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JACC. Advances Apr 2024Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality among adults with type 2 diabetes. Currently, available MACE prediction models...
BACKGROUND
Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality among adults with type 2 diabetes. Currently, available MACE prediction models have important limitations, including reliance on data that may not be routinely available, narrow focus on primary prevention, limited patient populations, and longtime horizons for risk prediction.
OBJECTIVES
The purpose of this study was to derive and internally validate a claims-based prediction model for 1-year risk of MACE in type 2 diabetes.
METHODS
Using medical and pharmacy claims for adults with type 2 diabetes enrolled in commercial, Medicare Advantage, and Medicare fee-for-service plans between 2014 and 2021, we derived and internally validated the annualized claims-based MACE estimator (ACME) model to predict the risk of MACE (nonfatal acute myocardial infarction, nonfatal stroke, and all-cause mortality). The Cox proportional hazards model was composed of 30 covariates, including patient age, sex, comorbidities, and medications.
RESULTS
The study cohort comprised 6,623,526 adults with type 2 diabetes, mean age 68.1 ± 10.6 years, 49.8% women, and 73.0% Non-Hispanic White. ACME had a concordance index of 0.74 (validation index range: 0.739-0.741). The predicted 1-year risk of the study cohort ranged from 0.4% to 99.9%, with a median risk of 3.4% (IQR: 2.3%-6.5%).
CONCLUSIONS
ACME was derived in a large usual care population, relies on routinely available data, and estimates short-term MACE risk. It can support population risk stratification at the health system and payer levels, participant identification for decentralized clinical trials of cardiovascular disease, and risk-stratified observational studies using real-world data.
PubMed: 38939660
DOI: 10.1016/j.jacadv.2024.100852 -
Frontiers in Public Health 2024Childhood choking is a global health concern that mainly affects children under the age of 5 years. The parent's and caretaker's responsibility is critical in the... (Observational Study)
Observational Study
BACKGROUND AND AIM
Childhood choking is a global health concern that mainly affects children under the age of 5 years. The parent's and caretaker's responsibility is critical in the children's lives and can potentially influence the result of at-home injuries such as choking. We aimed to assess the knowledge, attitude, practice, and associated factors of first aid management toward choking hazards among Saudi adults from the Eastern Province.
METHODS
The present analytical study was carried out among 390 Saudi adults attending different primary health centers in the Eastern Province of Saudi Arabia. We used a standard and validated data research topic tool to assess knowledge, attitude, and practice. Spearman's correlation was applied to determine the correlation between each section, while binomial logistic regression analysis was applied to identify the associated factors.
RESULTS
We observed knowledge, attitude, and practice scores in 43.3, 38.9, and 36.4% of the participants, respectively. Furthermore, positive correlations between knowledge and attitude (rho = 0.42, = 0.001), between knowledge and practice (rho = 0.57, = 0.001), and between attitude and practice (rho = 0.41, = 0.001) were revealed in our survey. The knowledge of the participants was significantly higher with the age group of 30-40 years [adjusted odds ratio (AOR) = 3.67 (1.94-4.65), = 0.001] and participants who received training in first aid management [AOR = 1.64 (1.12-2.49), = 0.037]. This study found that males [AOR = 0.36 (0.21-0.63), = 0.001] and those working in the private sector [AOR = 0.61 (0.31-0.87), = 0.018] had significantly lower attitudes.
CONCLUSION
Our results underscore the importance of continuous health education initiatives and training courses at primary health care centers regarding first aid management of choking hazards to improve awareness and practices. Furthermore, we recommend prospective multicenter studies to address region-specific knowledge gaps.
Topics: Humans; Saudi Arabia; Male; Health Knowledge, Attitudes, Practice; Female; Adult; First Aid; Surveys and Questionnaires; Airway Obstruction; Middle Aged; Young Adult
PubMed: 38939560
DOI: 10.3389/fpubh.2024.1376033 -
Chemical Science Jun 2024Developing electrocatalysts with high activity toward the hydrogen evolution reaction (HER) is a prerequisite for hydrogen fuel generation and sustainable development,...
Developing electrocatalysts with high activity toward the hydrogen evolution reaction (HER) is a prerequisite for hydrogen fuel generation and sustainable development, but current Pt-based catalysts usually suffer from high cost and unsatisfactory performance in non-acidic media. In this work, we report an environmentally friendly and pyrolysis-free synthesis strategy to prepare an efficient catalyst, CNT-NPA-PtRu, with Pt single-atom engineered sub-nanometric Ru clusters anchored at phytic acid-modified carbon nanotubes for electrochemical HER at all pH conditions. The electronic structure of active sub-nanometric Ru clusters was optimized, which further enhanced the HER activity. The synthesized CNT-NPA-PtRu catalyst presents superior performance, reaching the current density of 10 mA cm with only 18.3, 18.7 and 15 mV overpotential in alkaline, acidic and neutral electrolyte, respectively. Experimental results and theoretical calculations reveal that the single Pt atom on the sub-nanometric Ru cluster surface could modulate the electronic structure of Ru and subsequently optimize the adsorption of reaction intermediates, thus promoting HER performance. These findings underscore the importance of engineering the electronic structure of sub-nanometric clusters and offer an effective approach for the generation of high-performance electrocatalysts for HER.
PubMed: 38939150
DOI: 10.1039/d4sc00182f -
Practical Laboratory Medicine May 2024Most glycated hemoglobin A1c (HbA1c) analytical reagents used were obtained from the analyzer's manufacturer. However, clinical laboratories need more choices for HbA1c...
BACKGROUND
Most glycated hemoglobin A1c (HbA1c) analytical reagents used were obtained from the analyzer's manufacturer. However, clinical laboratories need more choices for HbA1c analytical reagents to overcome the limitations of dedicated reagents for special analyzers. We developed new mobile phase buffers as HbA1c diagnostic reagents and evaluated their analytical performance for the HbA1c assay.
METHODS
Different mobile phase buffers used as HbA1c diagnostic reagents were prepared using different concentrations of sodium salts. According to the Clinical and Laboratory Standards Institute (CLSI) recommendation guidelines, the analytical performances of the newly developed mobile phase buffers were evaluated on an ARKRAY HA-8160 Analyzer. Both quality controls and clinical blood samples were used in these experiments. To assess the quality of the newly developed mobile phase buffers, precision, accuracy, linearity, carryover, interference, bias, correlation with commercial reagents, and stability were analyzed.
RESULTS
The s of intra-assay precision and interassay precision of quality control and clinical.There were fewer than 1.00 % blood sample assays using the newly developed mobile phase buffer. The of accuracy were less than 1.00 %. Linearity: R = 0.9998 in the concentration range of 4.40%-17.30 %. Carryover: 0.00 %. Reagent comparison revealed that the Pearson regression equation was Y = 0.9884x+0.05692 (R = 0.9977), and the Bland-Altman mean difference was -0.02650 % (CI: -0.2121 %-0.1591 %) between the two analytical reagents. Stability was also acceptable within 12 months. This mobile phase buffer showed good anti-interference ability.
CONCLUSION
The newly developed mobile phase buffers demonstrated good analytical performance and were suitable for clinical HbA1c assays on an ARKRAY HA-8160 Analyzer.
PubMed: 38939102
DOI: 10.1016/j.plabm.2024.e00414 -
Przeglad Gastroenterologiczny 2024Because not all liver dysfunction patients are suitable for transplantations and there is a shortage of grafts, liver support therapies have gained interest. In this... (Review)
Review
Safety and efficacy of Single-Pass Albumin Dialysis (SPAD), Prometheus, and Molecular Adsorbent Recycling System (MARS) liver haemodialysis vs. Standard Medical Therapy (SMT): meta-analysis and systematic review.
INTRODUCTION
Because not all liver dysfunction patients are suitable for transplantations and there is a shortage of grafts, liver support therapies have gained interest. In this regard, extracorporeal albumin dialysis devices such as single-pass albumin dialysis (SPAD), Prometheus, and molecular adsorbent recycling system (MARS) have been valuable in supplementing standard medical therapy (SMT). However, the efficacy and safety of these devices is often questioned.Aim: We performed a systematic review to summarize the efficacy and safety of MARS, SPAD, and Prometheus as supportive treatments for liver dysfunction.
MATERIAL AND METHODS
PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar electronic databases were extensively searched for all randomized trials published in English. In addition, meta-analytic analyses were performed with Review Manager software, and Cochrane's risk of bias tool embedded in this software was used for bias assessment.
RESULTS
Twelve trials including a total of 653 patients were eligible for inclusion. Subgroup analyses of data from these trials revealed that MARS and Prometheus were associated with significant removal of bilirubin (MD = -5.14 mg/dl; 95% CI: -7.26 - -3.02; < 0.00001 and MD = -8.11 mg/dl; 95% CI: -12.40 - -3.82; = 0.0002, respectively) but not bile acids and ammonia when compared to SMT. Furthermore, MARS was as effective as Prometheus and SPAD in the reduction of bilirubin (MD = 2.98 mg/dl; 95% CI: -4.26 - 10.22; = 0.42 and MD = 0.67 mg/dl; 95% CI: -2.22 - 3.56; = 0.65), bile acids (MD = -17.06 µmol/l; 95% CI: -64.33 - 30.20; = 0.48 and MD = 16.21 µmol/l; 95% CI: -17.26 - 49.68; = 0.34), and ammonia (MD = 26 µmol/l; 95% CI: -12.44 - 64.44; = 0.18). In addition, MARS had a considerable effect in improving hepatic encephalopathy (HE) (RR = 1.54; 95% CI: 1.15-2.05; = 0.004). However, neither MARS nor Prometheus had a mortality benefit compared to SMTRR (0.86; 95% CI: 0.71-1.03; = 0.11 and RR = 0.87; 95% CI: 0.66-1.14; = 0.31, respectively).
CONCLUSIONS
MARS, SPAD, and Prometheus, as liver support therapies, are equally effective in reducing albumin-bound and water-soluble substances. Moreover, MARS is associated with HE improvement. However, none of the therapies was associated with a significant reduction in mortality or adverse events.
PubMed: 38939063
DOI: 10.5114/pg.2024.139297 -
Kidney Medicine Jul 2024In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the United States federal government expanded originating telemedicine sites to include outpatient...
RATIONALE & OBJECTIVE
In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the United States federal government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology practitioners across the United States could replace face-to-face visits with telemedicine for patients receiving in-center hemodialysis. This study describes patients' perspectives on the use of telemedicine during in-center hemodialysis.
STUDY DESIGN
A qualitative study.
SETTING & PARTICIPANTS
Thirty-two patients from underserved populations (older, less educated, unemployed, persons of color) receiving in-center hemodialysis who used telemedicine with their nephrologist during the COVID-19 pandemic.
ANALYTICAL APPROACH
Telephone semistructured interviews were conducted in English or Spanish. Transcripts were thematically analyzed.
RESULTS
We identified 6 themes with subthemes: adapting to telemedicine (gaining familiarity and confidence, overcoming and resolving technical difficulties, and relying on staff for communication); ensuring availability of the physician (enabling an immediate response to urgent medical needs, providing peace of mind, addressing patient needs adequately, and enhanced attention and contact from physicians); safeguarding against infection (limiting COVID-19 exposures and decreasing use); straining communication and physical interactions (loss of personalized touch, limited physical examination, and unable to reapproach physicians about forgotten issues); maintaining privacy (enhancing privacy and projecting voice enables others to hear); and supporting confidence in telemedicine (requiring established rapport with physicians, clinical stabilty of health, and ability to have in-person visits when necessary).
LIMITATIONS
Interviews were conducted later in the pandemic when some nephrology care providers were using telemedicine infrequently.
CONCLUSIONS
Patients receiving in-center hemodialysis adapted to telemedicine visits by their nephrologists in the context of the COVID-19 pandemic and observed its benefits. However, further considerations regarding communication, privacy, and physical assessments are necessary. Integrating telemedicine into future in-center hemodialysis care using a hybrid approach could potentially build trust, optimize communication, and augment care.
PubMed: 38938646
DOI: 10.1016/j.xkme.2024.100848 -
Frontiers in Plant Science 2024Global warming has led to increased environmental stresses on plants, notably drought. This affects plant distribution and species adaptability, with some medicinal...
INTRODUCTION
Global warming has led to increased environmental stresses on plants, notably drought. This affects plant distribution and species adaptability, with some medicinal plants showing enhanced drought tolerance and increased medicinal components. In this pioneering study, we delve into the intricate tapestry of , a medicinal plant renowned for its resilience in arid environments. By fusing a rich historical narrative with cutting-edge analytical methodologies, this research endeavors to demystify the plant's intricate response to drought stress, illuminating its profound implications for medicinal valorization.
METHODS
The methodology includes a comprehensive textual research and resource investigation of , regionalization studies, field sample distribution analysis, transcriptome and metabolome profiling, rhizosphere soil microbiome analysis, and drought stress experiments. Advanced computational tools like ArcGIS, MaxEnt, and various bioinformatics software were utilized for data analysis and modeling.
RESULTS
The study identified significant genetic variations among samples from different regions, correlating with environmental factors, particularly precipitation during the warmest quarter (BIO18). Metabolomic analysis revealed marked differences in metabolite profiles, including shikonin content, which is crucial for the plant's medicinal properties. Soil microbial community analysis showed variations that could impact plant metabolism and stress response. Drought stress experiments demonstrated 's resilience and its ability to modulate metabolic pathways to enhance drought tolerance.
DISCUSSION
The findings underscore the complex interplay between genetic makeup, environmental factors, and microbial communities in shaping 's adaptability and medicinal value. The study provides insights into how drought stress influences the synthesis of active compounds and suggests that moderate stress could enhance the plant's medicinal properties. Predictive modeling indicates future suitable growth areas for , aiding in resource management and conservation efforts. The research contributes to the sustainable development of medicinal resources and offers strategies for improving the cultivation of .
PubMed: 38938629
DOI: 10.3389/fpls.2024.1395046 -
Frontiers in Immunology 2024TRIM21 is a pivotal effector in the immune system, orchestrating antibody-mediated responses and modulating immune signaling. In this comprehensive study, we focus on...
TRIM21 is a pivotal effector in the immune system, orchestrating antibody-mediated responses and modulating immune signaling. In this comprehensive study, we focus on the interaction of TRIM21 with Fc engineered antibodies and subsequent implications for viral neutralization. Through a series of analytical techniques, including biosensor assays, mass photometry, and electron microscopy, along with structure predictions, we unravel the intricate mechanisms governing the interplay between TRIM21 and antibodies. Our investigations reveal that the TRIM21 capacity to recognize, bind, and facilitate the proteasomal degradation of antibody-coated viruses is critically dependent on the affinity and avidity interplay of its interactions with antibody Fc regions. We suggest a novel binding mechanism, where TRIM21 binding to one Fc site results in the detachment of PRYSPRY from the coiled-coil domain, enhancing mobility due to its flexible linker, thereby facilitating the engagement of the second site, resulting in avidity due to bivalent engagement. These findings shed light on the dual role of TRIM21 in antiviral immunity, both in recognizing and directing viruses for intracellular degradation, and demonstrate its potential for therapeutic exploitation. The study advances our understanding of intracellular immune responses and opens new avenues for the development of antiviral strategies and innovation in tailored effector functions designed to leverage TRIM21s unique binding mode.
Topics: Humans; Ribonucleoproteins; Protein Binding; Antibodies, Neutralizing; Immunoglobulin Fc Fragments; Protein Engineering; Antibodies, Viral; Antibody Affinity; Animals
PubMed: 38938560
DOI: 10.3389/fimmu.2024.1401471 -
RSC Advances Jun 2024In this study, a novel environmentally friendly route was explored for the synthesis of a tin-doped titanium dioxide/calcium oxide (Sn-TiO/CaO) composite using eggshell...
In this study, a novel environmentally friendly route was explored for the synthesis of a tin-doped titanium dioxide/calcium oxide (Sn-TiO/CaO) composite using eggshell as a ternary photocatalyst. The composite was prepared a simple hydrothermal method, resulting in a unique material with potential applications in photocatalysis. The prepared photocatalysts were characterized by X-ray diffraction, Fourier transform infrared spectroscopy, UV-vis/diffuse reflectance spectroscopy, scanning electron microscopy, X-ray fluorescence, and the Brunauer-Emmett-Teller techniques. At the same time, the Sn-TiO/CaO composite shows excellent degradation activity for toxic dyes. The degradation efficiencies for alizarin red, bromophenol blue, methylene blue, malachite green, and methyl red are 68.38%, 62.39%, 76.81%, 86.93%, and 17.52%, respectively, under ultraviolet light irradiation for 35 min at pH = 3. In addition, the best photocatalytic degradation efficiency for zero charge (pH 7) and basic pH is for AR 98.21% and 68.38%, MR 33.01% and 17.52%, BPB 73.17% and 17.52%, MB 72.32% and 76.81%, and MG 85.59% and 86.93%, respectively, under UV light irradiation for 35 min. The increase in photocatalytic activity of the ternary photocatalyst is accredited to the enhancement of electron-hole pair separation. Simultaneous photodegradation and photoreduction of organic dyes show that ternary photocatalysts could be used in real wastewater applications.
PubMed: 38938525
DOI: 10.1039/d4ra03641g -
Frontiers in Endocrinology 2024This study aimed to evaluate the relationship between systemic immune-inflammation index (SII) and sex hormones in children and adolescents aged 6-19 years.
OBJECTIVES
This study aimed to evaluate the relationship between systemic immune-inflammation index (SII) and sex hormones in children and adolescents aged 6-19 years.
METHODS
Data were obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2016. Inclusion criteria comprised subjects aged 6-19 years with complete data on both SII and sex hormones. We employed weighted multiple regression analysis and subgroup analytical methods to independently estimate the relationship between SII and sex hormones.
RESULTS
In this study, a total of 3767 participants were included, with an average age of 12.32 ± 3.95 years. Males constituted 50.54%, and females 49.46%. Among males, a statistically significant negative correlation emerged between SII and sex hormone-binding globulin (SHBG). Similarly, in the female population, SII exhibited a statistically significant negative correlation with total testosterone (TT), SHBG, and the Ratio of TT to estradiol, while maintaining a positive correlation with free androgen index (FAI). Subgroup analysis underscored variances in the association between sex hormones and SII within cohorts distinguished by pubertal status or different body mass index (BMI). In addition, the relationship between SII and estradiol exhibited nonlinearity. Employing a two-segment linear regression model, we identified an inverted U-shaped association between SII and estradiol, with an inflection point of 748.09 (1000cell/ml).
CONCLUSION
Our findings suggest that SII may be an independent risk factor for changes in sex hormones in both male and female children and adolescents. More prospective and experimental studies should be conducted to validate our results and elucidate the underlying molecular pathways.
Topics: Humans; Adolescent; Female; Male; Child; Gonadal Steroid Hormones; Inflammation; Young Adult; Sex Hormone-Binding Globulin; Nutrition Surveys; Cross-Sectional Studies; Body Mass Index; Testosterone; Estradiol; Immunity
PubMed: 38938517
DOI: 10.3389/fendo.2024.1355738