learning achievements of computational thinking and the behavioral patterns of computational participation. The results revealed that the learning achievements of the students who worked together to solve the clear-ended task objectives were significantly higher than those of the students who cooperated within their groups to solve the open-ended competitive tasks. When the target task is not gained in advance, the students had to compete with other groups and vie for their target task, resulting in students' logical thinking constantly changing and being interrupted. From the behavioral pattern analysis, it was found that the students continued to discuss the problems during the game. The pattern of collaborative analysis was iterative itself, indicating that the board game can deepen students' interaction and enhance their higher level thinking. The results also showed that collaborative creation was observed (RO) by others, proving that the game can increase students' desire to learn, and thus improve their learning achievement.

Background: Endovascular thrombectomy (EVT) for acute ischemic stroke associated with tandem lesion is challenging. Achieving rapid intracranial revascularization and managing the extracranial lesion without complications are the main challenges. Materials and Methods: The balloon angioplasty followed by aspiration of large-vessel occlusion (BAFALO) technique was used to address this clinical issue. A review of a prospectively maintained stroke registry from January 2015 to April 2020 was performed. Patients had stroke with TO and treated with the BAFALO technique were included. Results: Twelve patients were enrolled: 11 had anterior circulation stroke, and 1 had posterior circulation stroke. There were 10 ipsilateral internal carotid artery stenosis/occlusion, one left common carotid artery to subclavian artery bypass stenosis, and 1 vertebral artery orifice stenosis. The median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 14–16). Revascularization with a Modified Thrombolysis in Cerebral Infarction score of 2b or more was achieved in 11 (92%) patients. The median puncture-to-revascularization time was 25 min (IQR: 19.5–31). Emergent stent implantation was performed in five (42%) patients. Three had distal protection devices (DPDs) with no distal embolization. Two patients did not use a DPD, and one had intracranial reocclusion. Eight (67%) proximal stenotic vessels remained patent. No symptomatic intracranial hemorrhage occurred. Eight (67%) patients had favorable clinical outcomes (modified Rankin Score 0–2 at 90 days). Conclusion: While managing TO, the BAFALO technique could achieve rapid intracranial revascularization and treat extracranial lesions under embolic protection. These merits translate into favorable clinical outcomes.

Starting in 2019, the ongoing COVID-19 pandemic has lasted 3 years and will likely continue to affect the lives of people all over the world. According to a United Nations Educational, Scientific and Cultural Organization (UNESCO) survey, more than 91% of students from all over the world have been affected by the spread of COVID-19. The application of technological networks can help solve problems related to being unable to attend school in person, as online teaching can effectively help reduce learning loss in the short term. In Taiwan, the higher education system has been using online learning, but now faces a new and huge crisis, as some courses do not readily translate to this setting. In professional courses run by hospitality departments, it is essentially impossible to accurately convey the practical skills required, for example, aspects of color, aroma, and taste through online teaching. Moreover, the learning level of each student varies greatly. During the online teaching process, instructors teach professional skills and movements through a single teaching video, which may not meet the needs of all students. In response, this study explores using the flipped teaching method, to not only enable students to master and control their learning and effectively adjust their self- adaptive learning progress but also to help teachers solve problems and impart professional skills using a two-way, interactive, online teaching method. This approach, flipping a class in an online learning environment, could effectively make up for the one-way teaching sometimes created by video content, and address the problem of gaps in learning professional practical skills. It can also induce students with poor learning attitudes to actively participate in learning. This study involved 55 bachelor students from a university of science and technology in Taiwan. The research results are as follows: (1) Students who participated in the flipped teaching mode, which involved two-way interaction showed better professional understanding of the course and improved willingness to learn, thereby improving the learning effect. (2) Awareness of these poor practical catering professional skills in students, assisted in laying the professional foundation for students to gradually improve their learning attitude and their advanced skills. This indicates that students with poor academic performance in an online environment might benefit from two-way interactive teaching. Teachers should clarify detailed descriptions of professional practical actions that confuse students. (3) In flipped learning, the grouping of “game/toy-based e-learning” can not only improve the performance of students who actively study to achieve good grades but also help and motivate other students to learn together. These results indicate that in flipped classrooms that use an online learning environment, the active learning and learning attitudes of students were positive and that their interest in learning and learning efficiency was also significantly improved. At the same time, this approach stimulated the innovation, creativity, and creative development of students in using professional technology in the hospitality industry. It transformed the passive learning situation of online one-way teaching into an active two-way teaching environment.

Science and technology are driving people's life changes, including education and the environment. Many scholars have attempted to import technology into the classroom to help students learn in different subjects. However, students often need assistance with unfamiliar learning approaches and learning environments. This study proposed a non-immersive virtual reality (VR) guidance system combined with a two-tier strategy to help students learn geology knowledge. Two groups of students used different learning approaches: the experimental group students were guided by the two-tier test VR guidance system, and the control group students learned with the conventional VR guidance system. According to the experimental result, the two-tier test VR guidance system not only improved the students' learning achievement in natural science, but also enhanced their learning motivation. In addition, according to the sequential results, we found that VR learning materials or environmental resources can help students answer questions and solve problems more effectively.

The Lorenz Energy Cycle (LEC) in the Taiwan Earth System Model Version 1 (TaiESM1) historical simulation is calculated and compared with ERA5 to evaluate the model performance from the thermodynamic aspect. The future change of LEC is accessed by comparing the SSP5‐8.5 and historical simulations in TaiESM1. TaiESM1 reasonably simulates the global mean, seasonal cycle, and spatial patterns of the energy reservoirs with larger values in the mean energy components and smaller in the eddy energy components. The energy cycle in TaiESM1 is about 35%–45% stronger than ERA5, except from December to February. The impact of global warming on the LEC is different at the vertical levels. The influence of meridional temperature gradient change is the dominant factor in the intensity of the energy cycle, and the change in static stability only contributes to the lower troposphere. Lifting the tropopause in the tropics increases the meridional temperature gradient and produces more zonal mean potential energy (PM) in the upper troposphere. PM is the primary driver of the LEC and leads to a more active energy cycle in the upper troposphere. As the tropical tropospheric depth increases and the mid‐latitude eddy activities become more active, more (less) energy is stored in the upper (lower) troposphere, and the energy conversion processes tend to become stronger (weaker) in the upper (lower) troposphere. Plain Language Summary: The Lorenz Energy Cycle represents the atmosphere as a heat engine. TaiESM1 is a newly developed climate model. Therefore, we evaluate the model performance and future projection from the thermodynamic aspect to understand the model's overall capability and characteristics. The global mean values of energy reservoirs are in a reasonable range. Energy reservoirs have good spatial patterns and a proper seasonal cycle, but the model has a much stronger energy cycle than reanalysis data due to a stronger meridional temperature gradient. After warming, the energy cycle tends to be stronger (weaker) in the warming scenario's upper (lower) troposphere. This research shows that TaiESM1 is a reliable research tool and provides insights for future improvements for the model development team. Key Points: The newly developed TaiESM1 can simulate atmospheric energy reservoirs regarding global and seasonal means and spatial patternsThe energy cycle in TaiESM1 is 35%–45% stronger than ERA5, mainly contributed by the more active mean flows and eddiesIn the SSP5‐8.5 scenario, the energy cycle intensifies (weakens) in the upper (lower) troposphere due to changes in temperature gradient [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is common in the general population worldwide, and the prevalence and severity of vitamin D deficiency increase in critically ill patients. The prevalence of vitamin D deficiency in a community-based cohort in Northern Taiwan was 22.4%. This multicenter cohort study investigated the prevalence of vitamin D deficiency and associated factors in critically ill patients in Northern Taiwan.Methods: Critically ill patients were enrolled and divided into five groups according to their length of stay at intensive care units (ICUs) during enrolment as follows: group 1,

From the popularity of flipped teaching in United States primary and high schools, it is thought that students have more learning control to adjust to the learning progress and are assisted in problem solving and learning guidance during class period. It is believed that flipped teaching could prompt underachieving learners’ active learning and thereby enhance learning effectiveness. A total of 386 high school students in Chungli, Taiwan, were part of an experimental study and the research results are summarized below: (1) Students who participated in the flipped teaching models demonstrated better comprehension levels with the teaching content due to this change in learning style and attitude, which in turn, enhanced learning effectiveness. (2) To eliminate poor language performance of underachieving students, it is necessary to lay solid foundations to gradually enhance language learning effectiveness regarding this particular group of students. Films suitable for students’ individual ability could be combined with new language learned in the unit to genuinely assist underachieving learners’ language learning effectiveness. (3) For students who care about their performance, a “system of play” style grouping should be determined in order to enable the tracking of group performance and term performance. According to the results, further developments regarding active learning ability, boosts in learning interests, enhanced learning effectiveness, and the prompting of creativity resulting in a shift from passive learner to active learner have been proposed.

Background Patients with end-stage renal disease (ESRD) are often excluded from clinical trials of endovascular thrombectomy (EVT). This study investigated the outcome in these patients. Methods From September 2014 to July 2021, all patients undergoing EVT for anterior circulation stroke in two stroke centers in Taiwan were included. They were divided into no renal dysfunction (non-RD, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m²), RD (eGFR <60 mL/min/1.73 m² but no dialysis), and ESRD undergoing dialysis (ESRD-dialysis). The clinical features and outcomes were compared. Results Of 482 patients included, there were 20 ESRD-dialysis, 110 RD, and 352 non-RD patients. The Alberta Stroke Program Early CT Score (ASPECTS), National Institutes of Health Stroke Scale (NIHSS), use of intravenous thrombolysis, EVT-related time metrics, and successful recanalization rates were comparable among the three groups. However, the ESRD-dialysis patients had more symptomatic intracerebral hemorrhage (ICH, 15% vs 3.6% vs 3.7%), more contrast-induced encephalopathy (15% vs 1.8% vs 0.9%), and a higher mortality at 90 days (35% vs 18% vs 11%) than the other groups. Multivariable analysis revealed that ESRD-dialysis was associated with a less favorable outcome (OR 0.21, 95% CI 0.04 to 0.77) and more severe disability or mortality (modified Rankin Scale 5 or 6; OR 13.1, 95% CI 3.93 to 48.1) at 90 days. In the ESRD-dialysis group, the patients with premorbid functional dependence had a significantly higher mortality than those without (75% vs 8.3%; P=0.004). Conclusion ESRD-dialysis patients were associated with symptomatic ICH and less favorable outcome at 90 days. Patients with premorbid functional dependency had an excessively high mortality. [ABSTRACT FROM AUTHOR]

Digital dental reconstruction can be a more efficient and effective mechanism for artificial crown construction and period inspection. However, optical methods cannot reconstruct those portions under gums, and X-ray-based methods have high radiation to limit their applied frequency. Optical coherence tomography (OCT) can harmlessly penetrate gums using low-coherence infrared rays, and thus, this work designs an OCT-based framework for dental reconstruction using optical rectification, fast Fourier transform, volumetric boundary detection, and Poisson surface reconstruction to overcome noisy imaging. Additionally, in order to operate in a patient’s mouth, the caliber of the injector is small along with its short penetration depth and effective operation range, and thus, reconstruction requires multiple scans from various directions along with proper alignment. However, flat regions, such as the mesial side of front teeth, may not have enough features for alignment. As a result, we design a scanning order for different types of teeth starting from an area of abundant features for easier alignment while using gyros to track scanned postures for better initial orientations. It is important to provide immediate feedback for each scan, and thus, we accelerate the entire signal processing, boundary detection, and point-cloud alignment using Graphics Processing Units (GPUs) while streamlining the data transfer and GPU computations. Finally, our framework can successfully reconstruct three isolated teeth and a side of one living tooth with comparable precisions against the state-of-art method. Moreover, a user study also verifies the effectiveness of our interactive feedback for efficient and fast clinic scanning.