External validity of type 2 diabetes clinical trials on cardiovascular outcomes for a multimorbid population.

AIM: To investigate the external validity of recent antihyperglycaemic trials evaluating cardiovascular outcomes in a multimorbid population. MATERIALS AND METHODS: Selection criteria of 15 randomized controlled trials from the 2020 American Diabetes Association Standard of Care statement were applied in a stepwise manner to tertiary care patients with type 2 diabetes. Primary outcomes were the number of patients eligible per individual trial and for the aggregate of trials. Secondary outcomes included patient predictors of trial eligibility. RESULTS: Of 1059 patients, the mean (SD) age was 66 (10.74) years, the median (IQR) Charlson index was 2 (2, 3) and 458 (43%) had documented cardiovascular disease. The median (IQR) number of patients included in individual trials was 263 (174.25-308.75) and 795 (75.1%) of them were eligible for at least one trial. Among those 264 ineligible, 127 (48.1%) had an HbA1c level of 7% or less and no cardiovascular disease; 53.5% and 34.4% of the patients were eligible for two and three different classes of drugs, respectively. The strongest predictor of trial eligibility was cardiovascular disease (risk ratio 2.17, 95% CI 2.01-2.35). CONCLUSIONS: A considerable proportion of multimorbid patients would be eligible for recent antihyperglycaemic trials. This positive finding can be attributed to development guidance in diabetes trials and the different approach we took, in which we evaluated inclusion by trials as an aggregate.

Exposure to fine particles increases blood pressure of hypertensive outdoor workers: A panel study.

BACKGROUND: Hypertension and air pollution are two important risk factors for cardiovascular morbidity and mortality. Although several studies suggest that air pollution has a significant impact on blood pressure, studies on long-term effects are sparse and still controversial. OBJECTIVE: To evaluate the effects of exposure of outdoor workers to different levels of traffic-generated PM2.5 on blood pressure. DESIGN: This is an observational panel study. PARTICIPANTS: 88 non-smoking workers exposed to different concentrations of air pollution were evaluated weekly along four successive weeks. MEASUREMENTS: In each week, personal monitoring of 24-h PM2.5 concentration and 24-h ambulatory blood pressure were measured. The association between blood pressure variables and PM2.5, adjusted for age, body mass index, time in job, daily work hours, diabetes, hypertension and cholesterol was assessed by means of multiple linear regression models fitted by least squares. RESULTS: Exposure to PM2.5 (ranging from 8.5 to 89.7 µg/m3) is significantly and consistently associated with an increase in average blood pressure. An elevation of 10 µg/m3 in the concentration of PM2.5 is associated with increments of 3.9 mm Hg (CI 95% = [1.5; 6.3]) in average systolic 24-h blood pressure for hypertensive and/or diabetic workers. CONCLUSION: Exposure to fine particles, predominantly from vehicular traffic, is associated with elevated blood pressure in hypertensive and/or diabetic workers.

Acupuncture for Climacteric-Like Symptoms in Breast Cancer Improves Sleep, Mental and Emotional Health: A Randomized Trial.

Objective: Breast cancer is the most prevalent malignant neoplasm in women. Optimal treatment frequently includes a hormonal-blockage phase maintained for 5-10 years. Pharmacologic agents used for this blockage induce many climacteric-like symptoms, which often exact a heavy toll on patients' quality of life. Acupuncture has had promising results for treating climacteric-like symptoms induced by hormonal blockage, but there is no evidence of efficacy for controlling hot flashes. Materials and Methods: This trial used acupuncture to treat the climacteric-like symptoms of patients with breast cancer, focusing on the mental, physical, and genitourinary symptoms and sleep disturbances, to determine the influence of acupuncture treatment. The randomized placebo-controlled trial, at a university-based cancer center, with blinded data collectors, compared an Acupuncture group (A), a Sham-Acupuncture group (S), and a Wait-List Control group (C). The patients were receiving tamoxifen. Group A had 10 weekly sessions of manual Acupuncture; Group S had 10 weekly sessions of Sham Acupuncture; and Group C spent 10 weeks on a Wait-List. The main outcome measures were the Beck Depression Inventory-II (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), and the Menopause Rating Scale (MRS). Results: Primary analysis revealed differences among the groups' improvements in scores for the 3 questionnaires (P < 0.001), The A group had significant improvements on the BDI-II (P < 0.001), PSQI (P < 0.002), and MRS (P < 0.004) compared to the S group in a post hoc analysis. Conclusions: Acupuncture improved sleep, and mental and emotional distress symptoms induced by hormonal blockage in patients with breast cancer. Clinical Trial: This trial was registered at CAAE as trial #: 37758414.8.0000.0065.

Electronic structures of well-aligned Er-doped ZnO nanorod arrays.

Electronic structures of well-aligned Er-doped ZnO (ZnO:Er) nanorod arrays (NRAs) synthesized by a solution-based hydrothermal process were characterized by high-resolution transmission electron microscopy (HRTEM) and X-ray absorption fine structure (XAFS). HRTEM and angular dependent X-ray absorption near-edge structure analysis at O K and Zn L3 edges indicates that the spontaneous polarization is along the [0001] direction. The analysis of Er L3-edge XAFS demonstrates that the local structure around Er in the ZnO:Er NRAs was transformed from O(h) to C(4v), after annealing.

Periodic si nanopillar arrays fabricated by colloidal lithography and catalytic etching for broadband and omnidirectional elimination of Fresnel reflection.

Periodic Si nanopillar arrays (NPAs) were fabricated by the colloidal lithography combined with catalytic etching. By varying the size of colloidal crystals using oxygen plasma etching, Si NPAs with desirable diameter and fill factor could be obtained. The Fresnel reflection can be eliminated effectively over broadband regions by NPAs; i.e., the wavelength-averaged specular reflectance is decreased to 0.70% at wavelengths of 200-1900 nm. The reflectance is reduced greatly for the incident angles up to 70 degrees for both s- and p-polarized light. These excellent antireflection performances are attributed to light trapping effect and very low effective refractive indices, which can be modified by the fill factor of Si in the NPA layers.

Packaging Glass with a Hierarchically Nanostructured Surface: A Universal Method to Achieve Self-Cleaning Omnidirectional Solar Cells.

Fused-silica packaging glass fabricated with a hierarchical structure by integrating small (ultrathin nanorods) and large (honeycomb nanowalls) structures was demonstrated with exceptional light-harvesting solar performance, which is attributed to the subwavelength feature of the nanorods and an efficient scattering ability of the honeycomb nanowalls. Si solar cells covered with the hierarchically structured packaging glass exhibit enhanced conversion efficiency by 5.2% at normal incidence, and the enhancement went up to 46% at the incident angle of 60°. The hierarchical structured packaging glass shows excellent self-cleaning characteristics: 98.8% of the efficiency is maintained after 6 weeks of outdoor exposure, indicating that the nanostructured surface effectively repels polluting dust/particles. The presented self-cleaning omnidirectional light-harvesting design using the hierarchical structured packaging glass is a potential universal scheme for practical solar applications.

Association between Traffic Air Pollution and Reduced Forced Vital Capacity: A Study Using Personal Monitors for Outdoor Workers.

BACKGROUND: The effects of outdoor air pollution on lung function in adults are still controversial. OBJECTIVE: Evaluate the effects of exposure to different levels of traffic-generated PM2.5 on workers' lung functions in São Paulo, Brazil. METHODS: To cover a wide range of exposures, 101 non-smoking workers from three occupations (taxi drivers, traffic controllers, and forest rangers) were selected for the study. After clinical evaluation, the participants were scheduled to attend four consecutive weekly visits in which they received a 24-hour personal PM2.5 sampler and had lung function tests measured on the following day. The association between the spirometric variables and the averaged PM2.5 levels was assessed using robust regression models adjusted for age, waist circumference, time at the job, daily work hours, diabetes or hypertension and former smoking habits. RESULTS: Relative to workers in the lowest exposed group (all measures < 25 µg/m3), those with the highest level of exposure (all measures > 39.6 µg/m3) showed a reduction of predicted FVC (-12.2%; CI 95%: [-20.0% to -4.4%]), a marginal reduction of predicted FEV1 (-9.1%; CI 95%: [-19.1% to 0.9%]) and an increase of predicted FEF25-75%/FVC (14.9%; CI 95%: [2.9% to 26.8%]) without changes of FEV1/FVC. CONCLUSIONS: Exposure to vehicular traffic air pollution is associated with a small but significant reduction of FVC without a reduction of FEV1/FVC.

Homeopathy and acupuncture teaching at Faculdade de Medicina da Universidade de São Paulo: the undergraduates' attitudes.

CONTEXT AND OBJECTIVE: Homeopathy and acupuncture, although recognized as medical specializations in Brazil, are not taught in most medical schools. The objective was to evaluate undergraduate attitudes towards them following their inclusion as optional disciplines at Faculdade de Medicina da Universidade de São Paulo (FMUSP) in 2002. DESIGN AND SETTING: Questionnaire, at FMUSP. METHODS: 484 students answered a self-administered questionnaire on these therapies, regarding their interest in learning, the teaching methods, their knowledge/experience (or that of someone close to them) and how it was acquired, the main indicators and general effectiveness of these therapies, and the possibilities for offering and integrating them within public healthcare units. RESULTS: Over 85% of the students considered that homeopathy and acupuncture should be included in curricula, as options (72%) or compulsorily (19%); 56% showed great interest in learning about them. Although 76% had little or no knowledge, 67% believed that these therapies had some effectiveness, and that chronic diseases (37%) or even chronic and acute diseases (29%) would be the main indicators for their use. Around 35% were receptive towards offering public primary care using both therapies, while 34% thought these treatments should also be available in hospitals and 60% believed they could be integrated with conventional medical practices. CONCLUSION: The medical students were interested in learning the principles of homeopathy and acupuncture, were able to observe and report on the effectiveness of these treatments and defended the use of these medical specializations within public healthcare.

A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture.

OBJECTIVES: This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma. METHODS: This was a randomized, controlled, crossover trial conducted at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A total of 74 patients with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short- and long-acting ß-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (α=0.05). RESULTS: In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0.001) and vitality (p=0.019). Sham acupuncture also led to significant differences in symptoms, but these were not different from those seen with real acupuncture. Spirometry and exhaled NO levels did not show a difference between sham and real acupuncture treatment. In addition, no significant difference was demonstrated between treatments regarding the quality of life evaluation. CONCLUSION: Real and sham acupuncture have different effects and outcomes on asthma control. The crossover approach was not effective in this study because both interventions led to improvement of asthma symptoms, quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.

Evaluation of acupuncture for cancer symptoms in a cancer institute in Brazil.

INTRODUCTION: Acupuncture has been progressively included in the practice of mainstream medicine in recent decades. The State of Sao Paulo Cancer Institute is a public hospital established in 2008 and its acupuncture service follows the experience and model of several oncology centres in the USA, aiming to optimise the treatment of symptoms such as postoperative pain, oncological pain, neuropathic pain, nausea, vomiting, xerostomia and fatigue induced by chemotherapy. This paper describes the population given acupuncture treatment and the effects of the intervention on symptom management. METHODS: One hundred and eighty-three patients from our service were enrolled in the study. Baseline and final symptom intensity was recorded using a visual analogue score (VAS) ranging from 0 to 10 cm, with a higher score meaning higher symptom intensity. RESULTS: Fifty-four (29.50%) were receiving active treatment with chemotherapy and/or radiotherapy, 29 (15.85%) were receiving hormone therapy and 100 (54.65%) were considered to be in remission. The main symptoms were: oncological pain in 44 (24.04%), chemotoxicity in 34 (18.6%), lumbar pain in 53 (28.96%) and chronic postoperative pain in 54 (28.4%). The mean (SD) initial symptom score was 7.04 (1.8), which was reduced to 2.56 (2.75) after treatment (p<0.001), an improvement of 63.6% in control of the symptoms. Further analysis of the data showed that the effect was similar in different indications for acupuncture treatment. CONCLUSIONS: Use of acupuncture may have improved symptom control in patients enrolled in this study.

An energy-harvesting scheme employing CuGaSe2 quantum dot-modified ZnO buffer layers for drastic conversion efficiency enhancement in inorganic-organic hybrid solar cells.

We demonstrated a promising route to enhance the performance of inverted organic photovoltaic (OPV) devices by the incorporation of CuGaSe2 (CGS) quantum dots (QDs) into the ZnO buffer layer of P3HT:PCBM-based devices. The modification of QDs provides better band alignment between the organic/cathode interface, improves ZnO crystal quality, and increases photon absorption, leading to more effective carrier transport/collection. By employing this energy-harvesting scheme, short-circuit current density, open-circuit voltage, and fill factor of the OPV device after CGS QD modification are improved by 9.43%, 7.02% and 6.31%, respectively, giving rise to a 23.8% enhancement in the power conversion efficiency.

Few-Layer MoS2 with high broadband Photogain and fast optical switching for use in harsh environments.

Few-layered MoS2 as Schottky metal-semiconductor-metal photodetectors (MSM PDs) for use in harsh environments makes its debut as two-dimensional (2D) optoelectronics with high broadband gain (up to 13.3), high detectivity (up to ~10(10) cm Hz(1/2)/W), fast photoresponse (rise time of ~70 µs and fall time of ~110 µs), and high thermal stability (at a working temperature of up to 200 °C). Ultrahigh responsivity (0.57 A/W) of few-layer MoS2 at 532 nm is due to the high optical absorption (~10% despite being less than 2 nm in thickness) and a high photogain, which sets up a new record that was not achievable in 2D nanomaterials previously. This study opens avenues to develop 2D nanomaterial-based optoelectronics for harsh environments in imaging techniques and light-wave communications as well as in future memory storage and optoelectronic circuits.

An efficient broadband and omnidirectional light-harvesting scheme employing a hierarchical structure based on a ZnO nanorod/Si3N4-coated Si microgroove on 5-inch single crystalline Si solar cells.

We employ a ZnO nanorod/Si(3)N(4)-coated Si microgroove-based hierarchical structure (HS) for a light-harvesting scheme in 5 inch single crystalline Si solar cells. ZnO nanorods and Si microgrooves were fabricated by a simple and scalable aqueous process. The excellent light-harvesting characteristics of the HS, such as broadband working ranges and omnidirectionality have been demonstrated using external quantum efficiencies and reflectance measurements. The solar cells with the hierarchical surface exhibit excellent photovoltaic characteristics, i.e., a short-circuit current (J(SC)) of 38.45 mA cm(-2), open-circuit voltage of 609 mV and conversion efficiency of 14.04%. As incident angles increase from 0° to 60°, only 5.3% J(SC) loss is achieved by employing the hierarchical surface, demonstrating the enhanced omnidirectional photovoltaic performances, also confirmed by the theoretical analysis. A viable scheme for broadband and omnidirectional light harvesting using the HS employing microscale/nanoscale surface textures on single crystalline Si solar cells has been demonstrated.

Hierarchical structures consisting of SiO2 nanorods and p-GaN microdomes for efficiently harvesting solar energy for InGaN quantum well photovoltaic cells.

We experimentally and theoretically demonstrated the hierarchical structure of SiO(2) nanorod arrays/p-GaN microdomes as a light harvesting scheme for InGaN-based multiple quantum well solar cells. The combination of nano- and micro-structures leads to increased internal multiple reflection and provides an intermediate refractive index between air and GaN. Cells with the hierarchical structure exhibit improved short-circuit current densities and fill factors, rendering a 1.47 fold efficiency enhancement as compared to planar cells.

Significant enhancement of yellow-green light emission of ZnO nanorod arrays using Ag island films.

Surface plasmon (SP) mediated emission from ZnO nanorod arrays (NRAs)/Ag/Si structures has been investigated. The ratio of visible emission to UV emission can be increased by over 30 times via coupling with SP without deterioration of the crystal quality. The fact that the effect of SP crucially depends on the size of Ag island films provides the feasibility to significantly enhance the yellow-green emission of the ZnO nanostructures without sacrificing the crystallinity of ZnO.