This research aimed to investigate the associations of anthropometric measurements, physiological parameters, chronic disease comorbidities, and social and lifestyle factors with cognitive function ...amongst community-dwelling older adults in Taiwan.
This was an observational, cross-sectional study involving 4,578 participants at least 65 years old, recruited between January 2008 and December 2018 from the Annual Geriatric Health Examinations Program. Cognitive function was assessed using the short portable mental state questionnaire (SPMSQ). Multivariable logistic regression was done to analyze the factors associated with cognitive impairment.
Among the 4,578 participants, 103 people (2.3%) with cognitive impairment were identified. Associated factors were age (odds ratio (OR) = 1.16, 95% confidence interval (CI) = 1.13,1.20), male gender (OR = 0.39, 95% CI = 0.21,0.72), diabetes mellitus (DM) (OR = 1.70, 95% CI = 1.03, 2.82), hyperlipidemia (OR = 0.47, 95% CI = 0.25, 0.89), exercise (OR = 0.44, 95% CI = 0.34, 0.56), albumin (OR = 0.37, 95% CI = 0.15, 0.88), and high-density lipoprotein (HDL) (OR = 0.98, 95% CI = 0.97, 1.00). Whereas waistline, alcohol intake in recent six months, and hemoglobin was not significantly associated with cognitive impairment (all p > 0.05).
Our findings suggested that people with older age and a history of DM had a higher risk of cognitive impairment. Male gender, a history of hyperlipidemia, exercise, a high albumin level, and a high HDL level seemed to be associated with a lower risk of cognitive impairment amongst older adults.
A Takagi-Sugeno-Kang type fuzzy neural network with asymmetric membership function (TSKFNN-AMF) is proposed in this study for the fault-tolerant control of a six-phase permanent-magnet synchronous ...motor (PMSM) drive system. First, the dynamics of the six-phase PMSM drive system is described in detail. Then, the fault detection and operating decision method is briefly introduced. Moreover, to achieve the required control performance and to maintain the stability of a six-phase PMSM drive system under faulty condition, the TSKFNN-AMF control, which combines the advantages of a Takagi-Sugeno-Kang type fuzzy logic system and an asymmetric membership function, is developed. The network structure, online learning algorithm using a delta adaptation law, and convergence analysis of the TSKFNN-AMF are described in detail. Furthermore, to enhance the control performance of the proposed intelligent fault-tolerant control, a 32-bit floating-point digital signal processor TMS320F28335 is adopted for the implementation of the proposed fault-tolerant control system. Finally, some experimental results are illustrated to show the validity of the proposed TSKFNN-AMF fault-tolerant control for the six-phase PMSM drive system.
Loss of β‐cell number and function is a hallmark of diabetes. β‐cell preservation is emerging as a promising strategy to treat and reverse diabetes. Here, we first found that Pdia4 was primarily ...expressed in β‐cells. This expression was up‐regulated in β‐cells and blood of mice in response to excess nutrients. Ablation of Pdia4 alleviated diabetes as shown by reduced islet destruction, blood glucose and HbA1c, reactive oxygen species (ROS), and increased insulin secretion in diabetic mice. Strikingly, this ablation alone or in combination with food reduction could fully reverse diabetes. Conversely, overexpression of Pdia4 had the opposite pathophysiological outcomes in the mice. In addition, Pdia4 positively regulated β‐cell death, dysfunction, and ROS production. Mechanistic studies demonstrated that Pdia4 increased ROS content in β‐cells via its action on the pathway of Ndufs3 and p22phox. Finally, we found that 2‐β‐D‐glucopyranosyloxy1‐hydroxytrideca 5,7,9,11‐tetrayne (GHTT), a Pdia4 inhibitor, suppressed diabetic development in diabetic mice. These findings characterize Pdia4 as a crucial regulator of β‐cell pathogenesis and diabetes, suggesting Pdia4 is a novel therapeutic and diagnostic target of diabetes.
SYNOPSIS
Pancreatic β‐cell failure is associated with diabetes. Pdia4, a protein disulfide isomerase, is identified as a crucial regulator of β‐cell pathogenesis and diabetes.
Pdia4 interacts with Ndufs3 and p22phox and engages them in mitochondrial and cytosolic ROS production in β‐cells.
Pharmacological inhibition of Pdia4 disrupts the interaction of Pdia4 and its downstream partners, decreases ROS production, and ameliorates β‐cell failure and diabetes.
Pancreatic β‐cell failure is associated with diabetes. Pdia4, a protein disulfide isomerase, is identified as a crucial regulator of β‐cell pathogenesis and diabetes.
Concerns were raised about pneumonia development from benzodiazepines (BZDs) and Z-drugs, but direct evidence is limited, conflicting and without examining the highly susceptible patients with ...chronic kidney disease (CKD) nor specifying the risk for different drug utilizations. This study aimed to investigate whether use of BZDs and Z-drugs was each associated with an increased risk of pneumonia in a CKD population.
We performed a nested case-control study of 36,880 CKD patients analyzing the Taiwan National Health Insurance Database between 01/1/2000 and 12/31/2011. Among the study cohort, we identified 4,533 cases of pneumonia based on validated disease codes, chest x-ray examination, and prescriptions of respiratory antibiotics, and randomly selected 16,388 controls from risk sets, matched by sex, age, and number of CKD-related hospitalizations. All prescription filling records of BZDs and Z-drugs in the year before the event/index date were analyzed for cases and controls. Conditional logistic regressions were performed to estimate the odds ratios (ORs).
Current use of BZDs was associated with a 1.31-fold (95% CI, 1.18-1.26) increased risk of pneumonia compared to nonuse, but not for recent and past use. The risk from current BZD use was confined to new initiation (adjusted OR, 2.47; 95% CI, 2.02-3.03) or use for ≤ 30 days, and elevated to 2.88-fold (95% CI, 1.87-4.42) with parenteral administration. New initiation and current short-term use of Z-drugs was associated with a 2.94-fold (95% CI, 1.65-5.26) and 1.75-fold (95% CI, 1.13-2.72) increased risk of pneumonia, respectively. The findings were robust to adoption of a case-crossover study that analyzed cases only.
Use of BZRAs is associated with an increased risk of pneumonia in CKD patients, especially for patients newly initiating BZDs or Z-drugs or those injected with BZDs. Physicians should exercise cautions for signs of pneumonia when prescribing BZDs or Z-drugs to CKD patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aims
Evidence on acute respiratory failure (ARF) from antipsychotics is scant, and only 1 population‐based study examined this drug safety issue in chronic obstructive pulmonary disease patients. ...Antipsychotics have been frequently prescribed off‐label in adults, but whether antipsychotic use carries an increased ARF risk among adult patients is uncertain.
Methods
We adopted a nested case–control study analysing 716 493 adults aged ≥20 years, identified from the Taiwan nationwide healthcare claims records between January 2000 and December 2013. Among the study cohort, 7084 adults with ARF and 12,785 disease risk scored‐matched randomly selected controls were analysed. Multivariable logistic regression models were employed to estimate odds ratios of ARF with antipsychotic usages.
Results
Current, recent, and recent past use of antipsychotics was associated with a 2.33‐fold (95% confidence interval CI = 2.06–2.64), 1.79‐fold (95% CI = 1.43–2.25) and 1.41‐fold (95% CI = 1.20–1.66) increased risk of ARF, respectively, compared with nonuse, while antipsychotics discontinued >90 days carried no risk. A dose‐dependent association was observed with current therapy of antipsychotics (test for trend, P < .001), in which antipsychotic use at >1 defined daily dose yielded the highest risk of 6.53‐fold (95% CI = 3.33–12.79). The findings were robust to using carbamazepine as an active comparator.
Conclusion
Antipsychotic use was associated with an increased risk of ARF in adult patients. The risk was dose‐dependent and markedly higher with current use of antipsychotic agents at doses of 1 defined daily dose and above, <10% of this cohort. Physicians should be vigilant about any respiratory symptoms in patients currently receiving antipsychotics at such dose.
Background. In 1990s, complementary and alternative medicine (CAM), including use of herbs and supplements, gained popularity in the United States. However, more recent surveys suggest that demand ...for herbs and supplements has stabilized. Objective. This study examined the prevalence, patterns, and changes in herb and supplement use among the US adults, using the 2002, 2007, and 2012 National Health Interview Surveys (NHIS). Methods. Weighted population estimates were derived from three complementary and alternative medicine supplements to the NHIS. Prevalence rates for herb and supplement use were compared, using Wald chi-square tests to measure changes between years. Results. An estimated 40.6 million US adults reported herb and supplement use in 2012. However, the rate of herb and supplement use dropped from 18.9% in 2002 to 17.9% in 2007 and 2012 (P<0.05). This decline in use was more pronounced among women, racial or ethnic minorities, and adults with low incomes. Conclusion. Herb and supplements use remains common in the USA, but adult use rates are on the decline. It is still important for health care providers to ask patients about herb and supplement use.
The bolted joints make timber-steel composites (TSCs) easily to be assembled; however, seams exist between the timber components for bolted TSC components resulting in the risk of fire spreading into ...the joint seam when the component is under fire. The efficient charring depth provided by timber needs to be clarified; furthermore, the raising temperature potentially affects the strength of steel component. In this study, TSCs were tested in fire for 1 hour, and the following issues were examined, including the experimental charring depth of timber components, the influence of fire-retardant finish in order to provide the efficient charring depth, and additionally the suggested charring depth are proposed for the design of TSCs. In conclusion, the charring depth in the seams was greater than the regulation values, and evaluation methods for the charring depth at seams should be reconsidered. Although the fire-retardant finish reduced the formation rate of the char layer, the flames still breached the seams. The results reveal that Douglas fir TSCs with fire retardant are the most efficient specimen, with effective charring depth 52 mm. While the effective charring depth of Douglas fir TSCs without fire retardant and Japanese Cedar TSCs with fire retardant are increased, at least 64 mm and 65 mm needed, respectively.
IMPORTANCE: Acute respiratory failure (ARF) is a life-threatening event that has been linked in case reports to antipsychotic use, but this association lacks population-based evidence. Particular ...attention should be focused on patients with chronic obstructive pulmonary disease (COPD) regarding this drug safety concern because these patients are prone to ARF and are commonly treated with antipsychotics. OBJECTIVE: To determine whether the use of antipsychotics is associated with an increased risk of ARF in patients with COPD. DESIGN, SETTING, AND PARTICIPANTS: A population-based case-crossover study analyzing the Taiwan National Health Insurance Research Database was conducted of all patients with COPD, who were newly diagnosed with ARF in hospital or emergency care settings necessitating intubation or mechanical ventilation from January 1, 2000, to December 31, 2011. Patients with prior ARF, lung cancer, and cardiogenic, traumatic, or septic ARF were excluded to analyze idiopathic ARF. The pilot study was conducted from November 1 to December 31, 2013, and full data analysis was performed from October 15, 2015, to November 8, 2016. EXPOSURES: The use of antipsychotics was self-compared during days 1 to 14 (the risk period according to previous case reports) and days 75 to 88 (control period) preceding the ARF event or index date. The antipsychotic class, route of administration, and dose were also examined. MAIN OUTCOMES AND MEASURES: Risk of ARF. RESULTS: There were 5032 patients with ARF (mean SD age, 74.4 9.9 years; 3533 males 70.2%) among the 61 620 patients with COPD. Five hundred ninety patients with ARF (11.7%) filled at least 1 antipsychotic prescription during the case period compared with 443 (8.8%) during the control period, corresponding to a 1.66-fold (95% CI, 1.34-2.05; P < .001) adjusted increased risk of ARF regardless of antipsychotic class and administration route. A dose-dependent risk of ARF associated with antipsychotics was identified (test for trend, adjusted odds ratio, 1.35; 95% CI, 1.19-1.52; P < .001), which increased from a 1.52-fold risk for a low daily dose (95% CI, 1.20-1.92; P < .001) to a 3.74-fold risk for a high dose (95% CI, 1.68-8.36; P = .001). The increased risk persisted under a case-time-control analysis (adjusted odds ratio, 1.62; 95% CI, 1.16-2.27; P = .005) and nested case-control study (adjusted odds ratio, 2.16; 95% CI, 1.91-2.15; P < .001). CONCLUSIONS AND RELEVANCE: Antipsychotic use is associated with an acute and dose-dependent increased risk of ARF in patients with COPD. Clinicians should exercise caution when prescribing antipsychotics to patients with COPD and avoid high doses if possible.
Four types of commercial E-One Moli 18650 lithium-ion batteries at full-charged state were subjected to confinement tests. The average exothermic onset temperature was measured to be ...(159.1 ± 8.3) °C. Adiabatic temperature rise was measured to be (498.4 ± 25.6) °C which corresponded to the enthalpy changes of (19.7 ± 1.5) kJ. Maximum self-heat rate were determined to have an average value of 11,412.8 °C min
−1
with the range from 6354.0 to 15,192.0 °C min
−1
. Lithium-ion batteries composed of cathode materials made of LiNi
x
Mn
y
Co
z
O
2
have been demonstrated to exhibit the calamitous characteristics of thermal runaway if they rise above the crucial temperature of (204.8 ± 16.5) °C. Surface coating of self-terminated oligomers with hyper-branched architecture (STOBA) upon cathode materials was unable to prevent the uncontrollable thermal runaway under external heating in these lithium-ion batteries.
Inhaled long-acting bronchodilators, including long-acting β2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are the mainstay therapy in the treatment of chronic obstructive ...pulmonary disease (COPD), a disease that poses a heavy burden on morbidity and mortality worldwide. Use of LABAs and LAMAs in patients with COPD, however, has been concerned about an increased risk of adverse cardiovascular events, despite inconsistent findings reported from randomized controlled trials (RCTs) and observational studies. In this review, we detailed the relevant evidence generated from RCTs and observational studies with respect to the risk of cardiovascular disease with use of LABAs and LAMAs in management of COPD, and analyzed the contradictory findings in the literature, as well as recommended future research directions to clear the air regarding the cardiovascular safety of inhaled long-acting bronchodilators.
Display omitted
•Inhaled long-acting β2 agonists (LABA) and muscarinic antagonists (LAMA) are concerned about the cardiovascular (CV) risk.•Randomized trials did not find CV risk with LABAs and LAMAs despite insufficient power and exclusion of high-risk patients.•Most observational studies, however, tied CV risk with LABAs and LAMAs, though they may be subject to confounding and bias.
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