Individuals with diabetes mellitus (DM) have an increased risk of fracture. Glycemic control is crucial to the management of DM, but there are concerns pertaining to hypoglycemia development in the ...course of glycemic control target achievement. The extent to which glycemic control may affect the risk of fracture remains less defined. Hypoglycemia-induced falls have been suggested to contribute to an elevated risk of fracture in DM patients. In this meta-analysis of observational studies, we aimed to investigate the relative contribution of glycemic control, as measured by glycated hemoglobin (HbA1c), and hypoglycemia to the risk of fracture in DM. The PubMed and Web of Science databases were searched for relevant studies. A random-effects model was used to generate summary relative risks (RRs) and 95% confidence intervals (CIs). Both increased HbA1c levels (RR
per 1% increase
1.08, 95% CI 1.03, 1.14;
n
studies
= 10) and hypoglycemia (RR 1.52, 95% CI 1.23, 1.88;
n
studies
= 8) were associated with an increased risk of fracture. The association between HbA1c levels and the risk of fracture was somewhat nonlinear, with a noticeably increased risk observed at an HbA1c level ≥ 8%. The positive associations of HbA1c levels and hypoglycemia with the risk of fracture did not reach statistical significance in the studies that adjusted for insulin use, hypoglycemia, or falls for the former and in those that adjusted for falls for the latter. In summary, both increased HbA1c levels and hypoglycemia may increase the risk of fracture in patients with DM. The positive association between HbA1c levels and the risk of fracture appears to be, in part, explained by hypoglycemia-induced falls, possibly due to insulin use. The avoidance of hypoglycemia in the course of achieving good glycemic control through the careful selection of glucose-lowering medications may contribute to fracture prevention by reducing the risk of falls related to treatment-induced hypoglycemia.
Background
Mild cognitive impairment (MCI) is a transitional stage of cognitive function between normal aging and dementia. Substantial variations in the prevalence of MCI in different countries have ...been studied including China. In this study, we established a prediction system to assess the risk of MCI among the elderly in China.
Methods
The Rothman-Keller model was conducted on the basis of the risk factors of MCI obtained by the combined results of a meta-analysis. The accuracy of the model was verified using actual population data.
Results
A total of 1826 subjects as a verification set were enrolled in this study in February 2019. There were statistically significant differences in the combined results of 10 risk factors including hypertension, diabetes, educational level, hyperlipidemia, smoking, physical exercise, living alone, stroke, drinking and heart disease (
P
<0.05). The area under the curve (AUC) of the actual data and the predictive results of this model was 0.859 (95%CI: 0.812–0.906,
P
<0.05), the sensitivity was 86.6% and the specificity was 76.5%.
Conclusions
This model performs an effective prediction that may be applied to the primary prevention for patients with MCI, helping to reduce the risk of MCI.
SnO2 attracts considerable interest as a promising high-capacity anode material for lithium ion batteries. It is believed that SnO2 stores lithium by the alloying and de-alloying reactions after the ...initial irreversible reduction from SnO2 to Li2O and metallic Sn. Here we report that a reversible conversion reaction, similar to that often observed in transition metal oxides, can occur in the cycling of the carbon-coated SnO2 hollow microspheres (SnO2/C), as is evidenced by Raman spectroscopy, high-resolution transmission electron microscopy (HRTEM) and theoretical calculations. However, only alloying and de-alloying reactions can reversibly take place in carbon-free SnO2 hollow microspheres. The reversible capacity of the SnO2/C is even higher than the theoretical capacity of the free SnO2. These findings provide guidance to designing anode materials with higher reversible capacities.
Display omitted
► The SnO2 and carbon-coated SnO2 (SnO2/C) hollow microspheres are fabricated by hydrothermal reactions respectively. ► The SnO2/C shows higher reversible capacity and good cycling performance than that of pure SnO2. ► A further electrochemical conversion reaction of SnO2/C is proposed according to the experimental and theoretical evidences.
Scaling and root planing are widely considered as effective methods for treating chronic periodontitis. A meta‐analysis published in 2008 showed no statistically significant differences between ...full‐mouth disinfection (FMD) or full‐mouth scaling and root planing (FMS) and quadrant scaling and root planing (Q‐SRP). The FMD approach only resulted in modest additional improvements in several indices. Whether differences exist between these two approaches requires further validation. Accordingly, a study was conducted to further validate whether FMD with antiseptics or FMS without the use of antiseptics within 24 h provides greater clinical improvement than Q‐SRP in patients with chronic periodontitis. Medline (via OVID), EMBASE (via OVID), PubMed and CENTRAL databases were searched up to 27 January 2015. Randomized controlled trials comparing FMD or FMS with Q‐SRP after at least 3 mo were included. Meta‐analysis was performed to obtain the weighted mean difference (WMD), together with the corresponding 95% confidence intervals. Thirteen articles were included in the meta‐analysis. The WMD of probing pocket depth reduction was 0.25 mm (p < 0.05) for FMD vs. Q‐SRP in single‐rooted teeth with moderate pockets, and clinical attachment level gain in single‐ and multirooted teeth with moderate pockets was 0.33 mm (p < 0.05) for FMD vs. Q‐SRP. Except for those, no statistically significant differences were found in the other subanalyses of FMD vs. Q‐SRP, FMS vs. Q‐SRP and FMD vs. FMS. Therefore, the meta‐analysis results showed that FMD was better than Q‐SRP for achieving probing pocket depth reduction and clinical attachment level gain in moderate pockets. Additionally, regardless of the treatment, no serious complications were observed. FMD, FMS and Q‐SRP are all effective for the treatment of adult chronic periodontitis, and they do not lead to any obvious discomfort among patients. Moreover, FMD had modest additional clinical benefits over Q‐SRP, so we prefer to recommend FMD as the first choice for the treatment of adult chronic periodontitis.
Background
Effects of low tidal volume (LTV) ventilation preconditioning in endotoxin‐induced acute lung injury (ALI) have not been studied. We investigated the effect of LTV ventilation ...pre‐treatment on ALI induced by lipopolysaccharide (LPS) in rats.
Methods
Male Sprague–Dawley rats were assigned to four groups (n = 8 each): (1) sham rats injected (i.p.) with 0.9% (physiologic) saline; sham rats pre‐treated with tidal volume 6 ml/kg ventilation for 1 h followed by injection (i.p.) of physiologic saline (mechanical ventilation; MV‐saline group); (2) LPS group (rats injected with LPS (i.p.); rats pre‐treated with tidal volume 6 ml/kg ventilation for 1 h before injection (i.p.) with LPS (MV‐LPS group). Animals were observed for 6 h. ALI extent was evaluated by lung wet‐to‐dry ratio, Evans Blue Dye extravasation, and histologic examination. We measured levels of tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, and IL‐6. Apoptotic index (AI) and the expression of pulmonary RhoA, ROCK2 mRNA, and ROCK1 protein in lung alveolar cells was determined.
Results
Lipopolysaccharide caused severe ALI, as evidenced by increases in ALI extent, impairment of pulmonary functions, and increases in pulmonary levels of TNF‐α, IL‐1β, IL‐6, and AI. LTV ventilation preconditioning mitigated LPS‐induced increases in release of pulmonary pro‐inflammatory cytokines and AI of alveolar cells. Expression of pulmonary RhoA, ROCK2 mRNA, and ROCK1 protein was upregulated by LPS and reduced by LTV ventilation pre‐treatment.
Conclusion
Low tidal volume ventilation preconditioning can attenuate release of pulmonary pro‐inflammatory cytokines and decrease the AI induced by severe sepsis. Early protection seems to be mediated partly through inhibition of activation of a Rho pathway.
Summary
To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report ...data—simple descriptions of patient characteristics, cancer categories, and non–risk‐adjusted survival—for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty‐three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all‐cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5–25 mg/kg2, 47%), little weight loss (2.4 ± 7.8 kg), 0‐1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2‐G3 (89%); most involved the distal esophagus (73%). Non–risk‐adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre‐treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection.
Despite the importance of immunological memory for protective immunity against viral infection, whether H7N9-specific antibodies and memory T-cell responses remain detectable years after the original ...infection is unknown.
A cross-sectional study was conducted to investigate the immune memory responses of H7N9 patients who contracted the disease and survived during the 2013–2016 epidemics in China. Sustainability of antibodies and T-cell memory to H7N9 virus were examined. Healthy individuals receiving routine medical examinations in a physical examination centre were recruited as control.
A total of 75 survivors were enrolled and classified into four groups based on the time elapsed from illness onset to specimen collection: 3 months (n = 14), 14 months (n = 14), 26 months (n = 28) and 36 months (n = 19). Approximately 36 months after infection, the geometric mean titres of virus-specific antibodies were significantly lower than titres in patients 3 months after infection, but 16 of 19 (84.2%) survivors in the 36-month interval had microneutralization (MN) titres ≥40. Despite the overall declining trend, the percentages of virus-specific cytokine-secreting memory CD4+ and CD8+ T cells remained higher in survivors at nearly all time-points in comparison with control individuals. Linear regression analysis showed that severe disease (mean titre ratio 2.77, 95% CI 1.17–6.49) was associated with higher haemagglutination inhibition (HI) titre and female sex for both HI (1.92, 1.02–3.57) and MN (3.33, 1.26–9.09) antibody, whereas female sex (mean percentage ratio 1.69, 95% CI 1.08–2.63), underlying medical conditions (1.94, 95% CI 1.09–3.46) and lack of antiviral therapy (2.08, 95% CI 1.04–4.17) were predictors for higher T-cell responses.
Survivors of H7N9 virus infection produced long-term antibodies and memory T-cell responses. Our findings warrant further serological investigation in general and high-risk populations and have important implications for vaccine design and development.
Several genome‐wide association studies (GWASs) in Caucasian populations have identified 12 loci that are significantly associated with migraine. More evidence suggests that serotonin receptors are ...also involved in migraine pathophysiology. In the present study, a case–control study was conducted in a cohort of 581 migraine cases and 533 ethnically matched controls among a Chinese population. Eighteen polymorphisms from serotonin receptors and GWASs were selected, and genotyping was performed using a Sequenom MALDI‐TOF mass spectrometry iPLEX platform. The genotypic and allelic distributions of MEF2D rs2274316 and ASTN2 rs6478241 were significantly different between migraine patients and controls. Univariate and multivariate analysis revealed significant associations of polymorphisms in the MEF2D and ASTN2 genes with migraine susceptibility. MEF2D, PRDM16 and ASTN2 were also found to be associated with migraine without aura (MO) and migraine with family history. And, MEF2D and ASTN2 also served as genetic risk factors for the migraine without family history. The generalized multifactor dimensionality reduction analysis identified that MEF2D and HTR2E constituted the two‐factor interaction model. Our study suggests that the MEF2D, PRDM16 and ASTN2 genes from GWAS are associated with migraine susceptibility, especially MO, among Chinese patients. It appears that there is no association with serotonin receptor related genes.
SUMMARY
We report data—simple descriptions of patient characteristics, cancer categories, and non–risk‐adjusted survival—for patients with pathologically staged cancer of the esophagus and ...esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty‐three institutions from six continents submitted de‐identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all‐cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0–2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2‐G3 (78%); most involved distal esophagus (71%). Non–risk‐adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis‐1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics, and should direct 9th edition data collection. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning.
Dye‐sensitized solar cells (DSSCs) are receiving considerable attention as low‐cost alternatives to conventional solar cells. In DSSCs based on liquid electrolytes, a photoelectric efficiency of 11 % ...has been achieved, but potential problems in sealing the cells and the low long‐term stability of these systems have impeded their practical use. Here, we present a thermoplastic gel electrolyte (TPGE) as an alternative to the liquid electrolytes used in DSSCs. The TPGE exhibits a thermoplastic character, high conductivity, long‐term stability, and can be prepared by a simple and convenient protocol. The viscosity, conductivity, and phase state of the TPGE can be controlled by tuning the composition. Using 40 wt % poly(ethylene glycol) (PEG) as the polymeric host, 60 wt % propylene carbonate (PC) as the solvent, and 0.65 M KI and 0.065 M I2 as the ionic conductors, a TPGE with a conductivity of 2.61 mS cm–2 is prepared. Based on this TPGE, a DSSC is fabricated with an overall light‐to‐electrical‐energy conversion efficiency of 7.22 % under 100 mW cm–2 irradiation. The present findings should accelerate the widespread use of DSSCs.
A thermoplastic gel electrolyte is developed for use in solar cells based on the incorporation of propylene carbonate in a poly(ethylene glycol) host, as illustrated in the figure. The electrolyte exhibits good thermoplastic behavior, high conductivity, and long‐term stability. Dye‐sensitized solar cells based on this electrolyte exhibit overall power efficiencies as high as 7.22 % under 100 mW cm–2 irradiation.
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