Abstract
Direct‐acting antivirals (DAAs) have become an effective first‐line treatment for chronic hepatitis C (CHC), and the fixed‐dose combination of sofosbuvir (SOF) and velpatasvir (VEL) is one ...of the most important pangenotypic DAA regimen according to present treatment guideline. The association between SOF‐based regimens and renal toxicity remains controversial. A total of 953 patients including 130 with estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73m
2
and 823 with eGFR > 60 mL/min/1.73m
2
receiving SOF/VEL therapy for 12 weeks were enrolled in this study. The eGFR was assessed at baseline, end of treatment (EOT), and 12 weeks after completion of the therapy (end of follow‐up, EOF). The eGFR in patients with eGFR ≤ 60 mL/min/1.73m
2
increased from baseline (47.89 ± 10.25 mL/min/1.73m
2
) to EOT (51.65 ± 15.92;
P
< .001) and EOF (51.51 ± 14.46 mL/min/1.73m
2
;
P
< .05). The eGFR in patients with eGFR > 60 mL/min/1.73m
2
at baseline (91.52 ± 22.06 mL/min/1.73m
2
) was lower at EOT (90.37 ± 22.3;
P
< .05), with no difference between EOT and EOF (
P
= .06). Multivariable analysis showed that a higher serum albumin level was associated with a lower risk of eGFR decrease at EOT, and the patients with baseline eGFR > 60 mL/min/1.73m
2
were associated with a higher risk of eGFR decrease at EOF. The rates of sustained virologic response 12 weeks after treatment cessation (SVR12) were 99.2% in per‐protocol analysis, and the most common adverse events were fatigue (4.7%), abdominal discomfort (4.5%), and skin itching (3.7%). In conclusion, renal function improved after the SOF/VEL treatment in patients with CHC and chronic kidney disease. Thus, SOF/VEL was safe, effective, and tolerable in these patients.
In Taiwan, the National Health Insurance Scheme reimburses lifelong antiviral agents for cirrhotic patients with hepatitis B virus (HBV) DNA higher than 2000 IU/mL. However, the requirement of image ...diagnosis is ultrasonographic cirrhosis with splenomegaly. The current study aimed to evaluate the validity of splenomegaly in the diagnosis of chronic hepatitis B (CHB)‐related liver cirrhosis (LC). Eliminated by exclusive criteria, 684 of 743 consecutive CHB patients with available liver biopsy reports were enrolled as the all populations group (Group all). Ultrasound cirrhosis score (UCS) was used to demonstrate the severity of liver fibrosis. A score of 7 as the best cut‐off point in the prediction of CHB‐related LC has been proposed by our previous report. Based on UCS ≥7, 222 patients were selected as the advanced fibrosis populations group (Group fibrosis). The splenic index (SI), the product of two vertical distances from the splenic surface to hilum, was measured retrospectively from the ultrasonographic pictures mostly close to the biopsy day. Splenomegaly is defined as SI ≥20. In Group all and Group fibrosis, the prevalence of pathological LC was 26.2% (179/684) and 64.4% (143/222), respectively. The area under receiver operating characteristic (ROC) curve of the SI in the diagnosis of LC was 72.3% and 68.2% for Group all and Group fibrosis, respectively. Using 20 as a cut‐off value, the accuracy was 73.1% and 60.8%. Based on the ROC curve, the best cut‐off point of the SI should be 17 (sensitivity: 70.4%, specificity: 63.4%) and 18 (sensitivity: 65.7%, specificity: 64.6%), respectively. Splenomegaly is not a good noninvasive surrogate in the diagnosis of LC in patients with CHB.
碩士
國立高雄師範大學
英語學系
102
The study aims to investigate the effects of audiobooks on junior high school students’ listening proficiency with the application of Cooperative Learning and to find out whether ...reading proficiency improves as well. Sixty-four eighth graders in a junior high school in Kaohsiung City participated in this study, and they were divided into an experimental group and a control group. Both received the same texts, but only the experimental group received the intervention of audiobooks and CL activities while the control group received the traditional reading aloud. Before and after the experiment, both groups took listening and reading comprehension tests to examine their improvement in listening and reading proficiency, and the results were analyzed by means of the independent sample t-test and the paired sample t-test. At last, the experimental group students were asked to fill out a questionnaire in order to explore their opinions on the use of audiobooks and CL in learning. The research findings are as follows:
1. Comparing the results of the pretests and posttests of the experimental group, the experimental group students significantly improved only in listening proficiency.
2. Although the experimental group students had improvement in listening and reading proficiency, the outcomes did not reach the level of significant difference compared with those from the control group.
3. Among the three proficiency levels, the high-, medium-, and low-achievers, the low-achievers improved most significantly in listening and reading proficiency even though there were no significant differences.
4. The results of the questionnaire and interviews showed that the use of audiobooks
increased students’ learning motivations, and they were more involved in the listening and reading process and accordingly had better listening and reading performances.
5. The results of the questionnaire and interviews also indicated that the use of CL
increased interactions among students in class. The interactions not only helped students learn to work with peers but also provided them with more chances to practice four language skills, which in turn were beneficial to English learning.
Finally, based on the findings of the present study, it is suggested that English teachers make good use of audiobooks to improve students’ listening comprehension as well as CL to enhance students’ motivations and interest on English learning.
Background
The advanced technology of interventional radiology may contribute to a rapid and timely angioembolization for hemostasis. We hypothesized that unstable hemodynamics is no longer an ...absolute contraindication of nonoperative management (NOM) in blunt splenic injury patients using rapid angioembolization.
Methods
From January 2009 to December 2019, blunt splenic injury patients with unstable hemodynamics initial pulse >120 beats/min or systolic blood pressure <90 mm Hg were included. Either emergency surgery or angioembolization was performed for hemostasis because of their unstable status. The characteristics of patients who underwent angioembolization or surgery were compared in each group (all patients, patients with hypotension, patients without response to resuscitation and hypotensive patients without response to resuscitation).
Results
A total of 73 patients were included in the current study. With respect to all patients, 68.5% (
N
= 50) of patients underwent NOM with angioembolization for hemostasis. Patients who underwent angioembolization for hemostasis had a significantly lower base deficit (5.3 ± 3.8 vs. 8.3 ± 5.2 mmol/L,
p
= 0.006) and a higher proportion of response to resuscitation (82.0% vs. 30.4%,
p
< 0.001) than did patients who underwent surgery. However, there was no significant difference in the proportion of hypotension (58.0% vs. 65.2%,
p
= 0.558) between these two groups. There were 44 patients with hypotension, and the angioembolization could be performed in 65.9% (
N
= 29) of them. Patients who underwent angioembolization had a significantly higher proportion of response to resuscitation than did patients who underwent surgery (89.7% vs. 33.3%,
p
< 0.001). In hypotensive patients without response to resuscitation (
N
= 13), 23.1% (
N
= 3) of the patients underwent angioembolization successfully. There was no significant difference in time to hemostasis procedure between patients who underwent angioembolization or surgery (24.7 ± 2.1 vs. 26.3 ± 16.7 min,
p
= 0.769). The demographics, vital signs, blood transfusion amount, injury severity, mortality rate and length of stay of patients who underwent angioembolization were not significantly different from patients who underwent surgery in each group.
Conclusions
With a short preparation time of angioembolization, the NOM could be performed selectively for hemodynamically unstable patients with blunt splenic injury. The base deficit serves as an early detector of the requirement of surgical treatment.
Studies conducted in the same seas or even study sites nearby each other, showed very different community structure, implying the patchiness of free-living marine nematodes which may be related to ...the sedimentary environment such as sediment type and food availability of the study area. This study was motivated by the concerns about the impacts of high level of anthropogenic activities on Chaojing Park (gazetted as Wanghaixiang's Chao-Jing Bay Resource Conservation Area (WCJBRA) in 2016). The present study provides baseline knowledge of free-living marine nematode community structure in WCJBRA and identify potential marine nematodes as bioindicators to indicate possible impacts of the anthropogenic activities to the Chaojing Park. A total of 15 stations were selected in the subtidal zones of WCJBRA and its adjacent area. Marine nematode sample collection was carried out on the 13th and 14th of September 2019 using SCUBA diving technique. Results showed positive correlation between nematode density and medium sand (500μm-1.0mm). Presence of certain species such as Daptonema sp., Pomponema sp. and Innocuonema sp. indicates presence of disturbances in S12 and S13. Several species also showed potential to be introduced as indicator for healthy environment subjected to further studies on nematode-pollutants relationship, particularly on autecology as per se. Higher species diversity, H' index of S1-S8 and S11 was categorised as Good Condition; followed by station with moderate species diversity index (S9, S10, S14 -Moderate Condition) zone; and lastly S12, S13 and S15 (Poor Condition).
To identify critical quality factors and critical satisfaction gaps in emergency training courses for new nurses through a systematic decision-making model.
Firstly, the service quality (SERVQUAL) ...was used in the evaluation index system of this study. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to analyze the relationship structure and the corresponding weights between the indicators. Finally, the importance-performance analysis (IPA) method was used to identify the categories of all indicators and the corresponding strategic directions. Fifteen new nurses in Taizhou Hospital of Zhejiang Province were selected as participants in this study.
The IPA results showed that "(C
)," "(C
)," "(C
)," "(C
)," "(C
)," "(C
)," "(C
),"and "(C
)" are critical satisfaction gaps. From the results of influence network and weight, empathy (C
) was the critical quality factor of the entire training course. The influence network relationship structure and weight had a 98.1% significant confidence level, indicating good stability.
Teachers' empathy is key to the learning outcomes of new nurses in emergency nursing training courses. Hence, teachers should be attentive to the empathetic quality of their teaching methods to help new nurses gain knowledge and experience in emergency care, especially when they come from different professions and departments.
ObjectivesCOVID-19 has changed the epidemiology of trauma. However, Taiwan is a country with a low COVID-19 threat, and people’s daily lives have remained mostly unchanged during this period. The ...purpose of this study is to investigate whether the trend of trauma incidence and the service of trauma care is affected by the relatively minor COVID-19 pandemic in Taiwan.DesignA single-institute, retrograde cohort study.SettingAn observational study based on the trauma registry of Chang Gung Memorial Hospital (CGMH).ParticipantsTrauma patients presented to the emergency department of CGMH in the period of 1 January to 30 June 2020 (week 1 to week 26) were designated as the COVID-19 group, with 1980 patients in total. Patients of the same period in 2015–2019 were designated as the pre-COVID-19 group, with 10 334 patients overall.Primary and secondary outcome measuresThe primary outcome is the incidence of trauma admission. Differences in trauma mechanism, severity, location and outcome were also compared in both groups.ResultsA decrease in trauma incidence during March and April 2020 was noticed. Significant change (p<0.001) in trauma mechanisms was discovered, with decreased burn (5.8% vs 3.6%) and assault (4.8% vs 1.2%), and increased transport accidents (43.2% vs 47.2%) and suicide (0.2% vs 1.0%) in the COVID-19 cohort. A shift in injury locations was also found with a 5% decrement of workplace injuries (19.8% vs 14.8%, p<0.001).ConclusionThe limited COVID-19 outbreak in Taiwan has led to a decreased incidence of trauma patients, and the reduction is mostly attributed to the decline in workplace injuries.
Cell transplantation therapy provides a regenerative strategy for neural repair. We tested the hypothesis that selective excitation of transplanted induced pluripotent stem cell-derived neural ...progenitor cells (iPS-NPCs) could recapitulate an activity-enriched microenvironment that confers regenerative benefits for the treatment of stroke. Mouse iPS-NPCs were transduced with a novel optochemogenetics fusion protein, luminopsin 3 (LMO3), which consisted of a bioluminescent luciferase,
luciferase, and an opsin,
Channelrhodopsin 1. These LMO3-iPS-NPCs can be activated by either photostimulation using light or by the luciferase substrate coelenterazine (CTZ).
stimulations of LMO3-iPS-NPCs increased expression of synapsin-1, postsynaptic density 95, brain derived neurotrophic factor (BDNF), and stromal cell-derived factor 1 and promoted neurite outgrowth. After transplantation into the ischemic cortex of mice, LMO3-iPS-NPCs differentiated into mature neurons. Synapse formation between implanted and host neurons was identified using immunogold electron microscopy and patch-clamp recordings. Stimulation of transplanted cells with daily intranasal administration of CTZ enhanced axonal myelination, synaptic transmission, improved thalamocortical connectivity, and functional recovery. Patch-clamp and multielectrode array recordings in brain slices showed that CTZ or light stimulation facilitated synaptic transmission and induced neuroplasticity mimicking the LTP of EPSPs. Stroke mice received the combined LMO3-iPS-NPC/CTZ treatment, but not cell or CTZ alone, showed enhanced neural network connections in the peri-infarct region, promoted optimal functional recoveries after stroke in male and female, young and aged mice. Thus, excitation of transplanted cells via the noninvasive optochemogenetics treatment provides a novel integrative cell therapy with comprehensive regenerative benefits after stroke.
Neural network reconnection is critical for repairing damaged brain. Strategies that promote this repair are expected to improve functional outcomes. This study pioneers the generation and application of an optochemogenetics approach in stem cell transplantation therapy after stroke for optimal neural repair and functional recovery. Using induced pluripotent stem cell-derived neural progenitor cells (iPS-NPCs) expressing the novel optochemogenetic probe luminopsin (LMO3), and intranasally delivered luciferase substrate coelenterazine, we show enhanced regenerative properties of LMO3-iPS-NPCs
and after transplantation into the ischemic brain of different genders and ages. The noninvasive repeated coelenterazine stimulation of transplanted cells is feasible for clinical applications. The synergetic effects of the combinatorial cell therapy may have significant impacts on regenerative approach for treatments of CNS injuries.
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