Aims/hypothesis
The aims of this study were to assess the clinical significance of introducing HbA
1c
into a risk score for diabetes and to develop a scoring system to predict the 5 year incidence of ...diabetes in Japanese individuals.
Methods
The study included 7,654 non-diabetic individuals aged 40–75 years. Incident diabetes was defined as fasting plasma glucose (FPG) ≥7.0 mmol/l, HbA
1c
≥6.5% (48 mmol/mol) or self-reported clinician-diagnosed diabetes. We constructed a risk score using non-laboratory assessments (NLA) and evaluated improvements in risk prediction by adding elevated FPG, elevated HbA
1c
or both to NLA.
Results
The discriminative ability of the NLA score (age, sex, family history of diabetes, current smoking and BMI) was 0.708. The difference in discrimination between the NLA + FPG and NLA + HbA
1c
scores was non-significant (0.836 vs 0.837;
p
= 0.898). A risk score including family history of diabetes, smoking, obesity and both FPG and HbA
1c
had the highest discrimination (0.887, 95% CI 0.871, 0.903). At an optimal cut-off point, sensitivity and specificity were high at 83.7% and 79.0%, respectively. After initial screening using NLA scores, subsequent information on either FPG or HbA
1c
resulted in a net reclassification improvement of 42.7% or 52.3%, respectively (
p
< 0.0001). When both were available, net reclassification improvement and integrated discrimination improvement were further improved at 56.7% (95% CI 47.3%, 66.1%) and 10.9% (9.7%, 12.1%), respectively.
Conclusions/interpretation
Information on HbA
1c
or FPG levels after initial screening by NLA can precisely refine diabetes risk reclassification.
Conventional and activated tungsten inert gas (TIG) welding were conducted under the same welding conditions in an experiment to compare the weld penetration, temperature distribution and angular ...distortion. The results showed that the quantities of heat input per unit welding length were almost the same, but the shapes of the weld penetration and heat-affected zones changed drastically. The difference in angular distortion between conventional and activated TIG welding was strongly dependent on the thickness of the welded plate. A distortion analysis was developed by considering convective heat transfer in the weld pool to obtain a more detailed understanding of the temperature distribution effect on the relation between welding heat input and angular distortion. The resulting distinguishable curves for conventional and activated TIG welding, which can lead to the thickness dependence of differences in angular distortion, showed the traditional relation between the heat input parameter and the angular distortion.
The first direct measurements of vertical turbulent nitrate flux,
Flux
NO3
, were conducted in the Kuroshio across the Izu Ridge and revealed large
Flux
NO3
near the sill crest at the 1% light depth. ...This large
Flux
NO3
possibly enhances downstream phytoplankton growth. Extremely large
Flux
NO3
was also observed at 26.0–26.6 σ
θ
between the core of the Kuroshio nutrient stream and the North Pacific Intermediate Water. We hypothesize that strong vertical mixing in the Izu Ridge draws sufficient nitrate upward from the North Pacific Intermediate Water to the nutrient stream, which eventually impacts the downstream biogeochemistry in the western North Pacific.
Purpose:
In carbon‐ion radiotherapy treatment planning, the planar integrated dose (PID) measured in water is applied to the patient dose calculation with density scaling using the stopping power ...ratio. Since body tissues are chemically different from water, this dose calculation can be subject to errors, particularly due to differences in inelastic nuclear interactions. In recent studies, the authors proposed and validated a PID correction method for these errors. In the present study, the authors used this correction method to assess the influence of these nuclear interactions in body tissues on tumor dose in various clinical cases.
Methods:
Using 10–20 cases each of prostate, head and neck (HN), bone and soft tissue (BS), lung, liver, pancreas, and uterine neoplasms, the authors first used treatment plans for carbon‐ion radiotherapy without nuclear interaction correction to derive uncorrected dose distributions. The authors then compared these distributions with recalculated distributions using the nuclear interaction correction (corrected dose distributions).
Results:
Median (25%/75% quartiles) differences between the target mean uncorrected doses and corrected doses were 0.2% (0.1%/0.2%), 0.0% (0.0%/0.0%), −0.3% (−0.4%/−0.2%), −0.1% (−0.2%/−0.1%), −0.1% (−0.2%/0.0%), −0.4% (−0.5%/−0.1%), and −0.3% (−0.4%/0.0%) for the prostate, HN, BS, lung, liver, pancreas, and uterine cases, respectively. The largest difference of −1.6% in target mean and −2.5% at maximum were observed in a uterine case.
Conclusions:
For most clinical cases, dose calculation errors due to the water nonequivalence of the tissues in nuclear interactions would be marginal compared to intrinsic uncertainties in treatment planning, patient setup, beam delivery, and clinical response. In some extreme cases, however, these errors can be substantial. Accordingly, this correction method should be routinely applied to treatment planning in clinical practice.
We investigated the effect of elevated concentrations of fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c) on the risk of development of hypertension among apparently healthy Japanese. Studied ...were 9584 individuals without known diabetes and hypertension. During a 5-year follow-up period, 1098 individuals developed hypertension. Elevated concentrations of FPG, rather than of HbA1c, were significantly predictive of future hypertension. Compared with the lowest quartile category of FPG (<4.9 mmol l(-1)), the second (4.9-<5.2 mmol l(-1)), third (5.2-<5.6 mmol l(-1)) and highest (⩾ 5.6 mmol l(-1)) quartile categories had age-, sex- and body mass index-adjusted odds ratios (95% confidence interval) of 1.35 (1.10, 1.66), 1.39 (1.13, 1.71) and 1.85 (1.51, 2.28) for hypertension, respectively. In the highest quartile of FPG, the multivariate-adjusted OR was 1.37 (1.10, 1.70) compared with the lowest quartile. Results of these adjusted models showed no significant association across quartile categories of HbA1c concentrations and an increased risk of developing hypertension. The joint effect of hyperglycemia and overweight, older age or prehypertension resulted in further elevated ORs for hypertension than the absence of such an association. Higher FPG levels rather than HbA1c were strongly predictive of future hypertension among Japanese. Hyperglycemia along with older age, overweight and prehypertension contributed to identifying individuals at increased risk of developing hypertension.
Herein we investigated the intestinal carriage of α-toxigenic and enterotoxigenic Clostridium perfringens during infancy, focusing on its association with other gut microbes and mode of delivery and ...feeding. Faecal samples from 89 healthy term infants were collected at age 7 days, 1 month, 3 months, 6 months and 3 years. C. perfringens was quantified by qPCR; other gut bacteria were quantified by reverse-transcription-qPCR. Alpha-toxigenic C. perfringens was detected in 3.4% infants at day 7 but was present in 35-40% infants at subsequent time-points, with counts ranging from 10
-10
cells/g faeces. Enterotoxigenic C. perfringens remained undetected at day 7 but was detected in 1.1, 4.5, 10.1 and 4.5% infants at 1 month, 3 months, 6 months and 3 years, respectively. Intriguingly, infants carrying α-toxigenic C. perfringens had lower levels of Bacteroides fragilis group, bifidobacteria, lactobacilli and organic acids as compared to non-carriers. Further analyses revealed that, compared to vaginally-born infants, caesarean-born infants had higher carriage of C. perfringens and lower levels of B. fragilis group, bifidobacteria, lactobacilli and faecal organic acids during first 6 months. Compared to formula-fed infants, breast-fed infants were slightly less often colonised with C. perfringens; and within caesarean-born infants, breast-fed infants had slightly lower levels of C. perfringens and higher levels of B. fragilis group, bifidobacteria, and lactobacilli than formula-fed infants. This study demonstrates the quantitative dynamics of toxigenic C. perfringens colonisation in infants during the early years of life. Caesarean-born infants acquire a somewhat perturbed microbiota, and breast-feeding might be helpful in ameliorating this dysbiosis. Higher carriage of toxigenic C. perfringens in healthy infants is intriguing and warrants further investigation of its sources and clinical significance in infants, particularly the caesarean-born who may represent a potential reservoir of this opportunistic pathogen and might be more prone to associated illnesses.
This letter presents a novel method for pair matching of elevation and azimuth angles in two-dimensional (2-D) angles-of-arrival estimation employing two uniform linear arrays (ULAs). The proposed ...pair-matching method exploits the cross-correlation matrix of two received signals impinging on each ULA that shows the characteristics of the corresponding angle pairs, and is conducted by combining it with a propagator method. Numerical simulations using L-shaped array geometry revealed that the proposed method provided better robustness over the SNR, angular separation, and number of sources than that of conventional methods.
