Near-term tropical cyclone risk and coupled Earth system model biases.

Most current climate models predict that the equatorial Pacific will evolve under greenhouse gas-induced warming to a more El Niño-like state over the next several decades, with a reduced zonal sea surface temperature gradient and weakened atmospheric Walker circulation. Yet, observations over the last 50 y show the opposite trend, toward a more La Niña-like state. Recent research provides evidence that the discrepancy cannot be dismissed as due to internal variability but rather that the models are incorrectly simulating the equatorial Pacific response to greenhouse gas warming. This implies that projections of regional tropical cyclone activity may be incorrect as well, perhaps even in the direction of change, in ways that can be understood by analogy to historical El Niño and La Niña events: North Pacific tropical cyclone projections will be too active, North Atlantic ones not active enough, for example. Other perils, including severe convective storms and droughts, will also be projected erroneously. While it can be argued that these errors are transient, such that the models' responses to greenhouse gases may be correct in equilibrium, the transient response is relevant for climate adaptation in the next several decades. Given the urgency of understanding regional patterns of climate risk in the near term, it would be desirable to develop projections that represent a broader range of possible future tropical Pacific warming scenarios-including some in which recent historical trends continue-even if such projections cannot currently be produced using existing coupled earth system models.

Influence of administration timing of San-Huang-Xie-Xin-Tang treatment on attenuating Salmonella enterica serovar Typhimurium infection.

Salmonella infections are a serious global health concern, particularly in developing countries, and are further exacerbated by the emergence of antibiotic resistance. San-Huang-Xie-Xin-Tang (SHXXT), a traditional herbal medicine with potent anti-inflammatory properties, has recently gained attention as an alternative treatment. Our study emphasizes on the importance of precise timing in accordance with traditional Chinese medicine principles. A mouse infection model was established while different administration times of SHXXT were recorded for the body weight, clinical scores, bacterial counts in blood, and organs. Additionally, cytokine levels, fatty acids, and amino acids in the serum were also monitored. We found that administering SHXXT 1 day after Salmonella enterica subsp. enterica serovar Typhimurium (S. Typhimurium) infection (T1 group) leads to positive outcomes. This includes restoration of body weight, improved clinical scores, and reduced bacterial counts in blood and vital organs. Interferon-gamma levels remained consistently high across all treatment groups 6 days post-infection. However, the T1 group showed exclusive suppression of serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1ß). The timing of administration significantly influenced serum fatty acid concentrations, countering Salmonella-induced disruptions, aligning with TNF-α and IL-1ß levels. SHXXT had also restored amino acid profiles disrupted by the infection, with notable effects when administered at the correct timing. Our research highlights SHXXT's potential in treating S. Typhimurium infection, emphasizing the importance of precise timing in line with traditional Chinese medicine principles for effective treatment at different disease stages.

Flap technique-assisted surgeries for advanced retinitis pigmentosa complicated with macular hole: a case report and literature review.

BACKGROUND: Full-thickness macular hole (FTMH) is a rare complication in retinitis pigmentosa (RP) patients and may increase intraoperative challenges. Furthermore, lens capsular flap transplantation and inverted internal limiting membrane (ILM) flap were reported to close complicated FTMH successfully. Here, we present a case of bilateral advanced RP complicated by a FTMH treated with a novel lens capsular flap transplantation and inverted internal limiting membrane flap. CASE PRESENTATION: A 46-year-old presented to our hospital with a complaint of progressively blurred vision and metamorphopsia in both eyes. Spectral-domain optical coherence tomography revealed a FTMH with retinoschisis in the right eye and another FTMH in the left eye. ILM peeling with inverted ILM flap technique was performed on the right eye and ILM peeling with anterior lens capsular flap technique was performed on the left eye. Post-operative follow-up showed successful closure of the FTMH and improved vision in both eyes. CONCLUSIONS: In our present case, flap-assisted techniques for retinitis pigmentosa with macular hole result in excellent visual and anatomic outcomes.

Epidemiology of Heart Valve Disease in Taiwan.

Studies conducted in developed nations have shown that increase in life expectancy has brought with it a rise in the incidence and treatment of degenerative aortic and mitral heart valve diseases. Current standards recommend valve replacement among even some asymptomatic patients. In this research, we examine the epidemiology of valvular heart disease and rate of valve replacement in Taiwan, where life expectancy now stands at 80.69 years. Patients were enrolled based on claims from a widely used national database and categorized into cohorts defined by type of valve disease and, further, by valve replacements and type of valve (mechanical, porcine, or bovine). Data, including disease type, age, and gender, were analyzed to determine annual and cumulative incidence rates and prosthetic usage from 2000 to 2017. Results showed that across the cohorts, the cumulative incidence rate in 2017 was 3.59%, and in the aortic valve cohort, the percentage of surgical valve replacement for those ≥60 years was 6.99%. Compared with other developed nations, this demonstrates that incidence rates are slightly higher, yet surgical replacements are less than half that of other developed nations. This under-treatment of patients with valvular heart disease presents an important public health challenge in Taiwan.

Neural Underpinnings of Early Speech Perception and Emergent Literacy.

Mismatch negativity (MMN) is an event-related potential component used to index automatic auditory change detection. Thus, MMN provides an excellent tool to assess the speech sensitivity of infants and children. Although MMN is well established in adults, the polarity and latency of mismatch responses (MMRs) in infants are highly inconsistent across studies. This paper aims to provide a comprehensive review of MMN studies of speech perception in early infancy. In particular, data from a series of MMN studies of Mandarin lexical tone, vowels, and initial consonants will be presented to demonstrate how phonological saliency, size of deviance, and neural maturation modulate MMRs in early infancy. These data suggest that MMN and positive MMRs index different functional characteristics and may provide information on when and how children's speech perception becomes automatic at different developmental stages. By using MMN to index sensitivity to speech discrimination, dyslexic children usually show reduced or absent MMN, which supports the relationship between phonological sensitivity and literacy. However, children with attention deficit/hyperactivity disorder showed the typical MMN, but attenuated P3a and enhanced late discriminative negativity. Taken together, the MMR characteristics, including amplitude, peak latency, and the transition of polarity, may be used to index the maturation of speech development and for the early identification of children with atypical language development.

The CD9, CD81, and CD151 EC2 domains bind to the classical RGD-binding site of integrin αvß3.

Tetraspanins play important roles in normal (e.g. cell adhesion, motility, activation, and proliferation) and pathological conditions (e.g. metastasis and viral infection). Tetraspanins interact with integrins and regulate integrin functions, but the specifics of tetraspanin-integrin interactions are unclear. Using co-immunoprecipitation with integrins as a sole method to detect interaction between integrins and full-length tetraspanins, it has been proposed that the variable region (helices D and E) of the extracellular-2 (EC2) domain of tetraspanins laterally associates with a non-ligand-binding site of integrins. We describe that, using adhesion assays, the EC2 domain of CD81, CD9, and CD151 bound to integrin αvß3, and this binding was suppressed by cRGDfV, a specific inhibitor of αvß3, and antibody 7E3, which is mapped to the ligand-binding site of ß3. We also present evidence that the specificity loop of ß3 directly bound to the EC2 domains. This suggests that the EC2 domains specifically bind to the classical ligand-binding site of αvß3. αvß3 was a more effective receptor for the EC2 domains than the previously known tetraspanin receptors α3ß1, α4ß1, and α6ß1. Docking simulation predicted that the helices A and B of CD81 EC2 bind to the RGD-binding site of αvß3. Substituting Lys residues at positions 116 and 144/148 of CD81 EC2 in the predicted integrin-binding interface reduced the binding of CD81 EC2 to αvß3, consistent with the docking model. These findings suggest that, in contrast with previous models, the ligand-binding site of integrin αvß3, a new tetraspanin receptor, binds to the constant region (helices A and B) of the EC2 domain.

Semantic ambiguity effects on traditional Chinese character naming: A corpus-based approach.

Words are considered semantically ambiguous if they have more than one meaning and can be used in multiple contexts. A number of recent studies have provided objective ambiguity measures by using a corpus-based approach and have demonstrated ambiguity advantages in both naming and lexical decision tasks. Although the predictive power of objective ambiguity measures has been examined in several alphabetic language systems, the effects in logographic languages remain unclear. Moreover, most ambiguity measures do not explicitly address how the various contexts associated with a given word relate to each other. To explore these issues, we computed the contextual diversity (Adelman, Brown, & Quesada, Psychological Science, 17; 814-823, 2006) and semantic ambiguity (Hoffman, Lambon Ralph, & Rogers, Behavior Research Methods, 45; 718-730, 2013) of traditional Chinese single-character words based on the Academia Sinica Balanced Corpus, where contextual diversity was used to evaluate the present semantic space. We then derived a novel ambiguity measure, namely semantic variability, by computing the distance properties of the distinct clusters grouped by the contexts that contained a given word. We demonstrated that semantic variability was superior to semantic diversity in accounting for the variance in naming response times, suggesting that considering the substructure of the various contexts associated with a given word can provide a relatively fine scale of ambiguity information for a word. All of the context and ambiguity measures for 2,418 Chinese single-character words are provided as supplementary materials.

Neurolinguistic Studies of Reading in Chinese.

Using the Chinese writing system, which is unique with respect to the composition of each character in terms of its graphic shape, as an example, this chapter addresses the neurobiological underpinnings of reading and writing and how these brain circuits are used in different languages.

Exploring orthographic neighborhood size effects in a computational model of Chinese character naming.

Orthographic neighborhood (N) size effects have been extensively studied in English consistently producing a facilitatory effect in word naming tasks. In contrast, several recent studies on Chinese character naming have demonstrated an inhibitory effect of neighborhood size. Response latencies tend to be inhibited by inconsistent characters with large neighborhoods relative to small neighborhoods. These differences in neighborhood effects between languages may depend on the characteristics (depth) of the mapping between orthography and phonology. To explore this, we first conducted a behavioral experiment to investigate the relationship between neighborhood size, consistency and reading response. The results showed an inhibitory effect of neighborhood size for inconsistent characters but a facilitatory effect for consistent characters. We then developed two computational models based on parallel distributed processing principles to try and capture the nature of the processing that leads to these results in Chinese character naming. Simulations using models based on the triangle model of reading indicated that consistency and neighborhood size interact with the division of labor between semantics and phonology to produce these effects.

A psycholinguistic database for traditional Chinese character naming.

In this study, we aimed to provide a large-scale set of psycholinguistic norms for 3,314 traditional Chinese characters, along with their naming reaction times (RTs), collected from 140 Chinese speakers. The lexical and semantic variables in the database include frequency, regularity, familiarity, consistency, number of strokes, homophone density, semantic ambiguity rating, phonetic combinability, semantic combinability, and the number of disyllabic compound words formed by a character. Multiple regression analyses were conducted to examine the predictive powers of these variables for the naming RTs. The results demonstrated that these variables could account for a significant portion of variance (55.8%) in the naming RTs. An additional multiple regression analysis was conducted to demonstrate the effects of consistency and character frequency. Overall, the regression results were consistent with the findings of previous studies on Chinese character naming. This database should be useful for research into Chinese language processing, Chinese education, or cross-linguistic comparisons. The database can be accessed via an online inquiry system (http://ball.ling.sinica.edu.tw/namingdatabase/index.html).

The modulation of semantic transparency on the recognition memory for two-character Chinese words.

This study demonstrated that semantic transparency as a linguistic property modulates the recognition memory for two-character Chinese words, with opaque words (i.e., words whose meanings cannot be derived from constituent characters-e.g., "[/guang/, light][/gun/, stick]", bachelor) remembered better than transparent words (i.e., words whose meanings can be derived from constituent characters-e.g., "[/cha/, tea][/bei/, cup]", teacup). In Experiment 1, the participants made lexical decisions on transparent words, opaque words, and nonwords in the study and then engaged in an old/new recognition test. Experiment 2 employed a concreteness judgment as the encoding task to ensure equivalent semantic processing for opaque and transparent words. In Experiment 3, the neighborhood size of the two-character words was manipulated together with their semantic transparency. In all three experiments, opaque words were found to be better remembered than transparent words. We concluded that the conceptual incongruence between the meanings of a whole word and its constituent characters made opaque words more distinctive and, hence, better remembered than transparent words.

Polyelectrolyte-coated liposomes microfluidically assembled in one-step for enhancing cell endocytosis and in-vivo immune responses.

To enhance the cellular uptake of liposomes, we prepared conventional liposomes with targeting molecules and surface-charged liposomes and evaluated their potential as nano-carriers and vaccine adjuvants by comparing their endocytosis efficiencies using immune cells. Surface-charged liposomes were synthesized via a one-step microfluidic method, which provided a novel, simple, fast, and highly reproducible method for preparing liposomes. Flow cytometry revealed that cationic polyelectrolyte-coated liposomes exhibited higher endocytosis efficiencies (of up to a factor of 100) in A774A.1 cells and JAWs II cells compared with uncoated liposomes or those coated with anionic polyelectrolytes. Positively charged liposomes exhibited some cytotoxicity at quaternary-chitosan coating concentrations higher than 6 mg/mL; however, significantly lower cytotoxicities (by a factor of almost ten) were obtained by protein mixing. Furthermore, BALB/c mice vaccinated with a mixture of Anthrax vaccine adsorbed (AVA) and quaternary chitosan-coated liposomes showed faster and stronger anti-PA IgG inductions compared to those vaccinated with AVA alone, with titers positively correlating with the amount of cationic liposome used. This finding clearly reveals that quaternary chitosan-coated liposomes act as both nano-carriers and vaccine adjuvants that significantly enhance in-vivo immune responses to vaccines with low immunogenicities.

A cloud system for mobile medical services of traditional Chinese medicine.

Many medical centers in Taiwan have started to provide Traditional Chinese Medicine (TCM) services for hospitalized patients. Due to the complexity of TCM modality and the increasing need for providing TCM services for patients in different wards at distantly separate locations within the hospital, it is getting difficult to manage the situation in the traditional way. A computerized system with mobile ability can therefore provide a practical solution to the challenge presented. The study tries to develop a cloud system equipped with mobile devices to integrate electronic medical records, facilitate communication between medical workers, and improve the quality of TCM services for the hospitalized patients in a medical center. The system developed in the study includes mobile devices carrying Android operation system and a PC as a cloud server. All the devices use the same TCM management system developed by the study. A website of database is set up for information sharing. The cloud system allows users to access and update patients' medical information, which is of great help to medical workers for verifying patients' identification and giving proper treatments to patients. The information then can be wirelessly transmitted between medical personnel through the cloud system. Several quantitative and qualitative evaluation indexes are developed to measure the effectiveness of the cloud system on the quality of the TCM service. The cloud system is tested and verified based on a sample of hospitalized patients receiving the acupuncture treatment at the Lukang Branch of Changhua Christian Hospital (CCH) in Taiwan. The result shows a great improvement in operating efficiency of the TCM service in that a significant saving in labor time can be attributable to the cloud system. In addition, the cloud system makes it easy to confirm patients' identity through taking a picture of the patient upon receiving any medical treatment. The result also shows that the cloud system achieves significant improvement in the acupuncture treatment. All the acupuncture needles now can be removed at the time they are expected to be removed. Furthermore, through the cloud system, medical workers can access and update patients' medical information on-site, which provides a means of effective communication between medical workers. These functions allow us to make the most use of the portability feature of the acupuncture service. The result shows that the contribution made by the cloud system to the TCM service is multi-dimensional: cost-effective, environment-protective, performance-enhancing etc. Developing and implementing such a cloud system for the TCM service in Taiwan symbolizes a pioneering effort. We believe that the work we have done here can serve as a stepping-stone toward advancing the TCM service quality in the future.

Reduction or enhancement? Repetition effects on early brain potentials during visual word recognition are frequency dependent.

Most studies on word repetition have demonstrated that repeated stimuli yield reductions in brain activity. Despite the well-known repetition reduction effect, some literature reports repetition enhancements in electroencephalogram (EEG) activities. However, although studies of object and face recognition have consistently demonstrated both repetition reduction and enhancement effects, the results of repetition enhancement effects were not consistent in studies of visual word recognition. Therefore, the present study aimed to further investigate the repetition effect on the P200, an early event-related potential (ERP) component that indexes the coactivation of lexical candidates during visual word recognition. To achieve a high signal-to-noise ratio, EEG signals were decomposed into various modes by using the Hilbert-Huang transform. Results demonstrated a repetition enhancement effect on P200 activity in alpha-band oscillation and that lexicality and orthographic neighborhood size would influence the magnitude of the repetition enhancement effect on P200. These findings suggest that alpha activity during visual word recognition might reflect the coactivation of orthographically similar words in the early stages of lexical processing. Meantime, there were repetition reduction effects on ERP activities in theta-delta band oscillation, which might index that the lateral inhibition between lexical candidates would be omitted in repetition.

One-Year Healthcare Utilization and Expenditures Among Patients with Clinically Significant Mitral Regurgitation in Taiwan.

INTRODUCTION: Mitral regurgitation (MR) is characterized by systolic blood flow reversal from the left ventricle to the left atrium. A 2019 study indicated that in the USA, clinically significant MR (sMR) is associated with a substantial healthcare cost burden. In Taiwan, few data are available to describe the clinical characteristics, treatment patterns, and economic burden of patients with sMR. METHODS: Using the National Health Insurance Research Database (NHIRD), a national, detailed claims database of all 23 million residents of Taiwan, we conducted a retrospective cohort study to identify patients with sMR and quantify the impact of the disease on Taiwan's healthcare system. We classified patients with sMR into three cohorts based on disease etiology: functional MR (sFMR), degenerative MR (sDMR), and uncharacterized MR (sUMR). RESULTS: We compared patient characteristics across cohorts and estimated attributable healthcare utilization and costs during the 12-month follow-up period. Our research shows that in Taiwan, patients with sFMR were older, sicker, and presented at casualty (emergency department) more frequently than those with sDMR and sUMR. Meanwhile, patients with sDMR had the highest 12-month healthcare expenditures across the cohorts. CONCLUSION: These findings are inconsistent with what has been shown in the USA, which warrants further investigation.

Speech comprehension in noisy environments: Evidence from the predictability effects on the N400 and LPC.

Introduction: Speech comprehension involves context-based lexical predictions for efficient semantic integration. This study investigated how noise affects the predictability effect on event-related potentials (ERPs) such as the N400 and late positive component (LPC) in speech comprehension. Methods: Twenty-seven listeners were asked to comprehend sentences in clear and noisy conditions (hereinafter referred to as "clear speech" and "noisy speech," respectively) that ended with a high-or low-predictability word during electroencephalogram (EEG) recordings. Results: The study results regarding clear speech showed the predictability effect on the N400, wherein low-predictability words elicited a larger N400 amplitude than did high-predictability words in the centroparietal and frontocentral regions. Noisy speech showed a reduced and delayed predictability effect on the N400 in the centroparietal regions. Additionally, noisy speech showed a predictability effect on the LPC in the centroparietal regions. Discussion: These findings suggest that listeners achieve comprehension outcomes through different neural mechanisms according to listening conditions. Noisy speech may be comprehended with a second-pass process that possibly functions to recover the phonological form of degraded speech through phonetic reanalysis or repair, thus compensating for decreased predictive efficiency.

Neural correlates of understanding emotional words in late childhood.

Prior studies involving adults have shown that words can elicit emotional processing, with emotion-label (e.g., happiness) and emotion-laden words (e.g., gift) having distinct processes. However, limited studies have explored the developmental changes in these processes in relation to emotional valence. To address this question, this exploratory study measured event-related potentials (ERPs) in 11-14-year-old children/adolescents (N = 25) and adults (N = 23) while performing an emotional categorization task. The stimuli used were two-character Chinese words, with factors for word type (emotion-label versus emotion-laden) and valence (positive versus negative). To confirm word emotionality, neutral words were also included and compared with all emotional words. The results showed that adults exhibited reduced N400 amplitudes to emotion-label words compared to emotion-laden ones in both positive and negative valence contexts. The differentiation was only sustained for negative valence in the late positive component (LPC). Similar scalp distributions of the effects of word type were found in children/adolescents; however, they exhibited a more prolonged processing of all emotional words than adults. These results suggest that the processing of emotion-label and emotion-laden words are distinct in late childhood, and this discrepancy varies with emotional valence and increasing age.

Transcatheter aortic valve implantation vs. surgical aortic valve replacement for aortic stenosis in Taiwan: A population-based cohort study.

OBJECTIVE: Aortic stenosis (AS) is a heart valve disease characterized by left ventricular outflow fixed obstruction. It can be managed by surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). However, real-world evidence for TAVI or SAVR outcomes is lacking in Taiwan. This study aimed to compare the clinical outcomes of TAVI and SAVR for treating of AS in Taiwan. MATERIALS AND METHODS: The National Health Insurance Research Database is a nationally representative cohort that contains detailed registry and claims data from all 23 million residents of Taiwan. This retrospective cohort study used this database to compare patients who underwent SAVR (bioprosthetic valves) or TAVI from 2017 to 2019. Survival outcomes and length of hospital stay (LOS) and intensive care unit (ICU) stay between TAVI and SAVR in the matched cohort. A Cox proportional hazards model was performed to identify the effect of treatment type on survival rates while controlling variables including age, gender, and comorbidities. RESULTS: We identified 475 and 1605 patients who underwent TAVI and SAVR with a bioprosthetic valve, respectively. Patients who underwent TAVI were older (82.19 vs. 68.75 y/o) and more likely to be female (55.79% vs. 42.31%) compared with patients who underwent SAVR. Propensity score matching (PSM) on age, gender, and Elixhauser Comorbidity Index (ECI) score revealed that 375 patients who underwent TAVI were matched with patients who underwent SAVR. A significant difference was found in survival rates between TAVI and SAVR. The 1-year mortality rate was 11.44% with TAVI and 17.55% with SAVR. Both the mean total LOS (19.86 vs. 28.24 days) and mean ICU stay (6.47 vs. 11.12 days) for patients who underwent TAVI were shorter than those who underwent SAVR. CONCLUSION: Patients who had undergone TAVI had better survival outcomes and shorter LOS compared with patients who had undergone SAVR in Taiwan.

Radial arterial waves for chemotherapy- and radiotherapy-related myocardial damage identification in patients with breast cancer.

Introduction: Chemotherapy and radiation therapy for breast cancer cause side effects, such as cardiovascular changes, which can be monitored with echocardiography. However, more convenient methods are always encouraged. Radial arterial waves that are used to detect cardiovascular changes can be used to assist in confirming cardiovascular changes. Aim: This retrospective study aimed to analyze the frequency and time domains of the radial artery pulse wave in patients with breast cancer to understand its effectiveness in identifying cardiovascular changes. Methods: Patients with breast cancer were screened from the pulse examination records in Changhua Christian Hospital and divided into the treatment and remission groups. After unlinking the data, the pulse data were analyzed for the breast cancer treatment and remission group, including the average value of the parameters of four consecutive pulse diagnosis records in four consecutive months to test the difference in pulse waves due to breast cancer treatment between the two groups. Additionally, the pulse wave stability of the two groups was compared using the coefficient of variation. Results and conclusion: The comparison of the pulse wave data between 19 patients in the treatment group and 40 patients in the remission group revealed 45 parameters in time and 50 in frequency domains. D3, ND3, NA1, and NT1 are the four parameters with significant differences (p < 0.05), which are all related to heart function, and mainly related to cardiac output and peripheral resistance, indicating that patients in the treatment period have poor heart function. No difference was found in the degree of data dispersion between the two groups. Cardiovascular side effects caused by breast cancer treatment can mainly be shown in the pulse wave time domain.

Formulation Development of Doxycycline-Loaded Lipid Nanocarriers using Microfluidics by QbD Approach.

Liposomes have been used to improve therapeutic efficacy of drugs by increasing their bioavailability and altering biodistribution. The loading capacity of small molecules in liposomes remains a critical issue. Besides, the manufacturing process of liposomes requires multi-step procedures which hinders the clinical development. In this study, we developed a promising lipid-based nanocarriers (LN) delivery system for hydrophilic charged compounds using doxycycline (Doxy) as a model drug. This Doxy-loaded lipid nanocarrier (LN-Doxy) was fabricated by microfluidic technology. Design of experiments (DoE) was constructed to outline the interactions among the critical attributes of formulation, the parameters of microfluidic systems and excipient compositions. Response surface methodology (RSM) was furthered used for the optimization of LN-Doxy formulation. The LN-Doxy developed in this study showed high drug to lipid ratio and uniform distribution of particle size. Compared to Doxy solution, this LN-Doxy has reduced in vitro cellular toxicity and significant therapeutic efficacy which was verified in a peritonitis animal model. These results show the feasibility of using microfluidic technology combined with QbD approach to develop the LN formulation with high loading efficiency for ionizable hydrophilic drugs.