Summary Background People with type 2 diabetes are at risk of cognitive impairment and brain atrophy. We aimed to compare the effects on cognitive function and brain volume of intensive versus ...standard glycaemic control. Methods The Memory in Diabetes (MIND) study was done in 52 clinical sites in North America as part of Action to Control Cardiovascular Risk in Diabetes (ACCORD), a double two-by-two factorial parallel group randomised trial. Participants (aged 55–80 years) with type 2 diabetes, high glycated haemoglobin A1c (HbA1c ) concentrations (>7·5%; >58 mmol/mol), and a high risk of cardiovascular events were randomly assigned to receive intensive glycaemic control targeting HbA1c to less than 6·0% (42 mmol/mol) or a standard strategy targeting HbA1c to 7·0–7·9% (53–63 mmol/mol). Randomisation was via a centralised web-based system and treatment allocation was not masked from clinic staff or participants. We assessed our cognitive primary outcome, the Digit Symbol Substitution Test (DSST) score, at baseline and at 20 and 40 months. We assessed total brain volume (TBV), our primary brain structure outcome, with MRI at baseline and 40 months in a subset of participants. We included all participants with follow-up data in our primary analyses. In February, 2008, raised mortality risk led to the end of the intensive treatment and transition of those participants to standard treatment. We tested our cognitive function hypotheses with a mixed-effects model that incorporated information from both the 20 and 40 month outcome measures. We tested our MRI hypotheses with an ANCOVA model that included intracranial volume and factors used to stratify randomisation. This study is registered with ClinicalTrials.gov , number NCT00182910. Findings We consecutively enrolled 2977 patients (mean age 62·5 years; SD 5·8) who had been randomly assigned to treatment groups in the ACCORD study. Our primary cognitive analysis was of patients with a 20-month or 40-month DSST score: 1378 assigned to receive intensive treatment and 1416 assigned to receive standard treatment. Of the 614 patients with a baseline MRI, we included 230 assigned to receive intensive treatment and 273 assigned to receive standard treatment in our primary MRI analysis at 40 months. There was no significant treatment difference in mean 40-month DSST score (difference in mean 0·32, 95% CI −0·28 to 0·91; p=0·2997). The intensive-treatment group had a greater mean TBV than the standard-treatment group (4·62, 2·0 to 7·3; p=0·0007). Interpretation Although significant differences in TBV favoured the intensive treatment, cognitive outcomes were not different. Combined with the non-significant effects on other ACCORD outcomes, and increased mortality in participants in the intensive treatment group, our findings do not support the use of intensive therapy to reduce the adverse effects of diabetes on the brain in patients with similar characteristics to those of our participants. Funding US National Institute on Aging and US National Heart, Lung, and Blood Institute.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
A promising novel high-capacity anode material for lithium-ion batteries based on a highly dispersed tin powder is considered. The powder has been obtained using pulsed electrochemical cathodic ...reduction on a titanium vibrocathode in an electrolyte based on a choline chloride–ethylene glycol ionic liquid. The discharge capacity of the anode material is 817 (mAh)/g, which is close to the theoretical specific electrochemical capacity of tin amounting to 924 (mAh)/g. The powder dispersion level and the morphology of tin crystals are determined. The particle size distribution for the fractions with an increased content of particles having a size less than 0.1 μm and the SEM images of grains having a rhombohedral shape are presented. For studying the reversibility of the aforementioned anode material, the following applied methods for electrochemical analysis under electrode charge and discharge have been used: cyclic voltammetry, galvanostatic cycling, and impedance spectroscopy. Changes in the characteristics of the electrode under study using equivalent circuits for impedance spectroscopy under the formation of a lithium–tin intermetallic compound, as well as change in the ratio between the diffusion coefficient of lithium ions at different stages of charge and at the initial stage are considered. It is shown that, when the charge capacity close to the theoretical value is reached, the intercalation can occur in two ways: through a solid-electrolyte film and through an intermetallic compound.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Possibilities of tin powders obtainment from the choline chloride-ethylene glycol ionic liquid are considered. The tin reduction from an ionic liquid mechanism is confirmed via chronovoltametry, ...chronopotentiometry, transient potential and impedance spectroscopy methods. Said mechanism includes the trichlorostanite complexes reduction at current densities up to 5 mA / cm2, recovery from a polyanionic adsorbed layer at current densities of 5-12 mA/cm2 and recovery from a mixed layer including polyanions bound and by electrolyte ions at current densities exceeding 12 mA/cm2. Tin ions reduction from the mixed coating layer facilitates forming of encapsulated tin powder particles with shape of symmetrical dendrites. Powders obtainment from an ionic liquid allows to reduce the resulting powder dispersion.
This article presents the research on the effect of substrate nature and electrolysis modes on ultramicron and nanosized electrolytic powders formation regularities. It was found that the ...preliminarily electropolishing of titanium cathode in combination with impulse electrolysis mode for nickel and copper powders obtaining provides for the predomination of nanosized fraction. The presence of water soluble polymers in the electrolyte for copper powder obtaining, polyvinylpyrrolidone (PVP) and polyacrilamide (PAA) allows forming stable dendritic powders with low agglomeration. Using of powders stabilized by polymers allows obtaining compositions with uniform particle distribution across the whole volume of the sample which provides for heightened wear resistance of composition materials.
In February 2007 an outbreak of Nipah virus (NiV) encephalitis in Thakurgaon District of northwest Bangladesh affected seven people, three of whom died. All subsequent cases developed illness 7–14 ...days after close physical contact with the index case while he was ill. Cases were more likely than controls to have been in the same room (100% vs. 9·5%, OR undefined, P<0·001) and to have touched him (83% vs. 0%, OR undefined, P<0·001). Although the source of infection for the index case was not identified, 50% of Pteropus bats sampled from near the outbreak area 1 month after the outbreak had antibodies to NiV confirming the presence of the virus in the area. The outbreak was spread by person-to-person transmission. Risk of NiV infection in family caregivers highlights the need for infection control practices to limit transmission of potentially infectious body secretions.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
—The mechanism of the electrochemical formation of WO
3
films on the surface of titanium, tin, and ITO electrodes is investigated under various regimes, including the deposition time τ = 2000–8000 s ...and the electrochemical potential of deposition on the cathode in the range from –0.4 to –1 V. A technique for the synthesis of peroxytungstic acid and a method of cathodic electrodeposition are presented. The studies carried out with tin and titanium extend the field of application of WO
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films to technologies of chemical current sources and fuel cells.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The principles of pulse electrolysis modes selection and their effect on the size distribution of the powder electrolytic copper in electrolyte with additions of water-soluble polymers, ...polyvinylpyrrolidone (PVP) and polyacrylamide (PAA) are considered in the paper. The research conducted with use of chronopotentiometry and potential transients as well as a simulation model of the electrocrystallisation process showed that the values of pulse duration were greater than the transient time of electroactive species and the pause duration equal to the linear part of potential transient was optimum to obtain a powder with a predominant fraction of nanoscale particles . PVP and PAA additives help to reduce the average particle size in the nanoscale fraction copper powder particles to 25-40 nm. Selected current pulse mode effect corresponds to the reduction of the emergence of new centers of crystallization probability and the adatoms on the surface of the cathode movement probability.
Background There is a growing use of procalcitonin (PCT) to facilitate the diagnosis and management of severe sepsis. We investigated the impact of one to two PCT determinations on ICU day 1 on ...health-care utilization and cost in a large research database. Methods A retrospective, propensity score-matched multivariable analysis was performed on the Premier Healthcare Database for patients admitted to the ICU with one to two PCT evaluations on day 1 of ICU admission vs patients who did not have PCT testing. Results A total of 33,569 PCT-managed patients were compared with 98,543 propensity score-matched non-PCT patients. In multivariable regression analysis, PCT utilization was associated with significantly decreased total length of stay (11.6 days 95% CI, 11.4 to 11.7 vs 12.7 days 95% CI, 12.6 to 12.8; 95% CI for difference, 1 to 1.3; P < .001) and ICU length of stay (5.1 days 95% CI, 5.1 to 5.2 vs 5.3 days 95% CI, 5.3 to 5.4; 95% CI for difference, 0.1 to 0.3; P < .03), and lower hospital costs ($30,454 95% CI, 29,968 to 31,033 vs $33,213 95% CI, 32,964 to 33,556); 95% CI for difference, 2,159 to 3,321; P < .001). There was significantly less total antibiotic exposure (16.2 days 95% CI, 16.1 to 16.5 vs 16.9 days 95% CI, 16.8 to 17.1; 95% CI for difference, –0.9 to 0.4; P = .006) in PCT-managed patients. Patients in the PCT group were more likely to be discharged to home (44.1% 95% CI, 43.7 to 44.6 vs 41.3% 95% CI, 41 to 41.6; 95% CI for difference, 2.3 to 3.3; P = .006). Mortality was not different in an analysis including the 96% of patients who had an independent measure of mortality risk available (19.1% 95% CI, 18.7 to 19.4 vs 19.1% 95% CI, 18.9 to 19.3; 95% CI for difference, –0.5 to 0.4; P = .93). Conclusions Use of PCT testing on the first day of ICU admission was associated with significantly lower hospital and ICU lengths of stay, as well as decreased total, ICU, and pharmacy cost of care. Further elucidation of clinical outcomes requires additional data.
Early detection of zoonotic diseases allows for the implementation of early response measures, reducing loss of human life and economic disruption. We implemented a surveillance system in hospitals ...in Bangladesh to screen acutely ill hospitalized patients with severe respiratory infection and meningoencephalitis for zoonotic exposures. Patients were screened for the risk of zoonotic exposures with five questions covering vocational exposures, sick domestic animal and wild animal contact, and date palm sap consumption in the three weeks preceding illness onset. Patients giving at least one positive response were considered a potential zoonotic exposure. From September 2013 to March 2017, a total of 11 429 hospitalized patients across 14 participating hospitals were screened for exposures. Overall, 2% of patients reported a potential zoonotic exposure in the three-week period prior to becoming ill. Sixteen per cent of hospitalized patients with reported exposures died. After routine surveillance diagnostic testing, 88% of patients admitted to the hospital after a potential zoonotic exposure did not have a laboratory diagnosed aetiology for their illness. Hospital-based surveillance systems such as the Bangladeshi example presented here could play an important future role in the early detection of zoonotic spillover diseases. This article is part of the theme issue 'Dynamic and integrative approaches to understanding pathogen spillover'.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
DNA mismatch repair is important because of its role in maintaining genomic integrity and its association with hereditary non-polyposis colon cancer (HNPCC). To identify new human mismatch repair ...proteins, we probed nuclear extracts with the conserved carboxy-terminal MLH1 interaction domain. Here we describe the cloning and complete genomic sequence of MLH3, which encodes a new DNA mismatch repair protein that interacts with MLH1. MLH3 is more similar to mismatch repair proteins from yeast, plants, worms and bacteria than to any known mammalian protein, suggesting that its conserved sequence may confer unique functions in mice and humans. Cells in culture stably expressing a dominant-negative MLH3 protein exhibit microsatellite instability. Mlh3 is highly expressed in gastrointestinal epithelium and physically maps to the mouse complex trait locus colon cancer susceptibility I (Ccs1). Although we were unable to identify a mutation in the protein-coding region of Mlh3 in the susceptible mouse strain, colon tumours from congenic Ccs1 mice exhibit microsatellite instability. Functional redundancy among Mlh3, Pms1 and Pms2 may explain why neither Pms1 nor Pms2 mutant mice develop colon cancer, and why PMS1 and PMS2 mutations are only rarely found in HNPCC families.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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