Current international guidelines recommend aerobic, resistance, and combined exercises for the management of type 2 diabetes mellitus (T2DM). In our study, we conducted a network meta-analysis to ...assess the comparative impact of different exercise training modalities on glycemic control, cardiovascular risk factors, and weight loss in patients with T2DM.
We searched five electronic databases to identify randomized controlled trials (RCTs) that compared the differences between different exercise training modalities for patients with T2DM. The risk of bias in the included RCTs was evaluated according to the Cochrane tool. Network meta-analysis was performed to calculate mean difference the ratio of the mean and absolute risk differences. Data were analyzed using R-3.4.0.
A total of 37 studies with 2208 patients with T2DM were included in our study. Both supervised aerobic and supervised resistance exercises showed a significant reduction in HbA1c compared to no exercise (0.30% lower, 0.30% lower, respectively), however, there was a less reduction when compared to combined exercise (0.17% higher, 0.23% higher). Supervised aerobic also presented more significant improvement than no exercise in fasting plasma glucose (9.38 mg/dl lower), total cholesterol (20.24 mg/dl lower), triacylglycerol (19.34 mg/dl lower), and low-density lipoprotein cholesterol (11.88 mg/dl lower). Supervised resistance showed more benefit than no exercise in improving systolic blood pressure (3.90 mmHg lower) and total cholesterol (22.08 mg/dl lower. In addition, supervised aerobic exercise was more powerful in improving HbA1c and weight loss than unsupervised aerobic (HbA1c: 0.60% lower; weight loss: 5.02 kg lower) and unsupervised resistance (HbA1c: 0.53% lower) exercises.
Compared with either supervised aerobic or supervised resistance exercise alone, combined exercise showed more pronounced improvement in HbA1c levels; however, there was a less marked improvement in some cardiovascular risk factors. In terms of weight loss, there were no significant differences among the combined, supervised aerobic, and supervised resistance exercises.
Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518 .
Abstract
Strain has been shown to modulate the electronic structure of noble metal nanomaterials and alter their catalytic performances. Since strain is spatially dependent, it is challenging to ...expose the active strained interfaces by structural engineering with atomic precision. Herein, we report a facile method to manipulate the planar strain in ultrathin noble metal nanosheets by constructing amorphous–crystalline phase boundaries that can expose the active strained interfaces. Geometric-phase analysis and electron diffraction profile demonstrate the in-plane amorphous–crystalline boundaries can induce about 4% surface tensile strain in the nanosheets. The strained Ir nanosheets display substantially enhanced intrinsic activity toward the hydrogen evolution reaction electrocatalysis with a turnover frequency value 4.5-fold higher than the benchmark Pt/C catalyst. Density functional theory calculations verify that the tensile strain optimizes the
d
-band states and hydrogen adsorption properties of the strained Ir nanosheets to improve catalysis. Furthermore, the in-plane strain engineering method is demonstrated to be a general approach to boost the hydrogen evolution performance of Ru and Rh nanosheets.
背景：加護病房運用安寧緩和醫療資源的使用狀況，因受到病人診斷複雜、病況緊急多變等因素影響，一直面臨諸多挑戰。即便研究及國際共識均鼓勵早期運用安寧緩和醫療資源，然而安寧緩和醫療在加護病房之利用率仍偏低，導致末期病人接受無效醫療之機率增加及較差的死亡品質。為改善上述臨床現況，首要須對加護單位安寧緩和醫療資源使用之現況有全面性的了解。目的：調查成人加護病房病人之安寧緩和醫療資源使用現況，並比較使用者與未使用者之差異。方法：本研究為回溯式相關性研究（retrospective correlation study），自北台灣一醫學中心之成人加護病房資料庫選取2022年6月1日到7月31日之個案，運用描述性統計、獨立樣本t檢定及卡方檢定進行分析。結果：本研究共分析1,181人，含458位女性（38.8%）及723位男性（61.2%）。共發現217人（18.4%）有使用安寧緩和醫療資源。其中「急需安寧緩和醫療資源者」，亦即加護病房入院30天內死亡者，共有124人（10.6%）；此族群仍有20.2%（n=25）未曾使用安寧緩和醫療資源。比較使用與未使用安寧緩和醫療資源者，其在年齡、疾病別、虛弱程度、心搏停止、感染、意識狀態、插管、氣切造口、強心升壓藥物、腎臟替代療法、葉克膜置放、譫妄、Sequential Organ Failure Assessment及Acute Physiology and Chronic Health Evaluation III分數上有顯著差異。結論／實務應用：約兩成具急迫需要者無法即時使用安寧緩和醫療資源，顯示目前之醫療決策依據，仍有可討論之空間。結果呈現有使用與無使用安寧緩和資源之組間有多面向之差異，顯示醫療團隊廣泛考量各面向因子以判斷安寧緩和醫療需求，但如何選定更精準且具經濟效益之決策輔佐指標，以協助安寧緩和醫療資源啟動與分配之判斷，為未來研究與臨床實踐之要務。
To date, effective control over the electrochemical reduction of CO2 to multicarbon products (C ≥ 2) has been very challenging. Here, we report a design principle for the creation of a selective yet ...robust catalytic interface for heterogeneous electrocatalysts in the reduction of CO2 to C2 oxygenates, demonstrated by rational tuning of an assembly of nitrogen-doped nanodiamonds and copper nanoparticles. The catalyst exhibits a Faradaic efficiency of ~63% towards C2 oxygenates at applied potentials of only −0.5 V versus reversible hydrogen electrode. Moreover, this catalyst shows an unprecedented persistent catalytic performance up to 120 h, with steady current and only 19% activity decay. Density functional theory calculations show that CO binding is strengthened at the copper/nanodiamond interface, suppressing CO desorption and promoting C2 production by lowering the apparent barrier for CO dimerization. The inherent compositional and electronic tunability of the catalyst assembly offers an unrivalled degree of control over the catalytic interface, and thereby the reaction energetics and kinetics.The interfacing of Cu with nitrogen-doped nanodiamond enables the electrocatalytic production of C2 oxygenates from CO2 with promising stability.
Fiber reinforced composite laminates have been increasingly replacing conventional materials in various manufacturing sectors due to their extremely superior mechanical properties. Usually, ...mechanical drilling is an important final manufacturing process for composite laminates, whereas drilling of high-strength composite laminates is very challenging and difficult. As the most undesirable damage and challenging failure mode, drilling-induced delamination for fiber reinforced composite laminates is a hot research area of immerse engineering importance. A review on the path towards delamination-free drilling for composite laminates can significantly help researchers improve currently-available cost-effective drilling process and develop high performance drilling process. This review paper summarizes an up-to-date progress in drilling-induced delamination for composite laminates reported in the literature. It covers delamination formation mechanism, delamination quantification methodologies and measurement technologies, delamination suppression strategies (including tool design optimization, drilling conditions optimization and high performance drilling methods). This general review of drilling-induced delamination for composite laminates can be referenced as not only a summary of the current results from literature survey but also future work possibilities, giving the researchers the opportunity to deepen specific aspects and explore new aspects for reaching delamination-free drilling for composite laminates.
•Propose a framework for Digital Twin-driven thin-walled part manufacturing.•Design to improve different manufacturing processes, including preparation, machining, and measurement.•Aim to support the ...machine operator in making the start-up phases faster and more accurate.•Develop a case study on a 5-axis milling machine to demonstrate the proposed framework.•Prove the feasibility of the proposed framework and the toolpath optimization algorithms.
Thin-walled parts are widely used in the aerospace, shipbuilding, and automotive industry, but due to its unique structure and high accuracy requirements, which leads to an increase in scrapped parts, high cost in production, and a more extended period in the trial machining process. However, to adapt to fast production cycles and increase the efficiency of thin-walled parts machining, this paper presents a Digital Twin-driven thin-walled part manufacturing framework to allow the machine operator to manage the product changes, make the start-up phases faster and more accurate. The framework has three parts: preparation, machining, and measurement, driven by Digital Twin technologies in detail. By establishing and updating the workpiece Digital Twin under a different status, various manufacturing information and data can be integrated and available to machine operators and other Digital Twins. It can serve as a guideline for establishing the machine tool and workpiece Digital Twin and integrating them into the machining process. It provides the machine operator opportunities to interact with both the physical manufacturing process and its digital data in real-time. The digital representation of the physical process can support them to manage the trial machining from different aspects. In addition, a demonstrative case study is presented to explain the implementation of this framework in a real manufacturing environment.
In order to improve the efficiency, reliability and maintainability of the aircraft, the aerospace world has found in progressive electrification that reduces or removes the hydraulic, mechanical and ...pneumatic power systems. Power devices are widely applied in power system, while conventional Si power devices have reached the theoretical limitation. Admittedly, many advantages, such as high breakdown electric field strength, high saturated electron drift velocity and high thermal conductivity can be seen from SiC semiconductor material, and SiC power electronic devices made of which can have the ability to adapt to high voltage, high power, high frequency, high temperature and other harsh environment. This paper presents an overview of SiC power electronic devices used for the secondary power source in aerospace, through the comparison of power electronic devices between SiC and Si, the advantages of SiC devices and the development are analyzed, on the basis of which, emphatically discussed the application status of SiC devices in secondary power source, including aeronautical static inverter, transformer rectifier unit, DC-DC converter, and motor drive. In the end, the existing problems in the application of SiC power electronic devices are discussed, as well as the impacts on aviation technology.
Epstein–Barr virus (EBV)‐associated gastric carcinomas (EBVaGCs) may account for 8–9% of all gastric cancer (GC) patients. All previous reports on EBVaGC were retrospective. Prospective study is ...warranted to evaluate the exact role of EBV status in predicting the prognosis of GC. It is of special interest to figure out whether dynamic detection of plasma EBV‐DNA load could be a feasible biomarker for the monitor of EBVaGC. From October 2014 to September 2017, we consecutively collected GC patients (n = 2,760) from Sun Yat‐sen University Cancer Center for EBER examination. We detected EBV‐DNA load in plasma and tissue samples of EBVaGC patients at baseline. Subsequently, plasma EBV‐DNA load was dynamically monitored in EBVaGC patients. The overall prevalence of EBVaGC is 5.1% (140/2,760). The incidence rate of EBVaGC decreased with advanced AJCC 7th TNM stage (p < 0.001), with the corresponding percentages of 9.3, 9.9, 6.7 and 1.4% for Stage I, II, III and IV patients. EBVaGC patients were predominately young males with better histologic differentiation and earlier TNM stage than EBV‐negative GC (EBVnGC) patients. EBVaGC patients were confirmed to had a favorable 3‐year survival rate (EBVaGC vs. EBVnGC: 76.8% vs. 58.2%, p = 0.0001). Though only 52.1% (73/140) EBVaGC patients gained detectable EBV‐DNA and 43.6% (61/140) reached a positive cutoff of 100 copies/ml, we found the plasma EBV‐DNA load in EBVaGC decreased when patients got response, while it increased when disease progressed. Our results suggested that plasma EBV‐DNA is a good marker in predicting recurrence and chemotherapy response for EBVaGC patients.
What's new?
Epstein–Barr Virus (EBV)‐associated gastric carcinomas (EBVaGC) may account for 8–9% of all gastric cancers (GC). The exact role of EBV status in predicting the prognosis of GC remains to be clarified, however. Here, the authors report a prevalence of EBVaGC in GC in China of 5.1%, as defined by EBER staining in cancerous tissue. EBVaGC patients had a better overall survival than EBV‐negative patients. Though only half of EBVaGC patients gained detectable plasma EBV‐DNA levels, elevated plasma EBV‐DNA predicted relapse and poor response to chemotherapy. Dynamic detection of plasma EBV‐DNA load may offer an easily accessible biomarker to monitor EBVaGC.
Background This study was to compare the clinical presentations and survivals between the non-small cell lung cancer (NSCLC) patients with occult lymph node metastasis (OLNM) and those with evident ...lymph node metastasis (ELNM). We also intended to analyze the predictive factors for OLNM. Methods Kaplan-Meier method with log-rank test was used to compare survivals between groups. Propensity score matching (PSM) was used to reduce bias. The least absolute shrinkage and selection operator (LASSO)-penalized Cox multivariable analysis was used to identify the prognostic factors. Random forest was used to determine the predictive factors for OLNM. Results A total of 2,067 eligible cases (N0: 1,497 cases; occult N1: 165 cases; evident N1: 54 cases; occult N2: 243 cases; evident N2: 108 cases) were included. The rate of OLNM was 21.4%. Patients with OLNM were tend to be female, non-smoker, adenocarcinoma and had smaller-sized tumors when compared with the patients with ELNM. Survival curves showed that the survivals of the patients with OLNM were similar to those of the patients with ELNM both before and after PSM. Multivariable Cox analysis suggested that positive lymph nodes (PLN) was the only prognostic factor for the patients with OLNM. Random forest showed that clinical tumor size was an important predictive factor for OLNM. Conclusions OLNM was not rare. OLNM was not a favorable sign for resected NSCLC patients with lymph node metastasis. PLN determined the survivals of the patients with OLNM. Clinical tumor size was a strong predictive factor for OLNM. Keywords: Non-small cell lung cancer, Occult lymph node metastasis, Survivals, Predictive factors
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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