Abstract
To evaluate the accuracy of biomarkers for the early diagnosis of biliary atresia (BA) and prognostic stratification after Kasai portoenterostomy (KPE). We conducted a systematic review of ...PubMed, Web of Science, Embase, Scopus and OVID for English literature reporting BA biomarkers published before August 2020. Screening, data extraction, and quality assessment were performed in duplicate. A total of 51 eligible studies were included in the systematic review, and data from 12 (4182 subjects) were extracted for meta-analysis regarding the following 2 domains: (1) serum matrix metallopeptidase-7 (MMP-7), interleukin33 (IL-33) and γ-glutamyl transferase (GGT) to differentiate BA from non-BA; (2) the aspartate aminotransferase to platelet ratio index (APRi) to predict post-KPE liver fibrosis/cirrhosis. The summary sensitivity, specificity and area under the curve (AUC) of MMP-7 for diagnosing BA were 96%, 91% and 0.9847, respectively, and those of GGT were 80%, 79% and 0.9645, respectively. The summary sensitivity and specificity of IL-33 for diagnosing BA were 77% and 85%, respectively. The summary sensitivity and specificity of APRi for predicting post-KPE liver fibrosis were 61% and 80%, respectively, and the summary sensitivity, specificity and AUC of APRi for predicting post-KPE cirrhosis were 78%, 83% and 0.8729, respectively. Moreover, good evidence was shown in investigations of serum IL-18 and IL-33 in distinguishing BA from healthy controls, serum IL-18 for prognosis of post-KPE persistent jaundice, and serum hyaluronic acid and MMP-7 for prognosis of post-KPE significant liver fibrosis. MMP-7, IL-33 and GGT are useful biomarkers to assist in the diagnosis of BA. APRi might be used to predict post-KPE significant liver fibrosis and cirrhosis. These noninvasive biomarkers can be integrated into the management protocol of BA.
Background:Little is known about the effect of the coronavirus disease 2019 (COVID-19) pandemic and the outbreak response measures on door-to-balloon time (D2B). This study examined both D2B and ...clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).Methods and Results:This was a retrospective study of 303 STEMI patients who presented directly or were transferred to a tertiary hospital in Singapore for PPCI from October 2019 to March 2020. We compared the clinical outcomes of patients admitted before (BOR) and during (DOR) the COVID-19 outbreak response. The study outcomes were in-hospital death, D2B, cardiogenic shock and 30-day readmission. For direct presentations, fewer patients in the DOR group achieved D2B time <90 min compared with the BOR group (71.4% vs. 80.9%, P=0.042). This was more apparent after exclusion of non-system delay cases (DOR 81.6% vs. BOR 95.9%, P=0.006). Prevalence of both out-of-hospital cardiac arrest (9.5% vs. 1.9%, P=0.003) and acute mitral regurgitation (31.6% vs. 17.5%, P=0.006) was higher in the DOR group. Mortality was similar between groups. Multivariable regression showed that longer D2B time was an independent predictor of death (odds ratio 1.005, 95% confidence interval 1.000–1.011, P=0.029).Conclusions:The COVID-19 pandemic and the outbreak response have had an adverse effect on PPCI service efficiency. The study reinforces the need to focus efforts on shortening D2B time, while maintaining infection control measures.
Abstract
Outer tropical cyclone rainbands (TCRs) are a concentrated region of heavy precipitation and hazardous weather within tropical cyclones (TCs). Outer TCRs pose considerable risk to human ...societies, but their origin remains unresolved. Here, we identify a total of 1029 outer TCRs at their formative stage from 95 TCs and present a large collection of radar observations in order to establish a robust foundation of the natural diversity of rainband origin. The results show the dominance of outer origin for the observed outer TCRs, in distinct contrast to theoretical modeling works of outer TCRs, which propose inner-origin scenarios. Our analysis also suggests that squall-line dynamics are a common, but not the sole, mechanism responsible for outer TCR formation. The nature of preexisting outer precipitation is found to be an important factor to influence the squall-line and non-squall-line outer TCR initiation.
This article presents a high-speed 5-bit/cycle successive-approximation register (SAR) analog-to-digital converter (ADC) facilitated by a linearized configurable voltage-to-time (V2T) buffer with ...time-domain (TD) quantization. Configuring the TD full-scale (TD-FS) input of the TD quantizer among cycles allows a single capacitive digital-to-analog converter (CDAC). The configuration is accomplished by the V2T buffer, which also provides isolation between the backend TD quantizer and CDAC, thus enabling over 3-GHz effective resolution bandwidth. The configurated FS also relieves the critical accuracy requirement in the TD quantizer due to the small residue voltage in the backend cycles, while the two-stage compensation scheme suppresses the nonlinearity from the V2T buffer. By incorporating 2<inline-formula> <tex-math notation="LaTeX">\times </tex-math></inline-formula> time interleaving, the 28-nm prototype achieves a 2.8-GS/s sampling rate with a 51.79-dB signal-to-noise and distortion ratio (SNDR) and 72.36-dB spurious-free dynamic range (SFDR) at a Nyquist input while consuming only 18 mW under a 0.9-V supply, resulting in a Walden figure of merit (FoM) of 20.3 fJ/conversion-step.
Background Recent studies have increasingly shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors may have beneficial cardiovascular and metabolic effects in patients without diabetes ...mellitus. Hence, we conducted a systematic review and meta-analysis to determine the effect of SGLT2 inhibitors on cardiovascular and metabolic outcomes in patients without diabetes mellitus. Methods and Results Four electronic databases (PubMed, Embase, Cochrane, and SCOPUS) were searched on August 30, 2020 for articles published from January 1, 2000 to August 30, 2020, for studies that examined the effect of SGLT2 inhibitors on cardiovascular and metabolic outcomes in patients without diabetes mellitus. A random-effects pairwise meta-analysis model was used to summarize the studies. A total of 8 randomized-controlled trials were included with a combined cohort of 5233 patients. In patients without diabetes mellitus, those with heart failure treated with SGLT2 inhibitors had a 20% relative risk reduction in cardiovascular deaths and heart failure hospitalizations, compared with those who were not treated (risk ratio, 0.78;
<0.001). We additionally found that treatment with SGLT2 inhibitors improved multiple metabolic indices. Patients on SGLT2 inhibitors had a reduction in body weight of -1.21 kg (
<0.001), body mass index of -0.47 kg/m
(
<0.001), systolic blood pressure of -1.90 mm Hg (
=0.04), and fasting plasma glucose of -0.38 mmol/L (
=0.05), compared with those without. There were no between-group differences in NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, waist circumference, diastolic blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol levels, and estimated glomerular filtration rates. Across our combined cohort of 5233 patients, hypoglycemia was reported in 22 patients. Conclusions SGLT2 inhibitors improve cardiovascular outcomes in patients without diabetes mellitus with heart failure. In patients without diabetes mellitus, SGLT2 inhibitors showed positive metabolic outcomes in weight and blood pressure control.
Background & Aims
How adiposity influences the effect of genetic variants on non‐alcoholic fatty liver disease (NAFLD) in the Asian population remains unclear. We aimed to study the association ...between genetic risk variants and susceptibility/severity of NAFLD in the lean, overweight and obese individuals.
Methods
Nine hundred and four community subjects underwent proton‐magnetic resonance spectroscopy and transient elastography examination. Lean (<23 kg/m2), overweight (23‐24.9 kg/m2) and obesity (≥25 kg/m2) were defined according to the body mass index cut‐offs for Asians. NAFLD was defined as intrahepatic triglycerides ≥5%. PNPLA3, TM6SF2, MBOAT7 and 9 other gene polymorphisms were analysed by rhAMPTM SNP assays.
Results
Five hundred and twenty‐nine (58.5%), 162 (17.9%) and 213 (23.6%) subjects were lean, overweight and obese, respectively. The prevalence of NAFLD was 12.4%, 41.4% and 59.1% in the three groups (P < .001). Amongst those with NAFLD, lean subjects (30.3%) were more likely to carry the PNPLA3 rs738409 GG genotype than overweight (17.9%) and obese subjects (17.4%) (P = .003). Compared with the CC genotype, the GG genotype was associated with the greatest increase in the risk of NAFLD in lean subjects (odds ratio OR 6.04), compared with overweight (OR 3.43, 95% CI 1.06, 11.14) and obese subjects (OR 2.51, 95% CI 0.93, 6.78). Additionally, the TM6SF2 rs58542926 TT genotype was associated with reduced serum triglycerides only in lean subjects. A gene‐BMI effect was not observed for the other gene polymorphisms.
Conclusions
The PNPLA3 rs738409 gene polymorphism has a greater effect on liver fat in Asian lean individuals than in overweight or obese ones.
A 1.2 V 10-bit 100 MS/s Successive Approximation (SA) ADC is presented. The scheme achieves high-speed and low-power operation thanks to the reference-free technique that avoids the static power ...dissipation of an on-chip reference generator. Moreover, the use of a common-mode based charge recovery switching method reduces the switching energy and improves the conversion linearity. A variable self-timed loop optimizes the reset time of the preamplifier to improve the conversion speed. Measurement results on a 90 nm CMOS prototype operated at 1.2 V supply show 3 mW total power consumption with a peak SNDR of 56.6 dB and a FOM of 77 fJ/conv-step.
Most polymers solidify into a glassy amorphous state, accompanied by a rapid increase in the viscosity when cooled below the glass transition temperature (Tg). There is an ongoing debate on whether ...the Tg changes with decreasing polymer film thickness and on the origin of the changes. We measured the viscosity of unentangled, short-chain polystyrene films on silicon at different temperatures and found that the transition temperature for the viscosity decreases with decreasing film thickness, consistent with the changes in the Tg of the films observed before. By applying the hydrodynamic equations to the films, the data can be explained by the presence of a highly mobile surface liquid layer, which follows an Arrhenius dynamic and is able to dominate the flow in the thinnest films studied.
Environmental change poses challenges to many organisms. The resilience of a species to such change depends on its ability to respond adaptively. Social flexibility is such an adaptive response, ...whereby individuals of both sexes change their reproductive tactics facultatively in response to fluctuating environmental conditions, leading to changes in the social system. Social flexibility focuses on individual flexibility, and provides a unique opportunity to study both the ultimate and proximate causes of sociality by comparing between solitary and group‐living individuals of the same population: why do animals form groups and how is group‐living regulated by the environment and the neuro‐endocrine system? These key questions have been studied for the past ten years in the striped mouse Rhabdomys pumilio. High population density favours philopatry and group‐living, while reproductive competition favours dispersal and solitary‐living. Studies of genetic parentage reveal that relative fitness of alternative reproductive tactics depends on the prevailing environment. Tactics have different fitness under constrained ecological conditions, when competitive ability is important. Under conditions with relaxed ecological constraints, alternative tactics can yield equal fitness. Both male and female striped mice display alternative reproductive tactics based on a single strategy, i.e. all individuals follow the same decision rules. These changes are regulated by endocrine mechanisms. Social flexibility is regarded as an adaptation to unpredictably changing environments, selecting for high phenotypic flexibility based on a broad reaction norm, not on genetic polymorphism for specific tactics.
Thermoelectric technology, harvesting electric power directly from heat, is a promising environmentally friendly means of energy savings and power generation. The thermoelectric efficiency is ...determined by the device dimensionless figure of merit ZTdev, and optimizing this efficiency requires maximizing ZT values over a broad temperature range. Here, we report a record high ZTdev ~1.34, with ZT ranging from 0.7 to 2.0 at 300 to 773 kelvin, realized in hole-doped tin selenide (SnSe) crystals. The exceptional performance arises from the ultrahigh power factor, which comes from a high electrical conductivity and a strongly enhanced Seebeck coefficient enabled by the contribution of multiple electronic valence bands present in SnSe. SnSe is a robust thermoelectric candidate for energy conversion applications in the low and moderate temperature range.
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