Background
Although diabetes is a poor prognostic factor for colorectal cancer (CRC), whether diabetes severity provides an additional predictive value for CRC prognosis remains unclear. The study ...aimed to investigate the prognostic differences after curative CRC resection among patients with different diabetic severities.
Methods
This population‐based retrospective cohort study analyzed data registered between 2007 and 2015 in the Cancer Registry Database, which is linked to the National Health Insurance Research Database and National Death Registry. Patients with CRC who underwent curative radical resection for stage I–III disease were evaluated, with their diabetic status subdivided into no diabetes, diabetes without complication, and diabetes with complications. Cox regressions were applied to determine the association between diabetes severity and CRC survival, including overall survival (OS), disease‐free survival (DFS), time to recurrence, and cancer‐specific survival (CSS).
Results
A total of 59,202 patients with CRC were included. Compared with the no diabetes group, the diabetes without complication group has insignificantly worse OS (hazard ratio HR, 1.05; 95% confidence interval CI, 1.01–1.09), DFS (HR, 1.08; 95% CI, 1.04–1.12), and CSS (HR, 0.98; 95% CI, 0.93–1.03), whereas those with complicated diabetes had a significantly higher risk of poor survival (OS: HR, 1.85; 95% CI, 1.78–1.92; DFS: HR, 1.75; 95% CI, 1.69–1.82; CSS: HR, 1.41; 95% CI, 1.33–1.49). Patients with CRC and diabetes also had a higher risk of recurrence than did those without diabetes. Sex and TNM staging were important effect modifiers.
Conclusions
Among patients with CRC who undergo curative resection, the severity of the diabetes is inversely correlated with long‐term outcomes, especially in women and patients in the earlier stages of CRC.
Plain Language Summary
The prognostic impact of diabetes severity in colorectal cancer (CRC) is yet to be clarified.
In this cohort study of 59,202 patients with CRC, compared with patients with CRC and without diabetes, those with uncomplicated diabetes had an insignificantly worse CRC survival, whereas those with complicated diabetes had a significantly higher risk of poor survival.
Multidisciplinary medical care to prevent progression into diabetes with complications is needed to improve survival among patients with CRC and diabetes.
Among patients with colorectal cancer (CRC) who undergo curative resection, the severity of diabetes is inversely correlated with long‐term outcomes, especially in women and those in earlier CRC stages. Multidisciplinary medical care to prevent progression into diabetes with complications is needed to improve survival among patients with CRC and diabetes.
Nanocasting was used to develop epoxy/graphene composites (EGCs) as corrosion inhibitors with hydrophobic surfaces (HEGC). The contact angle of water droplets on a sample surface can be increased ...from ∼82° (epoxy surface) to ∼127° (hydrophobic epoxy and EGC). It should be noted that EGC coating was found to provide an excellent corrosion protection effect on cold-rolled steel (CRS) electrode. Enhancement of corrosion protection using EGC coatings could be attributed to the following three reasons: (1) epoxy could act as a physical barrier coating, (2) the hydrophobicity repelled the moisture and further reduced the water/corrosive media adsorption on the epoxy surface, preventing the underlying metals from corrosion attack, and (3) the well-dispersed graphene nanosheets (GNSs) embedded in HEGC matrix could prevent corrosion owing to a relatively higher aspect ratio than clay platelets, which enhances the oxygen barrier property of HEGC.
Excess free fatty acid accumulation from abnormal lipid metabolism results in the insulin resistance in peripheral cells, subsequently causing hyperinsulinemia, hyperglycemia and/or hyperlipidemia in ...diabetes mellitus (DM) patients. Herein, we investigated the effect of phenolic acids on glucose uptake in an insulin-resistant cell-culture model and on hepatic insulin resistance and inflammation in rats fed a high-fat diet (HFD). The results show that vanillic acid (VA) demonstrated the highest glucose uptake ability among all tested phenolic acids in insulin-resistant FL83B mouse hepatocytes. Furthermore, rats fed HFD for 16 weeks were orally administered with VA daily (30 mg/kg body weight) at weeks 13-16. The results show that levels of serum insulin, glucose, triglyceride, and free fatty acid were significantly decreased in VA-treated HFD rats (p < 0.05), indicating the protective effects of VA against hyperinsulinemia, hyperglycemia and hyperlipidemia in HFD rats. Moreover, VA significantly reduced values of area under the curve for glucose (AUCglucose) in oral glucose tolerance test and homeostasis model assessment-insulin resistance (HOMA-IR) index, suggesting the improving effect on glucose tolerance and insulin resistance in HFD rats. The Western blot analysis revealed that VA significantly up-regulated expression of hepatic insulin-signaling and lipid metabolism-related protein, including insulin receptor, phosphatidylinositol-3 kinase, glucose transporter 2, and phosphorylated acetyl CoA carboxylase in HFD rats. VA also significantly down-regulated hepatic inflammation-related proteins, including cyclooxygenase-2 and monocyte chemoattractant protein-1 expressions in HFD rats. These results indicate that VA might ameliorate insulin resistance via improving hepatic insulin signaling and alleviating inflammation pathways in HFD rats. These findings also suggest the potential of VA in preventing the progression of DM.
This paper attempts to use a delta robot's structure and reliable coordinates to develop a self-learning Chinese calligraphy-writing system that requires precise control. Ideally, to achieve ...human-like behavior, a delta robot can learn stroke trajectories autonomously and present the stroke beauty of calligraphy characters. Unfortunately, state-of-the-art approaches have not yet considered the presentation of stroke beauty resulting from angles of rotation and tilt of the brush. This paper presents an integrated system consisting of a stroke processing module, a hypothesis generation net (HGN) learning model, a delta robot, and an image capture module. Our approach utilizes both the stroke trajectories from the stroke processing module and angles information from the HGN learning model to automatically produce five degrees of freedom action instructions. Based on the instructions, the delta robot completes calligraphy writing. Then, the image capture module provides feedback to the writing system for error calculation and coordinate correction. We utilize the mean absolute percentage error to verify the performance of the writing results. A correction algorithm and linear regression were used to improve the error correction results (less than 2% error). After several cycles, the written results approached the target sample finally. Consequently, the written results produced by the delta robot prove that our proposed system is capable of self-learning and correction.
The associations with cancer and cardiovascular diseases (CVD) had inconsistent results. The study aimed to investigate the risk of cardiovascular diseases (CVD) between populations with and without ...cancer.
Patients with common cancers in Taiwan were enrolled in the study between 2007 and 2018 using the Taiwan Cancer Registry. We focused on colorectal cancer, women's breast cancer, lung cancer, liver cancer, oral cancer, prostate cancer, and thyroid cancers. The study endpoint was fatal and non-fatal CVD, which was defined as ischemic heart disease and ischemic stroke according to the National Health Insurance Research Database. We compared the risk of CVD between patients with cancer and age- and sex-matched (1:1 ratio) participants who did not have cancer or CVD. Multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained from Cox regression analysis. To evaluate the chronological trend, we estimated the HRs and 95% CI yearly since the diagnosis.
Among the 552,485 cancer patients (mean age, 60.6 years; women, 47.7%) during the median follow-up period of 4.1 years, 32,634 cases of fatal and non-fatal CVD were identified. Compared with that noted in the non-cancer population, the overall fully adjusted HR with 95% CI was 1.28 (1.25, 1.30) in the cancer population. The CVD risk was the highest in the first year, the adjusted HR with 95% CI was 2.31 (2.23, 2.40), and this risk decreased yearly.
Patients with cancer had a significantly higher risk of fatal or non-fatal CVD. The risk was the highest in the first year since diagnosis and decreased yearly.
Over 90% of patients with pancreatic ductal adenocarcinoma (PDAC) have oncogenic KRAS mutations. Nevertheless, mutated KRAS alone is insufficient to initiate pancreatic intraepithelial neoplasia ...(PanIN), the precursor of PDAC. The identities of the other factors/events required to drive PanIN formation remain elusive. Here, optic‐clear 3D histology is used to analyze entire pancreases of 2‐week‐old Pdx1‐Cre; LSL‐KrasG12D/+ (KC) mice to detect the earliest emergence of PanIN and observed that the occurrence is independent of physical location. Instead, it is found that the earliest PanINs overexpress Muc4 and associate with αSMA+ fibroblasts in both transgenic mice and human specimens. Mechanistically, KrasG12D/+ pancreatic cells upregulate Muc4 through genetic alterations to increase proliferation and fibroblast recruitments via Activin A secretion and consequently enhance cell transformation for PanIN formation. Inhibition of Activin A signaling using Follistatin (FST) diminishes early PanIN‐associated fibroblast recruitment, effectively curtailing PanIN initiation and growth in KC mice. These findings emphasize the vital role of interactions between oncogenic KrasG12D/+‐driven genetic alterations and induced microenvironmental changes in PanIN initiation, suggesting potential avenues for early PDAC diagnostic and management approaches.
This study found that early PanIN cells express elevated levels of Muc4, specifically the oncogenic Muc4/X variant, and are closely associated with αSMA+ fibroblasts. This is observed in KrasG12D/+ transgenic mice and human pancreatic specimens with early PanINs. Importantly, upregulated Muc4 expression and Activin A secretion are identified as critical factors driving PanIN initiation in pancreatic cells with KrasG12D/+ mutation.
Gestational diabetes mellitus has been linked to inflammation, immune dysregulation in offspring, and changes in the microbiota. It may have long-term implications for the health of children. The aim ...of this study was to determine if gestational diabetes mellitus increases the risk of allergic diseases in offspring.
The data source was the National Health Insurance Research Database (NHIRD) of Taiwan. The pairing of mothers and children was established by connecting the NHIRD with the Taiwan Maternal and Child Health Database. First-time pregnant mothers between 2004 and 2019 were enrolled. The GDM group consisted of 22,741 cases. The control group was selected from individuals without GDM matched by maternal age, neonatal gender, and neonatal birthdate at a ratio of 1–4. The primary endpoint was the incidence of childhood allergic diseases, such as asthma, allergic rhinitis, atopic dermatitis, and urticaria. The secondary endpoint was the risk associated with the development of allergic diseases in offspring, considering the presence or absence of insulin therapy.
The development of allergic rhinitis, atopic dermatitis, and urticaria were found to be significantly associated with GDM. However, no significant association was observed between GDM and asthma. GDM control without insulin was associated with an increased risk of developing allergic rhinitis, urticaria, and atopic dermatitis. However, in the group receiving insulin treatment, there was no significant elevation in the risk of any allergic diseases.
GDM may elevate the risk of certain atopic diseases in offspring, such as allergic rhinitis, atopic dermatitis, and urticaria.
Acceptance sampling plan is widely used for the inspections of incoming or outgoing products to provide the producer and the consumer a general benchmark for lot sentencing. To reduce the inspection ...cost, the multiple‐dependent‐state (MDS) plan that takes account of the preceding lots' quality history into the current lot disposition has been proposed. However, recent studies overlook the fact that the MDS plan's performance needed to reach target compliance decreases with an increase in the number of preceding lots considered. This unawareness makes the MDS plan fall into a conflictive situation. To overcome the drawback of the MDS plan, in this paper, we introduce a modified MDS plan to accommodate an adjustable mechanism, called adjustable MDS (AMDS) sampling plans. The presented AMDS plans are designed on the basis of the advanced process capability index, which is cognizant of both the process yield and the process loss. This established process‐capability‐qualified AMDS plan efficiently solves the conflictive situation of the MDS plan when encompassing more preceding lots in the lot‐disposition decision. Notably, its efficacy has been shown on high improvements in terms of the required sample size for the inspection, the discriminatory power, and the average run length for lot sentencing.
Therapy with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKIs, such as gefitinib or erlotinib) significantly prolongs survival time for patients with tumors harboring an ...activated mutation on EGFR; however, up to 40% of lung cancer patients exhibit acquired resistance to EGFR-TKIs with an unknown mechanism. FOXO3a, a transcription factor of the forkhead family, triggers apoptosis, but the mechanistic details involved in EGFR-TKI resistance and cancer stemness remain largely unclear. Here, we observed that a high level of FOXO3a was correlated with EGFR mutation-independent EGFR-TKI sensitivity, the suppression of cancer stemness, and better progression-free survival in lung cancer patients. The suppression of FOXO3a obviously increased gefitinib resistance and enhanced the stem-like properties of lung cancer cells; consistent overexpression of FOXO3a in gefitinib-resistant lung cancer cells reduced these effects. Moreover, we identified that miR-155 targeted the 3′UTR of FOXO3a and was transcriptionally regulated by NF-κB, leading to repressed FOXO3a expression and increased gefitinib resistance, as well as enhanced cancer stemness of lung cancer in vitro and in vivo. Our findings indicate that FOXO3a is a significant factor in EGFR mutation-independent gefitinib resistance and the stemness of lung cancer, and suggest that targeting the NF-κB/miR-155/FOXO3a pathway has potential therapeutic value in lung cancer with the acquisition of resistance to EGFR-TKIs.
Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active ...learning. We aimed to examine process models of active learning to understand what works, for whom and why.
Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the 'context-mechanism-outcome' (CMO) configurations.
Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers' guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes).
We identified three CMO configurations of Taiwanese medical students' active learning. The connections among hierarchical culture, fear, teachers' guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.
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