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Background Diabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After treatment with ART, patients might experience clinical deterioration following an increase in the CD4 cell count, which is termed immune reconstitution inflammatory syndrome (IRIS). Here, we describe an HIV-infected patient on ART who developed T1DMat due to IRIS, highlighting the clinical complexity in diagnosis and treatment. Case presentation A 36-year-old man infected with HIV had a nadir CD4 cell count of 15.53/μL before medication, which increased to 429.09/μL after 9 months of regular ART. The fasting serum glucose at 9 months was between 96 mg/dL and 117 mg/dL. After 11 months of ART, the patient was admitted to hospital for diabetic ketoacidosis (DKA) and Graves’ disease (GD). Noninsulin antidiabetics (NIADs) were prescribed following the resolution of DKA. However, poor glycemic control was noted despite well-titrated NIADs. Further investigation demonstrated poor pancreatic beta cell function and elevated anti-glutamic acid decarboxylase (anti-GAD) and anti-tyrosine phosphatase-like insulinoma antigen 2 (anti-IA2) titers. According to the results, he was diagnosed with T1DM and received multiple daily injections(MDI) of insulin. The regimen of MDI was insulin degludec as basal insulin and insulin aspart as prandial insulin. After MDI therapy, his glycemic control was improved. Conclusion In this case, T1DM was ascribed to IRIS. Although this phenomenon has been demonstrated in previous case reports, further study is necessary to realize the mechanism of this association. Therefore, we emphasize that when HIV-infected patients on ART experience an unstable blood glucose level and abnormal thyroid function, physicians should consider T1DM and GD associated with ART-induced IRIS to reduce the subsequent complications and more serious endocrine dysfunction.

A 400-Gb/s wavelength-division-multiplexing (WDM) four-level pulse amplitude modulation (PAM4) optical wireless communication (OWC) system through a 200-m free-space transmission with either an 8.8-m piped water–air–piped water link or a 6.5-m turbid water–air–turbid water link is successfully constructed. Incorporating PAM4 modulation with an 8-wavelength WDM scheme greatly increases the total transmission rate of the WDM-PAM4 OWC system to 400 Gb/s (50 Gb/s/λ × 8 λs). By adopting doublet lenses in free-space transmission, a laser beam reducer/expander and a reflective spatial light modulator (SLM) with an angle expander through the water–air–water link, good bit error rate performance and acceptable PAM4 eye diagrams are obtained. Using a reflective SLM with an angle expander not only adaptively adjusts the laser beam, but also effectively solves the oceanic engineering problems. This demonstrates WDM-PAM4 OWC system outperforms existing OWC systems through the free-space transmission with an air–water–air link because it can solve the practical engineering problems in actual oceanic environments.

The purposes of this study were to provide a game-based anti-phishing lesson to 110 elementary school students in Taiwan, explore their learning behavioral patterns, and investigate the effects of the flow states on their learning behavioral patterns and learning achievement. The study recorded behaviour logs, and applied a pre- and post-test on phishing knowledge and a flow state measurement to analyze the learning process. The study used lag sequential analysis to infer the students' behavioural patterns. The results showed that the learning materials used in this study can enable learners' flow experience, whereby they can acquire anti-phishing knowledge through trial and error via a repeated ＂learning with gaming＂ behavioral pattern. We recommend that future educators and researchers on this topic appropriately increase the level of difficulty of the games used, and design learning materials with flexible difficulty based on learners' flow states.

Endometrial receptivity is essential for successful pregnancy, and endometriosis is widely recognized as a disruptor of this process. Poor endometrial receptivity is also a key factor contributing to recurrent implantation failure. Although some molecular mechanisms related to endometrial receptivity have been identified, their specific roles in endometriosis and recurrent implantation failure remain unclear. This study aimed to elucidate the shared molecular mechanisms affecting endometrial receptivity in endometriosis and recurrent implantation failure using multi-omics data analysis. We sourced datasets from the NCBI GEO database and employed weighted gene co-expression network analysis to identify gene modules associated with these conditions, followed by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. Single-cell sequencing analysis and immunofluorescence were used for expression analysis. We identified 3690 and 4892 upregulated genes and 2675 and 5065 downregulated genes in endometriosis and recurrent implantation failure, respectively. Functional enrichment analysis and validation identified 15 hub genes including SRPRB, SLC35B1, and SLC25A6. Receiver operating characteristic curve analysis demonstrated that these genes are associated with high diagnostic accuracy. Single-cell sequencing analysis indicated that these genes are predominantly expressed in basal epithelial cells, with RBM3 being particularly prominent. This study provides new insights into the molecular mechanisms underlying endometrial receptivity and identifies potential targets for the diagnosis and treatment of endometriosis and recurrent implantation failure.

A two-way 224-Gbit/s four-level pulse amplitude modulation (PAM4)-based fibre-free-space optical (FSO) converged system through a 25-km single-mode fibre (SMF) transport with 500-m free-space transmission is successfully constructed, which adopts injection-locked vertical-cavity surface-emitting lasers with polarisation-multiplexing mechanism for a demonstration. Compared with one-way transmission, two-way transmission is an attractive architecture for fibre-FSO converged system. Two-way transmission over SMF transport with free-space transmission not only reduces the required number of fibres and the setups of free-space transmission, but also provides the advantage of capacity doubling. Incorporating dual-wavelength four-level pulse amplitude modulation (PAM4) modulation with polarisation-multiplexing mechanism, the transmission capacity of fibre-FSO converged system is significantly enhanced to 224 Gbit/s (56 Gbit/s PAM4/wavelength × 2-wavelength × 2-polarisation) for downlink/uplink transmission. Bit error rate and PAM4 eye diagrams (downstream/upstream) perform well over 25-km SMF transport with 500-m free-space transmission. This proposed two-way fibre-FSO converged system is a prominent one not only because of its development in the integration of fibre backbone with optical wireless extension, but also because of its advantage in two-way transmission for affording high downlink/uplink data rate with good transmission performance.

This study explores the effects of integrated concept maps and classroom polling systems on students' learning performance, attentional behavior, and brainwaves associated with attention. Twenty-nine students from an Educational Research Methodology course were recruited as participants. For data collection, in-class quizzes, attentional behavior analysis, and a 20-minute structured interview were applied, and the attention-associated brainwaves of the participants were measured. In the first week, a group-polling method was introduced in class; in the second week, participants were asked to draw concept maps using pen and paper (PnP concept mapping); and in the third week, the polling system and concept maps were integrated (votable concept mapping) and applied. The results showed that the PnP concept mapping approach improved the quiz results of students with lower learning motivation prior to the course, while the votable concept mapping method was effective in stimulating students' attention during class. It was therefore suggested that instructors adopt methods integrating concept maps and polling tools to stimulate students' attention and thereby promote a positive cycle of attentional behavior in the classroom. For example, students' attentional behavior during an activity facilitated their attentional behavior after the activity, and this behavior continued until the next activity.

Previous studies on the impact of diabetes education on disease management have shown that different educational approaches yield varying degrees of effectiveness across different populations. Adopting face-to-face education with long-term follow-up not only allows for monitoring changes in numerical values but also facilitates the observation of patients' learning status. This study investigates the impact of a two-year structured Diabetes Health Education (DHE) program on disease-related serum markers in patients with type 2 diabetes mellitus (T2DM). A five-year observational cohort study with retrospective analysis was conducted, involving 1,080 participants who completed the DHE program and 192 non-participants. The DHE program included regular educational sessions every three months, covering topics such as blood glucose management, lipid profiles, and healthy lifestyle practices. Results demonstrated significant improvements among DHE participants: HbA1c levels decreased by 37%, fasting glucose by 4%, total cholesterol by 7%, LDL cholesterol by 13%, and triglycerides by 20%, with HDL cholesterol increasing by 3%. Body weight and diastolic blood pressure (DBP) also showed reductions of 4% and 3%, respectively, while systolic blood pressure (SBP) exhibited no significant changes. The improvements in lipid profiles were evident within six months, whereas glycemic markers required at least 1.5 years to achieve significance. These results suggest that a structured DHE program significantly improves glycemic control, lipid profile, and other metabolic-related markers in patients with T2DM. Notably, HbA1c and fasting glucose levels significantly improved after 1.5 years of consistent DHE participation, highlighting the importance of long-term engagement for glycemic benefits.

Melt-blown nonwoven fabrics for filtration are usually manufactured using polypropylene, but after a certain time period the middle layer of the mask may have a reduced effect on adsorbing particles and may not be easily stored. Adding electret materials not only increases storage time, but also shows in this study that the addition of electret can improve filtration efficiency. Therefore, this experiment uses a melt-blown method to prepare a nonwoven layer, and adds MMT, CNT, and TiO2 electret materials to it for experiments. Polypropylene (PP) chip, montmorillonite (MMT) and titanium dioxide (TiO2) powders, and carbon nanotube (CNT) are blended and made into compound masterbatch pellets using a single-screw extruder. The resulting compound pellets thus contain different combinations of PP, MMT, TiO2, and CNT. Next, a hot pressor is used to make the compound chips into a high-poly film, which is then measured with differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR). The optimal parameters are yielded and employed to form the PP/MMT/TiO2 nonwoven fabrics and PP/MMT/CNT nonwoven fabrics. The basis weight, thickness, diameter, pore size, fiber covering ratio, air permeability, and tensile property of different nonwoven fabrics are evaluated in order to have the optimal group of PP-based melt-blown nonwoven fabrics. According to the results of DSC and FTIR measurements, PP and MMT, CNT, and TiO2 are completely mixed, and the melting temperature (Tm), crystallization temperature (Tc) and endotherm area are changed accordingly. The difference in enthalpy of melting changes the crystallization of PP pellets, which in turn changes the fibers. Moreover, the Fourier transform infrared (FTIR) spectroscopy results substantiate that PP pellets are well blended with CNT and MMT, according to the comparisons of characteristic peaks. Finally, the scanning electron microscopy (SEM) observation suggests that with a spinning die temperature of 240 °C and a spinning die pressure lower than 0.01 MPa, the compound pellets can be successfully formed into melt-blown nonwoven fabrics with a 10-micrometer diameter. The proposed melt-blown nonwoven fabrics can be processed with electret to form long-lasting electret melt-blown nonwoven filters.

BackgroundIn this study, we aimed to compare the effects of metformin-based dual therapy versus triple therapy on glycemic control and lipid profile changes in Taiwanese patients with type 2 diabetes mellitus (T2DM).MethodsIn total, 60 patients were eligible for participation in this study. Patients received at least 24 months of metformin monotherapy, dual therapy, or triple therapy with metformin plus linagliptin (a dipeptidyl peptidase 4 (DPP-4) inhibitor) or dapagliflozin (a sodium-glucose cotransporter-2 (SGLT2) inhibitor). Blood samples were collected from each patient, followed by evaluation of changes in their blood glucose control and lipid profile-related markers.ResultsA combination of metformin and DPP4 and SGLT2 inhibitor therapy more effectively reduced low-density lipoprotein cholesterol (LDL-C) ( p = 0.016) than metformin monotherapy. A combination of metformin and DPP4 and SGLT2 inhibitor therapy more effectively improved total cholesterol (Chol, p = 0.049) and high-density lipoprotein cholesterol (HDL-C) than metformin monotherapy ( p = 0.037). Metformin plus linagliptin dual therapy was more effective than metformin monotherapy in reducing glycosylated hemoglobin (HbA1C, p = 0.011). Patients who received a combination of linagliptin and empagliflozin showed a significant reduction in their fasting blood glucose ( p = 0.019), HbA1c ( p = 0.036), and Chol ( p = 0.010) compared with those who received linagliptin dual therapy. Furthermore, patients who received metformin plus dapagliflozin and saxagliptin showed significantly reduced Chol ( p = 0.011) and LDL-C ( p = 0.035) levels compared with those who received metformin plus dapagliflozin.ConclusionIn conclusion, dual therapy with metformin and linagliptin yields similar glycemic control ability to triple therapy. Among metformin combination triple therapy, triple therapy of empagliflozin and linagliptin might have a better glycemic control ability than dual therapy of linagliptin. Moreover, Triple therapy of dapagliflozin and saxagliptin might have a better lipid control ability than dual therapy of dapagliflozin.

Previous studies have shown that hyperthyroidism is associated with heightened insulin resistance and dyslipidemia. Therefore, in this study, we aim to explore the relationship between elevated thyroid hormone levels and the lipid profile in insulin resistance in patients with type 2 diabetes mellitus (T2DM) with hyperthyroidism. A total of 177 participants were included and grouped according to diagnosis. The serum test results demonstrated that free thyroxine (FT4) increased the insulin resistance index (HOMA-IR) by positively correlating with triglyceride (TG) levels (p = 0.005, r2 = 0.35). In patients with T2DM with hyperthyroidism, the decreasing high-density lipoprotein levels showed an association with HOMA-IR (p = 0.005). Among all the patients, with different levels of FT4, the areas under the ROC curve (AUCs) of the TG level, TG/high-density lipoprotein ratio, and HOMA-IR were 0.620 (95% CI: 0.536 to 0.698), 0.614 (95% CI: 0.530 to 0.692), and 0.722 (95% CI: 0.645 to 0.791), respectively. Our results suggest that elevated FT4 levels due to hyperthyroidism could alter the association with the lipid profile and insulin resistance in patients with T2DM. We also suggest that among all the included patients with T2DM, irrespective of the presence of hyperthyroidism, FT4 levels are positively correlated with insulin resistance.