Competition between homogeneous and heterogeneous crystallization of CaCO3 during water softening.

Homogeneous and heterogeneous crystallization of CaCO3 simultaneously occur in seed-induced crystallization during water softening, while suppressing homogeneous crystallization is necessary due to the production of fine particulates that poorly precipitate. However, homogeneous crystallization is difficult to distinguish from heterogeneous crystallization. Consequently, a central focus in improving water softening is understanding their competing activities. In this study, a novel method for distinguishing homogeneous and heterogeneous calcium carbonate crystallization is described that utilizes magnetite as seed particles. Results showed that saturation index (SI) was the primary driver of both homogeneous and heterogeneous crystallizations. Heterogeneous crystallization was preferentially promoted at low SI, while homogeneous crystallization was promoted at high SI. The highest suppression effect to homogeneous crystallization occurred at SI of about 1.01. Seed dosage and mean particle size were the primary parameters related to the competition of the crystallization types. Higher seed dosage and smaller seed particle sizes promoted heterogeneous crystallization and suppressed homogeneous crystallization. Due to the good adaptability of heterogeneous crystallization at low SI, the absorption of CO2 from the air into the solutions also improved the efficiency of hardness removal. The introduction of seed particles did not change crystalline product phases, with calcite being the only observed phase and possessing rhombohedral forms with highly regular and smooth edges. Water softening pilot test results showed that SI of 1.5 was more favorite for CaCO3 layer formation on seed surface and hardness removal in comparison with SI of 1.0 and 2.0. Overall, the results from this study demonstrate that the introduction of seed particles is a promising approach to suppress the homogeneous crystallization of CaCO3. Moreover, these results can serve as a framework for improved seed-induced crystallization during water softening.

Stretchable and Lithography-Compatible Interconnects Enabled by Self-Assembled Nanofilms with Interlocking Interfaces.

Stretchable interconnects with miniature widths are vital for the high-density integration of deformable electronic components on a single substrate for targeted data logic or storage functions. However, it is still challenging to attain high-resolution patternability of stretchable conductors with robust circuit fabrication capability. Here, we report a self-assembled silver nanofilm firmly interlocked by an elastomeric nanodielectric that can be photolithographically patterned into microscale features while preserving high stretchability and conductivity. Both silver and dielectric nanofilms are fabricated by layer-by-layer assembly, ensuring wafer-scale uniformity and meticulous control of thicknesses. Without any thermal annealing, the as-fabricated nanofilms from silver nanoparticles (AgNPs) exhibit conductivity of 1.54 × 106 S m-1 and stretchability of ∼200%, which is due to the impeded crack propagation by the underlying PU nanodielectrics. Furthermore, it is revealed that AgNP microstrips defined by photolithography show higher stretchability when their widths are downscaled to 100 µm owing to confined cracks. However, further scaling restricts the stretchability, following the early development of cracks cutting across the strip. In addition, the resistance change of these silver interconnects can be decreased using serpentine architectures. As a demonstration, these self-assembled interconnects are used as stretchable circuit boards to power LEDs.

Association of skin autofluorescence with depressive symptoms and the severity of depressive symptoms: The prospective REACTION study.

AIM: Millions of people are afflicted by depression, a highly prevalent mental illness with increased morbidity and mortality. Advanced glycation end-products (AGEs) are potential risk factors for depression. We aimed to investigate the correlation of AGEs with depressive symptoms and the severity of depressive symptoms. METHODS: This study was nested in the prospective REACTION (Risk Evaluation of cAncers in Chinese diabeTic Individuals) study and included 4420 eligible participants. skin autofluorescence (SAF) was used to measure skin AGEs. Depressive symptoms were evaluated by the Self-Rating Depression Scale (SDS). Multiple logistic regression analysis was used to assess the association of AGEs with depressive symptoms and the severity of depressive symptoms. RESULTS: Logistic analysis showed a significantly positive relationship between quartiles of SAF-AGEs and the risk of depressive symptoms with the OR [95% confidence interval (CI), p value] of 1.24 (95% CI: 1.03-1.50, p = 0.022), 1.39 (95% CI: 1.15-1.68, p = 0.001) and 1.57 (95% CI: 1.28-1.91, p < 0.001) for multivariable-adjusted model respectively. And SAF-AGEs were associated with the severity of depressive symptoms with the multivariable-adjusted OR (95% CI, p value) of 1.06 (95% CI:0.79-1.43, p = 0.681), 1.47 (95% CI: 1.08-1.99, p = 0.014), and 1.54 (95% CI: 1.12-2.11, p = 0.008) respectively. Stratified analyses showed that SAF-AGEs were significantly associated with the severity of depressive symptoms only in females, overweight people, individuals with hypertension, and those without diabetes and insomnia. CONCLUSIONS: The present study showed that a higher SAF-AGEs level was associated with depressive symptoms and the severity of depressive symptoms.

Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture.

Purpose: To evaluate the impact of preoperative anemia on postoperative complications after hip fracture surgery. Patients and Methods: We conducted a retrospective study including hip fracture patients at a teaching hospital between 2005 and 2022. We defined preoperative anemia as the last hemoglobin measurement level before surgery < 130 g/L for men and < 120 g/L for women. The primary outcome was a composite of in-hospital major complications, including pneumonia, respiratory failure, gastrointestinal bleeding, urinary tract infection, incision infection, deep venous thrombosis, pulmonary embolism, angina pectoris, arrhythmia, myocardial infarction, heart failure, stroke, and death. Secondary outcomes were cardiovascular events, infection, pneumonia, and death. We used multivariate negative binomial or logistic regression to evaluate the impact of anemia and its severity, categorized as mild (90-130 g/L for men, 90-120 g/L for women) or moderate-to-severe (< 90 g/L for both) anemia on outcomes. Results: Of the 3540 included patients, 1960 had preoperative anemia. 188 anemic patients experienced 324 major complications, while 63 non-anemic patients had 94 major complications. The risk of major complications was 165.3 (95% CI, 149.5-182.4) and 59.5 (95% CI, 48.9-72.3) per 1000 persons in anemic and non-anemic patients, respectively. Anemic patients were more likely to have major complications than non-anemic patients (adjusted incidence rate ratio (aIRR), 1.87; 95% CI, 1.30-2.72), which was consistent in mild (aIRR, 1.77; 95% CI, 1.22-2.59) and moderate-to-severe (aIRR, 2.97; 95% CI, 1.65-5.38) anemia. Preoperative anemia also increased the risk of cardiovascular events (aIRR, 1.96; 95% CI, 1.29-3.01), infection (aIRR, 1.68; 95% CI, 1.01-2.86), pneumonia (adjusted odds ratio (aOR), 1.91; 95% CI, 1.06-3.57), and death (aOR, 3.17; 95% CI, 1.06-11.89). Conclusion: Our findings suggest that even mild preoperative anemia is associated with major postoperative complications in hip fracture patients. This finding highlights considering preoperative anemia as a risk factor in surgical decision-making for high-risk patients.

Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: A meta-analysis of randomised controlled trials.

Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, -9.31 [-17.54, -1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, -9.31 [-17.54, -1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well-designed RCTs with large sample sizes.

A Real-Time Defect Detection Strategy for Additive Manufacturing Processes Based on Deep Learning and Machine Vision Technologies.

Nowadays, additive manufacturing (AM) is advanced to deliver high-value end-use products rather than individual components. This evolution necessitates integrating multiple manufacturing processes to implement multi-material processing, much more complex structures, and the realization of end-user functionality. One significant product category that benefits from such advanced AM technologies is 3D microelectronics. However, the complexity of the entire manufacturing procedure and the various microstructures of 3D microelectronic products significantly intensified the risk of product failure due to fabrication defects. To respond to this challenge, this work presents a defect detection technology based on deep learning and machine vision for real-time monitoring of the AM fabrication process. We have proposed an enhanced YOLOv8 algorithm to train a defect detection model capable of identifying and evaluating defect images. To assess the feasibility of our approach, we took the extrusion 3D printing process as an application object and tailored a dataset comprising a total of 3550 images across four typical defect categories. Test results demonstrated that the improved YOLOv8 model achieved an impressive mean average precision (mAP50) of 91.7% at a frame rate of 71.9 frames per second.

Association of skin autofluorescence with low bone density/osteoporosis and osteoporotic fractures in type 2 diabetes mellitus.

BACKGROUND: Advanced glycation end products (AGEs) that abnormally accumulate in diabetic patients have been reported to damage bone health. We aimed to investigate the association between skin autofluorescence (SAF)-AGEage (SAF - AGEs × age/100) and low bone density (LBD)/osteoporosis or major osteoporotic fractures (MOFs) in patients with type 2 diabetes mellitus (T2DM). METHODS: This study was nested in the prospective REACTION (Risk Evaluation of Cancers in Chinese Diabetic Individuals) study and included 1214 eligible participants. SAF was used to measure skin AGEs (SAF-AGEs). Fracture events were determined by an in-person clinical follow-up. Binary logistic regression analysis, linear regression analysis, and a restricted cubic spline nested in logistic models were used to test outcomes. RESULTS: The overall prevalence of LBD/osteoporosis in middle-aged or elderly T2DM patients was 35.7% (n = 434), and the overall incidence of MOFs was 10.5% (n = 116). Logistic analysis showed a significantly positive relationship between quartiles of SAF-AGEage and the risk of LBD/osteoporosis (odds ratio [OR] 2.02, 95% CI 1.34-3.03; OR 3.63, CI 2.44-5.39; and OR 6.51, CI 4.34-9.78) for the multivariate-adjusted models, respectively. SAF-AGEage was associated with MOFs with a multivariate-adjusted OR of 1.02 (CI 0.52-2.02), 2.42 (CI 1.32-4.46), and 2.70 (CI 1.48-4.91), respectively. Stratified analyses showed that SAF-AGEage was significantly associated with MOFs only in females, nonsmokers, nondrinkers, individuals with lower body mass index, and those without LBD/osteoporosis. Linear regression analyses showed that higher SAF-AGEs were associated with a higher level of serum N-terminal propeptide of type I procollagen (s-PINP) and serum carboxy-terminal cross-linking peptide of type I collagen (s-CTX), with a multivariate-adjusted OR of 1.02 (CI 0.24-1.80) and 6.30 (CI 1.77-10.83), respectively. CONCLUSIONS: In conclusion, SAF-AGEage was positively associated with the prevalence of LBD/osteoporosis or MOFs in patients with T2DM. A positive association between SAF-AGEs and the level of s-PINP and s-CTX was found.

Selectively Metalizable Low-Temperature Cofired Ceramic for Three-Dimensional Electronics via Hybrid Additive Manufacturing.

With increasing interest in the rapid development of customized ceramic electronics, hybrid additive manufacturing (HAM) technology has become a competent alternative to traditional solutions such as printed circuit boards and cofired ceramic technology. Herein, the novel HAM technology is proposed by combining a dispensing three-dimensional (3D) printing process and selectively laser-activated electroless plating for fabricating 3D fully functional ceramic electronic products. An appropriative 3D-printable and metalizable low-temperature cofired ceramic slurry is developed to build the green body of ceramic electronics. After the debinding and sintering process, the 3D ceramic structure can be selectively laser-activated and then electrolessly plated to achieve electronic functionality. The thickness of the plated copper layer approaches 10 µm after 4 h of plating, and the electrical conductivity is 5.5 × 107 S m-1, which is close to pure copper (5.8 × 107 S m-1). To reduce the surface roughness of the laser-activated ceramic surface and thereby enhance the conductivity of the copper layer, the laser parameters are optimized as a 1250 mm s-1 scan speed, a 0.4 W laser power, and a 20 kHz laser-spot frequency. A high-power 3D light-emitting diode circuit board with an internal cooling channel is successfully developed to prove the feasibility of this HAM technology for customizing fully functional 3D conformal ceramic electronics.

Efficacy and Safety of Eldecalcitol for Osteoporosis: A Meta-Analysis of Randomized Controlled Trials.

Object: Eldecalcitol (ED-71) is a vitamin D analog for the treatment of osteoporosis. However, inconsistent results have been reported in this regard. Hence, this meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy and safety of ED-71 for osteoporosis. Methods: The PubMed, Embase, and the Cochrane Library databases were systematically searched to identify potential trials from inception until April 2021. The investigated outcomes included bone mineral density and fractures at various sites, and potential adverse events. The pooled effect estimates were calculated using weighted mean difference (WMD) and relative risk (RR) with 95% confidence interval (CI) using the random-effects model. Results: Eight RCTs involving 2368 patients were selected for the final meta-analysis. The pooled results showed that ED-71 were associated with a higher level of femoral neck (FN) bone mineral density (BMD) (WMD: 0.92; 95% CI: 0.24-1.60; P = 0.008), while it had no significant effect on lumbar spine BMD (WMD: 1.09; 95% CI: -0.11 to 2.30; P = 0.076) and hip BMD (WMD: 1.12; 95% CI: -0.16 to 2.40; P = 0.088). Moreover, the use of ED-71 could protect against the risk of all osteoporotic fracture (RR: 0.70; 95% CI: 0.55-0.88; P = 0.003) and vertebral fracture (RR: 0.74; 95% CI: 0.55-0.98; P = 0.038), while it did not affect the risk of nonvertebral fracture (RR: 0.53; 95%CI: 0.23-1.23; P = 0.140). The subgroup analyses found that the effects of ED-71 were superior to those of alfacalcidol on both BMD and fracture results. Moreover, the use of ED-71 plus bisphosphonate was associated with a greater improvement in BMD at various sites compared with bisphosphonate alone. Finally, ED-71 was associated with an increased risk of increased urine calcium level (RR: 1.69; 95% CI: 1.33-2.15; P < 0.001). Conclusion: This study found that the use of ED-71 could improve BMD and fractures at various sites, especially compared with alfacalcidol or a combination with bisphosphonate for patients with osteoporosis. Systematic Review Registration: [http://www.crd.york.ac.uk/prospero], identifier [CRD42021270536].

Association Between Blood Pressure and Branched-Chain/Aromatic Amino Acid Excretion Rate in 24-Hour Urine Samples from Elderly Hypertension Patients.

BACKGROUND: Recently, the association between lifestyle-related diseases and free amino acids in the blood plasma-especially branched-chain amino acids (BCAAs) and aromatic amino acids (AAAs)-has been highlighted. However, few studies have been carried out on 24-hour urine samples. Therefore, we aimed to explore the relationships between 24-hour urinary BCAAs and AAAs excretion rate and blood pressure (BP) in elderly patients with hypertension. METHODS AND RESULTS: Each of the 322 elderly patients with hypertension completed an in-person questionnaire interview, underwent a physical examination, and provided a 24-hour urine specimen. We measured their BCAAs and AAAs excretion rate, and used multiple linear regression analysis with variable selection to construct models describing the relationships between their BCAAs and AAAs excretion rate and BP. After adjusted for age, gender, height, and weight, valine was inversely associated with both systolic blood pressure (SBP) (ß: -0.232, 95% CI: -0.16, -0.006) and diastolic blood pressure (DBP) (ß: -0.144, 95% CI: -0.089, -0.005). These findings were invariant even following adjustment for urine volume and drugs history, and Ile was positively associated with DBP (ß: 0.170, 95% CI: 0.001, 0.066). CONCLUSION: The data revealed that the excretion rate of 24-hour urinary BCAAs was closely related to BP in elderly hypertension patients, and these findings will provide new insights into the association between BACC metabolism and BP.

A systematic review and meta-analysis comparing arthroplasty and internal fixation in the treatment of elderly displaced femoral neck fractures.

BACKGROUND: Currently, there are 2 mainstream treatments for displaced femoral neck fracture, including internal fixation and arthroplasty. However, there are still some controversial problems as to which treatment should be primarily chosen. METHODS: The relevant studies comparing arthroplasty with internal fixation were searched in the databases of PubMed, Embase, and Cochrane Library. Finally, 31 relevant randomized controlled trials were included in this meta-analysis. The quality of studies was evaluated and meta-analyses were performed using RevMan 5.3 software. We also assessed the heterogeneity among studies and publication bias via the I-squared index and forest plots. RESULTS: There was no significant difference between arthroplasty and internal fixation groups in patient mortality at both short-term and long-term points. However, patients treated with arthroplasty showed significantly lowered risks of reoperation both at short-term (5.6% vs 31.5%; relative risks (RR)  = 0.19; 95% CI, 0.13-0.28; P < .00001) and long-term follow-up (9.5% vs 45.9%; RR = 0.23; 95% CI, 0.17-0.33; P < .00001). Similarly, arthroplasty-treated patients demonstrated a significant decrease in the risk of postoperation complications at short-term (10.3% vs 34.4%; RR = 0.37, 95% CI, 0.24-0.57; P < .00001) and long-term follow-up (11.7% vs 42.5%; RR = 0.30, 95% CI, 0.16-0.57; P < .0002). Besides, patients in the arthroplasty group were associated with better alleviation of pain postoperation (18.3% vs 31.1%; RR = 0.50, 95% CI, 0.33-0.78; P = .002).In trial sequence analyses, all cumulative Z curves except that of mortality crossed the trial sequential monitoring boundaries and conventional boundaries, and required information size has been reached. CONCLUSIONS: Arthroplasty leads to a lower rate of reoperation, a reduced risk of complications, and a better alleviation of postoperation pain both at short-term and long-term follow-up. Most importantly, and according to trial sequence analyses, more than enough evidence has been achieved that arthroplasty does show better outcomes than internal fixation in terms of reoperation rate, complications, and postoperation pain. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Selectively Metalizable Stereolithography Resin for Three-Dimensional DC and High-Frequency Electronics via Hybrid Additive Manufacturing.

Direct manufacturing of customized end-use electronic products is becoming an emerging trend of additive manufacturing (AM). This highly demands the evolution of the conventional AM processes from simply building single-material parts to simultaneously delivering complex structures and end-use functionalities. In this work, we propose a novel hybrid additive manufacturing solution that combines stereolithography (SLA) three-dimensional (3D) printing and laser-activated electroless plating for the manufacture of 3D fully functional electronic products. With our newly developed functional SLA resin that can be 3D printed, laser-activated, and thereafter selectively metalized, high-resolution circuitry can be free-formly patterned on 3D structures. In virtue of high-performance electrical materials, this technology is capable of creating not only 3D direct-current (DC) electronics but also 3D high-frequency devices like microwave/millimeter-wave antennas, which cannot be fabricated via traditional printed circuit board (PCB) technology and not even by most AM processes. This study represents a significant advance in additive manufacturing technologies, and more importantly offers a unique opportunity for the mass customization of fully functional 3D electronic products, which shows great potentials in consumer electronics, communication engineering, and automobile and aerospace industries.

High-Resolution Printable and Elastomeric Conductors from Strain-Adaptive Assemblies of Metallic Nanoparticles with Low Aspect Ratios.

Stretchable conductors capable of precise micropatterning are imperative for applications in various wearable technologies. Metallic nanoparticles with low aspect ratios and miniscule sizes are preferred over metallic nanowires or nanoflakes for such applications. However, nanoparticles tend to lose mutual contact during stretching. Therefore, they are rarely used alone in stretchable conductors. In this study, electronic inks comprising silver nanoparticles (AgNPs) for the high-resolution printing of stretchable conductors are reported. AgNPs are synthesized using aqueous polyurethane micelles, which are subsequently disentangled into polymeric chains in isopropanol to stabilize the inks. The ink rheology can be arbitrarily tuned to allow direct-write printing with a minimum feature width of 3 µm. Owing to the absence of extra surfactants, direct drying of such inks at room temperature provides the stretchable conductors with an initial conductivity of 8846 S cm-1 and conductivity of 1305 S cm-1 at 100% strain. This enhanced performance is attributed to the conductive percolations through assemblies of AgNPs adapting to the strain and is equivalent to those of stretchable conductors filled with Ag nanowires or flakes. These inks are promising for the scalable fabrication of highly integrated stretchable electronics.

Adaptive expression of biofilm regulators and adhesion factors of Staphylococcus aureus during acute wound infection under the treatment of negative pressure wound therapy in vivo.

Negative pressure wound therapy (NPWT) is gaining acceptance as a physical therapy for a wide variety of infected wounds. To gain insight into the response of bacteria to NPWT in vivo, the adaptive expression of biofilm regulators and adhesion factors of Staphylococcus aureus (S. aureus), the most frequently isolated pathogen in the clinic, during acute wound infection was investigated. A 3 cm full-thickness dermal wound was created on each side of a rabbit back and inoculated with green fluorescent protein-labeled S. aureus. NPWT was initiated at 6 h post inoculation, with the wound on the contralateral side as the untreated self-control. The wounds were subjected to a 28 day observation period. Histological analysis, laser scanning confocal microscopy and scanning electron microscopy revealed a transition of S. aureus to a free-living phenotype in tissues treated with NPWT, compared with microcolonies in untreated wounds. Viable bacteria counts showed a modest reduction in the bioburden of NPWT group on day 8 (P<0.001), with ~1x106 colony-forming units/g tissue. Transcript analysis of biofilm- and colonization-related genes were investigated using reverse transcription-quantitative PCR on postoperative days 1, 2, 4 and 8. The poly-beta-1,6-N-acetyl-D-glucosamine synthase locus and holin-like protein CidA/antiholin-like protein LrgA network were less active in the NPWT group compared with the untreated control group. Accordingly, the expression profile switched to an elevated expression of the adhesive factors UDP-phosphate N-acetylglucosaminyl 1-phosphate transferase (at days 0-4) and fibronectin-binding protein A and iron-regulated surface determinant protein A at >4 days during both stages of colonization. Meanwhile, low expression levels of the effector molecule (RNAIII) of the accessory gene regulator type I (agr) system was detected in NPWT group, suggesting that the bacterial density in NPWT-treated wounds was under the threshold for agr activation, thus not leading to an active and invasive infection. The wounds treated by NPWT healed completely on day 28, compared with an average of an 8.11% defect area in the control group (P<0.001). The results of the current study indicated that S. aureus responds to NPWT by regulating gene expression, manifesting a decrease in biofilm formation and an increase in bacterial colonization in vivo, which potentially benefits the wound repair and healing process.

The association between ambient temperature and clinical visits for inflammation-related diseases in rural areas in China.

BACKGROUND: The association between temperature and mortality has been widely reported. However, it remains largely unclear whether inflammation-related diseases, caused by excessive or inappropriate inflammatory reaction, may be affected by ambient temperature, particularly in low-income areas. OBJECTIVES: To explore the association between ambient temperature and clinical visits for inflammation-related diseases in rural villages in the Ningxia Hui Autonomous Region, China, during 2012─2015. METHODS: Daily data on inflammation-related diseases and weather conditions were collected from 258 villages in Haiyuan (161 villages) and Yanchi (97 villages) counties during 2012─2015. A Quasi-Poisson regression with distributed lag non-linear model was used to examine the association between temperature and clinical visits for inflammation-related diseases. Stratified analyses were performed by types of diseases including arthritis, gastroenteritis, and gynecological inflammations. RESULTS: During the study period, there were 724,788 and 288,965 clinical visits for inflammation-related diseases in Haiyuan and Yanchi, respectively. Both exposure to low (RR: 2.045, 95% CI: 1.690, 2.474) and high temperatures (RR: 1.244, 95% CI: 1.107, 1.399) were associated with increased risk of total inflammation-related visits in Haiyuan county. Low temperatures were associated with increased risks of all types of inflammation-related diseases in Yanchi county (RR: 4.344, 95% CI: 2.887, 6.535), while high temperatures only affected gastroenteritis (RR: 1.274, 95% CI: 1.040, 1.561). Moderate temperatures explained approximately 26% and 33% of clinical visits due to inflammation-related diseases in Haiyuan and Yanchi, respectively, with the burden attributable to cold exposure higher than hot exposure. The reference temperature values ranged from 17 to 19 in Haiyuan, and 12 to 14 in Yanchi for all types of clinical visits. CONCLUSIONS: Our findings add additional evidence for the adverse effect of suboptimal ambient temperature and provide useful information for public health programs targeting people living in rural villages.

Functional interaction between plasma phospholipid fatty acids and insulin resistance in leucocyte telomere length maintenance.

BACKGROUND: Previous evidence suggests that plasma phospholipid fatty acids (PPFAs) and HOMA insulin resistance (HOMA-IR) are independently related to leukocyte telomere length (LTL). However, there is limited evidence of regarding the effect of their interaction on relative LTL (RLTL). Therefore, here, we aimed to determine the effect of the interaction between PPFAs and HOMA-IR on RLTL. METHODS: We conducted a cross-sectional study, involving a total of 1246 subjects aged 25-74 years. PPFAs and RLTL were measured, and HOMA-IR was calculated. The effect of the interaction between PPFAs and HOMA-IR on RLTL was assessed by univariate analysis, adjusting for potential confounders. RESULTS: In age-adjusted analyses, multivariate linear regression revealed a significant association of the levels of elaidic acid, HOMA-IR, monounsaturated fatty acids (MUFA) and omega-6 (n-6) polyunsaturated fatty acid (PUFA) with RLTL. After adjustment of age and gender, race, smoking, drinking, tea, and exercise, elaidic acid, and omega-3 (n-3) PUFA were negatively associated with RLTL, and HOMA-IR and n-6 PUFA were positively associated with RLTL. These associations were not significantly altered upon further adjustment for anthropometric and biochemical indicators. Meanwhile, the effect of the interaction of elaidic acid and HOMA-IR on RLTL was significant, and remained unchanged even after adjusting for the aforementioned potential confounders. Interestingly, individuals who had the lowest HOMA-IR and the highest elaidic acid levels presented the shortest RLTL. CONCLUSIONS: Our findings indicated that shorter RLTL was associated with lower HOMA-IR and higher elaidic acid level. These findings might open a new avenue for exploring the potential role of the interaction between elaidic acid and HOMA-IR in maintaining RLTL.

Three-dimensional mapping of intertrochanteric fracture lines.

BACKGROUND: Available research about the anatomic patterns of intertrochanteric fractures is lacking, and fracture mapping has not previously been performed on intertrochanteric fractures. This study aimed to determine the major trajectories of intertrochanteric fracture lines using computed tomography data from a series of surgically treated patients. METHODS: In this study, 504 patients with intertrochanteric fractures were retrospectively analyzed. Fracture patterns were graded according to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Fracture lines were transcribed onto proximal femoral templates and graphically superimposed to create a compilation of fracture maps that were subsequently divided into anterior, posterior, lateral, and medial fracture maps to create a three-dimensional (3D) pattern by reducing fragments in the 3D models. The fracture maps were then converted into frequency spectra. The major fracture patterns were assessed by focusing on the lateral femoral wall, lesser trochanter, intertrochanteric crest, and inner cortical buttress. RESULTS: Anterior, posterior, lateral, and medial fracture maps were created. The majority of fracture lines (85.9%, 433/504) on the anterior maps were along the intertrochanteric line where the iliofemoral ligament was attached. In the medial plane, the majority of fracture lines (49.0%, 247/504) shown on the frequency spectrum included the turning point involving the third quadrant. In the posterior plane, the majority of fracture lines (52.0%, 262/504) involved the intertrochanteric crest from the greater to the lesser trochanter. In the lateral plane, the majority of fracture lines (62.7%, 316/504) involved the greater trochanter at the gluteus medius attachment. CONCLUSIONS: The fracture patterns observed in the present study might be used to describe morphologic characteristics and aid with management strategies. Further classifications or modifications that incorporate the fracture patterns identified in this study may be used in future research.

Impact of negative-pressure wound therapy on bacterial behaviour and bioburden in a contaminated full-thickness wound.

The use of negative-pressure wound therapy (NPWT) has displayed significant clinical benefits in the healing of infected wounds. However, the effects of NPWT on bacterial colonisation and infection of traumatic wounds has been controversial. The aim of this study is to evaluate the impact of NPWT treatment in rabbits with a contaminated full-thickness wound on bacterial behaviour, including colony morphology, spatial distribution, fissional proliferation, and bacterial bioburden. Full-thickness wounds were created on the back of rabbits, and were inoculated with bioluminescent Staphylococcus aureus. The wounds were treated with sterile gauze dressings and NPWT with continuous negative pressure (-125 mm Hg). Wound samples were harvested on days 0 (6 hours after bacterial inoculation), 2, 4, 6, and 8 at the centre of wound beds before irrigation. Scanning electron microscopy and transmission electron microscopy (TEM) analyses were performed to determine the characteristic bacteriology. Laser scanning confocal microscopy was performed to obtain bioluminescent images, which were used to observe spatial distribution of the GFP-labelled S. aureus within the tissue and quantify the bacterial bioburden. NPWT resulted in sparse amounts of scattered bacteria on the wound surface or as sparsely spaced single colonies within the tissue. Wound bioburden on day 8 in the NPWT and gauze groups was 34.6 ± 5.5% and 141.9 ± 15.4% of the baseline values (N = 6), respectively (P < .0001). TEM showed a lack of S. aureus active fission within NPWT-treated tissue. NPWT can impact S. aureus colony morphology and spatial distribution both on the surface and within wound tissue, and reduce S. aureus as early as 48 hours after therapy initiation. Additionally, NPWT inhibits bacterial fissional proliferation in microcolonies.

Efficacy and safety of ipragliflozin as add-on to metformin for type 2 diabetes: a meta-analysis of double-blind randomized controlled trials.

Objectives: To evaluate the efficacy and safety of ipragliflozin as add-on therapy to metformin in patients with type 2 diabetes mellitus.Methods: Systematic literature searches were performed in several databases across PubMed, the Cochrane Central Register of Controlled Trials, Embase, Medline, ClinicalTrials.gov, PsycINFO, and Web of Science from inception to 12 March 2019. After the extraction of data from eligible studies, randomized controlled trials (RCTs) were assessed for quality and analyzed statistically. Standardized mean difference (SMD) and risk ratio (RR) with 95% CIs were used to evaluate efficacy and safety end-points. Sensitivity analyses and subgroup analyses based on intervention times were also performed.Results: Five RCTs with 847 patients were included. Compared to metformin alone, ipragliflozin as an adjuvant to metformin reduced glycated hemoglobin (HbA1c) in 12 weeks and 24 weeks, respectively [12 w: SMD -0.30, 95% CI -0.51 to -0.10%, p = 0.004; 24 w: SMD -0.88, 95% CI -1.04 to -0.72%, p < 0.00001; Total: SMD -0.66, 95% CI -0.79 to -0.53%, p < 0.00001]. In addition, ipragliflozin as adjuvant therapy to metformin body weight (Total: SMD -1.47, 95% CI [-1.80,-1.14], p < 0.00001), waist circumference (Total: SMD -1.09, 95% CI [-1.62,-0.56], p < 0.00001), and blood pressure (SBP Total: SMD -3.36, 95% CI [-5.11.-1.61], p = 0.0002; DBP Total: SMD -2.18, 95% CI [-3.63,-0.74], p = 0.003). Compared to metformin alone, ipragliflozin as an adjuvant to metformin showed significant risks in the skin and subcutaneous tissue disorders and constipation.Conclusion: Compared to metformin alone, ipragliflozin plus metformin significantly improved glycemic control, reduced body weight, and lowered blood pressure; however, further high-quality trials are required to determine their long-term efficacy and safety.

Different gut microbiome composition in obese Guizhou minipigs between female and castrated male.

Gut microbiome lives in the intestinal tract of animals and plays an important role in almost all life processes. Gut microbiome balance is beneficial to health, and imbalance leads to many diseases, one of which is obesity epidemic. However, gut microbiome is also influenced by host hormone, and different gut microbiome composition is observed between the sexes. Here, we studied whether castrated male Guizhou minipigs with obesity own the same gut microbiome composition and microbial function predictions with those in obese females. We sequenced the hypervariable regions V3 to V4 of bacterial 16s rRNA of fecal samples collected from our study subjects. We observed that the operational taxonomic units were small, which suggested that the abundance of gut microbiome may be influenced by low genetic diversity of host. Our results also suggested that the castrated male has different gut microbial composition compared to the obese female. An increasing Firmicutes/Bacteroidetes ratio was observed in both castrated male and obese female groups, which suggested that the main adipogenic gut microorganism in obese Guizhou minipigs in our studies is the same with that in other obese mammals. However, we also observed that there were function prediction differences of obese Guizhou minipigs between female and castrated male, which suggested that the influence of gut microbiome on obesity between them is different.