Unusual body weight loss due to primary hyperparathyroidism: A case study with literature review.

Brown tumors (osteitis fibrosa cystica) are rare pathognomonic signs that occur in patients with primary hyperparathyroidism (PHPT). Brown tumors can exist in multiple bones and can easily be misdiagnosed as a metastatic tumor or multiple myeloma. It is also localized in the forearm, humerus, and leg. The symptoms of hypercalcemia, pathologic fracture, and bodyweight loss may increase the diagnostic difficulty of brown tumors because multiple myeloma and bone metastasis also show the same symptoms. We studied a 68-year-old woman who had experienced unusual bodyweight loss in the past 6 months (56kg-40kg) and bone pain. She went to the hospital after a fall with a complaint of bone pain. An X-ray revealed a left bubbly-like cystic change and multiple fractures at the left ulna midshaft. Upon investigation, the level of intact parathyroid hormone was ascertained to be 1800 (normal: 10-60) pg/ml. Microscopically, the tumor demonstrated a benign bone lesion and was compatible with osteitis fibrosa cystica due to PHPT. The parathyroid scan (Tc-99 m sestamibi) indicated right parathyroid hyperplasia, which was later confirmed by a parathyroidectomy. She was diagnosed with osteitis fibrosa cystica associated with PHPT due to a parathyroid adenoma. PHPT can be presented with multiple fractures, bone pain, and bodyweight loss. Therefore, if a patient presents these symptoms, PHPT should be considered.

Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report.

BACKGROUND: Diabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After treatment with ART, patients might experience clinical deterioration following an increase in the CD4 cell count, which is termed immune reconstitution inflammatory syndrome (IRIS). Here, we describe an HIV-infected patient on ART who developed T1DMat due to IRIS, highlighting the clinical complexity in diagnosis and treatment. CASE PRESENTATION: A 36-year-old man infected with HIV had a nadir CD4 cell count of 15.53/µL before medication, which increased to 429.09/µL after 9 months of regular ART. The fasting serum glucose at 9 months was between 96 mg/dL and 117 mg/dL. After 11 months of ART, the patient was admitted to hospital for diabetic ketoacidosis (DKA) and Graves' disease (GD). Noninsulin antidiabetics (NIADs) were prescribed following the resolution of DKA. However, poor glycemic control was noted despite well-titrated NIADs. Further investigation demonstrated poor pancreatic beta cell function and elevated anti-glutamic acid decarboxylase (anti-GAD) and anti-tyrosine phosphatase-like insulinoma antigen 2 (anti-IA2) titers. According to the results, he was diagnosed with T1DM and received multiple daily injections(MDI) of insulin. The regimen of MDI was insulin degludec as basal insulin and insulin aspart as prandial insulin. After MDI therapy, his glycemic control was improved. CONCLUSION: In this case, T1DM was ascribed to IRIS. Although this phenomenon has been demonstrated in previous case reports, further study is necessary to realize the mechanism of this association. Therefore, we emphasize that when HIV-infected patients on ART experience an unstable blood glucose level and abnormal thyroid function, physicians should consider T1DM and GD associated with ART-induced IRIS to reduce the subsequent complications and more serious endocrine dysfunction.

Elevated Free Thyroxine Levels Might Alter the Effect of the Lipid Profile on Insulin Resistance in Type 2 Diabetes Mellitus.

Previous studies have shown that hyperthyroidism is associated with heightened insulin resistance and dyslipidemia. Therefore, in this study, we aim to explore the relationship between elevated thyroid hormone levels and the lipid profile in insulin resistance in patients with type 2 diabetes mellitus (T2DM) with hyperthyroidism. A total of 177 participants were included and grouped according to diagnosis. The serum test results demonstrated that free thyroxine (FT4) increased the insulin resistance index (HOMA-IR) by positively correlating with triglyceride (TG) levels (p = 0.005, r2 = 0.35). In patients with T2DM with hyperthyroidism, the decreasing high-density lipoprotein levels showed an association with HOMA-IR (p = 0.005). Among all the patients, with different levels of FT4, the areas under the ROC curve (AUCs) of the TG level, TG/high-density lipoprotein ratio, and HOMA-IR were 0.620 (95% CI: 0.536 to 0.698), 0.614 (95% CI: 0.530 to 0.692), and 0.722 (95% CI: 0.645 to 0.791), respectively. Our results suggest that elevated FT4 levels due to hyperthyroidism could alter the association with the lipid profile and insulin resistance in patients with T2DM. We also suggest that among all the included patients with T2DM, irrespective of the presence of hyperthyroidism, FT4 levels are positively correlated with insulin resistance.

Two-phase dual-signal-readout immunosensing platform based on multifunctional carbon nano-onions for ovarian cancer biomarker detection.

In order to detect early tumor markers and gain valuable time for treatment, there is an urgent need to develop a fast, cheap, and ultrasensitive multi-reading sensing platform. Herein, a solid/liquid two-phase dual-output biosensor was explored based on a sensitized sonochemiluminescence (SCL) strategy and a multifunctional carbon nano-onion (CNO) probe. It is clear that ultrasonic radiation caused the formation of hydroxyl radicals (˙OH), triggering the SCL signal of the emitter lucigenin (Luc2+). Meanwhile, titanium carbide nanodots and ethanol were used to enhance the SCL signal, and an astonishingly linear enhancement of the SCL intensity was produced with increasing ethanol concentration. More importantly, the CNOs, with their excellent photothermal properties and adsorption capacity, can output both the temperature signal and an enhanced SCL strength from the solid-liquid phase. Through inter-calibration of the signals from the two-phases, this biosensor shows excellent analytical performance for the detection of the ovarian cancer biomarker, human epididymis-specific protein 4, from 10-5 to 10 ng mL-1 with a low detection limit of 3.3 fg mL-1. This work not only provides a novel two-phase signal-output mode that broadens the scope of multiperformance joint applications of CNOs, but also enriches the quantitative detection of point-of-care testing.

Optical and Acoustic Synergetic Sensing Platform Enabled by a Pyrene-Based Conjugated Polymer Self-Circulating Amplified System for Lung Cancer Detection.

A stable and reusable electrochemiluminescent (ECL) signal amplification strategy was proposed through a pyrene-based conjugated polymer (Py-CP) triggered self-circulating enhancement system. Specifically, the delocalized conjugated π-electrons of Py-CPs made it an excellent coreactant to arouse the initial ECL signal improvement of Ru(phen)32+, but the subsequent signal reduction was attributed to the consumption of Py-CPs, in which this stage was called the signal sensitization evoking phase (SSEP). Then, the maximum use of ECL luminescence of Ru(phen)32+ produced in the SSEP was made to irradiate the photosensitizer Py-CPs for in situ producing numerous ·OH, and a stronger and more stable ECL response stage defined as the signal sensitization stabilize phase was reached. Encouragingly, the incorporation of Nb2C MXene quantum dots with an exceptional physicochemical property not only foreshortens the SSEP for quickly acquiring a stable ECL signal but also introduces the photoacoustic (PA) transduce mechanism for achieving dual-signal outputting. Ultimately, the portable and miniaturized ECL-PA synergetic sensing platform based on the closed-bipolar electrode realized sensitive let-7a detection in a wide linear range from 10-9 to 10-2 nM with a low detection limit of 3.3 × 10-10 nM and also demonstrated good selectivity, excellent stability, and high reliability. The successful application of an innovative signal transduction mechanism and dexterous coupling modality will provide new insights for advancing the development of flexible analytical devices.

Long-Lasting Electret Melt-Blown Nonwoven Functional Filters Made of Organic/Inorganixc Macromolecular Micron Materials: Manufacturing Techniques and Property Evaluations.

Melt-blown nonwoven fabrics for filtration are usually manufactured using polypropylene, but after a certain time period the middle layer of the mask may have a reduced effect on adsorbing particles and may not be easily stored. Adding electret materials not only increases storage time, but also shows in this study that the addition of electret can improve filtration efficiency. Therefore, this experiment uses a melt-blown method to prepare a nonwoven layer, and adds MMT, CNT, and TiO2 electret materials to it for experiments. Polypropylene (PP) chip, montmorillonite (MMT) and titanium dioxide (TiO2) powders, and carbon nanotube (CNT) are blended and made into compound masterbatch pellets using a single-screw extruder. The resulting compound pellets thus contain different combinations of PP, MMT, TiO2, and CNT. Next, a hot pressor is used to make the compound chips into a high-poly film, which is then measured with differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR). The optimal parameters are yielded and employed to form the PP/MMT/TiO2 nonwoven fabrics and PP/MMT/CNT nonwoven fabrics. The basis weight, thickness, diameter, pore size, fiber covering ratio, air permeability, and tensile property of different nonwoven fabrics are evaluated in order to have the optimal group of PP-based melt-blown nonwoven fabrics. According to the results of DSC and FTIR measurements, PP and MMT, CNT, and TiO2 are completely mixed, and the melting temperature (Tm), crystallization temperature (Tc) and endotherm area are changed accordingly. The difference in enthalpy of melting changes the crystallization of PP pellets, which in turn changes the fibers. Moreover, the Fourier transform infrared (FTIR) spectroscopy results substantiate that PP pellets are well blended with CNT and MMT, according to the comparisons of characteristic peaks. Finally, the scanning electron microscopy (SEM) observation suggests that with a spinning die temperature of 240 °C and a spinning die pressure lower than 0.01 MPa, the compound pellets can be successfully formed into melt-blown nonwoven fabrics with a 10-micrometer diameter. The proposed melt-blown nonwoven fabrics can be processed with electret to form long-lasting electret melt-blown nonwoven filters.

A case report: Marfan syndrome with X trisomy and FBN1 and SDHB mutations.

BACKGROUND: Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting the cardiovascular, skeletal, and ophthalmic systems. This report aimed to describe a novel genetic background and treatment prognosis of MFS. CASE PRESENTATION: A proband was initially diagnosed with bilateral pathologic myopia and suspected MFS. We performed whole exome sequencing and found a pathogenic nonsense FBN1 mutation in the proband, which confirmed the diagnosis of MFS. Notably, we identified a second pathogenic nonsense mutation in SDHB, which increased the risk of tumours. In addition, the proband karyotype was X trisomy, which may cause X trisomy syndrome. At the 6-month follow-up after posterior scleral reinforcement surgery, the proband's visual acuity improved significantly; however, myopia was still progressing. CONCLUSIONS: We report a rare case of MFS with a X trisomy genotype, a mutation in FBN1 and a mutation in SDHB for the first time, and our findings could be helpful for the clinical diagnosis and treatment of this disease.

Iodine nutritional status is not a direct factor in the prevalence of the BRAFV600E mutation in papillary thyroid cancer.

Objective: Papillary thyroid carcinoma (PTC) accounts for approximately 85%-90% of all thyroid cancers. Of the iodine-metabolizing genes, BRAFV600E is a highly specific target for PTC and may have a reciprocal causative relationship with iodide-metabolizing genes. Materials and methods: In this study, we performed a data analysis of selected quantitative studies to determine the relationship between iodine nutritional status and the prevalence of the BRAF600E mutation in patients with PTC. Five studies were selected for meta-analysis based on the selection criteria. Results: A total of 2,068 patients were divided into three groups: low (urinary iodine concentration [UIC] < 100 µg/L), adequate (UIC 100-200 µg/L), and high (UIC ≥ 200 µg/L). The results were obtained using RevMan software, and the pooled odds ratios (ORs) were calculated using Mantel-Haenszel statistics with a 95% confidence interval (CI). The OR for the prevalence of the BRAFV600E mutation between the high and adequate groups was 1.25 (95% CI 0.64-2.43, p = 0.51), and the OR between the low and adequate groups was 0.98 (95% CI 0.42-2.31, p = 0.96). The BRAFV600E mutation risk did not change significantly at different levels of iodine nutrition (p = 0.33) in statistical analyses. Conclusion: We conducted preliminary research on dietary iodine intake and the BRAFV600E mutation in PTC. The results suggested that abnormal iodine intake might not directly influence the prevalence of the BRAFV600E mutation in these patients. Further research into the associations between dietary iodine intake and the BRAFV600E mutation in PTC, including the underlying mechanisms, is required.

Combing High-Modulus Fibers with a Novel Foaming Structure Applied to Protective Sandwich-Structured Composites: Manufacturing Techniques and Property Evaluations.

This study proposes the composites with a sandwich structure that is primarily made by the multi-step foaming process. The staple material is polyurethane (PU) foam that is combined with carbon fibers, followed by a Kevlar woven fabric. The composites are evaluated in terms of puncture resistance, buffer absorption, and electromagnetic wave shielding effectiveness (EMSE). The manufacturing process provides the composites with a stabilized structure efficiently. Serving the interlayer, a Kevlar woven fabric are sealed between a top and a bottom layer consisting of both PU foam and an aluminum film in order, thereby forming five-layered composites. Namely, the upper and lower surfaces of the five-layered sandwiches are aluminum films which is laminated on a purpose for the EMSE reinforcement. The test results indicate that the PU foam composites are well bonded and thus acquire multiple functions from the constituent materials, including buffer absorption, puncture resistance, and EMSE. There is much prospect that the PU foam composites can be used as a protective material in diverse fields owing to a flexible range of functions.

Iodine nutritional status is not a direct factor in the prevalence of the BRAFV600E mutation in papillary thyroid cancer

ABSTRACT Objectives: Papillary thyroid carcinoma (PTC) accounts for approximately 85%-90% of all thyroid cancers. Of the iodine-metabolizing genes, BRAFV600E is a highly specific target for PTC and may have a reciprocal causative relationship with iodide-metabolizing genes. Materials and methods: In this study, we performed a data analysis of selected quantitative studies to determine the relationship between iodine nutritional status and the prevalence of the BRAF600E mutation in patients with PTC. Five studies were selected for meta-analysis based on the selection criteria. Results: A total of 2,068 patients were divided into three groups: low (urinary iodine concentration [UIC] < 100 μg/L), adequate (UIC 100-200 μg/L), and high (UIC ≥ 200 μg/L). The results were obtained using RevMan software, and the pooled odds ratios (ORs) were calculated using Mantel-Haenszel statistics with a 95% confidence interval (CI). The OR for the prevalence of the BRAFV600E mutation between the high and adequate groups was 1.25 (95% CI 0.64-2.43, p = 0.51), and the OR between the low and adequate groups was 0.98 (95% CI 0.42-2.31, p = 0.96). The BRAFV600E mutation risk did not change significantly at different levels of iodine nutrition (p = 0.33) in statistical analyses. Conclusion: We conducted preliminary research on dietary iodine intake and the BRAFV600E mutation in PTC. The results suggested that abnormal iodine intake might not directly influence the prevalence of the BRAFV600E mutation in these patients. Further research into the associations between dietary iodine intake and the BRAFV600E mutation in PTC, including the underlying mechanisms, is required.

Effect of metformin monotherapy and dual or triple concomitant therapy with metformin on glycemic control and lipid profile management of patients with type 2 diabetes mellitus.

Background: In this study, we aimed to compare the effects of metformin-based dual therapy versus triple therapy on glycemic control and lipid profile changes in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods: In total, 60 patients were eligible for participation in this study. Patients received at least 24 months of metformin monotherapy, dual therapy, or triple therapy with metformin plus linagliptin (a dipeptidyl peptidase 4 (DPP-4) inhibitor) or dapagliflozin (a sodium-glucose cotransporter-2 (SGLT2) inhibitor). Blood samples were collected from each patient, followed by evaluation of changes in their blood glucose control and lipid profile-related markers. Results: A combination of metformin and DPP4 and SGLT2 inhibitor therapy more effectively reduced low-density lipoprotein cholesterol (LDL-C) (p = 0.016) than metformin monotherapy. A combination of metformin and DPP4 and SGLT2 inhibitor therapy more effectively improved total cholesterol (Chol, p = 0.049) and high-density lipoprotein cholesterol (HDL-C) than metformin monotherapy (p = 0.037). Metformin plus linagliptin dual therapy was more effective than metformin monotherapy in reducing glycosylated hemoglobin (HbA1C, p = 0.011). Patients who received a combination of linagliptin and empagliflozin showed a significant reduction in their fasting blood glucose (p = 0.019), HbA1c (p = 0.036), and Chol (p = 0.010) compared with those who received linagliptin dual therapy. Furthermore, patients who received metformin plus dapagliflozin and saxagliptin showed significantly reduced Chol (p = 0.011) and LDL-C (p = 0.035) levels compared with those who received metformin plus dapagliflozin. Conclusion: In conclusion, dual therapy with metformin and linagliptin yields similar glycemic control ability to triple therapy. Among metformin combination triple therapy, triple therapy of empagliflozin and linagliptin might have a better glycemic control ability than dual therapy of linagliptin. Moreover, Triple therapy of dapagliflozin and saxagliptin might have a better lipid control ability than dual therapy of dapagliflozin.

Modular and Noncontact Wireless Detection Platform for Ovarian Cancer Markers: Electrochemiluminescent and Photoacoustic Dual-Signal Output Based on Multiresponse Carbon Nano-Onions.

An electrochemiluminescent (ECL)-photoacoustic (PA) dual-signal output biosensor based on the modular optimization and wireless nature of a bipolar electrode (BPE) was constructed. To further simplify the detection process, the BPE structure was designed as three separate units: anode ECL collection, cathode catalytic amplification, and intermediate functional sensing units. Specifically, the anode unit was placed with Eosin Yellow, a cheap and effective ECL reagent, and the cathode unit was a laser-induced polyoxometalate-graphene electrode, which was helpful to enhance the anode ECL signal. The intermediate functional sensing unit consisted of a temperature-sensitive conductive film. Further, using a carbon nano-onion nanocomposite with excellent absorption performance in the near-infrared region as a signal tag not only leads to changes in the electrical conductivity of the film through heat transfer and thus affects the ECL signal but also produces a strong PA response. With this design, PA and ECL signals can be output simultaneously. This work not only realizes multiple modularization processes in the design of sensors but also implements the diversification of signal output modes, which will enrich the joint research field of ECL detection technology and other new detection methods.

Clinical significance of hepatic function in Graves disease with type 2 diabetic mellitus: A single-center retrospective cross-sectional study in Taiwan.

Graves disease (GD) and type 2 diabetes mellitus (T2DM) both impair liver function; we therefore explored the possibility of a relationship among diabetic control, thyroid function, and liver function. This retrospective, cross-sectional study compared serum liver function biomarkers of primary GD patients in a single center between 2016 and 2020, derived from clinical databases, and clarified the correlation of liver function in GD patients with or without T2DM. Furthermore, the diabetes mellitus group was divided into glycated hemoglobin A1C (HbA1C) <6.5% group and ≥6.5% group to further analyze the effect by disease control in patients. Statistical differences between groups were assessed using independent t tests to clarify the association of serum biomarkers between GD with T2DM. Pearson test was applied to assess within-group statistical correlation of serum biomarkers. The correlation of factors in each group was demonstrated by using the Kendall tau-b method and stepwise regression analysis. A total of 77 patients were included in the study. In the study population, glutamate pyruvate transaminase (GPT) was significantly correlated with thyroid-stimulating hormone, and HbA1C was significantly correlated with alkaline phosphatase (ALK-P), glutamate oxaloacetate transaminase (GOT), and GPT. An examination of GOT, GPT, free thyroxine (FT4), and HbA1C levels revealed a significant difference between the non-T2DM and T2DM groups. GPT also exhibited a significant correlation with triiodothyronine in the T2DM group. The T2DM group was further divided into groups: HbA1C <6.5% and ≥6.5%. The results demonstrated that ALK-P, GOT, GPT, and FT4 levels were significantly different between the groups. A significant correlation between ALK-P and thyroid-stimulating hormone and between GOT and FT4 was also identified in the HbA1C <6.5% group. Our single-center study revealed that diabetes affects liver function in patients with GD. For patients with T2DM, when liver function becomes impaired, thyroid function control deteriorates. GPT was correlated with triiodothyronine but not with FT4, which indicated the impairment of deiodination in the liver. This phenomenon was not observed in the non-T2DM population. The early detection of abnormal liver function in patients with GD and T2DM may help limit the development of comorbidities and improve disease management.

A two-way 224-Gbit/s PAM4-based fibre-FSO converged system.

A two-way 224-Gbit/s four-level pulse amplitude modulation (PAM4)-based fibre-free-space optical (FSO) converged system through a 25-km single-mode fibre (SMF) transport with 500-m free-space transmission is successfully constructed, which adopts injection-locked vertical-cavity surface-emitting lasers with polarisation-multiplexing mechanism for a demonstration. Compared with one-way transmission, two-way transmission is an attractive architecture for fibre-FSO converged system. Two-way transmission over SMF transport with free-space transmission not only reduces the required number of fibres and the setups of free-space transmission, but also provides the advantage of capacity doubling. Incorporating dual-wavelength four-level pulse amplitude modulation (PAM4) modulation with polarisation-multiplexing mechanism, the transmission capacity of fibre-FSO converged system is significantly enhanced to 224 Gbit/s (56 Gbit/s PAM4/wavelength × 2-wavelength × 2-polarisation) for downlink/uplink transmission. Bit error rate and PAM4 eye diagrams (downstream/upstream) perform well over 25-km SMF transport with 500-m free-space transmission. This proposed two-way fibre-FSO converged system is a prominent one not only because of its development in the integration of fibre backbone with optical wireless extension, but also because of its advantage in two-way transmission for affording high downlink/uplink data rate with good transmission performance.

Is the level of serum lactate dehydrogenase a potential biomarker for glucose monitoring with type 2 diabetes mellitus?

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder due to defects in insulin secretion or insulin resistance leading to the dysfunction and damage of various organs. To improve the clinical evaluation of short-term blood glycemic variability monitoring, it is critical to identify another blood cell status and nutritional status biomarker that is less susceptible to interference. This study identifies the significance of serum lactate dehydrogenase (LDH) level among T2DM patients treated in outpatient clinics and investigates the relationship of LDH level with other variables. Methods: This study comprised 72 outpatients with T2DM over 20 years of age. Blood samples were collected followed by a hematological analysis of serum glycated albumin (GA), LDH, fasting blood glucose, glycosylated hemoglobin, C-peptide, and insulin antibodies (insulin Ab). Results: Serum LDH level was significantly correlated with GA (p < 0.001), C-peptide (p = 0.04), insulin Ab (p = 0.03), and thyroid-stimulating hormone (TSH) levels (p = 0.04). Hence, we performed a linear regression analysis of hematological markers. GA (p < 0.001, r2 = 0.45) and insulin Ab (p < 0.001, r2 = 0.40) were significantly associated with LDH level. Then, we classified patients into low (<200 U/L) and high (≥200 U/L) serum LDH level groups, respectively. GA (p < 0.001), C-peptide (p = 0.001), and TSH (p = 0.03) showed significant differences in patients with high LDH levels compared with those in patients with low LDH levels. Conclusion: In conclusion, we suggested that LDH level was independent of long-term but associated with short-term blood glucose monitoring. The results indicated that changes in serum GA induced cell damage and the abnormal elevation of the serum level of LDH may occur simultaneously with glycemic variability. It has been reported that many biomarkers are being used to observe glucose variability in T2DM. However, LDH could provide a more convenient and faster evaluation of glycemic variability in T2DM.

The effect of 12 weeks of combined training on hepatic fat content and metabolic flexibility of individuals with non-alcoholic fatty liver disease: Protocol of an open-label, single-center randomized control trial.

Introduction: Metabolic flexibility (MetF) is the capacity of an organism to oxidate substrate according to substrate availability or demand. The mismatch of substrate availability and oxidation may cause ectopic fat accumulation in the muscle and the liver. The objectives of the study are to examine the effect of 12 weeks of combined exercise on hepatic fat reduction and investigate metabolites related to MetF before and after the high-fat diet between individuals with NAFLD and healthy control with an active lifestyle. Methods: This study is an open-label, single-center trial randomized controlled clinical study plus a cross-sectional comparison between individuals with NAFLD and healthy control. Individuals with NAFLD were allocated into two groups receiving resistance training (RT) combined with high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT). Anthropometric indicators, clinical blood markers about glucose, lipid metabolism, and hepatic fat content (HFC) were assessed before and after the intervention. The metabolomics was also used to investigate the discrepant metabolites and mechanisms related to MetF. Discussion: Metabolic flexibility reflects the capacity of an organism to switch the oxidation substrates flexibly, which is associated with ectopic fat accumulation. Our study aimed to explore the discrepant metabolites related to MetF before and after a high-fat diet between individuals with NAFLD and healthy control. In addition, the study also examined the effectiveness of RT combined with HIIT or MICT on hepatic fat reduction and quantificationally analyzed the metabolites related to MetF before and after the intervention. Our results provided a perspective on fatty liver-associated metabolic inactivity. Trial registration: ClinicalTrials.gov: ChiCTR2200055110; Registered 31 December 2021, http://www.chictr.org.cn/index.aspx.

A 400-Gb/s WDM-PAM4 OWC system through the free-space transmission with a water-air-water link.

A 400-Gb/s wavelength-division-multiplexing (WDM) four-level pulse amplitude modulation (PAM4) optical wireless communication (OWC) system through a 200-m free-space transmission with either an 8.8-m piped water-air-piped water link or a 6.5-m turbid water-air-turbid water link is successfully constructed. Incorporating PAM4 modulation with an 8-wavelength WDM scheme greatly increases the total transmission rate of the WDM-PAM4 OWC system to 400 Gb/s (50 Gb/s/λ × 8 λs). By adopting doublet lenses in free-space transmission, a laser beam reducer/expander and a reflective spatial light modulator (SLM) with an angle expander through the water-air-water link, good bit error rate performance and acceptable PAM4 eye diagrams are obtained. Using a reflective SLM with an angle expander not only adaptively adjusts the laser beam, but also effectively solves the oceanic engineering problems. This demonstrates WDM-PAM4 OWC system outperforms existing OWC systems through the free-space transmission with an air-water-air link because it can solve the practical engineering problems in actual oceanic environments.

Chronic Alcohol Abuse-Induced Hypokalemia Might Lead to Delayed Diagnosis or Misdiagnosis of Thyrotoxic Periodic Paralysis.

Thyrotoxic periodic paralysis is an uncommon and potentially life-threatening complication of thyrotoxicosis and hyperthyroidism characterized by acute and reversible episodes of muscle weakness and hypokalemia. Here is a 41-year-old Taiwanese male patient without any family history of hyperthyroidism presented to the emergency room of our institution with initial symptom of acute lower limb weakness. Laboratory analysis revealed uncommonly severe hypokalemia (<1.5 mEq/L). A thyroid function test revealed hyperthyroidism, and thyroid ultrasonography revealed findings compatible with Graves' disease. However, symptoms such as nausea, vomiting, diarrhea, and heavy breathing were absent. He was administered with 15 mg of methimazole and 30 mg of propranolol per day for complications of hyperthyroidism. Then we exhaustively evaluated the patient's history and lifestyle habits, and found that the patient had chronic alcohol abuse (an 1-L bottle 45%-48% liquor per week) for more than 10 years. In this case, chronic alcohol abuse may have increased the patient's tolerance to the profound hypokalemia such that it did not immediately show critical symptoms. Therefore, according to this case report, we suggest that chronic alcohol consumption or abuse may lead patients, especially those with hyperthyroidism, to ignore or delay treatment.