Minimum Duration Research Articles

Evaluating Electrochemical Marker for Udavarta (Slow Transit Constipation) and Risk of Cardiovascular Events: A Cross-Sectional Study

Abstract The known risk factors for cardiovascular diseases (CVDs) are diabetes, obesity, unhealthy diet, lack of exercise, smoking, and excessive use of alcohol. The 10-year cardiovascular risk factor prevalence of hypertension, obesity, and diabetes mellitus is 55.8%, 14.4%, and 9.8%, respectively. Besides these known risk factors, other potential but less searched risk factors also need to be explored for better prevention of CVDs. To evaluate the association between Udavarta (STC), changes in lead III of ECG, and heart disease score to demonstrate the earliest pathological changes in the heart. A cross-sectional observational study using a survey method to collect data from November 11, 2021 to January 5, 2022. The Udavarta symptom score (USS) is associated with ECG changes in lead III (P > 0.0098). The USS shows an association with the Hrudroga (heart disease) symptom score: relative risk 1.83 (95% CI: 1.20–3.1), odds ratio 5.65 (95% CI: 1.06–30), and P > 0.0385. Udavarta (slow transit constipation) shows a strong association with heart disease symptom score and lead III ECG changes, and clinically is an equally contributing risk factor for the development of CVDs compared to the other risk factors. This study reports that the minimum duration of constipation for starting the development of heart diseases assessed by ECG is 3 months, and the maximum duration is 25 years. This study emphasizes that slow transit constipation is a risk factor for developing heart disease. Clinical research in this direction is warranted.

Glenohumeral bone lesions occurring during the first episode of shoulder dislocation do not influence function at an average of 2 years

BackgroundAfter a first shoulder dislocation, the rate of recurrence varies according to age and type of activity. The rule of bony lesions is logical but not demonstrated. We conducted a study to analyze bony lesions observed after a first episode of anterior shoulder dislocation in patients younger than 50 years of age. We assessed the functional outcomes and rate of recurrence among dislocations depending on bony lesions. MethodsWe conducted a prospective, multicenter study for an average of 2 years that included patients aged 18–50 years who had experienced a first episode of anterior shoulder dislocation and who agreed to undergo computed tomography imaging within 3 weeks of trauma. A minimum follow-up duration of 1 year was required for clinical analysis. ResultsNinety-two patients, with a mean follow-up duration of 2 years, participated in the study. Ultimately, 13 patients were excluded: 2 were lost to follow-up, 6 underwent stabilization surgery, and 5 had a follow-up duration of less than 1 year. The mean age at inclusion was 27 years and 94% were men. Glenoid lesions were observed in 39% of patients; humeral lesions were present in 95%. Recurrence occurred in 24% of cases. There was no significant difference in functional scores between patients with and without bony lesion. There was a lower rate of residual apprehension in non-recurrent patients compared with those who had experienced recurrence (p = 0.02) and a greater return to sport in the "no recurrence" subgroup (p = 0.02). The risk of recurrence was equivalent, regardless of the status of glenoid, humerus, or bipolar lesions. The sole predictor of recurrence after a first episode of dislocation was age younger than 20 years (p = 0.002). ConclusionOur study results provide insight into the functional outcomes and likelihood of dislocation recurrence with bony lesions after initial glenohumeral dislocation. If the first episode occurred before the age of 50 years, bony lesions were common. The overall recurrence rate was 24% with an average time of recurrence of 16 months (1-24). In our study, the presence of glenoid and/or humeral bony lesions doesn’t seem to be a risk factor for luxation recurrence.

Duration and Frequency of Spirometry Needed to Accurately Reflect Annualized Change of FEV1 in Chronic Obstructive Pulmonary Disease.

Rationale: The slope of decline in forced expiratory volume in 1 second (FEV1) is commonly used to reflect the rate of disease progression for descriptive studies and therapeutic trials in chronic obstructive pulmonary disease (COPD). The frequency and duration of spirometric testing needed to report the true slope are unknown. Objectives: We sought to define the minimum frequency and follow-up duration needed to accurately describe the annualized rate of FEV1 change among patients with moderate to very severe COPD. Methods: We performed a post hoc analysis of the annualized rate of FEV1 change among 4,412 subjects previously enrolled in the 4-year Understanding Potential Long-Term Impacts on Function with Tiotropium-or, UPLIFT-trial of tiotropium versus placebo. Slope estimates were modeled for different iterations of semiannual or annual testing over a variable duration up to 42 months. All models were compared with a reference of semiannual spirometry for 42 months. Results: The overall annual rate of postbronchodilator FEV1 decline measured semiannually for 42 months (44.6 ml; 95% confidence interval [CI] = 42.5-46.6) did not differ significantly from annual spirometry over the same period (43.7 ml; 95% CI = 41.3-46.1) or semiannual spirometry over the first 2 years (44.3 ml; 95% CI = 41.1-47.5). Agreement was consistent for two follow-up values as far as 24 months apart (43.3 ml; 95% CI = 39.9-46.8). Models that are based on less than two follow-up values or a duration less than 18 months were characterized by relative underestimation of the slope. Conclusions: In a large cohort of patients with moderate to very severe COPD, the annualized rate of change in FEV1 was accurately represented by a minimum of two annual follow-up measurements over 18 months compared with semiannual testing over 42 months.

Ceftazidime-avibactam tolerance and persistence among difficult-to-treat KPC-producing Klebsiella pneumoniae clinical isolates from bloodstream infections.

Tolerance and persistence occur "silently" in bacteria categorized as susceptible by antimicrobial susceptibility testing in clinical microbiology laboratories. They are different from resistance phenomena, not well-studied, and often remain unnoticeable. We aimed to investigate and characterize ceftazidime-avibactam (CZA) tolerance/persistence in 80 Klebsiella pneumoniae isolates from bloodstream infections. We used the Tolerance Disk Test (TDtest) to detect CZA tolerance/persistence and investigate the avibactam (AVI) influence on them, and time-kill assays with minimal duration for killing (MDK) determination to characterize/differentiate CZA tolerance from persistence, for selected isolates. Whole genome sequencing was performed for 49/80 selected isolates to investigate genes related to beta-lactam tolerance/persistence and resistance as well as phylogeny studies. Tolerance/persistence to CZA was detected in 48/80 (60%) isolates, all extensively drug-resistant (XDR) or multidrug-resistant, carbapenem-resistant K. pneumoniae (CRKp), KPC producers, and previously categorized as susceptible (not resistant) to CZA. No heteroresistance was detected. CZA tolerance/persistence occurred due to ceftazidime tolerance/persistence and was not related to AVI in the CZA combination. 5/11 isolates were characterized as CZA-tolerant and 5/11 as CZA-persistent. The single (1/11) XDR and CRKp non-KPC producer was truly susceptible. All the CZA-tolerant/persistent isolates (ST11, ST258, ST340, ST437, ST16, ST17, and ST307) harbored the carbapenemase-encoding gene blaKPC-2. Mutation in only two genes (rpoS and degQ) related to beta-lactam tolerance/persistence was found in only 7/49 CZA-tolerant/persistent isolates, suggesting the presence of yet unknown beta-lactam tolerance/persistence genes. Among the K. pneumoniae bloodstream isolates studied, 60%, previously categorized as susceptible to CZA, were, actually, tolerant/persistent to this antibiotic, all these KPC producers.

Brief communication: efficacy and safety of the dolutegravir/lamivudine dual therapy in antiretroviral treatment-experienced Chinese people living with HIV

This study aimed to evaluate the efficacy and safety of dolutegravir plus lamivudine (DTG/3TC) in antiretroviral treatment (ART)-experienced people living with HIV (PLWH). A total of 303 PLWH in Shanghai, China, who switched from triple ART to DTG/3TC between January 2019 and June 2022, with a minimum ART duration of 6 months, were retrospectively enrolled. More than 95% of PLWH maintained viral suppression with no significant changes in CD4 counts 12 months after switching. Patients transitioning from non-tenofovir (TDF)-based regimens demonstrated more pronounced improvements in lipid profiles, while those previously on TDF-based regimens showed greater enhancements in bone metabolism.

A Coloring-Based Packet Loss Rate Measurement Scheme on Network Nodes

Network measurement is an efficient way to understand network behavior. Traditional measurement techniques focus on internet protocol (IP) networks, where the processing capacity of network nodes is limited and primarily dedicated to packet forwarding. As a result, these techniques typically rely on end hosts or external systems to analyze traffic and evaluate network performance. This reliance introduces several challenges, such as increased measurement latency and scalability limitations, particularly in large-scale networks. With the emergence of next-generation internet architectures, especially information-centric networking (ICN), network nodes have gained enhanced capabilities, enabling measurement tasks to be performed directly at these nodes. This paper proposes a distributed measurement scheme where network nodes collaborate to monitor the packet loss rate on the intermediate link. By setting an unused bit in the packet header, the upstream node “colors” the packets into different color blocks. The minimum duration of each block is determined by the degree of reordering on the link, and the number of packets in each block must be a power of two. The downstream node recognizes blocks, assigns packets to the right block, and deduces the original number of packets for each block to calculate packet loss. Moreover, the upstream node adjusts the number of packets in each block based on the packet transmission rate on the link, aiming to balance measurement accuracy and frequency. A P4-based implementation on a BMv2 software switch is presented to demonstrate the feasibility of the proposed scheme. Simulations show that this scheme improves measurement accuracy and is more robust against packet reordering. Additionally, the proposed scheme maintains relatively low network overhead and, at higher measurement frequencies, exhibits the lowest overhead compared to existing methods.

Adjustable repetition rate mode-locked fiber laser using a ZnO nanolaminate

This paper experimentally demonstrates the use of a zinc oxide (ZnO) nanolaminate as a polarization-dependent loss element to control the frequency repetition rate in a passive mode-locked fiber laser. The ZnO nanolaminate was deposited via the atomic layer deposition technique. The system achieves repetition frequencies ranging from 2.2 to 6.6 MHz, with emission peaks occurring at wavelengths between 1569.1 nm and 1570.8 nm, exhibiting three to four peaks. The fiber exhibits a minimal pulse duration of around 9.78 ns; the maximal pulse-to-pulse separation was 452 ns. The fiber laser demonstrates excellent stability in both power and wavelength emission. The compact experimental setup leverages the properties of the thin film of zinc oxide, offering a versatile laser system capable of quickly altering pulse repetition rates by simply adjusting the polarization state.

High-Fidelity Clinical Simulation to Improve a Pediatric Clinical Trial Design: Lessons Learned and Conceptualization of the Return on Investment (ROI) and Return on Engagement (ROE) Analysis.

Clinical trials entail complex processes that are more challenging when they are addressed to pediatric patients and include a decentralized design. High-realistic simulation allows for the testing and refining of procedures, organizational systems, and interactions between professionals and patients/families, narrowing the gap between work-as-imagined and work-as-done. The aim of this research was to analyze the impact of simulation in three key moments of a clinical trial: the baseline visit, home administration of the investigational drug by parents, and the drawing and processing of pharmacokinetics samples by a home nurse. Multidisciplinary meetings were held between the team of Barcelona Children's Hospital and the sponsor to define the simulation objectives. Three simulation scenarios were executed in 2 days. Subsequently, a post-process analysis was performed, including the assessment of the patient/family experience. In the baseline visit scenario, minimum duration was calculated, and main aspects related to task dynamics, materials, and training were identified. In the drug administration scenario, the family was able to carry out the infusion within the time established in the protocol, but with some difficulties. In the home nursing scenario, some recommendations for improving safety and patient experience were suggested. High-realistic clinical simulation can contribute to anticipate risks, refine the design of activities, and to identify specific needs prior to the protocol finalization, a timepoint in the process when modifications can still be made that constitutes a significant return on investment and return on the engagement, in the experience of the patients that will participate in the study. NCT04644575.

Four-year outcomes after intravitreal aflibercept for macular neovascularization in patients with pathologic myopia.

The natural course of the visual acuity in eyes with myopic macular neovascularization (myopic MNV) is poor. Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents have demonstrated safety and efficacy in the short-term for managing myopic MNV. The purpose of this study was to determine the 4-year outcomes of intravitreal aflibercept (IVA) injections. A retrospective monocentric study including 49 eyes of 48 patients diagnosed with myopic MNV. These patients underwent treatment with IVA using the pro re nata (PRN) regimen after the first injection. The minimum follow-up duration was 4 years. The patients had an average age of 63.8 years and an average axial length of 29.7 mm. The mean number of IVA injections was 1.6, and 30 eyes (61.2%) had a single injection. At the baseline and at 1-, 2-, 3-, and 4-years, the mean best-corrected visual acuities (BCVAs) were 20/45, 20/41, 20/43, 20/51, and 20/53, respectively. The differences in the BCVA at the different times from that at the baseline were not significant. IVA therapy with the PRN regimen provides a 4-year visual benefit in eyes with myopic MNV, and it is better than the reported natural course in maintaining the BCVA.

Effect of different interventions on lumbar spinal stenosis: a systematic evaluation and network meta-analysis

BackgroundSurgery is the preferred option for lumbar spinal stenosis (LSS) when conservative methods cannot meet the needs. Recent advancements in surgical techniques have brought various new methods for treating LSS. MethodFour databases, PubMed, Embase, the Cochrane Library, and Web of Science, were searched, covering the period from the establishment of the databases until May 2024. Randomized controlled trials (RCTs) were carried out to treat LSS using different surgical approaches. The outcome measures included the visual analogue scale (VAS) score, Oswestry disability index (ODI) score, surgical duration, intraoperative blood loss, and length of hospital stay of patients. Bayesian random-effects network meta-analysis (NMA) was performed using R software (V4.4) and STATA17.0 software to analyze each surgical approach. ResultsA total of 29 studies involving 4,200 patients were included. Nine intervention methods, including laminotomy, decompression, decompression plus fusion (DPF), endoscopic decompression, interspinous process spacer device (IPSD), laminectomy, minimally invasive decompression (MID), spinous process osteotomy (SPO), and lumbar interbody fusion (LIF), were analyzed. NMA results indicated that endoscopic decompression (SUCRA=88.70%) was the most effective in reducing short-term back VAS scores. IPSD (SUCRA=98.00%) was the most effective in reducing long-term back VAS scores, surgical duration (SUCRA=95.20%), and intraoperative blood loss (SUCRA=100.00%). Endoscopic decompression (SUCRA=83.60%) also showed the most significant effect in reducing hospital stays. ConclusionEndoscopic decompression can effectively improve short-term back VAS scores and reduce hospital stays, while IPSD is effective in reducing long-term back VAS scores with minimal surgical duration and blood loss.

SGLT2 inhibitors, cardiovascular outcomes, and mortality across the spectrum of kidney disease: A systematic review and meta-analysis

AimsTo evaluate the effects of SGLT2 inhibitors on cardiovascular outcomes and mortality across KDIGO and urinary albumin-to-creatinine ratio [UACR] groups. MethodsWe searched MEDLINE, EMBASE, and CENTRAL up to August 8th, 2023. In pairs, researchers selected large randomized placebo-controlled trials of SGLT2 inhibitors, with minimum duration of one year. Researchers independently extracted study-level data and assessed within-study risk of bias with RoB 2.0 and certainty of evidence with GRADE. Meta-analyses employed a random-effects model. ResultsWe included 14 trials, encompassing 97,412 participants and a median follow-up of 2.5 years. Risk of bias was overall low. Overall, SGLT2 inhibitors reduced major adverse cardiovascular events (MACE) (HR 0.89, 95 %-CI 0.85–0.93), cardiovascular death or hospitalization for heart failure (HHF) (HR 0.78, 95 %-CI 0.75–0.82), all-cause death (HR 0.89, 95 %-CI 0.83–0.94), and HHF (HR 0.71, 95 %-CI 0.67–0.75). The effect of SGLT2 inhibitors on MACE was different across KDIGO (Pinteraction = 0.038) and UACR (Pinteraction = 0.008) groups, with greater benefits in KDIGO Very High (HR 0.72, 95 %-CI 0.61–0.86) and UACR > 300 mg/g (HR 0.76, 95 %-CI 0.68–0.86) groups. ConclusionsSGLT2 inhibitors are associated with reductions in cardiovascular outcomes and mortality. Greater reductions in MACE are expected in subjects in high-risk groups for kidney disease.

Abstract 4113486: Cardiovascular Benefits of Sotagliflozin in Diabetic Populations: A Meta-Analysis

Background: Sotagliflozin, an inhibitor of both SGLT1 and SGLT2, is under investigation for potential cardioprotective effects in diabetic patients. Aims: This study assesses the efficacy and cardiovascular benefits of sotagliflozin in patients with type 1 or type 2 diabetes at high cardiovascular risk or with diagnosed heart failure. Methods: We systematically searched digital databases including ClinicalTrials.gov, PubMed, Google Scholar, Cochrane, Medline, and Embase, using a PICOS-based strategy and the PRISMA framework for data reporting. Randomized controlled trials comparing sotagliflozin against placebo over a minimum duration of eight weeks were analyzed using Review Manager (RevMan) 5.4.1. Results: Our meta-analysis included 7 studies with 16,315 participants with all studies comparing either 200 or 400 mg sotagliflozin to placebo. The meta analaysis revealed significant improvements in reduction the total number of cardiovascular deaths [OR= 0.70 (95% CI (0.51- 0.95)), p = 0.02]; reduction in Non-fatal MI [OR=0.76 (95% CI (0.70- 0.84)), p < 0.00001]; reduction in the incidence of hospitalizations due to HF [OR=0.54 (95% CI (0.44, 0.66)), p < 0.00001]; reduction In urgent hospitalizations [OR=0.66 (95% CI (0.53, 0.83)), p=0.0004]; improvement in LVEF>50% [ OR= 0.41 (95%CI (0.34, 0.51)), p<0.0001] and reduction in systolic blood pressure mean reduction of -0.81 (95% CI (1.36, -0.25)), p=0.005]. However there was no statistically significant reduction in all cause mortality [0.73 (95% CI (0.42, 1.26)), p=0.26] . Conclusion: Sotagliflozin significantly reduces the incidence of cardiovascular deaths, adverse events, and hospitalizations in diabetic patients at high risk of cardiovascular complications.

The Role of Spirituality, Marital Satisfaction and Socio-Economic Status on Attitudes Toward Childbearing Among Married Women Without the Intention and History of Pregnancy: A Cross-Sectional Study

Background: Iran has experienced a sharp decline in childbearing rates over the past three decades, and the extent to which attitudes toward childbearing are influenced by marital satisfaction, socio-economic status, and spiritual health remains unclear. Additionally, past research has largely focused on women who already have children. This study, however, examines all women who, after five years of marriage, have not yet decided to have children. Objectives: This study aimed to determine the role of spirituality, marital satisfaction, and socio-economic status in shaping attitudes toward childbearing among married women in Semnan City in 2023, specifically those without a history of pregnancy or intention to conceive. Methods: This cross-sectional study included 235 married women who had neither the intention nor history of pregnancy, with a minimum marriage duration of five years. Participants were purposefully selected during visits to the family health center in Semnan City in 2023. Data were collected using the Childbearing Attitudes Questionnaire, the Spiritual Health Questionnaire, the Marital Satisfaction Questionnaire, and the Socio-Economic Status Questionnaire. Statistical analysis was conducted using multiple linear regression tests in SPSS software version 24. Results: The largest proportion of participants belonged to the age group of 26-32 years (31.35%). A majority (137 individuals, 58.3%) had either an associate or bachelor’s degree, and most participants (58.3%) were employed. The results demonstrated that spirituality (41%), socio-economic status (56%), and marital satisfaction (65%) were significant predictors of attitudes toward childbearing (P < 0.01). Conclusions: As marital satisfaction emerged as the strongest predictor of attitudes toward childbearing, it is recommended that health centers offer courses to improve and enhance marital satisfaction among women.

Effect of additional free sustentaculum tali screw fixation through modified sinus tarsi approach on intra-articular calcaneal fractures

BackgroundCalcaneal fractures are the most common type of tarsal fractures. The sustentaculum tali (ST) offers anatomical stability in calcaneal fractures, and recently, ST screws have been widely used in their treatment. This study aimed to investigate the clinical efficacy and value of ST screw fixation via a modified sinus tarsi approach (MSTA) for treating displaced intraarticular calcaneal fractures (DIACFs).MethodsThis study enrolled 64 patients (64 feet): 32 patients in the calcaneal locking plate combined with the ST screw group (CLP-STS Group) and 32 patients in the simple calcaneal locking plate internal fixation group (CLP Group). The minimum follow-up duration was 18 months. Ankle function was evaluated using VAS, AOFAS, and Short Form-36 scores. Imaging evaluation included the Böhler angle, Gissane angle, length, height, and width of the calcaneus, and the Böhler angle in both groups 1 year after surgery.ResultsFunctional evaluation revealed that postoperative AOFAS and VAS scores in the CLP-STS Group were significantly better than those in the CLP Group. After surgery, the Böhler angle, Gissane angle, and length, height, and width of the calcaneus were significantly corrected compared to the preoperative values; however, the difference in these indicators between the two groups was not significant. Nevertheless, at the 1-year postoperative follow-up, the calcaneal Böhler angle loss in the CLP-STS Group was significantly better than that in the CLP Group.ConclusionCompared to simple calcaneal locking plate internal fixation, combining the plate with the additionally free ST screw can resolve the limited intraoperative exposure of MSTA, reduce postoperative foot pain in patients, and improve clinical efficacy.

Assessment of the Impact of Gabapentin on Postoperative Pain Following Shoulder Open Rotator Cuff Repair: A Double-Blind Clinical Trial

BackgroundGabapentin is an anticonvulsant used for managing neuropathic pain. Its effectiveness and dosing strategies for postoperative pain, particularly in open shoulder rotator cuff repair, are still debated. This study assesses gabapentin ‘s impact on postoperative pain intensity in open rotator cuff repair. MethodsSixty eligible patients were randomly distributed into two groups: placebo and gabapentin. The gabapentin group received a daily dose of 600 mg, administered in two divided increments, beginning three days before the surgery and continuing for one week postoperatively. Pain intensity, assessed via the Visual Analog Scale (VAS), was the primary endpoint during the first postoperative week. Secondary aims conducted on both groups included quantifying opioid consumption, evaluation of side effects attributed to gabapentin and opioids, assessment of sleep quality, and patients’ satisfaction levels with the employed approach. ResultPostoperative pain in the gabapentin group significantly decreased from the first twenty-four hours until the fourth day post-surgery (p<0.002), accompanied by reduced opioid consumption (P=0.02). Following discharge, the prevalence of nocturnal sleep disruptions and oxycodone consumption in the gabapentin group notably decreased compared to the placebo group, alongside a significant improvement in sleep quality and duration until the fifth day, as well as overall satisfaction with the pain management approach seen within the gabapentin group (P=0.003). ConclusionAdministering gabapentin perioperatively at 600 mg daily and divided over a minimum duration of four days postoperatively may significantly reduce postoperative pain intensity and opioid consumption in open shoulder rotator cuff repair surgery patients.

Evaluation of real-world evidence to assess health outcomes related to deprescribing medications in older adults: an International Society for Pharmacoepidemiology-endorsed systematic review of methodology.

Observational studies using real-world data (RWD) can address gaps in knowledge on deprescribing medications but are subject to methodological issues. Limited data exist on the methods employed to use RWD to measure the effects of deprescribing. To describe methodological approaches used in observational studies of deprescribing medications in older adults. We conducted a systematic review in Medline for observational studies published in English (01/01/2000-09/14/2023) that examined the health effects of medication deprescribing in older adults. We described study characteristics and methods, focusing on the operationalization of deprescribing as an exposure and potential time-related biases. Forty-five studies were included, representing a variety of drug classes (e.g., statins, aspirin, bisphosphonates) and diseases. Most studies adequately addressed potential time-related biases. The definition of deprescribing was not clearly defined in 12 studies. There was heterogeneity regarding the minimum duration of time that qualified as deprescribing, even within a drug class; fewer than one-third of studies provided a justification for these definitions. Observational studies are common to examine the effects of deprescribing; however, there were inconsistencies in measuring deprescribing and a lack of transparency in reporting. There is a need for minimum sufficient reporting criteria for observational studies on deprescribing.

Predictors of liver fibrosis progression in cohort of type 2 diabetes mellitus patients with MASLD

AimTo investigate predictors of liver fibrosis progression in patients with T2DM over a minimum follow-up duration of three years. MethodsTwo hundred and thirty-three patients completed the follow-up period and their clinical, laboratory and liver FibroScan data are reported. Patients were categorized into progressors 42 (18.0 %) and non-progressors 191 (82.0 %) based on liver fibrosis progression. Factors influencing fibrosis progression were identified by comparing these groups. ResultsProgressors showed significantly increased aspartate aminotransferase (AST) (p = 0.010), increased alkaline phosphatase (ALP) (p = 0.001) and decreased platelet count (p = 0.002). Non-progressors exhibited significant decreases in diastolic blood pressure (DBP) (p = 0.050), body mass index (BMI) (p < 0.001), waist circumference (p < 0.001), gamma-glutamyl transferase (GGT) (p < 0.001), albumin (p < 0.001), alanine aminotransferase (ALT) (p = 0.022), glycosylated haemoglobin (HbA1c) (p = 0.002) and fasting blood sugar (FBS) (p = 0.030) with increase in HDL-cholesterol (p < 0.001), creatinine (p < 0.001), bilirubin (p < 0.001), and ALP (p = 0.007). Baseline parameters predictive of liver fibrosis progression included elevated AST and reduced platelet count. Delta changes from baseline to follow-up revealed that increases in ALP, BMI, waist circumference, and reduction in platelet count were correlated with fibrosis progression. Use of GLP-1 receptor agonist was associated with reduced progression. ConclusionIn conclusion, increase in ALP and waist circumference and reduction in platelet count are predictive of liver fibrosis progression in patients with T2DM. GLP-1 receptor agonists use seems to have a promising protective effect against liver fibrosis progression.ClinicalTrials.govID:NCT05697991

Coordinated Islanding Partition and Scheduling Strategy for Service Restoration of Active Distribution Networks Considering Minimum Sustainable Duration

Coordinated Islanding Partition and Scheduling Strategy for Service Restoration of Active Distribution Networks Considering Minimum Sustainable Duration

Five principles and protocols for the clinician based on the 2021 ERS and BTS statements for treating sarcoidosis.

The European Respiratory Society (ERS) and the British Thoracic Society (BTS) have recently published their statements on the treatment of sarcoidosis. There are five key questions in sarcoidosis treatment that need to be addressed: when to treat, how to initiate treatment, how long to treat, when and how to change treatment, and how to treat relapses. Herein, we describe the principles and protocols to answer these questions based on the ERS and BTS statements and other expert reviews. Pulmonary or extrapulmonary sarcoidosis should be treated with anti-inflammatory therapy if it significantly impairs the quality of life (QoL), causes significant organ dysfunction, or threatens to cause organ damage, disability, or death. If treatment is initiated for improving the QoL alone, low-dose (10 mg/day) prednisone is a good initial treatment that can be tapered and stopped over 3 months. Disease that causes significant organ dysfunction needs to be treated with medium-dose glucocorticoids (initial daily dose, 20 mg of prednisone equivalent) tapered over a minimum duration of 6 months. Worsening of disease while tapering treatment indicates that longer (9-24 months) treatment may be necessary. If a daily prednisone dose of >10 mg is required for >6 months to maintain remission, it is best to use a second-line drug such as methotrexate or azathioprine. Anti-tumor necrosis factor agents, such as infliximab or adalimumab, may be used to treat inflammatory disease that persists on combination treatment with glucocorticoids and a second-line agent.

Association Between Serum Magnesium Levels and Depression in Patients Undergoing Peritoneal Dialysis: A Study Conducted at Handan First Hospital, China.

Depression exhibits notable prevalence among patients affected by chronic kidney disease(CKD) and end-stage renal disease (ESRD). Emerging reports suggest a potential association between magnesium (Mg) levels and depressive symptoms, there has been a surge of interest in exploring Mg supplementation as a complementary measure in depression treatment. In this study our aim is to investigate the correlation between depressive symptoms and serum Mg level in patients undergoing peritoneal dialysis (PD) at Handan First Hospital, China. Additionally, we assessed the diagnostic significance of this relationship and identified pertinent influencing factors. This study comprises a cohort of 140 individuals undergoing PD for a minimum duration of 3 months at the PD center of the Handan First Hospital. The Hamilton Depression Scale (HAMD) served as the assessment tool to evaluate the psychological status of the patients. Serum Mg levels, hemoglobin (Hb), and various demographic and clinical data were collected. Logistic regression and ROC analysis were performed to identify significant predictors of depression. The prevalence of depression was higher in patients with hypomagnesemia (60%) compared to those with normal or elevated Mg levels. Notably, a correlation emerged between abnormal serum Mg levels and the presence of depressive symptoms among individuals undergoing PD. Furthermore, binary logistic regression analysis revealed that serum Mg levels, hemoglobin (Hb) concentration, and unemployment significantly influenced the likelihood of occurrence of depression in patients undergoing PD (P< 0.05). In addition, serum Mg levels demonstrate significant predictive value in anticipating onset of depression, indicating that rectifying low serum Mg levels among patients undergoing PD may serve as a preventive measure against depression. Further research is recommended to explore the therapeutic potential of Mg supplementation in this population.