Two previous literature review-based studies have provided important insights into mobile learning, but the issue still needs to be examined from other directions such as the distribution of research ...purposes. This study takes a meta-analysis approach to systematically reviewing the literature, thus providing a more comprehensive analysis and synthesis of 164 studies from 2003 to 2010. Major findings include that most studies of mobile learning focus on effectiveness, followed by mobile learning system design, and surveys and experiments were used as the primary research methods. Also, mobile phones and PDAs are currently the most widely used devices for mobile learning but these may be displaced by emerging technologies. In addition, the most highly-cited articles are found to focus on mobile learning system design, followed by system effectiveness. These findings may provide insights for researchers and educators into research trends in mobile learning.
► Most studies of M-learning focus on effectiveness and mobile learning system design. ► Most M-learning studies adopted surveys and experiments as the main research methods. ► Mobile phones and PDAs currently are the most used devices for mobile learning. ► Use of M-devices for learning is common in higher education and elementary schools. ► Most highly cited articles categorize to M-learning system design and effectiveness.
Paranasal sinusitis is widespread and can lead to orbital complications, blindness, and death. However, the correlation between ophthalmological findings and disease staging remains unclear. This ...study aimed to investigate the staging, acute ophthalmological manifestations, diagnosis, management, and outcomes of orbital complications of paranasal sinusitis during a 27-year period.
We retrospectively reviewed the medical records of all patients with orbital complications of paranasal sinusitis hospitalized at the National Cheng Kung University Hospital, a medical center in Taiwan during 1988-2015. Sex, age, symptoms, history, ophthalmological findings, laboratory and imaging findings, treatments, and outcomes were analyzed by staging.
Eighty-three patients aged 9 days to 80 years had stage I (preseptal cellulitis, n = 39 patients), II (postseptal orbital cellulitis, n = 8), III (subperiosteal abscess, n = 16), IV (orbital abscess, n = 8), or V (intracranial involvement, n = 12) complications. Peak incidences occurred in patients aged 0-19 and 60-69 years. Chronic sinusitis and diabetes mellitus were common preexisting diseases. Extraocular movement limitation and proptosis predicted postseptal (stage II or more) involvement. The likelihood of elevated intraocular pressure increased with stage. Reduced visual acuity and presence of relative afferent pupillary defect indicated consideration of magnetic resonance imaging to investigate possible intracranial extension. Ipsilateral maxillary (81.7%) and ethmoidal (75.6%) sinuses were the most common sources of infection, and the most frequently implicated pathogens were coagulase-negative Staphylococcus spp. (25.3%) and Staphylococcus aureus (20.5%). All patients received intravenous antimicrobial therapy (multi-drug therapy in 88.0%), and 55.4% underwent surgery, most commonly endoscopic sinus surgery. One (1.2%) diabetic man with stage V complications died of fungal sinusitis with intracranial invasion. Five (6.0%) patients, all stage V, lost vision despite intensive treatment. The average length of hospital stay was 13.8 days (range 2-72 days), and significantly longer stays were associated with stages II-V as compared to stage I.
Orbital infection originating from paranasal sinusitis can cause vision loss and death due to intracranial extension. Acute ophthalmological findings predict staging and prognosis. Cooperative consultation between ophthalmologists, otorhinolaryngologists, and neurologists is essential. Urgent diagnostic studies and aggressive antimicrobial therapy are indicated, and surgery should be considered.
Hepatitis C virus (HCV) infection is a silent killer that leads to rapid progression of liver cirrhosis and hepatocellular carcinoma (HCC). High prevalence of HCV infection has been reported in ...Taiwan, especially in high-risk populations including people who inject drugs (PWID) and patients requiring dialysis. Besides, certain populations merit special considerations due to suboptimal outcome, potential drug–drug interaction, or possible side effect. Therefore, in the second part of this 2-part consensus, the Taiwan Association for the Study of the Liver (TASL) proposes the treatment recommendations for the special population in order to serve as guidance to optimizing the outcome in the direct-acting antiviral (DAA) era. Special populations include patients with acute or recent HCV infection, previous DAA failure, chronic kidney disease, decompensated cirrhosis, HCC, liver and other solid organ transplantations, receiving an HCV viremic organ, hepatitis B virus (HBV) and HCV dual infection, HCV and human immunodeficiency virus (HIV) coinfection, active tuberculosis infection, PWID, bleeding disorders and hemoglobinopathies, children and adolescents, and pregnancy. Moreover, future perspectives regarding the management of hepatitis C are also discussed and summarized in this consensus statement.
Abstract
The streaming instability (SI) is one of the most promising candidates for triggering planetesimal formation by producing dense dust clumps that undergo gravitational collapse. Understanding ...how the SI operates in realistic protoplanetary disks (PPDs) is therefore crucial to assess the efficiency of planetesimal formation. Modern models of PPDs show that large-scale magnetic torques or winds can drive laminar gas accretion near the disk midplane. In a previous study, we identified a new linear dust-gas instability, the azimuthal drift SI (AdSI), applicable to such accreting disks and is powered by the relative azimuthal motion between dust and gas that results from the gas being torqued. In this work, we present the first nonlinear simulations of the AdSI. We show that it can destabilize an accreting, dusty disk even in the absence of a global radial pressure gradient, which is unlike the classic SI. We find the AdSI drives turbulence and the formation of vertically extended dust filaments that undergo merging. In dust-rich disks, merged AdSI filaments reach maximum dust-to-gas ratios exceeding 100. Moreover, we find that even in dust-poor disks the AdSI can increase local dust densities by 2 orders of magnitude. We discuss the possible role of the AdSI in planetesimal formation, especially in regions of an accreting PPD with vanishing radial pressure gradients.
While immunotherapy holds great promise for combating cancer, the limited efficacy due to an immunosuppressive tumor microenvironment and systemic toxicity hinder the broader application of cancer ...immunotherapy. Here, we report a combinatorial immunotherapy approach that uses a highly efficient and tumor-selective gene carrier to improve anticancer efficacy and circumvent the systemic toxicity. In this study, we engineered tumor-targeted lipid-dendrimer-calcium-phosphate (TT-LDCP) nanoparticles (NPs) with thymine-functionalized dendrimers that exhibit not only enhanced gene delivery capacity but also immune adjuvant properties by activating the stimulator of interferon genes (STING)-cGAS pathway. TT-LDCP NPs delivered siRNA against immune checkpoint ligand PD-L1 and immunostimulatory IL-2-encoding plasmid DNA to hepatocellular carcinoma (HCC), increased tumoral infiltration and activation of CD8
T cells, augmented the efficacy of cancer vaccine immunotherapy, and suppressed HCC progression. Our work presents nanotechnology-enabled dual delivery of siRNA and plasmid DNA that selectively targets and reprograms the immunosuppressive tumor microenvironment to improve cancer immunotherapy.
Background
Lenvatinib and atezolizumab plus bevacizumab(A + B) have been used for unresectable hepatocellular carcinoma (HCC) as first‐line therapy. Real‐world studies comparison of efficacy and ...safety in these two regimens are limited, we therefore conduct this study to investigate these issues.
Methods
We retrospectively reviewed patients received lenvatinib (n = 46) and A + B (n = 46) as first‐line systemic therapy for unresectable HCC in a tertiary medical center. Objective response rate (ORR), progression free survival (PFS), and overall survival (OS) were evaluated according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Inverse probability weighting (IPW) was performed for baseline clinical features balance.
Results
A total of 92 patients with median age of 63.8 year‐old, 78.3% male, 85.9% viral hepatitis infected, 67.4% BCLC stage C were enrolled. The median treatment and follow‐up duration were 4.7 months and 9.4 months, respectively. There was no significant difference in ORR (26.1% vs. 41.3%, p = 0.1226), PFS (5.9 vs. 5.3 months, p = 0.4066), and OS (not reached vs. not reached, p = 0.7128) between the lenvatinib and A + B groups. After IPW, the results of survival and response rate were also compared. Subgroup analysis suggested that using lenvatinib was not inferior to A + B in regards of PFS, including those with elder, Child‐Pugh class B, beyond up‐to‐seven, or portal vein invasion VP4 patients. Among the lenvatinib treated patients, multivariate analysis showed patients elder than 65‐year‐old was an independent predictor associated with shorter PFS (adjust HR: 2.0850.914–4.753, p = 0.0213). The incidence rates of adverse events were similar between two groups (76 vs. 63%, p = 0.1740). Both of two regimens had similarly few impact on liver function by comparison of baseline, third month, and sixth month albumin‐bilirubin index and Child‐Pugh score.
Conclusions
The efficacy and safety of lenvatinib are similar to A + B as a first‐line systemic therapy for unresectable HCC.
This study provides real‐world experience of lenvatinib and A + B as firstline treatment for unresectable HCC. The data showed that compared survival, response rate, and adverse events between two regimens.
Introduction: High sustained virological response (SVR) rate (>95%) and liver stiffness regression can be achieved with direct acting antivirals treatment (DAA) in patients with chronic hepatitis C ...virus (CHC) infection. Reactivation of hepatitis B virus (HBV) was reported during DAA treatment in patients co-infected with HBV, although its impact on liver stiffness remains unknown. This study aims to investigate whether the liver stiffness (LSM) regression is different between HBV/HCV co-infected and mono-HCV-infected patients. Materials and Methods: CHC patients with/without HBV co-infection who received DAA treatment and achieved SVR12 between March 2015 and December 2019 in Chang Gung Memorial Hospital, Linkou branch were prospectively enrolled. LSM was assessed by transient elastography (TE, Fibroscan) at baseline and after SVR. Propensity score matching (PSM) at 3:1 ratio, adjusted for age, gender, pre-DAA alanine aminotransferase (ALT), platelet count, and LSM, between CHC with and without HBV co-infection, was performed before further analysis. Results: Among 906 CHC patients enrolled, 52 (5.7%) patients had HBV/HCV co-infection. Patients with HBV/HCV co-infection were of younger age (61.8 vs. 63.2, p = 0.31), with a higher proportion of males (53.8% vs. 38.9%, p = 0.03), and lower pretreatment LSM level (8.15 vs. 10.2 kPa, p = 0.09), while other features were comparable. After PSM, patients with HBV/HCV co-infection had insignificantly lower LSM regression compared to mono-HCV-infected patients (−0.85 kPa vs. −1.65 kPa, p = 0.250). Conclusions: The co-infection of HBV among CHC patients has limited impact on liver stiffness regression after successful DAA treatment.
Abstract
The streaming instability (SI) is one of the most promising pathways to the formation of planetesimals from pebbles. Understanding how this instability operates under realistic conditions ...expected in protoplanetary disks (PPDs) is therefore crucial to assess the efficiency of planet formation. Contemporary models of PPDs show that magnetic fields are key to driving gas accretion through large-scale, laminar magnetic stresses. However, the effect of such magnetic fields on the SI has not been examined in detail. To this end, we study the stability of dusty, magneftized gas in a protoplanetary disk. We find the SI can be enhanced by passive magnetic torques and even persist in the absence of a global radial pressure gradient. In this case, instability is attributed to the azimuthal drift between dust and gas, unlike the classical SI, which is driven by radial drift. This suggests that the SI can remain effective inside dust-trapping pressure bumps in accreting disks. When a live vertical field is considered, we find the magneto-rotational instability can be damped by dust feedback, while the classic SI can be stabilized by magnetic perturbations. We also find that Alfvén waves can be destabilized by dust–gas drift, but this instability requires nearly ideal conditions. We discuss the possible implications of these results for dust dynamics and planetesimal formation in PPDs.
Novel meso‐ or β‐derivatized porphyrins with a carboxyl group have been designed and synthesized for use as sensitizers in dye‐sensitized solar cells (DSSCs). The position and nature of a bridge ...connecting the porphyrin ring and carboxylic acid group show significant influences on the spectral, electrochemical, and photovoltaic properties of these sensitizers. Absorption spectra of porphyrins with a phenylethynyl bridge show that both Soret and Q bands are red‐shifted with respect to those of porphyrin 6. This phenomenon is more pronounced for porphyrins 3 and 4, which have a π‐conjugated electron‐donating group at the meso position opposite the anchoring group. Upon introduction of an ethynylene group at the meso position, the potential at the first oxidation alters only slightly whereas that for the first reduction is significantly shifted to the positive, thus indicating a decreased HOMO–LUMO gap. Quantum‐chemical (DFT) results support the spectroelectrochemical data for a delocalization of charge between the porphyrin ring and the amino group in the first oxidative state of diarylamino‐substituted porphyrin 5, which exhibits the best photovoltaic performance among all the porphyrins under investigation. From a comparison of the cell performance based on the same TiO2 films, the devices made of porphyrin 5 coadsorbed with chenodeoxycholic acid (CDCA) on TiO2 in ratios 5/CDCA=1:1 and 1:2 have efficiencies of power conversion similar to that of an N3‐based DSSC, which makes this green dye a promising candidate for colorful DSSC applications.
Colorful character: A diarylamino‐substituted porphyrin (1) exhibits an overall efficiency of power conversion of 6.0 %. From a comparison of cell performance using the same TiO2 films, the green dye 1 (see figure) outperforms the best reported porphyrin sensitizer and gives a performance comparable to that of an N3‐based dye‐sensitized solar cell.
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