To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual ...glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options.
Systematic review and network meta-analysis.
Ovid Medline, Embase, and Cochrane Central up to 14 October 2022.
Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach.
The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finerenone in patients with chronic kidney disease, probably reduce mortality (0.89, 0.79 to 1.00; moderate certainty); other drugs may not. The study confirmed the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing cardiovascular death, non-fatal myocardial infarction, admission to hospital for heart failure, and end stage kidney disease. Finerenone probably reduces admissions to hospital for heart failure and end stage kidney disease, and possibly cardiovascular death. Only GLP-1 receptor agonists reduce non-fatal stroke; SGLT-2 inhibitors are superior to other drugs in reducing end stage kidney disease. GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life. Reported harms were largely specific to drug class (eg, genital infections with SGLT-2 inhibitors, severe gastrointestinal adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to admission to hospital with finerenone). Tirzepatide probably results in the largest reduction in body weight (mean difference -8.57 kg; moderate certainty). Basal insulin (mean difference 2.15 kg; moderate certainty) and thiazolidinediones (mean difference 2.81 kg; moderate certainty) probably result in the largest increases in body weight. Absolute benefits of SGLT-2 inhibitors, GLP-1 receptor agonists, and finerenone vary in people with type 2 diabetes, depending on baseline risks for cardiovascular and kidney outcomes (https://matchit.magicevidence.org/230125dist-diabetes).
This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes.
PROSPERO CRD42022325948.
Gravitational‐wave high‐energy Electromagnetic Counterpart All‐sky Monitor (GECAM) is a space‐borne instrument dedicated to monitoring high‐energy transients, including Terrestrial Gamma‐ray Flashes ...(TGFs) and Terrestrial Electron Beams (TEBs). We implemented a TGF/TEB search algorithm for GECAM, with which 147 bright TGFs, 2 typical TEBs and 2 special TEB‐like events are identified during an effective observation time of ∼9 months. We show that, with gamma‐ray and charged particle detectors, GECAM can effectively identify and distinguish TGFs and TEBs, and measure their temporal and spectral properties in detail. A very high TGF‐lightning association rate of ∼80% is obtained between GECAM and GLD360 in east Asia region.
Plain Language Summary
Terrestrial gamma‐ray flashes (TGFs) and Terrestrial Electron Beams (TEBs) represent the most energetic radioactive phenomena in the atmosphere of the Earth. They reflect a natural particle accelerator that can boost electrons up to at least several tens of mega electron volts and produce gamma‐ray radiation. With novel detection technologies, Gravitational‐wave high‐energy Electromagnetic Counterpart All‐sky Monitor (GECAM) is a new powerful instrument to observe TGFs and TEBs, as well as study their properties. For example, it is difficult for most space‐borne high‐energy instruments to distinguish between TGFs and TEBs. However, we show here that, with the joint observation of gamma‐ray and charged particle detectors, GECAM can effectively identify TGFs and TEBs. GECAM can also reveal their fine features in the light curves and spectra.
Key Points
During 9‐month observation, Gravitational‐wave high‐energy Electromagnetic Counterpart All‐sky Monitor (GECAM) has detected 147 bright Terrestrial Gamma‐ray Flashes (TGFs), 2 typical Terrestrial Electron Beams (TEBs), and 2 special TEB‐like events
With novel detector design, GECAM can effectively classify TGFs and TEBs, and reveal their fine temporal features
We obtained a very high TGF‐lightning association rate (∼80%) between GECAM and GLD360 in east Asia region
Aim
To investigate simultaneously the effect of voxel size and fracture width on the accuracy of detecting vertical root fractures (VRFs) in non‐root filled teeth when using cone beam computed ...tomography.
Methodology
Fifty‐one of 161 extracted human permanent teeth (16 anterior teeth, 132 premolars and 13 mandibular molars) were selected randomly for VRF induction with two fracture widths. All teeth were scanned with four CBCT units at different voxel sizes provided by the units. Three observers classified the presence or absence of VRF using a 5‐point scale. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the ROC curve (AUC) were calculated. AUCs amongst voxel sizes and between the fracture widths were compared using the Z test. Intra‐ and inter‐observer agreement was assessed using weighted Cohen kappa.
Results
For the NewTom VGi and ProMax 3D Mid CBCT unit, no significant differences were found amongst voxel sizes for the AUCs, irrespective of the fracture width (P > 0.05). There were significant differences between images scanned with voxel size 250 and 160 μm (P = 0.02), and images scanned with voxel size 250 and 80 μm for AUCs in the narrow VRF group for the 3D Accuitomo 170 unit (P = 0.03). For i‐CAT FLX, significant differences were found between the voxel protocols of 300 μm and of the other three voxel sizes for AUC, sensitivity and NPV (P < 0.05). Significant differences between the wide and the narrow VRF groups for AUCs were found for 3D Accuitomo 170 (P = 0.01) and ProMax 3D Mid (P < 0.01).
Conclusions
Cone beam computed tomography was accurate for detecting VRF in non‐root filled teeth. Fracture width had an effect on the detection of VRF. The effect of the voxel size on the detection of VRF depended on the CBCT unit used.
Purpose
It has been estimated in the UK that 27 % of men and 3 % of women will undergo an inguinal hernia repair (IHR) during their lifetimes. However, no epidemiologic study investigating IHR has ...been performed to date in an Asian population. The present study explored the incidence and recurrence of IHR in an Asian population using a nation-wide population-based dataset in Taiwan.
Methods
Based on the National Health Insurance Database, we identified 5806 patients who underwent an IHR between 2000 and 2010 and followed them until they had a recurrence, died during hospitalization, left the program, or the study ended. We calculated the age-stratified recurrence rates and used Cox proportional hazards to explore the influence of demographic and clinical factors on recurrence. We also plotted IHR occurrence over the study period.
Results
Among the 5806 sampled subjects who had an IHR, 565 (9.73 %) had an IHR recurrence yielding an overall incidence of 18.23 per 1000 person-years. The hazard ratios for recurrence increased with age, and were greater among men and blue collar workers. The incidence of IHR decreased from 168.21 to 92.10 per 100,000 person-years over the study period. Surgical complication rates ranged between 0.16 and 2.57 %.
Conclusions
On account of the increased risk of recurrence with age, young hernia patients may not want to delay surgery. This study detected a decreasing trend in initial IHR rates, confirming similar trends reported in Western countries. However, the incidence of initial IHR is lower in Taiwan than it is in the West.
Purpose: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading worldwide, causing mental health concerns among people. People's perceptions of the disease affect their ...psychological adaptation and health outcomes. In this study, we present people's perceptions of coronavirus disease 2019 (COVID-19), level of government trust, and their psychological distress during the pandemic for examining the impact of peoples' COVID-19 perceptions on their mental health. Patients and Methods: This cross-sectional study was conducted through a telephone survey in Taiwan in April 2020. Participants were randomly selected for telephone screening using a computer-assisted telephone interviewer system. A total of 1098 participants aged more than 20 years participated in the survey. Results: The mean age of participants was 47.7 + or - 16.4 years. After controlling for covariates, participants who were worried about contracting COVID-19, those who believed that they had a chance of being infected with COVID-19, those who were reluctant to visit the hospital for fear of contracting the virus, those who felt that the pandemic had affected their daily life, and those with low levels of trust in the government's capacity to manage the pandemic had anxiety, hostility, depression, interpersonal sensitivity/inferiority, and psychological symptoms. Conclusion: People's perception of COVID-19 and public's trust in the government's ability to respond to the pandemic are related to psychological distress. Although the Taiwanese government may have undertaken effective epidemic control measures to address with the COVID-19 pandemic, this crisis may have still caused mental health problems in the general population. Health professionals and policy makers should pay more attention to high-risk groups among those at risk for developing mental health problems. Keywords: COVID-19, perceptions, psychological distress, mental health, fears, trust, economic crisis
A
bstract
With data samples collected with the BESIII detector at seven energy points at
s
= 3
.
68
−
3
.
71 GeV, corresponding to an integrated luminosity of 333 pb
−
1
, we present a study of the Λ ...transverse polarization in the
e
+
e
−
→
Λ
Λ
¯
reaction. The significance of polarization by combining the seven energy points is found to be 2.6
σ
including the systematic uncertainty, which implies a non-zero phase between the transition amplitudes of the
Λ
Λ
¯
helicity states. The modulus ratio and the relative phase of EM-
psionic
form factors combined with all energy points are measured to be
R
Ψ
=
0.71
−
0.10
+
0.10
±
0.03 and ∆Φ
Ψ
=
23
−
8.0
+
8.8
±
1.6
°
, where the first uncertainties are statistical and the second systematic.
A
bstract
Using a sample of (10
.
09
±
0
.
04)
×
10
9
J/ψ
decays collected with the BESIII detector, partial wave analyses of the decay
J
/
ψ
→
γ
K
S
0
K
S
0
π
0
are performed within the
K
S
0
K
S
0
...π
0
invariant mass region below 1.6 GeV/
c
2
. The covariant tensor amplitude method is used in both mass independent and mass dependent approaches. Both analysis approaches exhibit dominant pseudoscalar and axial vector components, and show good consistency for the other individual components. Furthermore, the mass dependent analysis reveals that the
K
S
0
K
S
0
π
0
invariant mass spectrum for the pseudoscalar component can be well described with two isoscalar resonant states using relativistic Breit-Wigner model, i.e., the
η
(1405) with a mass of
1391.7
±
0.7
−
0.3
+
11.3
MeV/
c
2
and a width of
60.8
±
1.2
−
12.0
+
5.5
MeV, and the
η
(1475) with a mass of
1507.6
±
1.6
−
32.2
+
15.5
MeV/
c
2
and a width of
115.8
±
2.4
−
10.9
+
14.8
MeV. The first and second uncertainties are statistical and systematic, respectively. Alternate models for the pseudoscalar component are also tested, but the description of the
K
S
0
K
S
0
π
0
invariant mass spectrum deteriorates significantly.
A
bstract
Using 6
.
32 fb
−
1
of
e
+
e
−
collision data collected at the center-of-mass energies between 4.178 and 4.226 GeV with the BESIII detector, we perform an amplitude analysis of the decay
D
...s
+
→ K
+
π
+
π
−
and determine the amplitudes of the various intermediate states. The absolute branching fraction of
D
s
+
→ K
+
π
+
π
−
is measured to be (6
.
11
±
0
.
18
stat
.
±
0
.
11
syst
.
)
×
10
−
3
. The branching fractions of the dominant intermediate processes
D
s
+
→ K
+
ρ
0
, ρ
0
→ π
+
π
−
and
D
s
+
→ K
*
(892)
0
π
+
, K
*
(892)
0
→ K
+
π
−
are determined to be (1
.
96
±
0
.
19
stat
.
±
0
.
23
syst
.
)
×
10
−
3
and (1
.
85
±
0
.
12
stat
.
±
0
.
13
syst
.
)
×
10
−
3
, respectively. The intermediate resonances
f
0
(500),
f
0
(980), and
f
0
(1370) are observed for the first time in this channel.
A
bstract
Using (10087 ± 44) × 10
6
J
/
ψ
events collected with the BESIII detector at the BEPCII
e
+
e
−
storage ring at the center-of-mass energy of
s
= 3.097 GeV, we present a search for the rare ...semi-muonic charmonium decay
J
/
ψ
→
D
−
μ
+
ν
μ
+ c.c.. Since no significant signal is observed, we set an upper limit of the branching fraction to be
B
(
J
/
ψ
→
D
−
μ
+
ν
μ
+ c.c.) < 5.6 × 10
−
7
at 90% confidence level. This is the first search for the weak decay of charmonium with a muon in the final state.
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