"Adjacent Bed Effect" of Total Knee Arthroplasty Patients During the Perioperative Period.

BACKGROUND: Knee osteoarthropathy is one of the most common degenerative joint diseases in the elderly, total knee arthroplasty (TKA) is the most commonly used treatment for end-stage knee osteoarthropathy. Negative emotions such as anxiety have been extensively documented in knee osteoarthropathy patients. AIM: This study aimed to investigate the Emotional Contagion during hospitalization in patients undergoing TKA. METHODS: Eligible subjects were divided into three case groups according to their anxiety states and bed arrangement. All subjects underwent a unilateral, cemented TKA under general anesthesia. Post-operative recovery outcomes including pain, pain behavior and physical function were recorded pre-operation, 1-day, 1 week, 2-weeks, 1-month and 3-months post-operation. RESULTS: A total of 38 subjects were included in the final analysis. Subjects with anxiety had higher Visual Analogue Scale pain scores, PROMIS-Pain Behavior scores than subjects without anxiety in the Contagion Group preoperation (p ≤ .05). Non-anxiety subjects hospitalized in beds physically adjacent to anxiety subjects experienced more severe pain and poorer function (p ≤ .05). After discharge, all clinical outcomes gradually became lower than anxiety subjects in the Contagion Group, reaching levels similar to non-anxiety subjects in the No Contagion Group within 1 month (p>.05). CONCLUSIONS: This study showed that patients with anxiety may have an "Adjacent Bed Effect" on patients with TKA in the adjacent bed, which may be associated with poorer postoperative recovery, including pain and physical function. We speculate this phenomenon can be effectively avoided by the nursing team through accurately assessing psychological status and reasonable bed arrangements in the inpatient assessment phase.

Combined healthy lifestyle in early pregnancy and risk of gestational diabetes mellitus: A prospective cohort study.

OBJECTIVE: To examine the association of a combined healthy lifestyle in early pregnancy with gestational diabetes mellitus (GDM) risk. DESIGN, SETTING AND POPULATION: A Chinese prospective cohort study with 6980 pregnant women. METHODS: Individual modifiable lifestyle factors were assessed in early pregnancy and a combined lifestyle score was derived from the sum of the lifestyle factors, with a higher score indicating a healthier lifestyle. The association of a combined healthy lifestyle with GDM risk was examined. MAIN OUTCOME MEASURES: Gestational diabetes mellitus was diagnosed in middle pregnancy according to the International Association of Diabetes and Pregnancy Study Group criteria or diagnoses in medical records. RESULTS: Overall, 501 (7.2%) pregnant women were diagnosed with GDM. Being physically active (total energy expenditure in upper three quintiles, i.e. ≥100.1 metabolic equivalent of task [MET]-hours/week; odds ratio [OR] 0.76, 95% confidence interval [CI] 0.63-0.92), healthy diet (total intake of vegetables and fruits ≥5 times/day; OR 0.74, 95% CI 0.59-0.94), sufficient sleep (night-time sleep duration ≥7 hours/night; OR 0.66, 95% CI 0.48-0.90) and healthy weight (early-pregnancy BMI <24.0 kg/m2 ; OR 0.57, 95% CI 0.46-0.71) were associated with lower GDM risk. The GDM risk decreased linearly across the combined lifestyle score (Ptrend <0.001): women with 2, 3 and 4 lifestyle factors compared with those with 0-1 factor had 38% (OR 0.62, 95% CI 0.46-0.84), 57% (OR 0.43, 95% CI 0.31-0.58) and 66% (OR 0.34, 95% CI 0.22-0.52) lower risks of GDM, respectively. CONCLUSION: A healthy lifestyle in early pregnancy was associated with a substantially lower GDM risk.

Transcriptome-Based Construction of the Gibberellin Metabolism and Signaling Pathways in Eucalyptus grandis × E. urophylla, and Functional Characterization of GA20ox and GA2ox in Regulating Plant Development and Abiotic Stress Adaptations.

Gibberellins (GAs) are the key regulators controlling plant growth, wood production and the stress responses in perennial woody plants. The role of GA in regulating the above-mentioned processes in Eucalyptus remain largely unclear. There is still a lack of systematic identification and functional characterization of GA-related genes in Eucalyptus. In this study, a total of 59,948 expressed genes were identified from the major vegetative tissues of the E. grandis × E. urophylla using transcriptome sequencing. Then, the key gene families in each step of GA biosynthesis, degradation and signaling were investigated and compared with those of Arabidopsis, rice, and Populus. The expression profile generated using Real-time quantitative PCR showed that most of these genes exhibited diverse expression patterns in different vegetative organs and in response to abiotic stresses. Furthermore, we selectively overexpressed EguGA20ox1, EguGA20ox2 and EguGA2ox1 in both Arabidopsis and Eucalyptus via Agrobacterium tumefaciens or A. rhizogenes-mediated transformation. Though both Arabidopsis EguGA20ox1- and EguGA20ox2-overexpressing (OE) lines exhibited better vegetative growth performance, they were more sensitive to abiotic stress, unlike EguGA2ox1-OE plants, which exhibited enhanced stress resistance. Moreover, overexpression of EguGA20ox in Eucalyptus roots caused significantly accelerated hairy root initiation and elongation and improved root xylem differentiation. Our study provided a comprehensive and systematic study of the genes of the GA metabolism and signaling and identified the role of GA20ox and GA2ox in regulating plant growth, stress tolerance, and xylem development in Eucalyptus; this could benefit molecular breeding for obtaining high-yield and stress-resistant Eucalyptus cultivars.

BdFAR4, a root-specific fatty acyl-coenzyme A reductase, is involved in fatty alcohol synthesis of root suberin polyester in Brachypodium distachyon.

Suberin is a complex hydrophobic polymer of aliphatic and phenolic compounds which controls the movement of gases, water, and solutes and protects plants from environmental stresses and pathogenic infection. The synthesis and regulatory pathways of suberin remain unknown in Brachypodium distachyon. Here we describe the identification of a B. distachyon gene, BdFAR4, encoding a fatty acyl-coenzyme A reductase (FAR) by a reverse genetic approach, and investigate the molecular relevance of BdFAR4 in the root suberin synthesis of B. distachyon. BdFAR4 is specifically expressed throughout root development. Heterologous expression of BdFAR4 in yeast (Saccharomyces cerevisiae) afforded the production of C20:0 and C22:0 fatty alcohols. The loss-of-function knockout of BdFAR4 by CRISPR/Cas9-mediated gene editing significantly reduced the content of C20:0 and C22:0 fatty alcohols associated with root suberin. In contrast, overexpression of BdFAR4 in B. distachyon and tomato (Solanum lycopersicum) resulted in the accumulation of root suberin-associated C20:0 and C22:0 fatty alcohols, suggesting that BdFAR4 preferentially accepts C20:0 and C22:0 fatty acyl-CoAs as substrates. The BdFAR4 protein was localized to the endoplasmic reticulum in Arabidopsis thaliana protoplasts and Nicotiana benthamiana leaf epidermal cells. BdFAR4 transcript levels can be increased by abiotic stresses and abscisic acid treatment. Furthermore, yeast one-hybrid, dual-luciferase activity, and electrophoretic mobility shift assays indicated that the R2R3-MYB transcription factor BdMYB41 directly binds to the promoter of BdFAR4. Taken together, these results imply that BdFAR4 is essential for the production of root suberin-associated fatty alcohols, especially under stress conditions, and that its activity is transcriptionally regulated by the BdMYB41 transcription factor.

First Report of Powdery Mildew in Eucalyptus Caused by Erysiphe neolycopersici in China.

Eucalyptus is one of the most fast-growing and widely planted hardwood trees in the tropical and subtropical regions (Grattapaglia and Kirst, 2008). In December 2021, powdery mildew diseases were observed on the Eucalyptus urophylla, E. urophylla × E. grandis, E. grandis × E. urophylla, and E. grandis trees growing in the Eucalyptus garden of the Guangxi University campus in Nanning (108°22'E, 22°48'N) of Guangxi Zhuang Autonomous Region, where is the main plantation area for Eucalyptus. The spread of this disease would bring potential challenges on the Eucalyptus plantation management in this region of China. The early symptoms of this disease in Eucalyptus were that the irregular white spots with surface-attached powder was observed on the leaves. At the late stages, this symptom was diffused to the whole leaves and even petioles and stems. It would finally cause significant defoliation, but barely lead to plant death in Eucalyptus. Microscopic observation showed that the mycelium was straight or flexuous, hyaline, thin-walled, septate, branched, and 3-7 µm wide (n = 50; average 4.86 µm). The appressorium was lobed and attached to one end of the mycelium alone, or paired attached to both ends of the mycelium. The conidiophore was straight or flexuous, unbranched, 54-100 × 6-10 µm (n = 40; average 75.47 µm × 8.22 µm). One to 3 conidium were connate on the conidiophores. Foot-cells were straight or flexuous at base, 5-8 µm wide (n = 40; average 6.53 µm). The conidium were ellipsoid or oval, and the size was 38-56 × 12-21 µm (n = 70; average 44.92 µm × 15.69 µm). The lobed or rod-shaped bud tube was produced at the conidium. According to the morphology, the fungus was identified as Erysiphe neolycopersici (Hsiao, et al. 2022). For the molecular characterization of the isolate, the sequences of the internal transcribed spacer (ITS), the 18S and 28S large subunit ribosomal DNA (SSU and LSU) (Scholin et al. 1994 , White et al. 1990), were sequenced and deposited in GenBank (OM422667, OM424285 and ON514159). The phylogenetic analysis showed that the ITS sequence showed 100% identity with sequences of E. neolycopersici (MW082786, MT370492, and JQ972700). The 28S rDNA sequence had the highest identity (99.69%) with that of E. neolycopersici (LC371327, LC371320, and OM368490). The SSU sequence had the highest identity (99.72%) with that of E. neolycopersici (LC516961). The pathogenicity test of the fungus was repeated thrice following the Koch's postulates. The diseased leaves were gently rubbed against 3 to 4 healthy mature leaves of more than five E. grandis seedlings (two-month-old). The inoculated and control plants were then cultured in the greenhouse (25 ℃, 16-h light/8-h dark and 70% humidity). Similar disease symptoms were observed on the inoculated leaves, but not on the control leaves seven days after inoculation. The isolates from three independent experiments were morphologically and genetically identical with the original isolate. As far as we know, this study is the first report of powdery mildew disease in Eucalyptus caused by E. neolycopersici in China.

Assessment of the cross-sectional areas of the psoas major in patients with adolescent idiopathic scoliosis before skeletal maturity.

BACKGROUND: The psoas major (PM) can support the lumbar spine and plays an important role in lumbar movement and maintaining lumbar curvature. PURPOSE: To analyze morphological changes of PM and its relation with the severity of adolescent idiopathic scoliosis (AIS). MATERIAL AND METHODS: The study was conducted on patients with AIS (age range = 10-18 years) with primary lumbar scoliosis. The cross-sectional area (CSA) of the PM at the L1-L5 levels were measured. The CSA of the PM in patients with AIS was compared with the average CSA of the PM in age-matched controls. The difference in PM at the apical vertebrae level was compared with the Cobb angle to determine the association between PM imbalance and severity of scoliosis. RESULTS: The CSA of the PM was larger on the concave side than the convex side at the apical vertebrae level and other lumber levels. Patients with a larger Cobb angle had statistically higher PM imbalance at the apical vertebrae level. The CSA of the PM on both the concave and convex sides of patients with AIS were larger than the average CSA of controls aged 16-18 years; however, there was no significant difference between patients with AIS and controls aged 10-15 years. CONCLUSION: There is a significant PM imbalance in patients with AIS before skeletal maturity, and the imbalance is related to the severity of scoliosis. The morphology of PM changed with the progression of scoliosis.

An assessment of morphological and pathological changes in paravertebral muscle degeneration using imaging and histological analysis: a cross-sectional study.

BACKGROUND: The high signal of paravertebral muscle (PVM) on T2-weighted image (T2WI) is usually considered to be fatty degeneration. However, it is difficult to distinguish inflammatory edema from fatty degeneration on T2WI. The purpose of this study was to identify different types of PVM high signal in patients with low back pain (LBP) through magnetic resonance imaging (MRI) and histology. METHODS: Seventy patients with LBP underwent MRI. The signal change of multifidus both on T2WI and fat suppression image (FSI) was quantified by Image J. Furthermore, 25 of the 70 patients underwent surgery for degenerative lumbar disease and their multifidus were obtained during the operation. Histological analysis of the samples was performed by HE staining. RESULT: Three types of PVM signal changes were identified from the MRI. Type 1 (n = 36) indicated fatty degeneration characterized by a high signal on T2WI and low signal on FSI. High signal on both T2WI and FSI, signifying type 2 meant inflammatory edema (n = 9). Type 3 (n = 25) showed high signal on T2WI and partial signal suppression on FSI, which meant a combination of fatty degeneration and inflammatory edema. Histological results were consistent with MRI. Among the 25 patients who underwent surgery, type 1 (n = 14) showed adipocytes infiltration, type 2 (n = 3) showed inflammatory cells infiltration and type 3 (n = 8) showed adipocytes and inflammatory cells infiltration. CONCLUSION: From our results, there are three types of pathological changes in patients with PVM degeneration, which may help to decide on targeted treatments for LBP.

Inhibition of Rac1 activity by NSC23766 prevents cartilage endplate degeneration via Wnt/ß-catenin pathway.

Cartilage endplate (CEP) degeneration has been considered as one of important factors related to intervertebral disc degeneration (IVDD). Previous researches have showed that Rac1 played a pivotal role in chondrocyte differentiation. However, the effect of Rac1 during the process of CEP degeneration remains unclear. Herein, we explored the effect of Rac1 on CEP degeneration and elucidated the underlying molecular mechanism. We found expression of Rac1-GTP increased in human-degenerated CEP tissue and IL-1ß-stimulated rat endplate chondrocytes (EPCs). Our study revealed that Rac1 inhibitor NSC23766 treatment promoted the expression of collagen II, aggrecan and Sox-9, and decreased the expression of ADTAMTS5 and MMP13 in IL-1ß-stimulated rat EPCs. Moreover, we also found that NSC23766 could suppress the activation of Wnt/ß-catenin pathway, suggesting that the beneficial effects of Rac1 inhibition in EPCs are mediated through the Wnt/ß-catenin signalling. Besides, puncture-induced rats models showed that NSC23766 played a protective role on CEP and disc degeneration. Collectively, these findings demonstrated that Rac1 inhibition delayed the EPCs degeneration and its potential mechanism may be associated with Wnt/ß-catenin pathway regulation, which may help us better understand the association between Rac1 and CEP degeneration and provide a promising strategy for delaying the progression of IVDD.

The projection of the thoracic nerve roots and their connection with intervertebral discs: a cadaver and radiological study.

BACKGROUND: The anatomical features of the thoracic nerve roots in connection with intervertebral discs may prevent surgery-related complications and improve patients' neurological functional status during thoracic spine surgery. There is limited literature evidence regarding this concept using cadavers. PURPOSE: To elucidate the qualitative anatomical features of the thoracic nerve roots in connection with intervertebral discs. MATERIAL AND METHODS: Fifteen formalin-preserved spine specimens were used in this study. Small pieces of stainless-steel wires were placed along the root sleeves from their points of origin, after exposing the dural sac and bilateral nerve roots. The standard anteroposterior and lateral radiographs were taken after the placement of the wires. Measurements were done on radiographs using the picture archiving communication system. RESULTS: Take-off angles of the nerve roots at the coronal plane gradually increased from the level of T2 (36.1°±2.72°) to T9 (84.1°±1.84°) and from T9, it decreased to T12 (46.3° ± 2.67°). Similar variation tendency was discovered in take-off angles of the nerve roots at the sagittal plane. No consistent tendency was found both in the distance from the origin of the root sleeve to its superior and inferior vertebral endplate. Distance from the origin of the root sleeve to the posterior midline (DM) exponentially decreased from T1 (8.2 ± 0.87 mm) to T4 (6.0 ± 0.93 mm). It slowly increased from T5 (5.5 ± 0.68 mm) to T12 (10.9 ± 1.79 mm), with T5 having the smallest DM. Distance between the origins of neighboring nerve roots showed an obvious increase from the T1-T2 interval (23.1 ± 2.22 mm) to T7-T8 interval (30.9 ± 2.68 mm). However, it progressively decreased at the T10-T11 interval (26.0 ± 2.40 mm). CONCLUSION: The dimensions of the thoracic nerve roots vary greatly from T1 to T12 intervertebral discs. Sound knowledge of these anatomical features of the thoracic nerve is mandatory for the thoracic spine surgery, especially in the posterolateral approach and transforaminal endoscopic surgery.

Evaluation of a dual signal subspace projection algorithm in magnetoencephalographic recordings from patients with intractable epilepsy and vagus nerve stimulators.

Magnetoencephalography (MEG) data is subject to many sources of environmental noise, and interference rejection is a necessary step in the processing of MEG data. Large amplitude interference caused by sources near the brain have been common in clinical settings and are difficult to reject. Artifact from vagal nerve stimulators (VNS) is a prototypical example. In this study, we describe a novel MEG interference rejection algorithm called dual signal subspace projection (DSSP), and evaluate its performance in clinical MEG data from people with epilepsy and implanted VNS. The performance of DSSP was evaluated in a retrospective cohort study of patients with epilepsy and VNS who had MEG scans for source localization of interictal epileptiform discharges. DSSP was applied to the MEG data and compared with benchmark for performance. We evaluated the clinical impact of interference rejection based on human expert detection and estimation of the location and time-course of interictal spikes, using an empirical Bayesian source reconstruction algorithm (Champagne). Clinical recordings, after DSSP processing, became more readable and a greater number of interictal epileptic spikes could be clearly identified. Source localization results of interictal spikes also significantly improved from those achieved before DSSP processing, including meaningful estimates of activity time courses. Therefore, DSSP is a valuable novel interference rejection algorithm that can be successfully deployed for the removal of strong artifacts and interferences in MEG.

Effects of ß-subunit on gating of a potassium ion channel: Molecular simulations of cardiac IKs activation.

Dynamic conformational changes of ion channel proteins during activation gating determine their function as carriers of current. The relationship between these molecular movements and channel function over the physiological timescale of the action potential (AP) has not been fully established due to limitations of existing techniques. We constructed a library of possible cardiac IKs protein conformations and applied a combination of protein segmentation and energy linearization to study this relationship computationally. Simulations reproduced the effects of the beta-subunit (KCNE1) on the alpha-subunit (KCNQ1) dynamics and function, observed in experiments. Mechanistically, KCNE1 increased the probability of "visiting" conducting pore conformations on activation trajectories, thereby increasing IKs current. KCNE1 slowed IKs activation by impeding the voltage sensor (VS) movement and reducing its coupling to pore opening. Conformational changes along activation trajectories determined that the S4-S5 linker (S4S5L) plays an important role in these modulatory effects by KCNE1. Integration of these molecular structure-based IKs dynamics into a model of human cardiac ventricular myocyte, revealed that KCNQ1-KCNE1 interaction is essential for normal AP repolarization.

Association of Oseltamivir Treatment With Virus Shedding, Illness, and Household Transmission of Influenza Viruses.

In an observational study of 582 patients with laboratory-confirmed influenza virus infections and their household contacts, we found that the initiation of oseltamivir within 24 hours was associated with shorter duration of self-reported illness symptoms (56% reduction in duration; 95% confidence interval, 41%-67%). However, we did not find any association of oseltamivir treatment with duration of viral shedding by polymerase chain reaction or with the risk of household transmission.

Glioblastoma multiforme: exploratory radiogenomic analysis by using quantitative image features.

PURPOSE: To derive quantitative image features from magnetic resonance (MR) images that characterize the radiographic phenotype of glioblastoma multiforme (GBM) lesions and to create radiogenomic maps associating these features with various molecular data. MATERIALS AND METHODS: Clinical, molecular, and MR imaging data for GBMs in 55 patients were obtained from the Cancer Genome Atlas and the Cancer Imaging Archive after local ethics committee and institutional review board approval. Regions of interest (ROIs) corresponding to enhancing necrotic portions of tumor and peritumoral edema were drawn, and quantitative image features were derived from these ROIs. Robust quantitative image features were defined on the basis of an intraclass correlation coefficient of 0.6 for a digital algorithmic modification and a test-retest analysis. The robust features were visualized by using hierarchic clustering and were correlated with survival by using Cox proportional hazards modeling. Next, these robust image features were correlated with manual radiologist annotations from the Visually Accessible Rembrandt Images (VASARI) feature set and GBM molecular subgroups by using nonparametric statistical tests. A bioinformatic algorithm was used to create gene expression modules, defined as a set of coexpressed genes together with a multivariate model of cancer driver genes predictive of the module's expression pattern. Modules were correlated with robust image features by using the Spearman correlation test to create radiogenomic maps and to link robust image features with molecular pathways. RESULTS: Eighteen image features passed the robustness analysis and were further analyzed for the three types of ROIs, for a total of 54 image features. Three enhancement features were significantly correlated with survival, 77 significant correlations were found between robust quantitative features and the VASARI feature set, and seven image features were correlated with molecular subgroups (P < .05 for all). A radiogenomics map was created to link image features with gene expression modules and allowed linkage of 56% (30 of 54) of the image features with biologic processes. CONCLUSION: Radiogenomic approaches in GBM have the potential to predict clinical and molecular characteristics of tumors noninvasively. Online supplemental material is available for this article.

Dynamic Recyclable High-Performance Epoxy Resins via Triazolinedione-Indole Click Reaction and Cation-π Interaction Synergistic Crosslinking.

Thermosetting plastics exhibit remarkable mechanical properties and high corrosion resistance, yet the permanent covalent crosslinked network renders these materials challenging for reshaping and recycling. In this study, a high-performance polymer film (EI25-TAD5-Mg) was synthesized by combining click chemistry and cation-π interactions. The internal network of the material was selectively constructed through flexible triazolinedione (TAD) and indole via a click reaction. Cation-π interactions were established between Mg2+ and electron-rich indole units, leading to network contraction and reinforcement. Dynamic non-covalent interactions improved the covalent crosslinked network, and the reversible dissociation of cation-π interactions during loading provided effective energy dissipation. Finally, the epoxy resin exhibited excellent mechanical properties (tensile strength of 91.2 MPa) and latent dynamic behavior. Additionally, the thermal reversibility of the C-N click reaction and dynamic cation-π interaction endowed the material with processability and recyclability. This strategy holds potential value in the field of modifying covalent thermosetting materials.

Electrophoretic deposition of Ru(bpy)32+ in vertically-ordered silica nanochannels: A solid-state electrochemiluminescence sensor for prolidase assay.

Prolidase (PLD) plays a crucial role as a dipeptidase in various physiological processes, specifically involved in the cleavage of proline-containing dipeptides for efficient recycling of proline. The accurate determination of PLD activity holds significant importance in clinical diagnosis. Herein, a solid-state electrochemiluminescence (ECL) biosensor was developed to address the urgent need for PLD assay. The Ru(bpy)32+ was electrophoretically deposited within the nanochannels of vertically-ordered mesoporous silica film (VMSF) on indium tin oxide (ITO) electrodes. The Ru(bpy)32+-deposited VMSF/ITO (Ru-VMSF/ITO) exhibited a remarkable ECL response towards proline, attributed to the enhanced concentration of the reactants and improved electron transfer resulting from the nanoconfinement effect. As PLD specifically enzymolyzed the Gly-Pro dipeptide to release proline, a proline-mediated biosensor was developed for PLD assay. Increased PLD activity led to enhanced release of proline into the porous solid-state ECL sensors, resulting in a more robust ECL signal. There was a linear relationship between ΔECL intensity and logarithmic concentration of PLD in the range of 10-10000 U/L, with a detection limit of 1.98 U/L. Practical tests demonstrated the reliability and convenience of the proposed bioassay, making it suitable for widespread application in PLD assays.

Vitamin D and heart failure risk among individuals with type 2 diabetes: observational and Mendelian randomization studies.

BACKGROUND: Evidence is limited and inconsistent regarding vitamin D and heart failure (HF) risk in people with type 2 diabetes (T2D), among whom vitamin D insufficiency or deficiency is common. OBJECTIVES: This study aimed to investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] with HF risk among individuals with T2D, in observational and Mendelian randomization (MR) frameworks. METHODS: Observational analyses were performed among 15,226 T2D participants aged 40-72 y from the UK Biobank. HF incidence was ascertained through electronic health records. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between serum 25(OH)D and HF risk among people with T2D. MR analyses were conducted among 11,260 unrelated participants with T2D. A weighted genetic risk score for genetically predicted 25(OH)D concentration was instrumented using 62 confirmed genome-wide variants. RESULTS: The mean ± standard deviation of serum 25(OH)D was 43.4 ± 20.4 nmol/L. During a median follow-up of 11.3 y, 836 incident HF events occurred. Serum 25(OH)D was nonlinearly and inversely associated with HF and the decreasing risk tended to plateau at around 50 nmol/L. Comparing those with 25(OH)D <25 nmol/L, the multivariable-adjusted HR (95% CI) was 0.67 (0.54, 0.83) for participants with 25(OH)D of 50.0-74.9 nmol/L and was 0.71 (0.52, 0.98) for 25(OH)D >75 nmol/L. In MR analysis, each 7% increment in genetically predicted 25(OH)D was associated with 36% lower risk of HF among people with T2D (HR: 0.64, 95% CI: 0.41, 0.99). CONCLUSIONS: Higher serum 25(OH)D was associated with lower HF risk among individuals with T2D and the MR analysis suggested a potential causal relationship. These findings indicate a role of maintaining adequate vitamin D status in the prevention of HF among individuals with T2D.

Association of trajectories and cumulative exposure of antenatal depression with high birth weight.

BACKGROUND: Inconsistent associations between antenatal depression and fetal birth weight were reported previously, and little is known about the dynamic changes and long-term cumulative effect of antenatal depression during pregnancy. METHODS: Participants were from the Tongji-Huaxi-Shuangliu Birth Cohort. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale in early, middle, and late pregnancy respectively. Trajectories of antenatal depression were assessed using the latent class mixed model. The percentage of days with depression (PDD) and frequency of antenatal depression were measured to assess the cumulative exposure. Multivariable logistic regression models were used to evaluate the associations of antenatal depression with macrosomia and large for gestational age (LGA). RESULTS: We identified four distinct trajectories, including the low stable group (n = 1,327, 27.99 %), the moderate stable group (n = 2,610, 55.05 %), the peak group (n = 407, 8.58 %), and the valley group (n = 397, 8.37 %). Compared with the low stable group, the valley group showed a higher risk of macrosomia (OR, 1.98; 95 % CI, 1.17, 3.38) and LGA (OR, 1.44; 95 % CI, 1.002, 2.09); the peak group showed a higher risk of LGA (OR, 1.52; 95 % CI, 1.07, 2.16), but the association was not significant for macrosomia (OR, 1.47; 95 % CI, 0.85, 2.55). Consistently, cumulative antenatal depression was also positively associated with the risks of macrosomia and LGA. LIMITATION: The antenatal depression was self-reported using a screening scale and information bias could not be ruled out. CONCLUSION: Certain trajectories and cumulative exposure of antenatal depression were associated with higher risks of high birth weight.

Two-stage dose finding for cytostatic agents in phase I oncology trials.

Conventional dose-finding methods in oncology are mainly developed for cytotoxic agents with the aim of finding the maximum tolerated dose. In phase I clinical trials with cytostatic agents, such as targeted therapies, designs with toxicity endpoints alone may not work well. For cytostatic agents, the goal is often to find the most efficacious dose that is still tolerable, although these agents are typically less toxic than cytotoxic agents and their efficacy may not monotonically increase with the dose. To effectively differentiate doses for cytostatic agents, we develop a two-stage dose-finding procedure by first identifying the toxicity upper bound of the searching range through dose escalation and then determining the most efficacious dose through dose de-escalation while toxicity is continuously monitored. In oncology, treatment efficacy often takes a relatively long period to exhibit compared with toxicity. To accommodate such delayed response, we model the time to the efficacy event by redistributing the mass of the censored observation to the right and compute the fractional contribution of the censored data. We evaluate the operating characteristics of the new dose-finding design for cytostatic agents and demonstrate its satisfactory performance through simulation studies.

Fractional dose-finding methods with late-onset toxicity in phase I clinical trials.

In Phase I clinical trials, the algorithm-based dose-finding methods, such as the 3 + 3 and up-and-down designs, do not impose any dose-toxicity curve. In contrast, model-based designs, such as the continual reassessment method (CRM), assume a parametric model to borrow information from all the doses under consideration. For these conventional dose-finding methods, toxicity outcomes need to be observed shortly after the treatment, so that newly enrolled patients can be treated without delay. However, in the case of late-onset toxicity, patients' outcomes may not be observed quickly enough to keep up with the speed of enrollment, and thus toxicity data may not be available when that information is needed. Patients who have not experienced toxicity by the decision-making time may yet experience toxicity later during the rest of the follow-up. Ignoring such late-onset toxicity information may lead to biased estimation of the dose toxicity probabilities and thus compromise the trial's performance. To expand the applicability of the 3 + 3, up-and-down, and CRM designs with late-onset toxicity, we propose to redistribute the mass of the censored observation to the right and utilize the fractional contribution for the unobserved toxicity outcome. We evaluate the operating characteristics of the proposed fractional designs through extensive simulation studies. The fractional designs satisfactorily resolve the issues associated with late-onset toxicity, and are compared favorably with other available methods.

Influence of Nano-SiO2 Content on Cement Paste and the Interfacial Transition Zone.

Nano-SiO2 (NS) is widely used in cement-based materials due to its excellent physical properties. To study the influence of NS content on a cement paste and the interfacial transition zone (ITZ), cement paste samples containing nano content ranging from 0 to 2% (by weight of cement) were prepared, and digital image correlation (DIC) technology was applied to test the mechanical properties. Finally, the optimal NS content was obtained with statistical analysis. The mini-slump cone test showed that, with the help of superplasticizer and ultrasonic treatment, the flowability decreased continuously, as the NS content increased. The DIC experimental results showed that NS could effectively improve the mechanical properties of the cement paste and the ITZ. Specifically, at the content level of 1%, the elastic modulus of cement paste and ITZ was 20.95 GPa and 3.20 GPa, respectively. When compared to that without nanomaterials, the increased amplitude was 73.50% and 90.50%, respectively. However, with the further increase in NS content, the mechanical properties decreased, which was mainly caused by the agglomeration of nanomaterials. Additionally, the NS content did not exhibit a significant effect on the thickness of the ITZ, and its value was maintained at 76.91-91.38 µm. SEM confirmed that NS would enhance the microstructure of both cement paste and ITZ.