The Potentiality of Natural Products and Herbal Medicine as Novel Medications for Parkinson's Disease: A Promising Therapeutic Approach.

As the global population ages, the prevalence of Parkinson's disease (PD) is steadily on the rise. PD demonstrates chronic and progressive characteristics, and many cases can transition into dementia. This increases societal and economic burdens, emphasizing the need to find effective treatments. Among the widely recognized causes of PD is the abnormal accumulation of proteins, and autophagy dysfunction accelerates this accumulation. The resultant Lewy bodies are also commonly found in Alzheimer's disease patients, suggesting an increased potential for the onset of dementia. Additionally, the production of free radicals due to mitochondrial dysfunction contributes to neuronal damage and degeneration. The activation of astrocytes and the M1 phenotype of microglia promote damage to dopamine neurons. The drugs currently used for PD only delay the clinical progression and exacerbation of the disease without targeting its root cause, and come with various side effects. Thus, there is a demand for treatments with fewer side effects, with much potential offered by natural products. In this study, we reviewed a total of 14 articles related to herbal medicines and natural products and investigated their relevance to possible PD treatment. The results showed that the reviewed herbal medicines and natural products are effective against lysosomal disorder, mitochondrial dysfunction, and inflammation, key mechanisms underlying PD. Therefore, natural products and herbal medicines can reduce neurotoxicity and might improve both motor and non-motor symptoms associated with PD. Furthermore, these products, with their multi-target effects, enhance bioavailability, inhibit antibiotic resistance, and might additionally eliminate side effects, making them good alternative therapies for PD treatment.

Variation in follow-up for children born very preterm in Europe.

BACKGROUND: Children born very preterm (<32 weeks of gestation) face high risks of neurodevelopmental and health difficulties compared with children born at term. Follow-up after discharge from the neonatal intensive care unit is essential to ensure early detection and intervention, but data on policy approaches are sparse. METHODS: We investigated the characteristics of follow-up policy and programmes in 11 European countries from 2011 to 2022 using healthcare informant questionnaires and the published/grey literature. We further explored how one aspect of follow-up, its recommended duration, may be reflected in the percent of parents reporting that their children are receiving follow-up services at 5 years of age in these countries using data from an area-based cohort of very preterm births in 2011/12 (N = 3635). RESULTS: Between 2011/12 and 22, the number of countries with follow-up policies or programmes increased from 6 to 11. The policies and programmes were heterogeneous in eligibility criteria, duration and content. In countries that recommended longer follow-up, parent-reported follow-up rates at 5 years of age were higher, especially among the highest risk children, born <28 weeks' gestation or with birthweight <1000 g: between 42.1% and 70.1%, vs. <20% in most countries without recommendations. CONCLUSIONS: Large variations exist in follow-up policies and programmes for children born very preterm in Europe; differences in recommended duration translate into cross-country disparities in reported follow-up at 5 years of age.

The Design, Fabrication, and Evaluation of a Phase-Resolved Partial Discharge Sensor Embedded in a MV-Class Bushing.

This paper proposes a novel phase-resolved partial discharge (PRPD) sensor embedded in a MV-class bushing for high-accuracy insulation analysis. The design, fabrication, and evaluation of a PRPD sensor embedded in a MV-class bushing aimed to achieve the detection of partial discharge (PD) pulses that are phase-synchronized with the applied primary HV signal. A prototype PRPD sensor was composed of a flexible printed circuit board (PCB) with dual-sensing electrodes, utilizing a capacitive voltage divider (CVD) for voltage measurement, the D-dot principle for PD detection, and a signal transducer with passive elements. A PD simulator was prepared to emulate typical PD defects, i.e., a metal protrusion. The voltage measurement precision of the prototype PRPD sensor was satisfied with the accuracy class of 0.2 specified in IEC 61869-11, as the maximum corrected voltage error ratios and corrected phase errors in 80%, 100%, and 120% of the rated voltage (13.2 kilovolts (kV)) were less than 0.2% and 10 min, respectively. In addition, the prototype PRPD sensor had good linearity and high sensitivity for PD detection compared with a conventional electrical detection method. According to performance evaluation tests, the prototype PRPD sensor embedded in the MV-class bushing can measure PRPD patterns phase-synchronized with the primary voltage without any additional synchronization equipment or system. Therefore, the prototype PRPD sensor holds potential as a substitute for conventional commercial PD sensors. Consequently, this advancement could lead to the enhancement of power system monitoring and maintenance, contributing to the digitalization and minimization of power apparatus.

The versatility of the proteasome in gene expression and silencing: Unraveling proteolytic and non-proteolytic functions.

The 26S proteasome consists of a 20S core particle and a 19S regulatory particle and critically regulates gene expression and silencing through both proteolytic and non-proteolytic functions. The 20S core particle mediates proteolysis, while the 19S regulatory particle performs non-proteolytic functions. The proteasome plays a role in regulating gene expression in euchromatin by modifying histones, activating transcription, initiating and terminating transcription, mRNA export, and maintaining transcriptome integrity. In gene silencing, the proteasome modulates the heterochromatin formation, spreading, and subtelomere silencing by degrading specific proteins and interacting with anti-silencing factors such as Epe1, Mst2, and Leo1. This review discusses the proteolytic and non-proteolytic functions of the proteasome in regulating gene expression and gene silencing-related heterochromatin formation. This article is part of a special issue on the regulation of gene expression and genome integrity by the ubiquitin-proteasome system.

Blast Resistance Capacities of Structural Panels Subjected to Shock-Tube Testing with ANFO Explosive.

This study presents a series of shock-tube tests conducted on structural panels using ammonium nitrate fuel oil (ANFO) as the explosive. The characteristics of the blast waves propagating through the shock tube were analyzed by measuring the pressure generated at specific locations inside the shock tube. The extent of differences in blast pressure generated in a confined space, such as the shock tube, was compared to that predicted by the proposed method in the Unified Facilities Criteria 3-340-02 report. The target specimens of this study were plain reinforced concrete (RC), high-performance fiber-reinforced cementitious composites (HPFRCCs), and composite panels. Polyurea-coated RC panels and steel plate grid structure-attached RC panels were used as composite panels to evaluate the effectiveness of the coating and structural damping methods on the enhancement of structural blast resistance. The tests were conducted with different ANFO charges, and the crack patterns and lengths on the rear surface of each panel were measured. Based on the measured results, discussions regarding the blast resistance capacities of each panel type are provided.

Surface decontamination of radioactive cesium by a reversibly cross-linkable hydrogel using poly(vinyl alcohol) and phenylboronic acid-grafted poly(methyl vinyl ether-alt-mono-sodium maleate).

Wide-area surface decontamination is essential during the sudden release of radioisotopes to the public, such as nuclear accidents or terrorist attacks. A self-generated hydrogel comprising a reversible complex between poly(vinyl alcohol) (PVA) and phenylboronic acid-grafted poly(methyl vinyl ether-alt-mono-sodium maleate) (PBA-g-PMVE-SM) was developed as a new surface decontamination coating agent to remove radioactive cesium from surfaces. The simultaneous application of PVA and PBA-g-PMVE-SM aqueous polymer solutions containing sulfur-zeolite to contaminated surfaces resulted in the spontaneous formation of a PBA-diol ester bond-based hydrogel. The sulfur-zeolite suspended in the hydrogel selectively removed 137Cs from the contaminated surface and was easily separated from the dissociable used hydrogel. This removal was performed by simple water rinsing without costly incineration to remove the organic materials for final disposal/storage of the radioactive waste, making it suitable for practical wide-area surface decontamination. In radioactive tests, the hydrogel containing sulfur-chabazite (S-CHA) showed substantial 137Cs removal efficiencies of 96.996% for painted cement and 63.404% for cement, which are 2.33 times better than the values for the commercial surface decontamination coating agent DeconGel. Due to its excellent zeolite ion-exchange ability, our hydrogel system has great potential for removing various hazardous contaminants, including radionuclides, from the surface.

Systematic Review of the Psychometric Performance of Generic Childhood Multi-attribute Utility Instruments.

BACKGROUND: Childhood multi-attribute utility instruments (MAUIs) can be used to measure health utilities in children (aged ≤ 18 years) for economic evaluation. Systematic review methods can generate a psychometric evidence base that informs their selection for application. Previous reviews focused on limited sets of MAUIs and psychometric properties, and only on evidence from studies that directly aimed to conduct psychometric assessments. OBJECTIVE: This study aimed to conduct a systematic review of psychometric evidence for generic childhood MAUIs and to meet three objectives: (1) create a comprehensive catalogue of evaluated psychometric evidence; (2) identify psychometric evidence gaps; and (3) summarise the psychometric assessment methods and performance by property. METHODS: A review protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO; CRD42021295959); reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. The searches covered seven academic databases, and included studies that provided psychometric evidence for one or more of the following generic childhood MAUIs designed to be accompanied by a preference-based value set (any language version): 16D, 17D, AHUM, AQoL-6D, CH-6D, CHSCS-PS, CHU9D, EQ-5D-Y-3L, EQ-5D-Y-5L, HUI2, HUI3, IQI, QWB, and TANDI; used data derived from general and/or clinical childhood populations and from children and/or proxy respondents; and were published in English. The review included 'direct studies' that aimed to assess psychometric properties and 'indirect studies' that generated psychometric evidence without this explicit aim. Eighteen properties were evaluated using a four-part criteria rating developed from established standards in the literature. Data syntheses identified psychometric evidence gaps and summarised the psychometric assessment methods/results by property. RESULTS: Overall, 372 studies were included, generating a catalogue of 2153 criteria rating outputs across 14 instruments covering all properties except predictive validity. The number of outputs varied markedly by instrument and property, ranging from 1 for IQI to 623 for HUI3, and from zero for predictive validity to 500 for known-group validity. The more recently developed instruments targeting preschool children (CHSCS-PS, IQI, TANDI) have greater evidence gaps (lack of any evidence) than longer established instruments such as EQ-5D-Y, HUI2/3, and CHU9D. The gaps were prominent for reliability (test-retest, inter-proxy-rater, inter-modal, internal consistency) and proxy-child agreement. The inclusion of indirect studies (n = 209 studies; n = 900 outputs) increased the number of properties with at least one output of acceptable performance. Common methodological issues in psychometric assessment were identified, e.g., lack of reference measures to help interpret associations and changes. No instrument consistently outperformed others across all properties. CONCLUSION: This review provides comprehensive evidence on the psychometric performance of generic childhood MAUIs. It assists analysts involved in cost-effectiveness-based evaluation to select instruments based on the application-specific minimum standards of scientific rigour. The identified evidence gaps and methodological issues also motivate and inform future psychometric studies and their methods, particularly those assessing reliability, proxy-child agreement, and MAUIs targeting preschool children.

Systematic review of economic evaluations of varicella vaccination programmes.

OBJECTIVES: This study carried out a systematic literature review of economic evaluations of varicella vaccination programmes from the earliest publication to the present day, including programmes in the workplace and in special risk groups as well as universal childhood vaccination and catch up programmes. METHODS: Articles published from 1985 until 2022 were sourced from PubMed/Medline, Embase, Web of Science, NHSEED and Econlit. Eligible economic evaluations, which included posters and conference abstracts, were identified by two reviewers who scrutinised each other's selections at both title and abstract and full report stages. The studies are described in terms of their methodological characteristics. Their results are aggregated by type of vaccination programme and the nature of the economic outcome. RESULTS: A total of 2575 articles were identified of which 79 qualified as economic evaluations. A total of 55 studies focused on universal childhood vaccination, 10 on the workplace and 14 on high risk groups. Twenty-seven studies reported estimates of incremental cost per quality-adjusted life year (QALY) gained, 16 reported benefit-cost ratios, 20 reported cost-effectiveness outcomes in terms of incremental cost per event or life saved and 16 reported cost-cost offset results. Most studies of universal childhood vaccination reported an increase in overall costs to health services, but often a reduction in cost from a societal perspective. CONCLUSIONS: The evidence surrounding the cost-effectiveness of varicella vaccination programmes remains sparse with contrasting conclusions in some areas. Future research should particularly aim to encompass the impact of universal childhood vaccination programmes on herpes zoster among adults.

MicroRNA-dependent inhibition of WEE1 controls cancer stem-like characteristics and malignant behavior in ovarian cancer.

Cancer stem-like cells (CSCs) have been suggested to be responsible for chemoresistance and tumor recurrence owing to their self-renewal capacity and differentiation potential. Although WEE1 is a strong candidate target for anticancer therapies, its role in ovarian CSCs is yet to be elucidated. Here, we show that WEE1 plays a key role in regulating CSC properties and tumor resistance to carboplatin via a microRNA-dependent mechanism. We found that WEE1 expression is upregulated in ovarian cancer spheroids because of the decreased expression of miR-424 and miR-503, which directly target WEE1. The overexpression of miR-424/503 suppressed CSC activity by inhibiting WEE1 expression, but this effect was reversed on the restoration of WEE1 expression. Furthermore, we demonstrated that NANOG modulates the miR-424/503-WEE1 axis that regulates the properties of CSCs. We also demonstrated the pharmacological restoration of the NANOG-miR-424/503-WEE1 axis and attenuation of ovarian CSC characteristics in response to atorvastatin treatment. Lastly, miR-424/503-mediated WEE1 inhibition re-sensitized chemoresistant ovarian cancer cells to carboplatin. Additionally, combined treatment with atorvastatin and carboplatin synergistically reduced tumor growth, chemoresistance, and peritoneal seeding in the intraperitoneal mouse models of ovarian cancer. We identified a novel NANOG-miR-424/503-WEE1 pathway for regulating ovarian CSCs, which has potential therapeutic utility in ovarian cancer treatment.

Comb-type polymer-hybridized MXene nanosheets dispersible in arbitrary polar, nonpolar, and ionic solvents.

Solution-based processing of two-dimensional (2D) nanomaterials is highly desirable, especially for the low-temperature large-area fabrication of flexible multifunctional devices. MXenes, an emerging family of 2D materials composed of transition metal carbides, carbonitrides, or nitrides, provide excellent electrical and electrochemical properties through aqueous processing. Here, we further expand the horizon of MXene processing by introducing a polymeric superdispersant for MXene nanosheets. Segmented anchor-spacer structures of a comb-type polymer, polycarboxylate ether (PCE), provide polymer grafting-like steric spacings over the van der Waals range of MXene surfaces, thereby reducing the colloidal interactions by the order of 103, regardless of solvent. An unprecedented broad dispersibility window for Ti3C2Tx MXene, covering polar, nonpolar, and even ionic solvents, was achieved. Furthermore, close PCE entanglements in MXene@PCE composite films resulted in highly robust properties upon prolonged mechanical and humidity stresses.

Fabrication of Electrospun Ni0.5Zn0.5Fe2O4 Nanofibers Using Polyvinyl Pyrrolidone Precursors and Electromagnetic Wave Absorption Performance Improvement.

Ni0.5Zn0.5Fe2O4 nanofibers with an average diameter of 133.56 ± 12.73 nm were fabricated by electrospinning and calcination. According to our thermogravimetric-differential thermal analysis and X-ray diffraction results, the calcination temperature was 650 °C. The microstructure, crystal structure, and chemical composition of the nanofibers were observed using field-emission scanning electron, X-ray diffraction, and energy-dispersive X-ray spectroscopy. Commercial particle samples and samples containing 10 wt% and 20 wt% nanofibers were fabricated, and the electromagnetic properties were analyzed with a vector network analyzer and a 7.00 mm coaxial waveguide. Regardless of the nanofiber content, Ni0.5Zn0.5Fe2O4 was dominantly affected by the magnetic loss mechanism. Calculation of the return loss based on the transmission line theory confirmed that the electromagnetic wave return loss was improved up to -59.66 dB at 2.75 GHz as the nanofiber content increased. The absorber of mixed compositions with Ni0.5Zn0.5Fe2O4 nanofibers showed better microwave absorption performance. It will be able to enhance the performance of commercial electromagnetic wave absorbers of various types such as paints and panels.

Complex Permittivity Measurements of Steel Fiber-Reinforced Cementitious Composites Using a Free-Space Reflection Method with a Focused Beam Lens Horn Antenna.

To measure the electromagnetic properties of steel fiber-reinforced concrete (SFRC) in the X-band, 1-port measurements were performed using a lens horn antenna in a free-space measurement system. Free-space 1-port calibration with translations of the position of the reflector regarding the characteristics of the focused beam lens horn antenna was applied. The intrinsic impedance and complex permittivity of the SFRC were obtained from the measured reflection characteristics. The steel fiber content increased and the electromagnetic properties of the SFRC gradually changed from a dielectric to a conductor, even in very low frequencies compared to the plasma frequencies of general metal, which are optical frequencies. This is considered to be the plasmon effect of the metallic structure formed by the steel fiber. This result is applicable for analyses of the electromagnetic phenomenon of large structures with fiber content.

Introducing an Integrated Model of Adults' Wearable Activity Tracker Use and Obesity Information-Seeking Behaviors From a National Quota Sample Survey.

BACKGROUND: Research from multiple perspectives to investigate adults' use of wearable activity-tracking devices is limited. We offer a multiperspective model and provide empirical evidence of what leads to frequent usage of wearable health technologies from a large, nationally representative survey sample. OBJECTIVE: This study aims to explore factors affecting the use of wearable activity-tracking devices among health consumers from the perspectives of individual health beliefs (perceived severity, perceived susceptibility, perceived benefits, and self-efficacy) and information-seeking behaviors. METHODS: Our Integrated Model of Wearable Activity Tracker (IMWAT) use and proposed hypotheses were validated and tested with data collected from a telephone survey with a national quota sample. The data were analyzed using a variety of statistical techniques, including structural equation analysis. RESULTS: The sample comprised 2006 participants. Our results showed that the perceived benefits of physical activity, perceived susceptibility, and self-efficacy toward obesity were significant predictors of information-seeking behaviors, which, in turn, mediated their effects on the use of wearable activity trackers. Perceptions of obesity severity directly promoted wearable device usage. CONCLUSIONS: This study provided a new and powerful theoretical model that combined the health beliefs and information-seeking behaviors behind the use of wearable activity trackers in the adult population. The findings provide meaningful implications for developers and designers of wearable health technology products and will assist health informatics practitioners and obesity prevention communicators.

Fabrication and Photocatalytic Properties of Electrospun Fe-Doped TiO2 Nanofibers Using Polyvinyl Pyrrolidone Precursors.

For the removal of pollutants, a modified TiO2 photocatalyst is attracting attention. Fe-doped TiO2 nanofibers were prepared through a combination of electrospinning and calcination. Morphological characterization of the sample was conducted using field-emission scanning electron and transmission electron microscopy. The crystal structure of each sample was analyzed using high-resolution transmission electron microscopy, selected area electron diffraction, and Fast Fourier Transform imaging. The average diameter of the Fe-doped TiO2 nanofibers was measured to be 161.5 nm and that of the pure TiO2 nanofibers was 181.5 nm. The crystal phase when heat treated at 350 °C was anatase for TiO2 nanofibers and rutile for Fe-doped TiO2 nanofibers. The crystal phase of the TiO2 matrix was easily transitioned to rutile by Fe-doping. The photocatalytic performance of each sample was compared via the photodegradation of methylene blue and acid orange 7 under ultraviolet and visible light irradiation. In the Fe-doped TiO2 nanofibers, photodegradation rates of 38.3% and 27.9% were measured under UV irradiation and visible light, respectively. Although other catalysts were not activated, the photodegradation rate in the Fe-doped TiO2 nanofibers was 9.6% using acid orange 7 and visible light. For improved photocatalytic activity, it is necessary to study the concentration control of the Fe dopant.

Cesium Removal from Nonexpandable Illite Clay by Chloride Salt Treatment.

Extracting cesium (Cs) from nonexpandable illite clay is important in the remediation of radioactive Cs-contaminated soil. In this study, we investigated a chloride salt treatment technique for the removal of Cs from illite. Cs-loaded illite samples with initial Cs concentrations of 2430 and 690 ppm were treated using a NaCl-MgCl2-CaCl2 ternary salt system at 400-850 °C under ambient pressure to suppress Cs loss by vaporization. As a result of the treatment at 850 °C, wherein the salt was in a molten state, the Cs concentration was reduced by 99.5% (to 11.6 ppm) in the first sample and by 99.4% (to 3.86 ppm) in the second sample. Cs removal was achieved for these two samples even in a solid-state reaction at 400 °C, with reductions of 83.3% (407 ppm) and 73.3% (184 ppm), respectively. CsCl was formed by the reaction and remained stable in the salt. The incorporation of cations from the salt (mainly Mg2+) to illite induced structural evolution forming an indialite phase to expel Cs from the clay samples.

Residual Tensile Properties and Explosive Spalling of High-Performance Fiber-Reinforced Cementitious Composites Exposed to Thermal Damage.

This study examined the effect of adding synthetic fibers, that is, polypropylene (PP) and nylon (Ny), on explosive spalling and residual tensile mechanical properties of high-performance fiber-reinforced cementitious composites (HPFRCCs). Three different matrix strengths (100 MPa, 140 MPa, and 180 MPa), four different volume contents of the synthetic fibers (0%, 0.2%, 0.4%, and 0.6%), and three different exposure time (1 h, 2 h, and 3 h) based on the Internatinoal Organization for Standardization (ISO) fire curve were adopted as variables for this experiment. The experimental results revealed that the addition of synthetic fibers improved the resistance to explosive spalling induced by high-temperature, especially when PP and Ny were mixed together. For a higher matrix strength, greater volume content of the synthetic fibers was required to prevent explosive spalling, and higher residual strengths were obtained after the fire tests. An increase in the volume fraction of the synthetic fibers clearly prevented explosive spalling but did not affect the residual tensile strength. In the case of a higher matrix strength, a reduction in the strength ratio was observed with increased exposure time.

Multivariate Generalized Linear Mixed-Effects Models for the Analysis of Clinical Trial-Based Cost-Effectiveness Data.

Economic evaluations conducted alongside randomized controlled trials are a popular vehicle for generating high-quality evidence on the incremental cost-effectiveness of competing health care interventions. Typically, in these studies, resource use (and by extension, economic costs) and clinical (or preference-based health) outcomes data are collected prospectively for trial participants to estimate the joint distribution of incremental costs and incremental benefits associated with the intervention. In this article, we extend the generalized linear mixed-model framework to enable simultaneous modeling of multiple outcomes of mixed data types, such as those typically encountered in trial-based economic evaluations, taking into account correlation of outcomes due to repeated measurements on the same individual and other clustering effects. We provide new wrapper functions to estimate the models in Stata and R by maximum and restricted maximum quasi-likelihood and compare the performance of the new routines with alternative implementations across a range of statistical programming packages. Empirical applications using observed and simulated data from clinical trials suggest that the new methods produce broadly similar results as compared with Stata's merlin and gsem commands and a Bayesian implementation in WinBUGS. We highlight that, although these empirical applications primarily focus on trial-based economic evaluations, the new methods presented can be generalized to other health economic investigations characterized by multivariate hierarchical data structures.

Comparison between Pin Fixation and Combined Screw Fixation in Proximal Chevron Metatarsal Osteotomy for Hallux Valgus Deformity Correction.

BACKGROUND: Problems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS). METHODS: Two groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. RESULTS: The mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group (p < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively (p < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group (p < 0.001). The mean IMA decreased from 14.5° (range, 11.8°-17.2°) to 6.4° (range, 2.7°-10.1°) in the KW group and from 18.0° (range, 14.8°-21.2°) to 5.3° (range, 2.5°-8.1°) in the KWS group (p < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group (p < 0.001) and no difference was found in the KWS group (p = 0.280). CONCLUSIONS: We found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.

Real-time continuous glucose monitoring in preterm infants (REACT): an international, open-label, randomised controlled trial.

BACKGROUND: Hyperglycaemia and hypoglycaemia are common in preterm infants and have been associated with increased risk of mortality and morbidity. Interventions to reduce risk associated with these exposures are particularly challenging due to the infrequent measurement of blood glucose concentrations, with the potential of causing more harm instead of improving outcomes for these infants. Continuous glucose monitoring (CGM) is widely used in adults and children with diabetes to improve glucose control, but has not been approved for use in neonates. The REACT trial aimed to evaluate the efficacy and safety of CGM in preterm infants requiring intensive care. METHODS: This international, open-label, randomised controlled trial was done in 13 neonatal intensive care units in the UK, Spain, and the Netherlands. Infants were included if they were within 24 h of birth, had a birthweight of 1200 g or less, had a gestational age up to 33 weeks plus 6 days, and had parental written informed consent. Infants were randomly assigned (1:1) to real-time CGM or standard care (with masked CGM for comparison) using a central web randomisation system, stratified by recruiting centre and gestational age (<26 or ≥26 weeks). The primary efficacy outcome was the proportion of time sensor glucose concentration was 2·6-10 mmol/L for the first week of life. Safety outcomes related to hypoglycaemia (glucose concentrations <2·6 mmol/L) in the first 7 days of life. All outcomes were assessed on the basis of intention to treat in the full analysis set with available data. The study is registered with the International Standard Randomised Control Trials Registry, ISRCTN12793535. FINDINGS: Between July 4, 2016, and Jan 27, 2019, 182 infants were enrolled, 180 of whom were randomly assigned (85 to real-time CGM, 95 to standard care). 70 infants in the real-time CGM intervention group and 85 in the standard care group had CGM data and were included in the primary analysis. Compared with infants in the standard care group, infants managed using CGM had more time in the 2·6-10 mmol/L glucose concentration target range (mean proportion of time 84% [SD 22] vs 94% [11]; adjusted mean difference 8·9% [95% CI 3·4-14·4]), equivalent to 13 h (95% CI 5-21). More infants in the standard care group were exposed to at least one episode of sensor glucose concentration of less than 2·6 mmol/L for more than 1 h than those in the intervention group (13 [15%] of 85 vs four [6%] of 70). There were no serious adverse events related to the use of the device or episodes of infection. INTERPRETATION: Real-time CGM can reduce exposure to prolonged or severe hyperglycaemia and hypoglycaemia. Further studies using CGM are required to determine optimal glucose targets, strategies to obtain them, and the potential effect on long-term health outcomes. FUNDING: National Institute for Health Research Efficacy and Mechanisms Evaluation Programme.

Cost-effectiveness of real time continuous glucose monitoring to target glucose control in preterm infants.

The optimal management of glucose levels in critical care remains an area for research due to the problems of balancing the risks of hyperglycemia versus hypoglycemia. This paper reports the first economic evaluation of real time continuous glucose monitoring to guide the clinical management of preterm infants, based on evidence from the REACT trial. Bivariate regression of costs (£, 2016-17 prices) and cases of adequate glucose control, with multiple imputation of missing data, was conducted. When the economic evaluation was restricted to the first week of life, real time continuous glucose monitoring was associated with increased costs and a statistically significant increase in adequate glucose control. When the assessment was performed over a time horizon extending to 36 weeks' corrected gestational age, real time CGM was dominant in health economic terms, i.e. associated with lower costs and better outcomes. These results largely remained robust to a range of sensitivity analyses and sub-group analyses designed to address uncertainty and heterogeneity surrounding the cost-effectiveness outcomes. This study suggests that the use of real time continuous glucose monitoring in preterm infants is associated with a high probability of cost-effectiveness.