Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes: A community-based prospective study.

AIM: The paradoxical protective association between overweight/obesity and diabetic microvascular complications (DMC), a phenomenon well-known as the obesity paradox, has been considered a non-causal association based on methodological influences. We aimed to investigate the association of generalized and abdominal obesity, as measured by body mass index (BMI) and waist circumference (WC), respectively, with DMC in patients with type 2 diabetes (T2D), using a causal inference approach. MATERIALS AND METHODS: We enrolled 1436 patients with clinically diagnosed T2D but not DMC at baseline in a community-based prospective cohort in China between 2017 and 2019 and followed them annually until 2022 with new-onset DMC recorded. Marginal structural Cox models with inverse probability weighting were constructed to determine the causal association. Subgroup analyses were performed to identify potential effect modifiers. RESULTS: We observed 360 incident DMC cases, including 109 cases of diabetic nephropathy (DN) and 277 cases of diabetic retinopathy (DR) during four follow-up visits. Multivariable-adjusted hazard ratios (95% confidence intervals) for overall DMC, DN and DR were 1.037 (1.005-1.071), 1.117 (1.062-1.175) and 1.018 (0.980-1.059) for 1 kg/m2 increase in BMI, and 1.005 (0.994-1.017), 1.034 (1.018-1.051) and 1.000 (0.987-1.014) for 1 cm increase in WC, respectively. Similar patterns were observed across the BMI and WC categories, while the positive association appeared to be more pronounced in women. CONCLUSIONS: Generalized but not abdominal obesity was associated with an increased risk for the overall DMC, whereas both obesities were causally related to DN, albeit not DR, in T2D. Routine weight management should not be neglected in diabetes care, particularly in women.

Association of Visceral Obesity Indices With Incident Diabetic Retinopathy in Patients With Diabetes: Prospective Cohort Study.

BACKGROUND: Visceral adipose tissue plays an active role in the pathogenesis of type 2 diabetes and vascular dysfunction. The lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese VAI (CVAI) have been proposed as simple and validated surrogate indices for measuring visceral adipose tissue. However, the evidence from prospective studies on the associations between these novel indices of visceral obesity and diabetic retinopathy (DR) remains scant. OBJECTIVE: This study aimed to investigate the longitudinal associations of LAP, VAI, and CVAI with incident DR in Chinese patients with diabetes. METHODS: This was a prospective cohort study conducted in Guangzhou in southern China. We collected baseline data between November 2017 and July 2020, while on-site follow-up visits were conducted annually until January 2022. The study participants consisted of 1403 patients with a clinical diagnosis of diabetes, referred from primary care, who were free of DR at baseline. The LAP, VAI, and CVAI levels were calculated by sex-specific equations based on anthropometric and biochemical parameters. DR was assessed using 7-field color stereoscopic fundus photographs and graded according to the modified Airlie House Classification scheme. Time-dependent Cox proportional hazard models were constructed to estimate the hazard ratios with 95% CIs. Restricted cubic spline curves were fitted to examine the dose-response relationship between the 3 indices of visceral obesity and new-onset DR. Subgroup analyses were performed to investigate the potential effect modifiers. RESULTS: The mean age of study participants was 64.5 (SD 7.6) years, and over half (816/1403, 58.2%) were female. During a median follow-up of 2.13 years, 406 DR events were observed. A 1-SD increment in LAP, VAI, or CVAI was consistently associated with increased risk for new-onset DR, with a multivariable­adjusted hazard ratio of 1.24 (95% CI 1.09-1.41; P=.001), 1.22 (95% CI 1.09-1.36; P<.001), and 1.48 (95% CI 1.19-1.85; P=.001), respectively. Similar patterns were observed across tertiles in LAP (P for trend=.001), VAI (P for trend<.001), and CVAI (P for trend=.009). Patients in the highest tertile of LAP, VAI, and CVAI had an 84%, 86%, and 82% higher hazard of DR, respectively, compared to those in the lowest tertile. A nonlinear dose-response relationship with incident DR was noted for LAP and VAI (both P for nonlinearity<.05), but not for CVAI (P for nonlinearity=.51). We did not detect the presence of effect modification by age, sex, duration of diabetes, BMI, or comorbidity (all P for interaction>.10). CONCLUSIONS: Visceral obesity, as measured by LAP, VAI, or CVAI, is independently associated with increased risk for new-onset DR in Chinese patients with diabetes. Our findings may suggest the necessity of incorporating regular monitoring of visceral obesity indices into routine clinical practice to enhance population-based prevention for DR.

Tannic acid-based dual-network homogeneous hydrogel with antimicrobial and pro-healing properties for infected wound healing.

The clinical treatment of infected skin injuries caused by exogenous bacteria faces great challenges. Conventional therapeutic approaches are difficult to achieve synergistic effects of infection control and induction of skin regeneration. In this study, a novel tannic acid-based physically cross-linked double network hydrogel (PDH gel) was prepared on demand by covalent cross-linking of tannic acid (TA) with polyvinyl alcohol (PVA) and chelating ligand of TA with Fe3+. The homogeneity of the hydrogel was achieved by the action of glycol dispersant. With the anti-inflammatory and antioxidant properties of Fe3+ and TA, this hydrogel exhibited excellent antibacterial properties by achieving 99.69% and 99.36% bacterial inhibition against E.coli and S. aureus, respectively. Moreover, the PDH gel exhibits good biocompatibility, stretchability (up to 200%) and skin-friendliness. After 14 days of PDH-1 gel implantation in a rat model infected by S. aureus, the wound healing rate was as high as 95.21%. PDH gel-1 showed more granulation tissue, more pronounced blood vessels, higher collagen fiber density and good collagen deposition, and its recovery effect was better than that of PSH gel and PDH gel-2 in vivo. Hence, this study provides a novel avenue for the design of future clinical infected wound healing dressings.

The relationship between renal function and diabetic retinopathy in patients with type 2 diabetes: A three-year prospective study.

Objective: To explore the association of diabetic retinopathy (DR) and diabetic macular edema (DME) with renal function in patients with type 2 diabetes mellitus (T2DM). Design: A prospective cohort study. Methods: This single-centre study included patients with no DR, mild non-proliferative DR (NPDR), and no DME at baseline. DR and DME were assessed using 7-field fundus photography and swept-source OCT (SS-OCT). The baseline renal function assessed included the estimated glomerular filtration rate (eGFR) and microalbuminuria (MAU). Cox regression analyses were used to assess the hazard ratio (HR) of renal function with the progression of DR and the development of DME. Results: A total of 1409 patients with T2DM (1409 eyes) were included. During 3 years of follow-up,143 patients had DR progression, and 54 patients developed DME. Low eGFR levels at baseline were associated with the development of DR (HR, 1.044 per 1-SD decrease; 95% CI, 1.035-1.053; P < 0.001). Compared to the participants with eGFRs >90 mL/min/1.73 m2, the participants with eGFRs of 60-90 mL/min/1.73 m2 (HR, 1.649; 95% CI, 1.094-2.485; P = 0.017) or < 60 mL/min/1.73 m2 (HR, 2.106; 95% CI, 1.039-4.269; P = 0.039) had a higher risk of DR progression. Increasing MAU tertiles were associated with progression of DR (Tertile 2: HR, 2.577; 95% CI, 1.561-4.256; P < 0.001; Tertile 3: HR, 3.135; 95% CI, 1.892-5.194; P < 0.001). No significant relationship was found between renal function and the development of DME (P > 0.05). Conclusions: Abnormal renal profiles (i.e., low levels of eGFR and high levels of MAU) were associated with the progression of DR, but not with the development of DME.

Co-designing hardware and control for robot hands.

Policy gradient methods can be used for mechanical and computational co-design of robot manipulators.

A SNARE Protein Identification Method Based on iLearnPlus to Efficiently Solve the Data Imbalance Problem.

Machine learning has been widely used to solve complex problems in engineering applications and scientific fields, and many machine learning-based methods have achieved good results in different fields. SNAREs are key elements of membrane fusion and required for the fusion process of stable intermediates. They are also associated with the formation of some psychiatric disorders. This study processes the original sequence data with the synthetic minority oversampling technique (SMOTE) to solve the problem of data imbalance and produces the most suitable machine learning model with the iLearnPlus platform for the identification of SNARE proteins. Ultimately, a sensitivity of 66.67%, specificity of 93.63%, accuracy of 91.33%, and MCC of 0.528 were obtained in the cross-validation dataset, and a sensitivity of 66.67%, specificity of 93.63%, accuracy of 91.33%, and MCC of 0.528 were obtained in the independent dataset (the adaptive skip dipeptide composition descriptor was used for feature extraction, and LightGBM with proper parameters was used as the classifier). These results demonstrate that this combination can perform well in the classification of SNARE proteins and is superior to other methods.