BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCT...BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and urinary infection-20(8.8%)&17(7.5%)with dapagliflozin;9(5.6%)&5(3.13%)with canagliflozin;and 4(5%)&4(5%)with empagliflozin.Diabetic ketoacidosis was observed in 4(1.8%)with dapagliflozin and 1(0.63%)with canagliflozin.CONCLUSION Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c,body weight,and better than those reported in RCTs,with low side effect profiles.A review of large-scale real-world data is needed to inform better clinical practice decision making.展开更多
Electrochemical production of hydrogen from water requires the development ofelectrocatalysts that are active,stable,and low-cost for water splitting.To address these challenges,researchers are increasingly exploring ...Electrochemical production of hydrogen from water requires the development ofelectrocatalysts that are active,stable,and low-cost for water splitting.To address these challenges,researchers are increasingly exploring binder-free electrocatalytic integratedelectrodes (IEs) as an alternative to conventional powder-based electrode preparation methods,for the former is highly desirable to improve the catalytic activity and long-term stability for large-scale applications of electrocatalysts.Herein,we demonstrate a laser-inducedhydrothermal reaction (LIHR) technique to grow NiMoO4nanosheets on nickel foam,which is then calcined under H2/Ar mixed gases to prepare the IE IE-NiMo-LR.This electrode exhibits superior hydrogen evolution reaction performance,requiring overpotentials of 59,116 and143 mV to achieve current densities of 100,500 and 1000 mA·cm-2.During the 350 h chronopotentiometry test at current densities of 100 and 500 m A·cm-2,the overpotentialremains essentially unchanged.In addition,NiFe-layered double hydroxide grown on Ni foam is also fabricated with the same LIHR method and coupled with IE-NiMo-IR to achieve water splitting.This combination exhibits excellent durability under industrial current density.The energy consumption and production efficiency of the LIHR method are systematicallycompared with the conventional hydrothermal method.The LIHR method significantly improves the production rate by over 19 times,while consuming only 27.78%of the total energy required by conventional hydrothermal methods to achieve the same production.展开更多
The joining of different light metals through friction stir welding(FSW)is gaining interest as a method to decrease weight and improve fuel efficiency.However,to ensure durability,these welded metals may require surfa...The joining of different light metals through friction stir welding(FSW)is gaining interest as a method to decrease weight and improve fuel efficiency.However,to ensure durability,these welded metals may require surface treatments to protect against corrosion or wear.This study presents a novel approach for the simultaneous delivery of two distinct corrosion inhibitors to Ti-Mg dissimilar PEO treated joints on demand.The research focuses on the synthesis,characterization,and application of cerium@polystyrene(Ce@PS)nanocontainers,which are loaded with 8-hydroxyquinoline(8-HQ)to enhance corrosion protection.The synthesis involves several key steps,including the formation of a cerium-based outer layer around polystyrene nanospheres,the selective removal of the polystyrene core to create a porous structure,and the subsequent loading of the 8-HQ inhibitor.Structural and compositional analyses,conducted using scanning transmission electron microscopy(STEM)and energy-dispersive X-ray spectroscopy(EDS),confirmed the successful incorporation of 8-HQ within the nanocontainers.Additionally,Fourier-transform infrared spectroscopy(FTIR)provided detailed information about the chemical composition of the organic materials throughout the synthesis process.Thermal decomposition analysis verified the successful fabrication and stability of the dual-shell nanocontainers.Corrosion tests on Ti-Mg joints treated with plasma electrolytic oxidation(PEO)coatings and loaded nanocontainers demonstrated sig-nificantly improved corrosion resistance compared to untreated joints.This research highlights the potential of dual-shell nanocontainers,containing both organic and inorganic inhibitors,to offer prolonged corrosion protection,particularly against galvanic corrosion in dissimilar joints.The findings suggest that these synthesized nanocontainers hold promise for various industrial applications,particularly in the context of friction stir welded(FSW)Ti-Mg dissimilar joints,providing valuable insights for the development of advanced materials designed to mitigate corrosion.展开更多
Polycaprolactone(PCL)scaffolds that are produced through additive manufacturing are one of the most researched bone tissue engineering structures in the field.Due to the intrinsic limitations of PCL,carbon nanomateria...Polycaprolactone(PCL)scaffolds that are produced through additive manufacturing are one of the most researched bone tissue engineering structures in the field.Due to the intrinsic limitations of PCL,carbon nanomaterials are often investigated to reinforce the PCL scaffolds.Despite several studies that have been conducted on carbon nanomaterials,such as graphene(G)and graphene oxide(GO),certain challenges remain in terms of the precise design of the biological and nonbiological properties of the scaffolds.This paper addresses this limitation by investigating both the nonbiological(element composition,surface,degradation,and thermal and mechanical properties)and biological characteristics of carbon nanomaterial-reinforced PCL scaffolds for bone tissue engineering applications.Results showed that the incorporation of G and GO increased surface properties(reduced modulus and wettability),material crystallinity,crystallization temperature,and degradation rate.However,the variations in compressive modulus,strength,surface hardness,and cell metabolic activity strongly depended on the type of reinforcement.Finally,a series of phenomenological models were developed based on experimental results to describe the variations of scaffold’s weight,fiber diameter,porosity,and mechanical properties as functions of degradation time and carbon nanomaterial concentrations.The results presented in this paper enable the design of three-dimensional(3D)bone scaffolds with tuned properties by adjusting the type and concentration of different functional fillers.展开更多
While chronic hyperglycaemia resulting from poorly controlled diabetes mellitus(DM)is a well-known precursor to complications such as diabetic retinopathy,neuropathy(including autonomic neuropathy),and nephropathy,a p...While chronic hyperglycaemia resulting from poorly controlled diabetes mellitus(DM)is a well-known precursor to complications such as diabetic retinopathy,neuropathy(including autonomic neuropathy),and nephropathy,a paradoxical intensification of these complications can rarely occur with aggressive glycemic management resulting in a rapid reduction of glycated haemoglobin.Although,acute onset or worsening of retinopathy and treatment induced neuropathy of diabetes are more common among these complications,rarely other problems such as albuminuria,diabetic kidney disease,Charcot’s neuroarthropathy,gastroparesis,and urinary bladder dysfunction are also encountered.The World Journal of Diabetes recently published a rare case of all these complications,occurring in a young type 1 diabetic female intensely managed during pregnancy,as a case report by Huret et al.It is essential to have a comprehensive understanding of the pathobiology,prevalence,predisposing factors,and management strategies for acute onset,or worsening of microvascular complications when rapid glycemic control is achieved,which serves to alleviate patient morbidity,enhance disease management compliance,and possibly to avoid medico-legal issues around this rare clinical problem.This editorial delves into the dynamics surrounding the acute exacerbation of microvascular complications in poorly controlled DM during rapid glycaemic control.展开更多
Childhood-onset obesity has emerged as a major public healthcare challenge across the globe,fueled by an obesogenic environment and influenced by both genetic and epigenetic predispositions.This has led to an exponent...Childhood-onset obesity has emerged as a major public healthcare challenge across the globe,fueled by an obesogenic environment and influenced by both genetic and epigenetic predispositions.This has led to an exponential rise in the incidence of type 2 diabetes mellitus in children and adolescents.The looming wave of diabetes-related complications in early adulthood is anticipated to strain the healthcare budgets in most countries.Unless there is a collective global effort to curb the devastation caused by the situation,the impact is poised to be pro-found.A multifaceted research effort,governmental legislation,and effective social action are crucial in attaining this goal.This article delves into the current epidemiological landscape,explores evidence concerning potential risks and consequences,delves into the pathobiology of childhood obesity,and discusses the latest evidence-based management strategies for diabesity.展开更多
“Last scene of all that ends this strange,eventful history,is second childishness and mere oblivion.I am sans teeth,sans eyes,sans taste,sans everything.”William Shakespeare‘As You Like It'Act 2,Sc.7,l.139Aging...“Last scene of all that ends this strange,eventful history,is second childishness and mere oblivion.I am sans teeth,sans eyes,sans taste,sans everything.”William Shakespeare‘As You Like It'Act 2,Sc.7,l.139Aging of the human brain is characterized by a progressive decline of its functional capacity;this decline however varies widely,and cognitive longevity differs substantially between individuals.展开更多
BACKGROUND Diabesity(diabetes as a consequence of obesity)has emerged as a huge healthcare challenge across the globe due to the obesity pandemic.Judicious use of antidiabetic medications including semaglutide is impo...BACKGROUND Diabesity(diabetes as a consequence of obesity)has emerged as a huge healthcare challenge across the globe due to the obesity pandemic.Judicious use of antidiabetic medications including semaglutide is important for optimal management of diabesity as proven by multiple randomized controlled trials.However,more real-world data is needed to further improve the clinical practice.AIM To study the real-world benefits and side effects of using semaglutide to manage patients with diabesity.METHODS We evaluated the efficacy and safety of semaglutide use in managing patients with diabesity in a large academic hospital in the United States.Several parameters were analyzed including demographic information,the data on improvement of glycated hemoglobin(HbA1c),body weight reduction and insulin dose adjustments at 6 and 12 months,as well as at the latest follow up period.The data was obtained from the electronic patient records between January 2019 to May 2023.RESULTS 106 patients(56 males)with type 2 diabetes mellitus(T2DM),mean age 60.8±11.2 years,mean durations of T2DM 12.4±7.2 years and mean semaglutide treatment for 2.6±1.1 years were included.Semaglutide treatment was associated with significant improvement in diabesity outcomes such as mean weight reductions from baseline 110.4±24.6 kg to 99.9±24.9 kg at 12 months and 96.8±22.9 kg at latest follow up and HbA1c improvement from baseline of 82±21 mmol/mol to 67±20 at 12 months and 71±23 mmol/mol at the latest follow up.An insulin dose reduction from mean baseline of 95±74 units to 76.5±56.2 units was also observed at the latest follow up.Side effects were mild and mainly gastrointestinal like bloating and nausea improving with prolonged use of semaglutide.CONCLUSION Semaglutide treatment is associated with significant improvement in diabesity outcomes such as reduction in body weight,HbA1c and insulin doses without major adverse effects.Reviews of largescale real-world data are expected to inform better clinical practice decision making to improve the care of patients with diabesity.展开更多
Purpose: Low back pain (LBP), Gonarthrosis, knee, and Carpal Tunnel Syndrome have been regarded as affecting more than three-quarters’ of individuals in their lifetime. The aim of this study was conducted to determin...Purpose: Low back pain (LBP), Gonarthrosis, knee, and Carpal Tunnel Syndrome have been regarded as affecting more than three-quarters’ of individuals in their lifetime. The aim of this study was conducted to determine and compare the effects of topical patients with sand compared with control related to Gonarthrosis, LBP, knee, and Carpal Tunnel Syndrome pain. Methods: This is a prospective case and control designed study based on 101 pain case with Sand and 101 control subjects. The interventional groups in addition either topical sand or without sand 2 months after the intervention were assessed. We assessed tolerability of an established pain perception scale by the Numeric Rating Scale (NRS). Categorical variables were compared using the chi-square (χ<sup>2</sup>) test. The paired t-test was used to compare the two groups before and after the intervention. One-way analysis of variance (ANOVA) was employed for comparison of several group means. Results: The study was based on 202 patients, 41 males (20.3%) and 161 females (79.7%). There were statistically significant differences between subjects with and without Sand in term of Gonarthrosis, Rheumatoid Arthritis LBP, knee, and Carpal Tunnel Syndrome pain (p = 0.033). Majority of patients were over age 55 years old (55%) and females 78 (77.2%). The mean score of total pain experience before and after the intervention was 7.41 ± 1.1 for black sand, and 4.24 ± 2.38 for without sand as control group. The mean scores of these 5 groups were highly significant before and after the intervention (p There was statistically highly significant in regarding subjects with Sand as compared with those before Sand after treatment mean score specifically with gonarthrosis before pain 7.23 ± 1.86 vs after treatment 4.54 ± 2.18 p < 0.001;rheumatoid arthritis before 8.28 ± 1.48 vs after treatment 4.80 ± 3.71 p < 0.001;Low Back Pain before 8.42 ± 1.83 vs after treatment 4.37 ± 1.52 p < 0.001;knee pain before 8.93 ± 0.89 vs after treatment 4.24 ± 0.24 p < 0.001;Carpal Tunnel Syndrome before 7.664 ± 1.04 vs after treatment 4.26 ± 1.03 p Conclusion: The current study has revealed that the topical treatments with sand could have a significant effect on the perception of pain compared to those in the control group with respect of gonarthrosis, rheumatoid arthritis, LBP, knee, and Carpal Tunnel Syndrome pain .展开更多
The great challenge of cemented tailings backfill(CTB)is difficult simultaneously maintaining its excellent mechanical properties and low cost.Fly ash(FA)can potentially address this problem and further replace cement...The great challenge of cemented tailings backfill(CTB)is difficult simultaneously maintaining its excellent mechanical properties and low cost.Fly ash(FA)can potentially address this problem and further replace cement in favor of low carbon development.However,its mechanism on CTB with low cement dosage and low Ca system remains unclear.Consequently,this study conducted uniaxial compression,Xray diffraction(XRD),and scanning electron microscopy(SEM)-energy dispersive spectrometer(EDS)tests to investigate the effect of FA dosage on the mechanical property and microstructure of CTB.A molecular model of FA-CSH was constructed to reproduce the molecular structure evolution of CTB with FA based on the test results.The influences of FA dosage and calcium/silica molar ratio(Ca/Si ratio)on the matrix strength and failure model were analyzed to reveal the mechanism of FA on calcium silicate hydrated(C-S-H).The results show that the strength of CTB increases initially and then decreases with FA dosage,and the FA supplement leads to a decrease in Ca(OH)_(2) diffraction intensity and Ca/Si ratio around the FA particles.XRD and SEM-EDS findings show that the Ca/Si ratio of C-S-H decreases with the progression of hydration.The FA-CSH model indicates that FA can reinforce the silica chain of C-S-H to increase the matrix strength.However,this enhancement is weakened by supplementing excessive FA dosage.In addition,the hydrogen bonds among water molecules deteriorate,reducing the matrix strength.A low Ca/Si ratio results in an increase in water molecules and a decrease in the ionic bonds combined with Ca^(2+).The hydrogen bonds among water molecules cannot withstand high stresses,resulting in a reduction in strength.The water absorption of the FA-CSH model is negatively correlated with the FA dosage and Ca/Si ratio.The use of optimal FA dosage and Ca/Si ratio leads to suitable water absorption,which further affects the failure mode of FA-CSH.展开更多
The blood-brain barrier(BBB)(discovered and defined by Max Lewandowsky and Lina Stern,and not,as it is universally,and yet erroneously believed,by Paul Ehrlich(Verkhratsky and Pivoriunas,2023))that separates the nervo...The blood-brain barrier(BBB)(discovered and defined by Max Lewandowsky and Lina Stern,and not,as it is universally,and yet erroneously believed,by Paul Ehrlich(Verkhratsky and Pivoriunas,2023))that separates the nervous system from the circulation is evolutionarily conserved from arthropods to man.The primeval BBB of the invertebrates and some early vertebrates was made solely by glial cells and secured(in invertebrates)by septate junctions.展开更多
In the present study,the distribution of Ag in the coating formed on Mg-Ag alloy by plasma electrolytic oxidation(PEO)and its ionic release kinetics when exposed to a 0.9 wt.%Na Cl solution at 37℃have been investigat...In the present study,the distribution of Ag in the coating formed on Mg-Ag alloy by plasma electrolytic oxidation(PEO)and its ionic release kinetics when exposed to a 0.9 wt.%Na Cl solution at 37℃have been investigated.Both metallic Ag and Ag oxide particles with~5 to~40 nm in diameters were observed in the PEO coating.Further,an Ag-enriched layer of~20 nm in thickness at the substrate/coating interface was also observed.The PEO coating on the Mg-Ag alloy not only increases its corrosion resistance with the corrosion current density decreasing by up to 3 orders of magnitude from 8.04×10^(-3)to 4.03×10^(-6)A/cm^(2),but also controls the release of Ag+to the level that is sufficient for anti-infective efficacy without causing cytotoxicity to mammal cells.展开更多
We combine the kinematics of 159 globular clusters(GCs) provided by the Gaia Early Data Release 3(EDR3) with other observational data to classify the GCs,and to estimate the mass of the Milky Way(MW).We use the agemet...We combine the kinematics of 159 globular clusters(GCs) provided by the Gaia Early Data Release 3(EDR3) with other observational data to classify the GCs,and to estimate the mass of the Milky Way(MW).We use the agemetallicity relation,integrals of motion,action space and the GC orbits to identify the GCs as either formed in situ(Bulge and Disk) or ex situ(via accretion).We find that 45.3% have formed in situ,while 38.4% may be related to known merger events:Gaia-Sausage-Enceladus,the Sagittarius dwarf galaxy,the Helmi streams,the Sequoia galaxy and the Kraken galaxy.We also further identify three new sub-structures associated with the Gaia-Sausage-Enceladus.The remaining 16.3% of GCs are unrelated to the known mergers and thought to be from small accretion events.We select 46 GCs which have radii 8.0 <r<37.3 kpc and obtain the anisotropy parameter β=0.315_(-0.049)^(+0.055),which is lower than the recent result using the sample of GCs in Gaia Data Release 2,but still in agreement with it by considering the error bar.By using the same sample,we obtain the MW mass inside the outermost GC as M(<37.3 kpc)=0.423_(-0.02)^(+0.02)×10^(12)M_(⊙),and the corresponding M_(200)=1.11_(-0.18)^(+0.25)×10^(12)M_(⊙).The estimated mass is consistent with the results in many recent studies.We also find that the estimated β and mass depend on the selected sample of GCs.However,it is difficult to determine whether a GC fully traces the potential of the MW.展开更多
Various studies have suggested several environmental,pharmacological,medical,and optical interventions and some are in use but their efficacy in myopia control may be transient,and the cellular,molecular,and biochemic...Various studies have suggested several environmental,pharmacological,medical,and optical interventions and some are in use but their efficacy in myopia control may be transient,and the cellular,molecular,and biochemical mechanisms involved unclear.Daylight exposure is currently regarded as an effective and enduring strategy in the control of myopia development and progression.However,the mechanism behind the effect of outdoor exposure and its association with genetic predisposition and other relatively more significant environmental factors on myopia is still a conundrum.This review focuses on survey-based and intervention-based studies carried out to propose a mechanism that accounts for myopia development and important for its control.展开更多
The diagnosis and management of thyroid cancer is fraught with challenges despite the advent of innovative diagnostic,surgical,and chemotherapeutic modalities.Challenges like inaccuracy in prognostication,uncertainty ...The diagnosis and management of thyroid cancer is fraught with challenges despite the advent of innovative diagnostic,surgical,and chemotherapeutic modalities.Challenges like inaccuracy in prognostication,uncertainty in cytopathological diagnosis,trouble in differentiating follicular neoplasms,intra-observer and inter-observer variability on ultrasound imaging preclude personalised treatment in thyroid cancer.Artificial intelligence(AI)is bringing a paradigm shift to the healthcare,powered by quick advancement of the analytic techniques.Several recent studies have shown remarkable progress in thyroid cancer diagnostics based on AI-assisted algorithms.Application of AI techniques in thyroid ultrasonography and cytopathology have shown remarkable improvement in sensitivity and specificity over the traditional diagnostic modalities.AI has also been explored in the development of treatment algorithms for indeterminate nodules and for prognostication in the patients with thyroid cancer.The benefits of high repeatability and straightforward implementation of AI in the management of thyroid cancer suggest that it holds promise for clinical application.Limited clinical experience and lack of prospective validation studies remain the biggest drawbacks.Developing verified and trustworthy algorithms after extensive testing and validation using prospective,multi-centre trials is crucial for the future use of AI in the pipeline of precision medicine in the management of thyroid cancer.展开更多
Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy(DPN),such as nerve conduction studies,there is still a knowledge gap about the pathophysiology,and thus limited availab...Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy(DPN),such as nerve conduction studies,there is still a knowledge gap about the pathophysiology,and thus limited available in-terventions for symptom control and curtailing disease progression.The pharma-cologic aspect of management is mainly centred on pain control,however,there are several important aspects of DPN such as loss of vibration sense,pressure sense,and proprioception which are associated with risks to lower limb health,which pharmacotherapy does not address.Furthermore,published evidence suggests non-pharmacologic interventions such as glycaemic control through dietary modification and exercise need to be combined with other measures such as psychotherapy,to reach a desired,however modest effect.Acupuncture is emerging as an important treatment modality for several chronic medical conditions including neuropathic and other pain syndromes.In their study published in the World Journal of Diabetes on the potential of acupuncture to reduce DPN symptoms and enhance nerve conduction parameters,Hoerder et al have been able to demonstrate that acupuncture improves sensory function and that this effect is likely sustained two months after treatment cessation.Although previous studies also support these findings,larger multi-center randomized control trials including a sham-controlled arm accounting for a placebo effect are required.Overall,given the satisfactory safety profile and the positive results found in these studies,it is likely that acupuncture may become an important aspect of the repertoire of effective DPN management.展开更多
The bidirectional association between type 2 diabetes mellitus(T2DM)and periodontitis is now well established,resulting in periodontal disease being considered as the 6th major complication of diabetes mellitus(DM)aft...The bidirectional association between type 2 diabetes mellitus(T2DM)and periodontitis is now well established,resulting in periodontal disease being considered as the 6th major complication of diabetes mellitus(DM)after cardiovascular disease,eye disease,neuropathy,nephropathy,and peripheral vascular disease.DM can worsen the virulence and invasiveness of pathogenic oral microbial flora aggravating the local inflammation and infection in those with periodontal disease.On the other hand,the chemical and immunological mediators released into the circulation as part of periodontal inflammation worsen the systemic insulin resistance with worsening of T2DM.Periodontitis if undiagnosed or left untreated can also result in eventual tooth loss.A study by Xu et al in the World Journal of Diabetes examined the predictive factors associated with periodontitis in Chinese patients with T2DM.The prevalence of periodontitis was found to be 75.7%in this study.Based on logistic regression analysis,the predictive factors for higher risk were low tooth brushing frequency[odds ratio(OR)=4.3],high triglycerides(TG;OR=3.31),high total cholesterol(TC;OR=2.87),higher glycated hemoglobin(HbA1c;OR=2.55),and higher age(OR=1.05)while higher education level was protective(OR=0.53).However,the most influential variables were HbA1c followed by age,TC,TG,low education level,brushing frequency,and sex on the random forest model(this model showed higher sensitivity for predicting the risk).A good understanding of the predictors for periodontitis in T2DM patients is important in prevention,early detection of susceptible patients,and intervention to improve periodontal health and enable long-term glycaemic control as observed by Xu et al.展开更多
Alzheimer’s disease(AD)is a major age-related form of dementia with a number of cases exponentially growing,causing enormous social and economic impact on individuals and society.Neuropathological hallmarks of AD,evi...Alzheimer’s disease(AD)is a major age-related form of dementia with a number of cases exponentially growing,causing enormous social and economic impact on individuals and society.Neuropathological hallmarks of AD,evident in postmortem AD brains,include a massive loss of the grey matter in the neocortex,extracellular deposition of amyloid-β(Aβ)in the form of senile plaques and cerebrovascular amyloid angiopathy,and intra-neuronal accumulation of neurofibrillary tangles,formed by hyper-phosphorylated tau protein.展开更多
The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism(MOSH)with emerging evidence on the role of testosterone therapy.We aim to provide an updated and prac...The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism(MOSH)with emerging evidence on the role of testosterone therapy.We aim to provide an updated and practical approach towards its management.We did a comprehensive literature search across MEDLINE(via PubMed),Scopus,and Google Scholar databases using the keywords“MOSH”OR“Obesity-related hypogonadism”OR“Testosterone replacement therapy”OR“Selective estrogen receptor modulator”OR“SERM”OR“Guidelines on male hypogonadism”as well as a manual search of references within the articles.A narrative review based on available evidence,recommendations and their practical implications was done.Although weight loss is the ideal therapeutic strategy for patients with MOSH,achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice.Therefore,androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity.However,there is conflicting evidence for the appropriate use of testosterone replacement therapy(TRT),and it can also be associated with complications.This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH.Before starting testosterone replacement in functional hypogonadism of obesity,it would be desirable to initiate lifestyle modification to ensure weight reduction.TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients.Balancing the risks and benefits of TRT should be considered in every patient before and during longterm management.展开更多
This study comprehensively analyzes the status,characteristics,focal points,and evolving trends of global research on“stroke risk analysis”over the past four years(2020–2023),aiming to provide insights for directin...This study comprehensively analyzes the status,characteristics,focal points,and evolving trends of global research on“stroke risk analysis”over the past four years(2020–2023),aiming to provide insights for directing future research endeavors.By utilizing the Newcastle-Ottawa Scale,63 high-quality research papers were selected and subjected to a systematic literature review.In terms of research methods,stroke risk analysis research has evolved from clinical trials(e.g.,establishing control groups,using authoritative scales)towards statistical and data analysis methods(e.g.,decision tree analysis).Regarding research factors,early studies primarily focused on pathological factors associated with hemorrhagic and ischemic stroke,such as hypertension,hyperlipidemia,and diabetes.Recent research from the past two years indicates a shift towards emerging factors,including temperature conditions,air quality,and Corona Virus Disease 2019(COVID-19).In terms of application domains,stroke research covers a broad range of fields but mainly focuses on exploring risk factors,interventions during diagnosis and treatment stages,and rehabilitation,with clinical diagnosis,treatment,and drug intervention studies being predominant.While the research landscape is becoming increasingly diversified and comprehensive,there remains a need for more comprehensive and in-depth studies on novel topics,as well as integrated applications of research methods,presenting ample opportunities for exploring dependent variables in future stroke.展开更多
文摘BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and urinary infection-20(8.8%)&17(7.5%)with dapagliflozin;9(5.6%)&5(3.13%)with canagliflozin;and 4(5%)&4(5%)with empagliflozin.Diabetic ketoacidosis was observed in 4(1.8%)with dapagliflozin and 1(0.63%)with canagliflozin.CONCLUSION Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c,body weight,and better than those reported in RCTs,with low side effect profiles.A review of large-scale real-world data is needed to inform better clinical practice decision making.
基金financial support from The University of Manchester to cover his PhD tuition fees for him to carry out this workChina National High-end Foreign Experts Recruitment Plan Project (G2023018001L) for partially supporting the work。
文摘Electrochemical production of hydrogen from water requires the development ofelectrocatalysts that are active,stable,and low-cost for water splitting.To address these challenges,researchers are increasingly exploring binder-free electrocatalytic integratedelectrodes (IEs) as an alternative to conventional powder-based electrode preparation methods,for the former is highly desirable to improve the catalytic activity and long-term stability for large-scale applications of electrocatalysts.Herein,we demonstrate a laser-inducedhydrothermal reaction (LIHR) technique to grow NiMoO4nanosheets on nickel foam,which is then calcined under H2/Ar mixed gases to prepare the IE IE-NiMo-LR.This electrode exhibits superior hydrogen evolution reaction performance,requiring overpotentials of 59,116 and143 mV to achieve current densities of 100,500 and 1000 mA·cm-2.During the 350 h chronopotentiometry test at current densities of 100 and 500 m A·cm-2,the overpotentialremains essentially unchanged.In addition,NiFe-layered double hydroxide grown on Ni foam is also fabricated with the same LIHR method and coupled with IE-NiMo-IR to achieve water splitting.This combination exhibits excellent durability under industrial current density.The energy consumption and production efficiency of the LIHR method are systematicallycompared with the conventional hydrothermal method.The LIHR method significantly improves the production rate by over 19 times,while consuming only 27.78%of the total energy required by conventional hydrothermal methods to achieve the same production.
文摘The joining of different light metals through friction stir welding(FSW)is gaining interest as a method to decrease weight and improve fuel efficiency.However,to ensure durability,these welded metals may require surface treatments to protect against corrosion or wear.This study presents a novel approach for the simultaneous delivery of two distinct corrosion inhibitors to Ti-Mg dissimilar PEO treated joints on demand.The research focuses on the synthesis,characterization,and application of cerium@polystyrene(Ce@PS)nanocontainers,which are loaded with 8-hydroxyquinoline(8-HQ)to enhance corrosion protection.The synthesis involves several key steps,including the formation of a cerium-based outer layer around polystyrene nanospheres,the selective removal of the polystyrene core to create a porous structure,and the subsequent loading of the 8-HQ inhibitor.Structural and compositional analyses,conducted using scanning transmission electron microscopy(STEM)and energy-dispersive X-ray spectroscopy(EDS),confirmed the successful incorporation of 8-HQ within the nanocontainers.Additionally,Fourier-transform infrared spectroscopy(FTIR)provided detailed information about the chemical composition of the organic materials throughout the synthesis process.Thermal decomposition analysis verified the successful fabrication and stability of the dual-shell nanocontainers.Corrosion tests on Ti-Mg joints treated with plasma electrolytic oxidation(PEO)coatings and loaded nanocontainers demonstrated sig-nificantly improved corrosion resistance compared to untreated joints.This research highlights the potential of dual-shell nanocontainers,containing both organic and inorganic inhibitors,to offer prolonged corrosion protection,particularly against galvanic corrosion in dissimilar joints.The findings suggest that these synthesized nanocontainers hold promise for various industrial applications,particularly in the context of friction stir welded(FSW)Ti-Mg dissimilar joints,providing valuable insights for the development of advanced materials designed to mitigate corrosion.
基金The authors wish to acknowledge Engineering and Physical Sciences Research Council(EPSRC)UK for the Global Challenges Research Fund(No.EP/R015139/1)Rosetrees Trust UK&Stoneygate Trust UK for the Enterprise Fellowship(Ref:M874).
文摘Polycaprolactone(PCL)scaffolds that are produced through additive manufacturing are one of the most researched bone tissue engineering structures in the field.Due to the intrinsic limitations of PCL,carbon nanomaterials are often investigated to reinforce the PCL scaffolds.Despite several studies that have been conducted on carbon nanomaterials,such as graphene(G)and graphene oxide(GO),certain challenges remain in terms of the precise design of the biological and nonbiological properties of the scaffolds.This paper addresses this limitation by investigating both the nonbiological(element composition,surface,degradation,and thermal and mechanical properties)and biological characteristics of carbon nanomaterial-reinforced PCL scaffolds for bone tissue engineering applications.Results showed that the incorporation of G and GO increased surface properties(reduced modulus and wettability),material crystallinity,crystallization temperature,and degradation rate.However,the variations in compressive modulus,strength,surface hardness,and cell metabolic activity strongly depended on the type of reinforcement.Finally,a series of phenomenological models were developed based on experimental results to describe the variations of scaffold’s weight,fiber diameter,porosity,and mechanical properties as functions of degradation time and carbon nanomaterial concentrations.The results presented in this paper enable the design of three-dimensional(3D)bone scaffolds with tuned properties by adjusting the type and concentration of different functional fillers.
文摘While chronic hyperglycaemia resulting from poorly controlled diabetes mellitus(DM)is a well-known precursor to complications such as diabetic retinopathy,neuropathy(including autonomic neuropathy),and nephropathy,a paradoxical intensification of these complications can rarely occur with aggressive glycemic management resulting in a rapid reduction of glycated haemoglobin.Although,acute onset or worsening of retinopathy and treatment induced neuropathy of diabetes are more common among these complications,rarely other problems such as albuminuria,diabetic kidney disease,Charcot’s neuroarthropathy,gastroparesis,and urinary bladder dysfunction are also encountered.The World Journal of Diabetes recently published a rare case of all these complications,occurring in a young type 1 diabetic female intensely managed during pregnancy,as a case report by Huret et al.It is essential to have a comprehensive understanding of the pathobiology,prevalence,predisposing factors,and management strategies for acute onset,or worsening of microvascular complications when rapid glycemic control is achieved,which serves to alleviate patient morbidity,enhance disease management compliance,and possibly to avoid medico-legal issues around this rare clinical problem.This editorial delves into the dynamics surrounding the acute exacerbation of microvascular complications in poorly controlled DM during rapid glycaemic control.
文摘Childhood-onset obesity has emerged as a major public healthcare challenge across the globe,fueled by an obesogenic environment and influenced by both genetic and epigenetic predispositions.This has led to an exponential rise in the incidence of type 2 diabetes mellitus in children and adolescents.The looming wave of diabetes-related complications in early adulthood is anticipated to strain the healthcare budgets in most countries.Unless there is a collective global effort to curb the devastation caused by the situation,the impact is poised to be pro-found.A multifaceted research effort,governmental legislation,and effective social action are crucial in attaining this goal.This article delves into the current epidemiological landscape,explores evidence concerning potential risks and consequences,delves into the pathobiology of childhood obesity,and discusses the latest evidence-based management strategies for diabesity.
文摘“Last scene of all that ends this strange,eventful history,is second childishness and mere oblivion.I am sans teeth,sans eyes,sans taste,sans everything.”William Shakespeare‘As You Like It'Act 2,Sc.7,l.139Aging of the human brain is characterized by a progressive decline of its functional capacity;this decline however varies widely,and cognitive longevity differs substantially between individuals.
文摘BACKGROUND Diabesity(diabetes as a consequence of obesity)has emerged as a huge healthcare challenge across the globe due to the obesity pandemic.Judicious use of antidiabetic medications including semaglutide is important for optimal management of diabesity as proven by multiple randomized controlled trials.However,more real-world data is needed to further improve the clinical practice.AIM To study the real-world benefits and side effects of using semaglutide to manage patients with diabesity.METHODS We evaluated the efficacy and safety of semaglutide use in managing patients with diabesity in a large academic hospital in the United States.Several parameters were analyzed including demographic information,the data on improvement of glycated hemoglobin(HbA1c),body weight reduction and insulin dose adjustments at 6 and 12 months,as well as at the latest follow up period.The data was obtained from the electronic patient records between January 2019 to May 2023.RESULTS 106 patients(56 males)with type 2 diabetes mellitus(T2DM),mean age 60.8±11.2 years,mean durations of T2DM 12.4±7.2 years and mean semaglutide treatment for 2.6±1.1 years were included.Semaglutide treatment was associated with significant improvement in diabesity outcomes such as mean weight reductions from baseline 110.4±24.6 kg to 99.9±24.9 kg at 12 months and 96.8±22.9 kg at latest follow up and HbA1c improvement from baseline of 82±21 mmol/mol to 67±20 at 12 months and 71±23 mmol/mol at the latest follow up.An insulin dose reduction from mean baseline of 95±74 units to 76.5±56.2 units was also observed at the latest follow up.Side effects were mild and mainly gastrointestinal like bloating and nausea improving with prolonged use of semaglutide.CONCLUSION Semaglutide treatment is associated with significant improvement in diabesity outcomes such as reduction in body weight,HbA1c and insulin doses without major adverse effects.Reviews of largescale real-world data are expected to inform better clinical practice decision making to improve the care of patients with diabesity.
文摘Purpose: Low back pain (LBP), Gonarthrosis, knee, and Carpal Tunnel Syndrome have been regarded as affecting more than three-quarters’ of individuals in their lifetime. The aim of this study was conducted to determine and compare the effects of topical patients with sand compared with control related to Gonarthrosis, LBP, knee, and Carpal Tunnel Syndrome pain. Methods: This is a prospective case and control designed study based on 101 pain case with Sand and 101 control subjects. The interventional groups in addition either topical sand or without sand 2 months after the intervention were assessed. We assessed tolerability of an established pain perception scale by the Numeric Rating Scale (NRS). Categorical variables were compared using the chi-square (χ<sup>2</sup>) test. The paired t-test was used to compare the two groups before and after the intervention. One-way analysis of variance (ANOVA) was employed for comparison of several group means. Results: The study was based on 202 patients, 41 males (20.3%) and 161 females (79.7%). There were statistically significant differences between subjects with and without Sand in term of Gonarthrosis, Rheumatoid Arthritis LBP, knee, and Carpal Tunnel Syndrome pain (p = 0.033). Majority of patients were over age 55 years old (55%) and females 78 (77.2%). The mean score of total pain experience before and after the intervention was 7.41 ± 1.1 for black sand, and 4.24 ± 2.38 for without sand as control group. The mean scores of these 5 groups were highly significant before and after the intervention (p There was statistically highly significant in regarding subjects with Sand as compared with those before Sand after treatment mean score specifically with gonarthrosis before pain 7.23 ± 1.86 vs after treatment 4.54 ± 2.18 p < 0.001;rheumatoid arthritis before 8.28 ± 1.48 vs after treatment 4.80 ± 3.71 p < 0.001;Low Back Pain before 8.42 ± 1.83 vs after treatment 4.37 ± 1.52 p < 0.001;knee pain before 8.93 ± 0.89 vs after treatment 4.24 ± 0.24 p < 0.001;Carpal Tunnel Syndrome before 7.664 ± 1.04 vs after treatment 4.26 ± 1.03 p Conclusion: The current study has revealed that the topical treatments with sand could have a significant effect on the perception of pain compared to those in the control group with respect of gonarthrosis, rheumatoid arthritis, LBP, knee, and Carpal Tunnel Syndrome pain .
基金financially supported by the National Natural Science Foundation of China (Nos.52004272,52122404,52061135111,52174092,and 52074259)the Natural Science Foundation of Jiangsu Province,China (Nos.BK20200660 and BK20220157)+1 种基金the Xuzhou Science and Technology Project,China (Nos.KC22005 and KC21033)the Open Foundation of Shandong Key Laboratory of Mining Disaster Prevention and Control,China (No.SMDPC 202104)。
文摘The great challenge of cemented tailings backfill(CTB)is difficult simultaneously maintaining its excellent mechanical properties and low cost.Fly ash(FA)can potentially address this problem and further replace cement in favor of low carbon development.However,its mechanism on CTB with low cement dosage and low Ca system remains unclear.Consequently,this study conducted uniaxial compression,Xray diffraction(XRD),and scanning electron microscopy(SEM)-energy dispersive spectrometer(EDS)tests to investigate the effect of FA dosage on the mechanical property and microstructure of CTB.A molecular model of FA-CSH was constructed to reproduce the molecular structure evolution of CTB with FA based on the test results.The influences of FA dosage and calcium/silica molar ratio(Ca/Si ratio)on the matrix strength and failure model were analyzed to reveal the mechanism of FA on calcium silicate hydrated(C-S-H).The results show that the strength of CTB increases initially and then decreases with FA dosage,and the FA supplement leads to a decrease in Ca(OH)_(2) diffraction intensity and Ca/Si ratio around the FA particles.XRD and SEM-EDS findings show that the Ca/Si ratio of C-S-H decreases with the progression of hydration.The FA-CSH model indicates that FA can reinforce the silica chain of C-S-H to increase the matrix strength.However,this enhancement is weakened by supplementing excessive FA dosage.In addition,the hydrogen bonds among water molecules deteriorate,reducing the matrix strength.A low Ca/Si ratio results in an increase in water molecules and a decrease in the ionic bonds combined with Ca^(2+).The hydrogen bonds among water molecules cannot withstand high stresses,resulting in a reduction in strength.The water absorption of the FA-CSH model is negatively correlated with the FA dosage and Ca/Si ratio.The use of optimal FA dosage and Ca/Si ratio leads to suitable water absorption,which further affects the failure mode of FA-CSH.
基金funding from European Regional Development Fund(project No 13.1.1-LMT-K-718-05-0005)under grant agreement with the Research Council of Lithuania(LMTLT)。
文摘The blood-brain barrier(BBB)(discovered and defined by Max Lewandowsky and Lina Stern,and not,as it is universally,and yet erroneously believed,by Paul Ehrlich(Verkhratsky and Pivoriunas,2023))that separates the nervous system from the circulation is evolutionarily conserved from arthropods to man.The primeval BBB of the invertebrates and some early vertebrates was made solely by glial cells and secured(in invertebrates)by septate junctions.
基金the financial support from the Hubei Provincial Natural Science Foundation of China(No.2020CFB295)the National Natural Science Foundation of China(No.52001128)+1 种基金the Innovative Foundation of Huazhong University of Science and Technology(No.2021JYCXJJ023)the Innovation and Talent Recruitment Base of New Energy Chemistry and Device(No.B21003)。
文摘In the present study,the distribution of Ag in the coating formed on Mg-Ag alloy by plasma electrolytic oxidation(PEO)and its ionic release kinetics when exposed to a 0.9 wt.%Na Cl solution at 37℃have been investigated.Both metallic Ag and Ag oxide particles with~5 to~40 nm in diameters were observed in the PEO coating.Further,an Ag-enriched layer of~20 nm in thickness at the substrate/coating interface was also observed.The PEO coating on the Mg-Ag alloy not only increases its corrosion resistance with the corrosion current density decreasing by up to 3 orders of magnitude from 8.04×10^(-3)to 4.03×10^(-6)A/cm^(2),but also controls the release of Ag+to the level that is sufficient for anti-infective efficacy without causing cytotoxicity to mammal cells.
基金support by the National Key R&D Program(No.2017YFA0402603)the Inter-government cooperation Flagship program(Grant No.2018YFE0120800)+2 种基金the National Natural Science Foundation of China(NSFC,Grant Nos.11773034 and 11633004)the Chinese Academy of Sciences(CAS)Strategic Priority Research Program XDA15020200the CAS Interdisciplinary Innovation Team(JCTD-2019-05)。
文摘We combine the kinematics of 159 globular clusters(GCs) provided by the Gaia Early Data Release 3(EDR3) with other observational data to classify the GCs,and to estimate the mass of the Milky Way(MW).We use the agemetallicity relation,integrals of motion,action space and the GC orbits to identify the GCs as either formed in situ(Bulge and Disk) or ex situ(via accretion).We find that 45.3% have formed in situ,while 38.4% may be related to known merger events:Gaia-Sausage-Enceladus,the Sagittarius dwarf galaxy,the Helmi streams,the Sequoia galaxy and the Kraken galaxy.We also further identify three new sub-structures associated with the Gaia-Sausage-Enceladus.The remaining 16.3% of GCs are unrelated to the known mergers and thought to be from small accretion events.We select 46 GCs which have radii 8.0 <r<37.3 kpc and obtain the anisotropy parameter β=0.315_(-0.049)^(+0.055),which is lower than the recent result using the sample of GCs in Gaia Data Release 2,but still in agreement with it by considering the error bar.By using the same sample,we obtain the MW mass inside the outermost GC as M(<37.3 kpc)=0.423_(-0.02)^(+0.02)×10^(12)M_(⊙),and the corresponding M_(200)=1.11_(-0.18)^(+0.25)×10^(12)M_(⊙).The estimated mass is consistent with the results in many recent studies.We also find that the estimated β and mass depend on the selected sample of GCs.However,it is difficult to determine whether a GC fully traces the potential of the MW.
文摘Various studies have suggested several environmental,pharmacological,medical,and optical interventions and some are in use but their efficacy in myopia control may be transient,and the cellular,molecular,and biochemical mechanisms involved unclear.Daylight exposure is currently regarded as an effective and enduring strategy in the control of myopia development and progression.However,the mechanism behind the effect of outdoor exposure and its association with genetic predisposition and other relatively more significant environmental factors on myopia is still a conundrum.This review focuses on survey-based and intervention-based studies carried out to propose a mechanism that accounts for myopia development and important for its control.
文摘The diagnosis and management of thyroid cancer is fraught with challenges despite the advent of innovative diagnostic,surgical,and chemotherapeutic modalities.Challenges like inaccuracy in prognostication,uncertainty in cytopathological diagnosis,trouble in differentiating follicular neoplasms,intra-observer and inter-observer variability on ultrasound imaging preclude personalised treatment in thyroid cancer.Artificial intelligence(AI)is bringing a paradigm shift to the healthcare,powered by quick advancement of the analytic techniques.Several recent studies have shown remarkable progress in thyroid cancer diagnostics based on AI-assisted algorithms.Application of AI techniques in thyroid ultrasonography and cytopathology have shown remarkable improvement in sensitivity and specificity over the traditional diagnostic modalities.AI has also been explored in the development of treatment algorithms for indeterminate nodules and for prognostication in the patients with thyroid cancer.The benefits of high repeatability and straightforward implementation of AI in the management of thyroid cancer suggest that it holds promise for clinical application.Limited clinical experience and lack of prospective validation studies remain the biggest drawbacks.Developing verified and trustworthy algorithms after extensive testing and validation using prospective,multi-centre trials is crucial for the future use of AI in the pipeline of precision medicine in the management of thyroid cancer.
文摘Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy(DPN),such as nerve conduction studies,there is still a knowledge gap about the pathophysiology,and thus limited available in-terventions for symptom control and curtailing disease progression.The pharma-cologic aspect of management is mainly centred on pain control,however,there are several important aspects of DPN such as loss of vibration sense,pressure sense,and proprioception which are associated with risks to lower limb health,which pharmacotherapy does not address.Furthermore,published evidence suggests non-pharmacologic interventions such as glycaemic control through dietary modification and exercise need to be combined with other measures such as psychotherapy,to reach a desired,however modest effect.Acupuncture is emerging as an important treatment modality for several chronic medical conditions including neuropathic and other pain syndromes.In their study published in the World Journal of Diabetes on the potential of acupuncture to reduce DPN symptoms and enhance nerve conduction parameters,Hoerder et al have been able to demonstrate that acupuncture improves sensory function and that this effect is likely sustained two months after treatment cessation.Although previous studies also support these findings,larger multi-center randomized control trials including a sham-controlled arm accounting for a placebo effect are required.Overall,given the satisfactory safety profile and the positive results found in these studies,it is likely that acupuncture may become an important aspect of the repertoire of effective DPN management.
文摘The bidirectional association between type 2 diabetes mellitus(T2DM)and periodontitis is now well established,resulting in periodontal disease being considered as the 6th major complication of diabetes mellitus(DM)after cardiovascular disease,eye disease,neuropathy,nephropathy,and peripheral vascular disease.DM can worsen the virulence and invasiveness of pathogenic oral microbial flora aggravating the local inflammation and infection in those with periodontal disease.On the other hand,the chemical and immunological mediators released into the circulation as part of periodontal inflammation worsen the systemic insulin resistance with worsening of T2DM.Periodontitis if undiagnosed or left untreated can also result in eventual tooth loss.A study by Xu et al in the World Journal of Diabetes examined the predictive factors associated with periodontitis in Chinese patients with T2DM.The prevalence of periodontitis was found to be 75.7%in this study.Based on logistic regression analysis,the predictive factors for higher risk were low tooth brushing frequency[odds ratio(OR)=4.3],high triglycerides(TG;OR=3.31),high total cholesterol(TC;OR=2.87),higher glycated hemoglobin(HbA1c;OR=2.55),and higher age(OR=1.05)while higher education level was protective(OR=0.53).However,the most influential variables were HbA1c followed by age,TC,TG,low education level,brushing frequency,and sex on the random forest model(this model showed higher sensitivity for predicting the risk).A good understanding of the predictors for periodontitis in T2DM patients is important in prevention,early detection of susceptible patients,and intervention to improve periodontal health and enable long-term glycaemic control as observed by Xu et al.
基金the following financial support grant FAR-2019 to DL from The Universita del Piemonte Orientale。
文摘Alzheimer’s disease(AD)is a major age-related form of dementia with a number of cases exponentially growing,causing enormous social and economic impact on individuals and society.Neuropathological hallmarks of AD,evident in postmortem AD brains,include a massive loss of the grey matter in the neocortex,extracellular deposition of amyloid-β(Aβ)in the form of senile plaques and cerebrovascular amyloid angiopathy,and intra-neuronal accumulation of neurofibrillary tangles,formed by hyper-phosphorylated tau protein.
文摘The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism(MOSH)with emerging evidence on the role of testosterone therapy.We aim to provide an updated and practical approach towards its management.We did a comprehensive literature search across MEDLINE(via PubMed),Scopus,and Google Scholar databases using the keywords“MOSH”OR“Obesity-related hypogonadism”OR“Testosterone replacement therapy”OR“Selective estrogen receptor modulator”OR“SERM”OR“Guidelines on male hypogonadism”as well as a manual search of references within the articles.A narrative review based on available evidence,recommendations and their practical implications was done.Although weight loss is the ideal therapeutic strategy for patients with MOSH,achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice.Therefore,androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity.However,there is conflicting evidence for the appropriate use of testosterone replacement therapy(TRT),and it can also be associated with complications.This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH.Before starting testosterone replacement in functional hypogonadism of obesity,it would be desirable to initiate lifestyle modification to ensure weight reduction.TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients.Balancing the risks and benefits of TRT should be considered in every patient before and during longterm management.
基金funded by 2020 National Social Science Fund(grant number:20BTQ073)The Special Fund for the“Community Medicine and Health Management Research Project”of the Shanghai Society of Integrated Traditional Chinese and Western Medicine(grant number:2023SQ19).
文摘This study comprehensively analyzes the status,characteristics,focal points,and evolving trends of global research on“stroke risk analysis”over the past four years(2020–2023),aiming to provide insights for directing future research endeavors.By utilizing the Newcastle-Ottawa Scale,63 high-quality research papers were selected and subjected to a systematic literature review.In terms of research methods,stroke risk analysis research has evolved from clinical trials(e.g.,establishing control groups,using authoritative scales)towards statistical and data analysis methods(e.g.,decision tree analysis).Regarding research factors,early studies primarily focused on pathological factors associated with hemorrhagic and ischemic stroke,such as hypertension,hyperlipidemia,and diabetes.Recent research from the past two years indicates a shift towards emerging factors,including temperature conditions,air quality,and Corona Virus Disease 2019(COVID-19).In terms of application domains,stroke research covers a broad range of fields but mainly focuses on exploring risk factors,interventions during diagnosis and treatment stages,and rehabilitation,with clinical diagnosis,treatment,and drug intervention studies being predominant.While the research landscape is becoming increasingly diversified and comprehensive,there remains a need for more comprehensive and in-depth studies on novel topics,as well as integrated applications of research methods,presenting ample opportunities for exploring dependent variables in future stroke.
