This study assessed risk adjustment performance of six comorbidity indices in two categories of comorbidity measures: diagnosis-based comorbidity indices and medication-based ones in patients with ...chronic obstructive pulmonary disease (COPD). This was a population-based retrospective cohort study. Data used in this study were sourced from the Taiwan National Health Insurance Research Database. The study population comprised all patients who were hospitalized due to COPD for the first time in the target year of 2012. Each qualified patient was individually followed for one year starting from the index date to assess two outcomes of interest, medical expenditures within one year after discharge and in-hospital mortality of patients. To assess how well the added comorbidity measures would improve the fitted model, we calculated the log-likelihood ratio statistic G.sup.2 . Subsequently, we compared risk adjustment performance of the comorbidity indices by using the Harrell c-statistic measure derived from multiple logistic regression models. Analytical results demonstrated that that comorbidity measures were significant predictors of medical expenditures and mortality of COPD patients. Specifically, in the category of diagnosis-based comorbidity indices the Elixhauser index was superior to other indices, while the RxRisk-V index was a stronger predictor in the framework of medication-based codes, for gauging both medical expenditures and in-hospital mortality by utilizing information from the index hospitalization only as well as the index and prior hospitalizations. In conclusion, this work has ascertained that comorbidity indices are significant predictors of medical expenditures and mortality of COPD patients. Based on the study findings, we propose that when designing the payment schemes for patients with chronic diseases, the health authority should make adjustments in accordance with the burden of health care caused by comorbid conditions.
Radiocesium remediation is desirable for ecological protection, human health and sustainable development of nuclear energy. Effective capture of Cs
from acidic solutions is still challenging, mainly ...due to the low stability of the adsorbing materials and the competitive adsorption of protons. Herein, the rapid and highly selective capture of Cs
from strongly acidic solutions is achieved by a robust K
-directed layered metal sulfide KInSnS
(InSnS-1) that exhibits excellent acid and radiation resistance. InSnS-1 possesses high adsorption capacity for Cs
and can serve as the stationary phase in ion exchange columns to effectively remove Cs
from neutral and acidic solutions. The adsorption of Cs
and H
O
is monitored by single-crystal structure analysis, and thus the underlying mechanism of selective Cs
capture from acidic solutions is elucidated at the molecular level.
Molecular desalination is broadly used in chemical, food, and textile industries, which needs efficient and anti‐fouling separation technologies to reach this goal. Interfacial polymerization is one ...of the most promising routes to construct ultrahigh selective nanofiltration membranes. However, the irreversible hydrolysis of residual acyl chlorides makes Donnan charges of nascent films distribute unevenly which hinders fine molecular desalination and anti‐fouling. Here, we propose a pioneering solvation‐amination‐synergy strategy to synchronously inhibit the hydrolysis of residual acyl chlorides and promote their amination. The electroneutral nanofiltration membrane with high water permeance (13.2 L m−2 h−1 bar−1) is quantitatively fabricated that has superb anti‐fouling abilities and minimizes Donnan impacts on competitive ion penetrations, so it transmits Na2SO4 and NaCl while fully obstructs cationic or anionic dyes (< 500 Da). The ultrahigh molecule to ion selectivities outperform state‐of‐art nanofiltration membranes, which may provide a paradigm shift for scalable membrane fabrication for various industrial product desalination.
The pathogenesis of Parkinson’s disease (PD) remains to be elucidated. Metabolomic analysis has the potential to identify biochemical pathways and metabolic profiles that are involved in PD ...pathogenesis. Here, we performed a targeted metabolomics to quantify the plasma levels of 184 metabolites in a discovery cohort including 82 PD patients and 82 normal controls (NCs) and found two up-regulated (dopamine, putrescine/ornithine ratio) and four down-regulated (octadecadienylcarnitine C18:2, asymmetric dimethylarginine, tryptophan, and kynurenine (KYN)) metabolites in the plasma of PD patients. We then measured the plasma levels of a panel of metabolic products of KYN pathway in an independent validation cohort including 118 PD patients, 22 Huntington’s disease (HD) patients, and 37 NCs. Lower kynurenic acid (KA)/KYN ratio, higher quinolinic acid (QA) level, and QA/KA ratio were observed in PD patients compared to HD patients and NCs. PD patients at advanced stage (Hoehn-Yahr stage > 2) showed lower KA and KA/KYN ratio, as well as higher QA and QA/KA ratio compared to PD patients at early stage (Hoehn-Yahr stage ≤ 2) and NCs. Levels of KA and QA, as well as the ratios of KA/KYN and QA/KA between PD patients with and without psychiatric symptoms, dementia, or levodopa-induced dyskinesia in the advanced PD were similar. This metabolomic analyses demonstrate a number of plasma biomarker candidates for PD, suggesting a shift toward neurotoxic QA synthesis and away from neuroprotective KA production in KYN pathway.
Receiver operating characteristic (ROC) curve is commonly used to evaluate and compare the accuracy of classification methods or markers. Estimating ROC curves has been an important problem in ...various fields including biometric recognition and diagnostic medicine. In real applications, classification markers are often developed under two or more ordered conditions, such that a natural stochastic ordering exists among the observations. Incorporating such a stochastic ordering into estimation can improve statistical efficiency (Davidov and Herman, 2012). In addition, clustered and correlated data arise when multiple measurements are gleaned from the same subject, making estimation of ROC curves complicated due to within‐cluster correlations. In this article, we propose to model the ROC curve using a weighted empirical process to jointly account for the order constraint and within‐cluster correlation structure. The algebraic properties of resulting summary statistics of the ROC curve such as its area and partial area are also studied. The algebraic expressions reduce to the ones by Davidov and Herman (2012) for independent observations. We derive asymptotic properties of the proposed order‐restricted estimators and show that they have smaller mean‐squared errors than the existing estimators. Simulation studies also demonstrate better performance of the newly proposed estimators over existing methods for finite samples. The proposed method is further exemplified with the fingerprint matching data from the National Institute of Standards and Technology Special Database 4.
Background: Combined therapy with tyrosine kinase inhibitors (TKIs) and anti-PD-1 antibodies has shown high tumor response rates for patients with unresectable hepatocellular carcinoma (HCC). ...However, using this treatment strategy to convert initially unresectable HCC to resectable HCC was not reported. Methods: Consecutive patients with unresectable HCC who received first-line therapy with combined TKI/anti-PD-1 antibodies were analyzed. Tumor response and resectability were evaluated via imaging every 2 months (±2 weeks) using RECIST v1.1. Resectability criteria were (1) R0 resection could be achieved with sufficient remnant liver volume and function; (2) intrahepatic lesions were evaluated as partial responses or stable disease for at least 2 months; (3) no severe or persistent adverse effects occurred; and (4) hepatectomy was not contraindicated. Results: Sixty-three consecutive patients were enrolled. Of them, 10 (15.9%) underwent R0 resection in 3.2 months (range: 2.4–8.3 months) after the initiation of combination therapy. At baseline, these 10 patients had a median largest tumor diameter of 9.3 cm, 7 had Barcelona Clinic Liver Cancer stage C (vascular invasion) disease, 2 had stage B, and 1 had stage A. Before surgery, 6 patients were evaluated as a partial response, 3 stable disease, and 1 partial response in the intrahepatic lesion but a new metastatic lesion in the right adrenal gland. Six patients (60%) achieved a pathological complete response. One patient died from immune-related adverse effects 2.4 months after hepatectomy. After a median follow-up of 11.2 months (range: 7.8–15.9 months) for other 9 patients, 8 survived without disease recurrence, and 1 experienced tumor recurrence. Conclusions: Combination of TKI/anti-PD-1 antibodies is a feasible conversion therapy for patients with unresectable HCC to become resectable. This study represents the largest patient cohort on downstaging role of combinational systemic therapy on TKI and PD-1 antibody for HCC.
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease that is not from excess alcohol consumption, but is often associated with obesity, type 2 diabetes, and metabolic ...syndrome. NAFLD pathogenesis is complicated and involves oxidative stress, lipotoxicity, mitochondrial damage, insulin resistance, inflammation, and excessive dietary fat intake, which increase hepatic lipid influx and de novo lipogenesis and impair insulin signaling, thus promoting hepatic triglyceride accumulation and ultimately NAFLD. Overproduction of proinflammatory adipokines from adipose tissue also affects hepatic metabolic function. Current NAFLD therapies are limited; thus, much attention has been focused on identification of potential dietary substances from fruits, vegetables, and edible plants to provide a new strategy for NAFLD treatment. Dietary natural compounds, such as carotenoids, omega‐3‐PUFAs, flavonoids, isothiocyanates, terpenoids, curcumin, and resveratrol, act through a variety of mechanisms to prevent and improve NAFLD. Here, we summarize and briefly discuss the currently known targets and signaling pathways as well as the role of dietary natural compounds that interfere with NAFLD pathogenesis.
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•The membrane has reversible molecular sieving architectures under pH stimulation.•The membrane could precisely separate three components by simple pH variation.•The dye molecule to ...NaCl selectivity of this smart gating membrane reached 942.1.•It is promising to design membranes for pollution control and resource recovery.
Precise molecular separation through a membrane is critical in sustainable water purification applications. Routine separation membranes with inflexible molecular transmission channels are effective for the separation of two substances, which cannot meet the practical treatment requirements of multicomponent complex wastewater. We report a pH-gating membrane (PGM) formed by cross-linking a polyaniline/polyimide substrate with polyethyleneimine. PGMs exhibit tunable and reversible molecular sieving architectures under pH stimuli, which are attributed to the contraction and extension of polyaniline (PANI) chains during the transition between protonation and deprotonation. Based on this smart pH gating property, precise separation of the three-component mixture of Alcian Blue 8 GX, Orange II, and NaCl can be achieved with a single membrane at pH 8 and 2. The dye molecule-to-NaCl selectivity of this membrane reaches 942.1. It outperforms most state-of-art membranes, demonstrating promising applications for the selective separation and recovery of valuable products instead of harmful discharge.
Scope
SlimTrym® is a formulated product composed of citrus polymethoxyflavones (PMFs), green tea extract, and lychee extract. We investigated the effect of dietary SlimTrym® on diet‐induced obesity ...and associated non‐alcoholic fatty liver disease (NAFLD) in mice.
Methods and results
Male C57BL/6 mice were fed a normal diet (ND), high fat diet (HFD) or HFD containing 0.1% or 0.5% SlimTrym® for 16 weeks. Dietary SlimTrym® significantly reduced weight gain and relative perigonadal, retroperitoneal, mesenteric fat weight as well as the size of adipocyte in HFD‐fed mice. SlimTrym® supplementation also effectively diminished hepatic steatosis and the serum levels of glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), triacylglycerol (TG), and total cholesterol (TCHO). Down‐regulation of peroxisome proliferator‐activated receptor (PPAR)γ, sterol regulatory element‐binding protein (SREBP)‐1, and the activation of AMP‐activated protein kinase (AMPK) signaling by SlimTrym® in both adipose tissue and liver may be responsible for the observed anti‐obesity effects.
Conclusion
SlimTrym® supplementation potentially diminished diet‐induced obesity and hepatic steatosis via regulating AMPK signaling and molecules involved in lipid metabolism.
Dietary SlimTrym reduces hepatic lipogenic protein levels of C/EBP‐β, PPAR‐γ, SREBP‐1c, and FAS via increasing the activation of AMPK and down‐regulated ACC, resulting in reduce TG accumulation in adipocytes.
Background
Fatigue is a common symptom in cancer patients receiving radiotherapy. However, previous studies report inconsistent patterns of fatigue change.
Aim
The aim of this study was to estimate ...changes in fatigue among patients with cancer before, during, and after radiotherapy.
Methods
Five databases (PubMed, SDOL, CINAHL Plus with Full Text, Medline ProQuest, and ProQuest Dissertations) were searched for studies published from January 2006 to May 2021. Three effect sizes of fatigue change (immediate, short‐term, and long‐term) were calculated for each primary study using standardized mean difference. A random‐effect model was used to combine effect sizes across studies. Subgroup analyses and meta‐regression were performed to identify potential categorical and continuous moderators, respectively.
Results
Sixty‐five studies were included in this meta‐analysis. The weighted mean effect size for immediate, short‐term, and long‐term effects was 0.409 (p < .001; 95% CI 0.280, 0.537), 0.303 (p < .001; 95% CI 0.189, 0.417), and 0.201 (p = .05; 95% CI −0.001, 0.404), respectively. Studies with prostate cancer patients had a significantly higher short‐term (0.588) and long‐term weight mean effect size (0.531) than studies with breast (0.128, −0.072) or other cancers (0.287, 0.215). Higher radiotherapy dosage was significantly associated with a higher effect size for both immediate (β = .0002, p < .05) and short‐term (β = .0002, p < .05) effect.
Linking Evidence to Action
Findings from this meta‐analysis indicated that radiotherapy‐induced fatigue (RIF) exist for more than 3 months after the completion of treatment. Assessment of radiation‐induced fatigue in cancer patients should extend long after treatment completion, especially for patients with prostate cancer and patients receiving a higher radiation dose. Interventions to reduce fatigue tailored for different treatment phases may be developed.
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