Self-monitoring diabetes with multiple mobile health devices

OBJECTIVE

The purpose of this study was to examine the use of multiple mobile health technologies to generate and transmit data from diverse patients with type 2 diabetes mellitus (T2DM) in between clinic visits. We examined the data to identify patterns that describe characteristics of patients for clinical insights.

METHODS

We enrolled 60 adults with T2DM from a US healthcare system to participate in a 6-month longitudinal feasibility trial. Patient weight, physical activity, and blood glucose were self-monitored via devices provided at baseline. Patients also responded to biweekly medication adherence text message surveys. Data were aggregated in near real-time. Measures of feasibility assessing total engagement in device submissions and survey completion over the 6 months of observation were calculated.

RESULTS

It was feasible for participants from different socioeconomic, educational, and racial backgrounds to use and track relevant diabetes-related data from multiple mobile health devices for at least 6 months. Both the transmission and engagement of the data revealed notable patterns and varied by patient characteristics.

DISCUSSION

Using multiple mobile health tools allowed us to derive clinical insights from diverse patients with diabetes. The ubiquitous adoption of smartphones across racial, educational, and socioeconomic populations and the integration of data from mobile health devices into electronic health records present an opportunity to develop new models of care delivery for patients with T2DM that may promote equity as well.

Nonmonotonic Energy Dependence of Net-Proton Number Fluctuations

Nonmonotonic variation with collision energy (sqrt[s_{NN}]) of the moments of the net-baryon number distribution in heavy-ion collisions, related to the correlation length and the susceptibilities of the system, is suggested as a signature for the quantum chromodynamics critical point. We report the first evidence of a nonmonotonic variation in the kurtosis times variance of the net-proton number (proxy for net-baryon number) distribution as a function of sqrt[s_{NN}] with 3.1  σ significance for head-on (central) gold-on-gold (Au+Au) collisions measured solenoidal tracker at Relativistic Heavy Ion Collider. Data in noncentral Au+Au collisions and models of heavy-ion collisions without a critical point show a monotonic variation as a function of sqrt[s_{NN}].

Tunable peak power square-wave pulse based on an all-PM thulium-doped mode-locked fiber laser

Nanosecond dissipative soliton resonance pulse is a demonstration of an all polarization-maintaining (PM) thulium-doped fiber laser in a nonlinear amplifying loop mirror (NALM)-based figure-eight configuration. Each loop of the apparatus includes a controllable power amplifier. With increased amplifier power, pulse width broadens linearly from 3.6 to 13.5 ns, and maximum single pulse energy can reach 27.5 nJ. Interestingly, the output peak power presents two completely opposite proportional effects in terms of the variation of settings for two amplifiers, respectively. The experimental results show that the NALM loop plays an important role for tunable pulse duration, and the unidirectional ring part makes a significant contribution for power scaling.

Effect of front-of-package nutrition labeling on food purchases: a systematic review

OBJECTIVES

This study systematically reviewed evidence from interventions on the effect of front-of-package (FOP) nutrition labeling on food purchases.

STUDY DESIGN

The study design used in this study is a systematic review.

METHODS

Keyword search was performed in PubMed, Web of Science, Scopus, and Cochrane Library.

RESULTS

Fifteen studies (10 randomized controlled trials, four pre-post studies, and one case-control study) met the eligibility criteria and were included in the review. Five studies were conducted in a controlled setting through the establishment of an online virtual supermarket or physical laboratory food store solely for the intervention. In contrast, the remaining ten studies were conducted in a naturalistic setting where people commonly purchase foods (e.g., supermarket, grocery store, school/hospital cafeteria, or vending machine). FOP labels assessed included traffic lights, health star rating, daily intake guides, health warnings, and high sugar symbol labels. Compared with the control, FOP labels were effective for helping participants make healthier food purchase decisions in five of the 12 studies that assessed traffic lights labels, in one of the two studies that assessed health warning labels, and in one study that assessed high sugar symbol labels. Three assessed health star ratings and one assessed daily intake guide labels, but none revealed an effect on food purchases compared with the control.

CONCLUSIONS

Findings on the effectiveness of FOP nutrition labels in 'nudging' consumers toward healthier food purchases remain mixed and inconclusive. Future studies should examine other types of FOP labels beside the traffic lights labels and explore the different effects by consumer affordability, population subgroup, and shopping environment.

Correlation between changes in the number of peripheral blood lymphocytes and survival rate in patients with cervical cancer after radio-chemotherapy

PURPOSE

This study aimed to compare the absolute numbers of various types of lymphocytes in the peripheral blood before and after chemotherapy following radio-chemotherapy in patients with cervical cancer, so as to explore the correlation between the changes in the absolute numbers of peripheral various types of lymphocytes and the overall survival rate of patients.

METHODS

Data of 205 patients with cervical cancer admitted to the hospital from June 2014 to August 2016 were retrospectively analyzed. These patients underwent concurrent radio-chemotherapy, followed by chemotherapy. The absolute numbers of peripheral blood lymphocytes and subtypes were compared before and after re-chemotherapy.

RESULTS

For patients with a good prognosis, the number of lymphocytes, T cells, and cytotoxic T cells (Tc) significantly decreased (P<0.05) after re-chemotherapy, while this phenomenon was not observed in patients with poor prognosis. Kaplan-Meier univariate analysis showed that patients with cervical cancer who had an advanced FIGO stage before treatment, presence of lymph node metastasis, and increased numbers of Tc and T helper cells after re-chemotherapy showed a low 30-month survival rate; the overall log-rank analysis showed significant differences (P<0.05). Multivariate Cox proportional hazards regression analysis, presence of lymph node metastasis: HR=9.718, P=0.002, 95% CI=0.183-0.679; Tc grouping: HR=3.239, P=0.0.072, 95% CI=0.950-03.347; Th group: HR=3.197, P=0.074, 95% CI=0.943-3.564.

CONCLUSIONS

After radio-chemotherapy, in patients with advanced cervical cancer, the change in the numbers of peripheral blood Tc and Th before and after re-chemotherapy was associated with the 30-month overall survival rate of patients. It can be considered as a predictor of the survival of patients with advanced cervical cancer.

Transmission characteristics of 1.55 and 2.04 µm laser carriers in a simulated smoke channel based on an actively mode-locked fiber laser

We experimentally demonstrate a free-space data transmission system in an indoor simulated smoke chamber with a laser carrier of an erbium-doped actively mode-locked fiber laser and a holmium-doped actively mode-locked fiber laser. Two additional semiconductor lasers operating at 0.85 and 1.06 µm are used to calibrate the visibility of a smoke channel using the Ijaz model and compare smoke attenuation with 1.55 and 2.04 µm lasers. The eye patterns and bit error rates of 1.55 and 2.04 µm laser carriers with a data rate of 4.04 Gbps are investigated experimentally at 0.5, 0.05, and 0.005 km visibilities. The experimental results show that the smoke attenuation is wavelength dependent for V < 0.5 km. As the visibility decreases, the long wavelength laser is less affected by the attenuation and power fluctuation caused by Mie scattering. The measured optical signal-to-noise ratios of the 1.55 and 2.04 µm laser carriers for V = 0.005 km are 4.83 and 8.62 dB, respectively. The corresponding link sensitivities are -14.59 and -17.74 dBm, respectively, indicating that the 2.04 µm data transmission system is more reliable under an extremely dense smoke condition.

Coordination of primary metabolism and virulence factors expression mediates the virulence of Vibrio parahaemolyticus towards cultured shrimp (Penaeus vannamei)

AIMS

Acute hepatopancreatic necrosis disease (AHPND) caused by Vibrio parahaemolyticus has emerged as a severe bacterial disease of cultured shrimp. To identify the key virulence factors, two AHPND-causing V. parahaemolyticus (Vp_AHPND ) strains (123 and 137) and two non-Vp_AHPND strains (HZ56 and ATCC 17082) were selected.

METHODS AND RESULTS

Challenge tests showed that the four strains exhibited different virulence towards shrimp with cumulative mortalities at 48 h postinfection (hpi) ranging from 10 to 92%. The expression of pirAB^VP in strain 123 and 137 was not significantly different. Genomic analysis revealed that the two Vp_AHPND strains contain a plasmid with the PirAB^VP toxins (pirAB^VP ) flanked by the insertion sequence (ISVal1) that has been identified in various locations of chromosomes in Vp_AHPND strains. The two Vp_AHPND strains possessed almost identical virulence factors, while ISVal1 disrupted three genes related to flagellar motility in strain 137. Phenotype assay showed that strain 123 possessed the highest growth rate and swimming motility, followed by strain 137, suggesting that the disruption of essential genes mediated by ISVal1 significantly affected the virulence level. Transcriptome analysis of two Vp_AHPND strains (123 and 137) further suggested that virulence genes related to the capsule, flagella and primary metabolism were highly expressed in strain 123.

CONCLUSIONS

Here for the first time, it is demonstrated that the virulence of Vp_AHPND is not only determined by the expression of pirAB^VP , but also is mediated by ISVal1 which affects the genes involved in flagellar motility and primary metabolism.

SIGNIFICANCE AND IMPACT OF THE STUDY

The genomic and transcriptomic analysis of Vp_AHPND strains provides valuable information on the virulence factors affecting the pathogenicity of Vp_AHPND.

What troponin I level post PCI in SIHD is predictive of higher risk of MACE?

Background

According to the 4th universal definition of myocardial infarction (MI), post percutaneous coronary intervention (PCI) MI is defined as an elevation of cardiac troponin values more than five times above the 99th percentile upper reference limit. The ISCHEMIA Trial in stable ischaemic heart disease (SIHD) patients reported post PCI troponin rise as part of the primary endpoint. What represents a clinically significant troponin rise post PCI has not been clearly established.

Purpose

The aim of our study was to correlate the level of troponin I rise with adverse events post PCI in SIHD.

Methods

We performed a retrospective analysis of our PCI registry in patients with SIHD between 2014 and 2018. Patients with acute coronary syndrome were excluded. HS-troponin I was measured one day after the procedure. The primary end point was major adverse cardiac events (MACE) including death, MI, stent thrombosis (ST) and need for repeat revascularization within 12 months from index procedure.

Results

Between 2014 and 2018, 920 patients (mean age 67.5 years, 78% male) underwent PCI for SIHD. Troponin rise post PCI was a common event and a level more than 100ng/L (reference range &lt;26 ng/L) occurred in 54% of patients. Mean and median troponin I level post PCI was 675 ng/L±2530 and 118 ng/L respectively. In patients with MACE, mean troponin I level was 1361 ng/L compared with 611 ng/L in patients without MACE (P=0.0176). Correlation of troponin I level with one year MACE rates are shown in the Graph. MACE rates were steady at 8.5% with troponin I levels below 2500 ng/L after which there was a significant increase in the MACE rates. At troponin I level above 5000 ng/L MACE was 13.6% and above 10,000 ng/L it was 33.3%.

Conclusion

Troponin I levels above 2500 ng/L (x100 upper limit normal) correlated with an increase in the risk of MACE in patients undergoing PCI for SIHD. Our results suggest that current definitions of procedural MI overestimate the clinical significance of post PCI troponin rise.

Funding Acknowledgement

Type of funding source: None

Optimization of GRACE risk stratification by NT-proBNP combined with D-dimer in patients with non-ST-elevation myocardial infarction

Background

GRACE risk score is the most widely used tool to predict the risk of death and myocardial infarction in patients with Non-ST-elevation myocardial infarction (NSTEMI). Some biomarkers have been shown to have a high predictive value for prognosis. But the models constructed using these studies have some drawbacks, including the using biomarkers that are not routinely monitored.

Aims

To explore the optimizing role of multiple biomarkers in GRACE risk stratification in NSTEMI and then develop a new scoring system based on GRACE.

Methods

1.This multi-center, prospective, cohort study enrolled 1357 patients (mean age 65±12 years; 57% male). Common clinical indicators were collected within the first 12h after admission. 2.The outcome was 1-year all-cause mortality and major adverse cardiac events (MACE: all-cause death,unstable angina, heart failure, recurrent myocardial infarction and stroke). 3.Cox multivariate anlysis was used to quantify the biomarker effect. C-index, NRI and IDI were calculated to verify that the biomarkers improve the predictive accuracy of GRACE.

Results

1. During follow-up (mean: 339 days), 57 participants died and 211 participants had 231 MACE. In COX analysis, NT-proBNP (P&lt;0.0001), and d-dimer (P=0.0092) were significant independent biomarkers for death. NT-proBNP (P&lt;0.0001), fibrinogen (P=0.0177) and d-dimer (P&lt;0.0001) were significant independent biomarkers for MACE. 2. For all-cause death, the combination of NT-proBNP and D-dimer improved the predictive accuracy of GRACE the most. For MACE, trigeminal combination of NT-proBNP, fibrinogen, and D-dimer improved GRACE the most 3. NT-proBNP, D-dimer, fibrinogen, and GRACE comprise a new scoring system for assessing 1-year clinical events. Kaplan-Meier analysis revealed a significant rise in 1-year mortality and MACE between different score groups.

Conclusions

The combination of NT-proBNP, and d-dimer added the prognostic value of GRACE for all-cause death and MACE. Our newly developed scoring system can be easily calculated in clinical practice and strongly correlated with all-cause mortality and MACE.

Risk score and survival curve

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Major Science and Technology Projects of Tianjin Science and Technology Commission in 2016; Key Project of Healthcare Industry of Tianjin in 2016

X-ray attenuation models to account for beam hardening in computed tomography

We introduce a beam-hardening correction method for lab-based X-ray computed tomography (CT) by modifying existing iterative tomographic reconstruction algorithms. Our method simplifies the standard Alvarez-Macovski X-ray attenuation model [Phys. Med. Biol.21, 733 (1976)] and is compatible with conventional (i.e., single-spectrum) CT scans. The sole modification involves a polychromatic projection operation, which is equivalent to applying a weighting that more closely matches the attenuation of polychromatic X-rays. Practicality is a priority, so we only require information about the X-ray spectrum and some constants relating to material properties. No other changes to the experimental setup or the iterative algorithms are necessary. Using reconstructions of simulations and several large experimental datasets, we show that this method is able to remove or reduce cupping, streaking, and other artefacts from X-ray beam hardening and improve the self-consistency of projected attenuation in CT. When the assumptions made in the simplifications are valid, the reconstructed tomogram can even be quantitative.

LncRNA AOC4P affects biological behavior of gastric cancer cells through MAPK signaling pathway

OBJECTIVE

Long non-coding RNA (lncRNA) is closely related to the occurrence and development of gastric cancer, but the mechanism and clinical significance of lncRNA AOC4P are still unclear. This study aimed to investigate the expression and function of lncRNA AOC4P in gastric cancer.

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to detect the expression of lncRNA AOC4P in 80 gastric cancer tissues and adjacent normal tissues. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide), flow cytometry and transwell assays were used to study the effects of lncRNA AOC4P on the proliferation, apoptosis, migration and invasion of gastric cancer cells. Western blot was used to detect the related protein level of the mitogen-activated protein kinase (MAPK) signal pathway.

RESULTS

The expression of lncRNA AOC4P in gastric cancer tissues was higher than that in adjacent tissues. OS or DFS time were significantly shortened in patients with gastric cancer with high expression of lncRNA AOC4P. Inhibition of lncRNA AOC4P expression can inhibit cell proliferation, migration and invasion, promoting cell apoptosis to some extent. Inhibition of lncRNA AOC4P expression also can result in the decreased expression levels of extracellular-signal-regulated kinase 1 (ERK1), c-Jun N-terminal kinases (JNK) and p38 proteins.

CONCLUSIONS

High expression of lncRNA AOC4P in gastric cancer may be related to the occurrence, development and prognosis of gastric cancer. LncRNA AOC4P is expected to become a new diagnostic marker and therapeutic target for gastric cancer.

Denitrosylation of nNOS induced by cerebral ischemia-reperfusion contributes to nitrosylation of CaMKII and its inhibition of autophosphorylation in hippocampal CA1

OBJECTIVE

The aim of this study is to investigate the relation between CaMKII S-nitrosylation and its activation, as well as the underlying mechanism, after global cerebral ischemia-reperfusion.

MATERIALS AND METHODS

The rat model of cerebral ischemia-reperfusion was established by four-vessel occlusion of 15 min and reperfusion of different times. nNOS inhibitor 7-nitroindazole (7-NI), exogenous nitric oxide donor GSNO (nitrosoglutathione), or N-methyl-D-aspartate receptor (NMDAR) antagonist MK-801 were administered before ischemia. The expressions of S-nitrosylation and phosphorylation of CaMKII and nNOS were detected by biotin switch assay, immunoblotting, and immunohistochemical staining after cerebral ischemia-reperfusion. The survival of hippocampal CA1 pyramidal cells after administration of the three drugs was examined by cresyl violet staining.

RESULTS

Following cerebral ischemia-reperfusion, the S-nitrosylation of CaMKII was increased, accompanied by a decrease of phosphorylation, suggesting a decrease of activity (p<0.05). Meanwhile, the phosphorylation and S-nitrosylation of nNOS were notably decreased at the same time point (p<0.05). The administration of 7-NI, GSNO, and MK-801 increased the S-nitrosylation and phosphorylation of nNOS, leading to the attenuation of increased S-nitrosylation and decreased autophosphorylation of CaMKII after cerebral ischemia-reperfusion (p<0.05). Administration of MK-801, GSNO, and 7-NI significantly decreased the neuronal damage in rat hippocampal CA1 caused by cerebral ischemia-reperfusion (p<0.05).

CONCLUSIONS

After cerebral ischemia-reperfusion, the decrease of autophosphorylation of CaMKII regulated by its S-nitrosylation may be due to the denitrosylation of nNOS and subsequent NO production. Increasing the phosphorylation of CaMKII by nNOS inhibitor, exogenous NO donor or NMDA receptor antagonist exerted neuroprotective effects against cerebral ischemia-reperfusion injury.

Replacing true unenhanced imaging in renal carcinoma with virtual unenhanced images in dual-energy spectral CT: a feasibility study

AIM

To investigate the clinical value of virtual unenhanced (VNC) spectral computed tomography (CT) images to replace the conventional true unenhanced spectral CT images (TNC) in diagnosing renal carcinoma.

MATERIALS AND METHODS

Fifty-six cases of renal carcinoma confirmed by histopathology underwent conventional plain CT and contrast-enhanced spectral CT at arterial phase (AP) and venous phase (VP). VNC images were generated on an AW4.6 workstation. The CT attenuation, image noise, contrast-to-noise ratio (CNR), and signal-noise-ratio (SNR) of the renal lesions and normal kidneys, long and short axis diameters of the lesion were measured from the three image sets and analysed using one-way analysis of variance (ANOVA). Two radiologists evaluated image quality subjectively using a five-point score, and lesion signature using a three-point score. Image quality scores were compared statistically and tested for consistency.

RESULTS

The two reviewers had good agreement for subjective evaluation (Kappa>0.70) and there was no difference in the quality of the scores among the three image groups. The lesion signature scores were all above the acceptable level. The CNR and SNR values in VNC were significantly higher than in TNC (p<0.05). VNC images had lower renal noise than in TNC (p<0.05). There was no difference in the long and short axis diameters of the lesion among the three image groups. VNC had higher CT attenuation values for the lesion and kidney than TNC (p<0.05), but the differences were <5 HU.

CONCLUSION

VNC images in spectral CT may be used to replace the conventional plain CT to reduce imaging duration and radiation dose in diagnosing renal carcinoma.

The prokaryotic expression, polyclonal antibody preparation, and subcellular localization of the transmembrane protein NS2A of the duck Tembusu virus

Duck Tembusu virus (DTMUV) is a single-stranded, positive-sense RNA arbovirus, belonging to the genus Flavivirus, the family Flaviviridae. As a transmembrane protein, non-structural protein 2A (NS2A) plays an important role in virion assembly, replication complex and antagonizing host immune response. Since NS2A protein contains many hydrophobic amino acids, it is hard to gain the full-length protein of NS2A for prokaryotic expression. Therefore, to make a deep study, prokaryotic expression and polyclonal antibody preparation of truncated DTMUV NS2A was performed. The truncated NS2A gene (178-450 bp) was obtained, and sub-cloned into the prokaryotic vector pGEX-4T-1 (pGEX-4T-1-NS2A178-450bp). Subsequently, the recombinant GST-NS2A60-150aa protein was successfully expressed in E. coli BL21 (DE3) with the induction by 0.3 mmol/l isopropyl β-D-thiogalactoside (IPTG) for 6 h at 37°C. The GST-NS2A60-150aa protein was extracted from the gel. The BALB/c mice were immunized with the purified recombinant NS2A protein to prepare polyclonal antibodies against the truncated NS2A protein. The titer of the polyclonal antibodies, determined by ELISA analysis, was 1:128,000. The specificity of the polyclonal antibodies (mPAb-DTMUV-NS2A60-150aa) were verified by Western blot analysis. Furthermore, the indirect immunofluorescence (IFA) was performed to explore the subcellular localization of NS2A. NS2A protein was, in the transfected cells, located mainly around nucleus in the endoplasmatic reticulum. Taken together, our study provided a useful tool for the further exploration of the biological functions and molecular mechanism of DTMUV NS2A. Keywords: duck Tembusu virus; non-structural protein 2A; prokaryotic expression; polyclonal antibodies; subcellular location.

Receiving sensitivity improvement by wide-spectrum OAM with OTDM and polarization multiplexing in weak atmospheric turbulence

In this paper, a wide-spectrum orbital angular momentum (OAM) system with a polarization and optical time division multiplexing (OTDM) free-space transmission system is experimentally demonstrated. To enhance the system transmission performance in atmospheric turbulent channel, a wide-spectrum laser and an OAM beam are used. The wide-spectrum laser can be generated by utilizing pumped laser to pump nonlinear fiber, and OAM can be generated with a special light modulator. Furthermore, OTDM and polarization multiplexing methods are used to enhance the communication rate from 4 Gbit/s to 32 Gbit/s. With the use of the wide-spectrum laser and the OAM beam, the receiving scintillation index (SI) can be reduced, and detection sensitivity can be improved. It is the first time a wide-spectrum OAM communication system performance has been studied. It is shown that under weak atmospheric turbulence condition, the SI can be reduced by 38% and the receiving sensitivity can be improved by 3.18 dB via wide-spectrum OAM beams.