Virtual Reality (VR) is increasingly used in health-related fields and interventions using VR have the potential to be powerful tools in patient management. The aim of this study was to synthesize ...the effects of VR interventions for people with mild cognitive impairment (MCI) or dementia.
Electronic databases were searched to identify studies that used an experimental design to investigate VR intervention outcomes for patients with MCI or dementia. Studies were excluded if the intervention did not focus on VR, if relevant quantitative outcomes were not reported, or if the intended study purpose was assessment or diagnosis. Data were extracted and analyzed from studies that met criteria. To synthesize the intervention effect sizes (ES), we used random effects models to accommodate heterogeneity in the main effect and sub-group analyses. To identify the potential reason for heterogeneity and compare ES according to the moderator variables, subgroup analyses were conducted based on study characteristics and intervention outcomes.
Data from eleven studies that met eligibility criteria were analyzed. VR intervention delivered to participants with MCI or dementia produced small to medium effects (ES = 0.29, CI = 0.16, 0.42). The ES for studies using semi-immersive technology (ES = 0.37, CI = 0.25, 0.49) was greater than the studies using full-immersive VR (ES = 0.03, CI = -0.14, 0.21). The results showed small-to-medium effects for VR interventions affecting key outcome variables such as cognition (ES = 0.42, CI = 0.24, 0.60) and physical fitness (ES = 0.41, CI = 0.16, 0.65).
VR interventions, particularly of the semi-immersive type, are useful for people with MCI or dementia. These results should contribute to the establishment of practical guidelines for VR interventions for patients with cognitive decline.
Aims/hypothesis
The aim of this study was to quantify the relative contributions of increased insulin secretion rate (ISR) and decreased insulin clearance rate (ICR) in the compensatory ...hyperinsulinaemia characteristic of insulin-resistant individuals without diabetes.
Methods
Obese (BMI ≥30 kg/m
2
) individuals without diabetes (
n
= 91) were identified from a registry of volunteers. Volunteers underwent the following measurements: oral glucose tolerance; insulin resistance (steady-state plasma glucose SSPG concentration during the insulin suppression test IST); ISR (using the graded glucose infusion test GGIT); and ICR (using the IST and GGIT). Participants were stratified into tertiles based on SSPG concentration: SSPG-1(insulin-sensitive); SSPG-2 (intermediate); and SSPG-3 (insulin-resistant).
Results
There were no differences in BMI and waist circumference among the SSPG tertiles. Serum alanine aminotransferase concentrations were higher in the SSPG-2 and SSPG-3 groups compared with the SSPG-1 group (
p
= 0.02). Following an oral glucose challenge, there was a progressive increase in the total integrated insulin response from the most insulin-sensitive to the most insulin-resistant tertiles (
p
< 0.001). Following intravenous glucose, the SSPG-3 group had significantly greater integrated glucose (median interquartile range, 32.9 30.8–36.3 mmol/l × h) and insulin responses (1711 1476–2223 mmol/l × h) compared with the SSPG-1 group (30.3 28.8–32.9 mmol/l × h,
p
= 0.04, and 851 600–1057 pmol/l × h,
p
< 0.001, respectively). Furthermore, only the SSPG-3 group had significant changes in both ISR and ICR (
p
< 0.001). In the SSPG-2 group, only the ICR was significantly decreased compared with the SSPG-1 group. Therefore, ICR progressively declined during the IST with increasing insulin resistance (SSPG-1, 0.48 0.41–0.59; SSPG-2, 0.43 0.39–0.50; SSPG-3, 0.34 0.31–0.40).
Conclusions/interpretation
While both increases in ISR and decreases in ICR compensate for insulin resistance, decreases in ICR may provide the first adaptation to decreased insulin sensitivity.
Deregulation of the cyclin D‐CDK4/6‐INK4‐RB pathway leading to uncontrolled cell proliferation, is frequently observed in breast cancer. Currently, three selective CDK4/6 inhibitors have been FDA ...approved: palbociclib, ribociclib and abemaciclib. Despite promising clinical outcomes, intrinsic or acquired resistance to CDK4/6 inhibitors has limited the success of these treatments; therefore, the development of various strategies to overcome this resistance is of great importance. We highlight the various mechanisms that are directly or indirectly responsible for resistance to CDK4/6 inhibitors, categorizing them into two broad groups; cell cycle‐specific mechanisms and cell cycle‐nonspecific mechanisms. Elucidation of the diverse mechanisms through which resistance to CDK4/6 inhibitors occurs, may aid in the design of novel therapeutic strategies to improve patient outcomes. This review summarizes the currently available knowledge regarding mechanisms of resistance to CDK4/6 inhibitors, and possible therapeutic strategies that may overcome this resistance as well.
Although the electroconversion of carbon dioxide (CO2) into ethanol is considered to be one of the most promising ways of using CO2, the ethanol selectivity is less than 50% because of difficulties ...in designing an optimal catalyst that arise from the complicated pathways for the electroreduction of CO2 to ethanol. Several approaches including the fabrication of oxide‐derived structures, atomic surface control, and the Cu+/Cu interfaces have been primarily used to produce ethanol from CO2. Here, a combined structure with Cu+ and high‐facets as electrocatalysts is constructed by creating high‐facets of wrinkled Cu surrounded by Cu2O mesh patterns. Using chemical vapor deposition graphene growth procedures, the insufficiently grown graphene is used as an oxidation‐masking material, and the high‐facet wrinkled Cu is simultaneously generated during the graphene growth synthesis. The resulting electrocatalyst shows an ethanol selectivity of 43% at −0.8 V versus reversible hydrogen electrode, which is one of the highest ethanol selectivity values reported thus far. This is attributed to the role of Cu+ in enhancing CO binding strength, and the high‐facets, which favor C–C coupling and the ethanol pathway. This method for generating the combined structure can be widely applicable not only for electrochemical catalysts but also in various fields.
A combined structure with Cu+ and high‐facets is developed via insufficient graphene growth and a postoxidation process. The synthesized catalysts show high ethanol selectivity from the electrochemical CO2 reduction. The enhanced CO binding strength due to the introduction of Cu+ induces stable CO adsorption while maintaining high‐facet properties, resulting in a favorable CO–CO coupling reaction for C2 formation.
This study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis (KOA) and evaluated safety.
A multi-centre, non-blinded, parallel-group, randomised controlled ...trial compared moxibustion with usual care (UC) in KOA. 212 South Korean patients aged 40-70 were recruited from 2011-12, stratified by mild (Kellgren/Lawrence scale grades 0/1) and moderate-severe KOA (grades 2/3/4), and randomly allocated to moxibustion or UC for four weeks. Moxibustion involved burning mugwort devices over acupuncture and Ashi points in affected knee(s). UC was allowed. Korean Western Ontario and McMaster Universities Questionnaire (K-WOMAC), Short Form 36 Health Survey (SF-36v2), Beck Depression Inventory (BDI), physical performance test, pain numeric rating scale (NRS) and adverse events were evaluated at 5 and 13 weeks. K-WOMAC global score at 5 weeks was the primary outcome.
102 patients (73 mild, 29 moderate-severe) were allocated to moxibustion, 110 (77 mild, 33 moderate-severe) to UC. K-WOMAC global score (moxibustion 25.42+/-SD 19.26, UC 33.60+/-17.91, p<0.01, effect size = 0.0477), NRS (moxibustion 44.77+/-22.73, UC 56.23+/-17.71, p<0.01, effect size = 0.0073) and timed-stand test (moxibustion 24.79+/-9.76, UC 25.24+/-8.84, p = 0.0486, effect size = 0.0021) were improved by moxibustion at 5 weeks. The primary outcome improved for mild but not moderate-severe KOA. At 13 weeks, moxibustion significantly improved the K-WOMAC global score and NRS. Moxibustion improved SF-36 physical component summary (p = 0.0299), bodily pain (p = 0.0003), physical functioning (p = 0.0025) and social functioning (p = 0.0418) at 5 weeks, with no difference in mental component summary at 5 and 13 weeks. BDI showed no difference (p = 0.34) at 5 weeks. After 1158 moxibustion treatments, 121 adverse events included first (n = 6) and second degree (n = 113) burns, pruritus and fatigue (n = 2).
Moxibustion may improve pain, function and quality of life in KOA patients, but adverse events are common. Limitations included no sham control or blinding.
Clinical Research Information Service (CRIS) KCT0000130.
Recent reports showing the favorable role of patent foramen ovale (PFO) closure in patients with cryptogenic stroke have raised the issue of selecting optimal candidates.
This study, DEFENSE-PFO ...(Device Closure Versus Medical Therapy for Cryptogenic Stroke Patients With High-Risk Patent Foramen Ovale), evaluated whether the benefits of PFO closure can be determined on the basis of the morphologic characteristics of the PFO, as evaluated by transesophageal echocardiography.
Patients with cryptogenic stroke and high-risk PFO were divided between a transcatheter PFO closure and a medication-only group. High-risk PFO included PFO with atrial septal aneurysm, hypermobility (phasic septal excursion into either atrium ≥10 mm), or PFO size (maximum separation of the septum primum from the secundum) ≥2 mm. The primary endpoint was a composite of stroke, vascular death, or Thrombolysis In Myocardial Infarction-defined major bleeding during 2 years of follow-up.
From September 2011 until October 2017, 120 patients (mean age: 51.8 years) underwent randomization. PFO size, frequency of septal aneurysm (13.3% vs. 8.3%; p = 0.56), and hypermobility (45.0% vs. 46.7%; p > 0.99) were similar between the groups. All PFO closures were successful. The primary endpoint occurred exclusively in the medication-only group (6 of 60 patients; 2-year event rate: 12.9% log-rank p = 0.013; 2-year rate of ischemic stroke: 10.5% p = 0.023). The events in the medication-only group included ischemic stroke (n = 5), cerebral hemorrhage (n = 1), Thrombolysis In Myocardial Infarction-defined major bleeding (n = 2), and transient ischemic attack (n = 1). Nonfatal procedural complications included development of atrial fibrillation (n = 2), pericardial effusion (n = 1), and pseudoaneurysm (n = 1).
PFO closure in patients with high-risk PFO characteristics resulted in a lower rate of the primary endpoint as well as stroke recurrence. (Device Closure Versus Medical Therapy for Cryptogenic Stroke Patients With High-Risk Patent Foramen Ovale DEFENSE-PFO; NCT01550588).
Use of Cu and Cu+ is one of the most promising approaches for the production of C2 products by the electrocatalytic CO2 reduction reaction (CO2RR) because it can facilitate CO2 activation and CC ...dimerization. However, the selective electrosynthesis of C2+ products on Cu0Cu+ interfaces is critically limited due to the low electrocatalytic production of ethanol relative to ethylene. In this study, a novel porous Cu/Cu2O aerogel network is introduced to afford high ethanol productivity by the electrocatalytic CO2RR. The aerogel is synthesized by a simple chemical redox reaction of a precursor and a reducing agent. CO2RR results reveal that the Cu/Cu2O aerogel produces ethanol as the major product, exhibiting a Faradaic efficiency (FEEtOH) of 41.2% and a partial current density (JEtOH) of 32.55 mA cm−2 in an H‐cell reactor. This is the best electrosynthesis performance for ethanol production reported thus far. Electron microscopy and electrochemical analysis results reveal that this dramatic increase in the electrosynthesis performance for ethanol can be attributed to a large number of Cu0Cu+ interfaces and an increase of the local pH in the confined porous aerogel network structure with a high‐surface‐area.
A Cu/Cu2O interconnected porous aerogel network exhibits remarkably high selectivity and productivity in ethanol electrosynthesis from CO2 (41.2% and 32.55mA cm−2 in an H‐cell). This high performance arises from a large population of Cu0Cu+ interfaces in the confined porous structure with a high surface area. This aerogel electrocatalyst is thought to be an appealing model for the commercial electrosynthesis of ethanol from CO2.
Searching for an optimal component and composition of multi‐metallic alloy catalysts, comprising two or more elements, is one of the key issues in catalysis research. Due to the exhaustive data ...requirement of conventional machine‐learning (ML) models and the high cost of experimental trials, current approaches rely mainly on the combination of density functional theory and ML techniques. In this study, a significant step is taken toward overcoming limitations by the interplay of experiment and active learning to effectively search for an optimal component and composition of multi‐metallic alloy catalysts. The active‐learning model is iteratively updated using by examining electrocatalytic performance of fabricated solid‐solution nanoparticles for the hydrogen evolution reaction (HER). An optimal metal precursor composition of Pt0.65Ru0.30Ni0.05 exhibits an HER overpotential of 54.2 mV, which is superior to that of the pure Pt catalyst. This result indicates the successful construction of the model by only utilizing the precursor mixture composition as input data, thereby improving the overpotential by searching for an optimal catalyst. This method appears to be widely applicable since it is able to determine an optimal component and composition of electrocatalyst without obvious restriction to the types of catalysts to which it can be applied.
A new and simple methodology is suggested in order to search for the optimal components and composition of multi‐metallic alloy catalysts regardless of the catalytic background by a combination of active learning and experiment. After conducting several iterations, the optimum ternary catalyst, which shows superior performance compared to unary or binary catalysts, is discovered.
The main gas‐sensing mechanisms of 2D materials are surface charge transfer by analytes and Schottky barrier (SB) modulation at the interface between the metallic and semiconducting surfaces. In ...particular, dramatic differences in the gas‐sensing performances of 2D materials originate from SB modulation. However, SB sites typically exist only at the interface between the semiconducting channel material and the metal electrode. Herein, in situ formed multiple SBs in a single gas‐sensing channel are demonstrated, which are derived from the heterojunction of metallic Ti3C2 and semiconducting TiO2. In stark contrast with previous techniques, edge‐oxidized Ti3C2 flakes are synthesized by solution oxidation, allowing the uniform formation of TiO2 crystals on all flakes that comprise the gas sensing channel. Oxidized colloidal solutions are subjected to vacuum filtration to automatically form SB sites at the multiple inter‐flake junctions in both the outer surface and inner bulk regions of the film. The TiO2/Ti3C2 composite sensor shows 13.7 times higher NO2 sensitivity as compared with pristine Ti3C2 MXene, while the responses of the reducing gases are almost unchanged. The results suggest a new strategy for improving gas‐sensing performance by maximizing the density of SB sites through a simple method.
Ti3C2 MXene thin films with in situ formed multiple Schottky barriers (SBs) are synthesized by employing a solution‐based oxidation method, selectively forming TiO2 nanocrystals at the edge sites of each individual MXene sheet. Gas sensors based on the TiO2/Ti3C2 heterostructure show a highly enhanced gas response toward nitrogen dioxide gas resulting from SB modulation.
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