Clinical manifestations and risk factors of shock in children with multisystem inflammatory syndrome.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a novel disease associated with COVID-19. The COVID-19 epidemic peaked in May 2022 in Taiwan, and we encountered our first case of MIS-C in late May 2022. We aimed to present patients' clinical manifestations and identify risk factors for shock. METHODS: We included patients diagnosed with MIS-C at two medical centers from May 2022 to August 2022. We separated those patients into two groups according to whether they experienced shock. We collected demographic, clinical manifestation, and laboratory data of the patients and performed statistical analysis between the two groups. RESULTS: We enrolled 28 patients, including 13 (46 %) with shock and 15 (54 %) without shock. The median age was 6.4 years (IQR: 1.9-7.5). In single variable analysis, patients with shock tended to be older, had more neurological symptoms, more conjunctivitis and strawberry tongue, lower lymphocyte count, lower platelet counts, and higher C-reactive protein, higher procalcitonin, higher ferritin, and higher D-dimer levels than those without shock. The area under the ROC curve that used procalcitonin to be the risk factor of shock with MIS-C was 0.815 (95 % CI 0.644 to 0.987). The cutoff value obtained by ROC analysis of procalcitonin was 1.68 ng/mL. With this cutoff, the test characteristics of procalcitonin were as follows: sensitivity 77 %, specificity 93 %, positive predictive value 91 %, negative predictive value 82 %. Multivariable analysis revealed that procalcitonin was the only independent risk factor of shock with MIS-C on admission (OR, 26.00, 95 % CI, 1.01-668.89). CONCLUSIONS: MIS-C patients with high initial procalcitonin levels have higher risks of experiencing shock and may need ICU admission.

Tip-Induced In-Plane Ferroelectric Superstructure in Zigzag-Wrinkled BaTiO3 Thin Films.

The complex micro-/nanoscale wrinkle morphology primarily fabricated by elastic polymers is usually designed to realize unique functionalities in physiological, biochemical, bioelectric, and optoelectronic systems. In this work, we fabricated inorganic freestanding BaTiO3 ferroelectric thin films with zigzag wrinkle morphology and successfully modulated the ferroelectric domains to form an in-plane (IP) superstructure with periodic surface charge distribution. Our piezoresponse force microscopy (PFM) measurements and phase-field simulation demonstrate that the self-organized strain/stress field in the zigzag-wrinkled BaTiO3 film generates a corresponding pristine domain structure. These domains can be switched by tip-induced strain gradient (flexoelectricity) and naturally form a robust and unique "braided" in-plane domain pattern, which enables us to offer an effective and convenient way to create a microscopic ferroelectric superstructure. The corresponding periodic surface potential distribution provides an extra degree of freedom in addition to the morphology that could regulate cells or polar molecules in physiological and bioelectric applications.

Simple way to fabricate orderly arranged nanostructure arrays on diamond utilizing metal dewetting effect.

We introduce a simple method with thermal annealing round gold disk for agglomeration to fabricate orderly arranged nanostructure arrays on diamond for single photon source applications. In the annealing process, the dependence of gold sphere size on disk thickness and diameter was investigated, showing that gold sphere diameter was decreased with decreasing gold disk thickness or diameter. The condition parameters of ICP etch were adjusted to obtain different nanostructure morphologies on diamond. The collection efficiency of nitrogen-vacancy (NV) center embedded in nanostructure as-fabricated could reach to 53.56% compared with that of 19.10% in planar case with the same simulation method.

Percolated Strain Networks and Universal Scaling Properties of Strain Glasses.

Strain glass is being established as a conceptually new state of matter in highly doped alloys, yet the understanding of its microscopic formation mechanism remains elusive. Here, we use a combined numerical and experimental approach to establish, for the first time, that the formation of strain glasses actually proceeds via the gradual percolation of strain clusters, namely, localized strain clusters that expand to reach the percolating state. Furthermore, our simulation studies of a wide variety of specific materials systems unambiguously reveal the existence of distinct scaling properties and universal behavior in the physical observables characterizing the glass transition, as obeyed by many existing experimental findings. The present work effectively enriches our understanding of the underlying physical principles governing glassy disordered materials.

[Effects of CSN4 knockdown on proliferation and apoptosis of breast cancer MDA-MB-231 cells].

Breast cancer is one of the most common malignant tumors endangering women. It has been found that the subunits of the COP9 complex are closely related to the occurrence and development of malignant tumors, and the CSN4 subunit plays an important role in regulating the whole complex. In the breast cancer cell line MDA-MB-231, we successfully established a lentivirus-mediated CSN4-knockdown cell line. CCK8 cell proliferation assays and colony formation experiments confirmed that CSN4 knockdown significantly decreased the cellular proliferation rate. Cell cycle analysis showed that CSN4 knockdown increased sub-G1 population and induced apoptosis. In addition, Western blotting assays confirmed that CSN4 regulates the expression of CDK6 and Caspase3, suggesting that CSN4 modulates the proliferation and apoptosis of breast cancer cells by regulating the expression of CDK6 and Caspase3 genes and thereby tumorigenesis. This study has deepened our understanding of the molecular mechanism of apoptosis and cell growth in breast cancers, and further revealed the role and mechanism of CSN4 in cancer biology.

Study on ECG in the Adolescent.

Normal ECG values in newborns, infants, and children have been collected and published. ECG in the adolescent, however, remains, to be collected and studied. The present study was designed and carried out to establish the normal ECG standards in male and female adolescents. A total of 898 school children and adolescents screened and examined as healthy were divided by age and sex into 6-9, 9-13, and 13-18 years age-groups. A 12 lead conventional ECG was recorded in 10 mm/mV and 25 mm/s, utilizing an automated Fukuda Denshi FCP-4301, MS-DOS/IBM-AT ECG machine. Lead V3R was not taken. Analog-to-digital conversion was performed by Fukuda signal acquisition module at a sampling rate of 500 Hz. The data on 69 ECG parameters were analyzed for the mean, standard deviation, 2nd to 98th percentiles, 95% confidence intervals, and sex difference. Normal values on 69 ECG parameters, sex-specific heart rate, P-QRS-T interval, duration, axis, wave amplitude, and calculated R/S amplitude ratio and ventricular activation time by age-group and sex were established. Male and female difference was noted in 49 (71.0%) parameters, of which 3 (6.1%) began in 6-9 years age-group, 30 (61.2%) began in 9-13 years age-group, and 16 (32.7%) in 13-18 years age-group. No sex difference occurred in 20 (29.0%) parameters. Normal male and female ECG standards on 69 ECG parameters in the adolescent were established. ECG sex difference began to appear the earliest at ages 6-9 years, and it occurred mostly at ages 9-13 years and 13-18 years, reflecting the anatomical and physiological consequences of puberty.

Postnatal Risk of Acquiring Kawasaki Disease: A Nationwide Birth Cohort Database Study.

OBJECTIVE: To investigate the postnatal risk of Kawasaki disease and coronary complications from a nationwide birth cohort in Taiwan, a country with the third-highest incidence of Kawasaki disease worldwide. STUDY DESIGN: We enrolled children born between 2000 and 2009 with complete postnatal medical care records for 2000-2014 in the Taiwan national database. RESULTS: Out of a total of 2 150 590 live births, we identified 6690 (62.6% boys) patients with Kawasaki disease. The onset was mostly (93.9%) within the first 5 years of life (median, 16 months; 38% during infancy), but was rare within the first 3 months of life. The overall cumulative incidence of Kawasaki disease by age 5 years was 2.78‰ (3.33‰ for boys and 2.17‰ for girls; P < .001) and exhibited an increasing trend with birth year (from 2.28‰ for 2000 to 3.67‰ for 2009). The incidence ratio was 1.535 in boys and 1.055 in each increasing year. Kawasaki disease recurred more often in younger patients (cumulative incidence, 2.3% in infants vs 1.7% in children aged 1-4 years). Coronary complications occurred in 16.2% of the patients, including 4 cases of acute myocardial infarction (3 occuring during the acute stage and 1 occurring 5 years later). The probability of a major cardiac event (infarction, undergoing percutaneous coronary intervention or coronary artery bypass grafting, or death) by adolescence was 1.9%. CONCLUSIONS: The postnatal risk of Kawasaki disease was 3‰-4‰ and increased with every birth year. Patients with Kawasaki disease are at substantial risk for a major cardiac events during childhood.

Structural stability and magnetic-exchange coupling in Mn-doped monolayer/bilayer MoS2.

Ferromagnetic (FM) two-dimensional (2D) transition metal dichalcogenides (TMDs) have potential applications in modern electronics and spintronics and doping of TMDs with transition metals can enhance the magnetic characteristics. In this work, the structural stability, electronic states, and magnetic properties of Mn-doped monolayer/bilayer MoS2 are studied systematically by first-principles calculations. Substitutional Mn dopants at the Mo sites are energetically favorable in both monolayer and bilayer MoS2 under the S-rich condition which is common in the synthesis of MoS2 nanosheets. Two Mn dopants participate in the FM interaction in monolayer MoS2 and magnetic coupling of two Mn dopants via the double-exchange mechanism can be mediated by the nearest neighboring S. Magnetic coupling can be ascribed to the competition between the double-exchange, direct-exchange, and super-exchange interactions, which take place between two Mn dopants in bilayer MoS2 with the MniMnMo, MniMnS and MnMo-MnMo configurations. Our results reveal the geometrical dependence of magnetic-exchange coupling suggesting that Mn-doped monolayer/bilayer MoS2 has large potential in spintronic devices.

Preconception Counseling for Women with Congenital Heart Disease.

UNLABELLED: With advances that have been made over the recent decades in transcatheter and surgical interventions, most patients with congenital heart disease (CHD) can survive into adulthood. Overall, probably half of these surviving patients are female. When these female CHD patients reach childbearing age, however, pregnancy management will be a major issue. In order to meet the demands of fetal growth, the maternal cardiovascular system starts a series of adaptations beginning in early pregnancy. These adaptations include: decreased systemic and pulmonary vascular resistances, decreased blood pressure, expansion of the blood volume, increased heart rate and increased cardiac output. For women with CHD, this hemodynamic alteration may increase the risks of adverse cardiovascular events as well as the fetal and neonatal complications. Therefore, proper risk stratification and effective counseling for women with CHD who are planning their pregnancies is an important undertaking. KEY WORDS: Congenital heart disease; Pregnancy.

The Evaluation of Interface Quality in HfO2 Films Probed by Time-Dependent Second-Harmonic Generation.

Time-dependent second-harmonic generation (TD-SHG) is an emerging sensitive and fast method to qualitatively evaluate the interface quality of the oxide/Si heterostructures, which is closely related to the interfacial electric field. Here, the TD-SHG is used to explore the interface quality of atomic layer deposited HfO2 films on Si substrates. The critical SHG parameters, such as the initial SHG signal and characteristic time constant, are compared with the fixed charge density (Qox) and the interface state density (Dit) extracted from the conventional electrical characterization method. It reveals that the initial SHG signal linearly decreases with the increase in Qox, while Dit is linearly correlated to the characteristic time constant. It verifies that the TD-SHG is a sensitive and fast method, as well as simple and noncontact, for evaluating the interface quality of oxide/Si heterostructures, which may facilitate the in-line semiconductor test.

Optical Modulation of MoTe2/Ferroelectric Heterostructure via Interface Doping.

Optical modulation through interface doping offers a convenient and efficient way to control ferroelectric polarization, thereby advancing the utilization of ferroelectric heterostructures in nanoelectronic and optoelectronic devices. In this work, we fabricated heterostructures of MoTe2/BaTiO3/La0.7Sr0.3MnO3 (MoTe2/BTO/LSMO) and demonstrated opposite ultraviolet (UV) light-induced polarization switching behaviors depending on the varied thicknesses of MoTe2. The thickness-dependent band structure of MoTe2 film results in interface doping with opposite polarity in the respective heterostructures. The polarization field of BTO interacts with the interface charges, and an enhanced effective built-in field (Ebi) can trigger the transfer of massive UV light-induced carriers in both MoTe2 and BTO films. As a result, the interplay among the contact field of MoTe2/BTO, the polarization field, and the optically excited carriers determines the UV light-induced polarization switching behavior of the heterostructures. In addition, the electric transport characteristics of MoTe2/BTO/LSMO heterostructures reveal the interface barrier height and Ebi under opposite polarization states, as well as the presence of inherent in-gap trap states in MoTe2 and BTO films. These findings represent a further step toward achieving multifield modulation of the ferroelectric polarization and promote the potential applications in optoelectronic, logic, memory, and synaptic ferroelectric devices.

Realization of sextuple polarization states and interstate switching in antiferroelectric CuInP2S6.

Realization of higher-order multistates with mutual interstate switching in ferroelectric materials is a perpetual drive for high-density storage devices and beyond-Moore technologies. Here we demonstrate experimentally that antiferroelectric van der Waals CuInP2S6 films can be controllably stabilized into double, quadruple, and sextuple polarization states, and a system harboring polarization order of six is also reversibly tunable into order of four or two. Furthermore, for a given polarization order, mutual interstate switching can be achieved via moderate electric field modulation. First-principles studies of CuInP2S6 multilayers help to reveal that the double, quadruple, and sextuple states are attributable to the existence of respective single, double, and triple ferroelectric domains with antiferroelectric interdomain coupling and Cu ion migration. These findings offer appealing platforms for developing multistate ferroelectric devices, while the underlining mechanism is transformative to other non-volatile material systems.

Electric Field Switching of Magnon Spin Current in a Compensated Ferrimagnet.

Manipulation of directional magnon propagation, known as magnon spin current, is essential for developing magnonic devices featuring nonvolatile functionalities and ultralow power consumption. Magnon spin current can usually be modulated by magnetic field or current-induced spin torques. However, these approaches may lead to energy dissipation due to Joule heating. Electric-field switching of magnon spin current without charge current is highly preferred but challenging to realize. By integrating magnonic and piezoelectric materials, the manipulation of the magnon spin current generated by the spin Seebeck effect in the ferrimagnetic insulator Gd3Fe5O12 (GdIG) film on a piezoelectric substrate is demonstrated. Reversible electric-field switching of magnon polarization without applied charge current is observed. Through strain-mediated magnetoelectric coupling, the electric field induces the magnetic compensation transition between two magnetic states of the GdIG, resulting in its magnetization reversal and the simultaneous switching of magnon spin current. This work establishes a prototype material platform that paves the way for developing magnon logic devices characterized by all electric field reading and writing and reveals the underlying physics principles of their functions.

Epidemiology of Kawasaki disease: prevalence from national database and future trends projection by system dynamics modeling.

OBJECTIVE: To update the epidemiologic trend in Kawasaki disease (KD) and develop models for projection. STUDY DESIGN: From our national databases 2000-2010 and previous studies, we obtained the epidemiologic data to develop and validate system dynamics models. Population model incorporated birth rate and mortality. KD model incorporated the population at risk, incidence, and risk of coronary complications. RESULTS: The average annual incidence in age group <5, 5-10, 10-15, and 15-20 years was 67.3, 5.75, 0.79, and 0.26 per 100,000. The KD population was 23,349 and the model estimated 20,254 patients with KD, and 25% of these patients received medical care or continued surveillance in 2010. Projection up to 2030 suggests an average of 725 new patients with KD annually and a KD population of 35,006 by 2030. In 2030, 1469 patients with KD will need medical care for coronary complications. Simulation on the model modified to US data is also effective and suggests an average of 6200 new patients annually and KD population of 161,776 by 2030, and 5664 patients will need coronary care in 2030. By 2030, there will be 1 per 700 people in Taiwan and 1 per 1600 in the US with a history of KD. CONCLUSION: Simulations on our system dynamics models tailored to any epidemiologic and outcome variables and any changes with medical advance can dynamically project the futures.

E-Spin: A Stochastic Ising Spin Based on Electrically-Controlled MTJ for Constructing Large-Scale Ising Annealing Systems.

With its unique computer paradigm, the Ising annealing machine has become an emerging research direction. The Ising annealing system is highly effective at addressing combinatorial optimization (CO) problems that are difficult for conventional computers to tackle. However, Ising spins, which comprise the Ising system, are difficult to implement in high-performance physical circuits. We propose a novel type of Ising spin based on an electrically-controlled magnetic tunnel junction (MTJ). Electrical operation imparts true randomness, great stability, precise control, compact size, and easy integration to the MTJ-based spin. In addition, simulations demonstrate that the frequency of electrically-controlled stochastic Ising spin (E-spin) is 50 times that of the thermal disturbance MTJ-based spin (p-bit). To develop a large-scale Ising annealing system, up to 64 E-spins are implemented. Our Ising annealing system demonstrates factorization of integers up to 264 with a temporal complexity of around O(n). The proposed E-spin shows superiority in constructing large-scale Ising annealing systems and solving CO problems.

Giant tunable spin Hall angle in sputtered Bi2Se3 controlled by an electric field.

Finding an effective way to greatly tune spin Hall angle in a low power manner is of fundamental importance for tunable and energy-efficient spintronic devices. Recently, topological insulator of Bi2Se3, having a large intrinsic spin Hall angle, show great capability to generate strong current-induced spin-orbit torques. Here we demonstrate that the spin Hall angle in Bi2Se3 can be effectively tuned asymmetrically and even enhanced about 600% reversibly by applying a bipolar electric field across the piezoelectric substrate. We reveal that the enhancement of spin Hall angle originates from both the charge doping and piezoelectric strain effet on the spin Berry curvature near Fermi level in Bi2Se3. Our findings provide a platform for achieving low power consumption and tunable spintronic devices.

Photovoltaic modulation of ferromagnetism within a FM metal/P-N junction Si heterostructure.

Obtaining small, fast, and energy-efficient spintronic devices requires a new way of manipulating spin states in an effective manner. Here, a prototype photovoltaic spintronic device with a p-n junction Si wafer is proposed which generates photo-induced electrons and changes the ferromagnetism by interfacial charge doping. A ferromagnetic resonance field change of 48.965 mT and 11.306 mT is achieved in Co and CoFeB thin films under sunlight illumination, respectively. The transient reflection (TR) analysis and the first principles calculation reveal the photovoltaic electrons that are doped into the magnetic layer and alter its Fermi level, correspondingly. This finding provides a new method of magnetism modulation and demonstrates a solar-driven spintronic device with abundant energy supply, which may further expand the landscape of spintronics research.

Probe and Control of the Tiny Amounts of Dopants in BHJ Film Enable Higher Performance of Polymer Solar Cells.

To achieve efficient doping in polymer solar cells (PSCs), the dopant needs to be selectively located in the binary components of a bulk heterojunction (BHJ) film according to its polarity. The rarely studied n-type dopant is thoroughly examined in a simplified planar heterojunction (PHJ) device to address its favored location in the active layer. Results show that the n-dopant distribution in the acceptor layer or at the donor/acceptor interface produces enhanced device performance, whereas it harms the device when located in the donor layer. Based on the results, the benefit of n-type doping is then transferred to the highly efficient BHJ devices via a sequential coating procedure. The performance improvement is closely linked to the variations in the dopant's location in the BHJ film, which is carefully examined by the synchrotron techniques with delicate chemical sensitivity. More interestingly, the sequential coating procedure can be easily extended to the p-doped device only by changing the dopant's polarity in the middle layer. These findings pave the way for ambipolar doping in PSCs and enable performance improvement by molecular doping within the expectations.

Phase transition enhanced superior elasticity in freestanding single-crystalline multiferroic BiFeO3 membranes.

The integration of ferroic oxide thin films into advanced flexible electronics will bring multifunctionality beyond organic and metallic materials. However, it is challenging to achieve high flexibility in single-crystalline ferroic oxides that is considerable to organic or metallic materials. Here, we demonstrate the superior flexibility of freestanding single-crystalline BiFeO3 membranes, which are typical multiferroic materials with multifunctionality. They can endure cyclic 180° folding and have good recoverability, with the maximum bending strain up to 5.42% during in situ bending under scanning electron microscopy, far beyond their bulk counterparts. Such superior elasticity mainly originates from reversible rhombohedral-tetragonal phase transition, as revealed by phase-field simulations. This study suggests a general fundamental mechanism for a variety of ferroic oxides to achieve high flexibility and to work as smart materials in flexible electronics.

Periodic Wrinkle-Patterned Single-Crystalline Ferroelectric Oxide Membranes with Enhanced Piezoelectricity.

Self-assembled membranes with periodic wrinkled patterns are the critical building blocks of various flexible electronics, where the wrinkles are usually designed and fabricated to provide distinct functionalities. These membranes are typically metallic and organic materials with good ductility that are tolerant of complex deformation. However, the preparation of oxide membranes, especially those with intricate wrinkle patterns, is challenging due to their inherently strong covalent or ionic bonding, which usually leads to material crazing and brittle fracture. Here, wrinkle-patterned BaTiO3 (BTO)/poly(dimethylsiloxane) membranes with finely controlled parallel, zigzag, and mosaic patterns are prepared. The BTO layers show excellent flexibility and can form well-ordered and periodic wrinkles under compressive in-plane stress. Enhanced piezoelectricity is observed at the sites of peaks and valleys of the wrinkles where the largest strain gradient is generated. Atomistic simulations further reveal that the excellent elasticity and the correlated coupling between polarization and strain/strain gradient are strongly associated with ferroelectric domain switching and continuous dipole rotation. The out-of-plane polarization is primarily generated at compressive regions, while the in-plane polarization dominates at the tensile regions. The wrinkled ferroelectric oxides with differently strained regions and correlated polarization distributions would pave a way toward novel flexible electronics.