Self-driven electrochemical system using solvent-regulated structural diversity of cadmium(II) metal-organic frameworks

Optimizing friction materials based on molecular diversity in a molecular framework system is an effective method to improve the output performance of triboelectric nanogenerators (TENGs). In this study, three cadmium(II) metal-organic frameworks (Cd-MOFs) with different cavities were synthesized solvothermally by the assembly of cadmium nitrate (Cd(NO3)2·4H2O), 4',4'''-carbonylbis(([1,1'-biphenyl]-3,5-dicarboxylic acid)) (H4CBBD), and trans-1,2-bis(4-pyridyl)ethylene (4,4'-bpe) via a solvent-regulated strategy. The topology and porosity of Cd-MOFs could be controlled effectively by the solvent constituents and were demonstrated to be closely related to their triboelectric behaviors. Theoretical calculations and experimental characterizations revealed that the TENGs fabricated by the Cd-MOF with maximum porosity exhibited the best triboelectric performance owing to the enhanced specific surface area and surface potential. In the applications, the high-output TENGs can be successfully used as an efficient power supply for electrochemical systems, enabling the direct bromination of aromatic compounds in high yields with good regioselectivity. This study provides a simple and feasible method to optimize positive friction materials at the molecular level and develops the practical applications of TENGs in electrochemical systems.

Water-richness evaluation method and application of clastic rock aquifer in mining seam roof

Clastic rock aquifer of the coal seam roof often constitutes the direct water-filling aquifer of the coal seam and its water-richness is closely related to the risk of roof water inrush. Therefore, the evaluation of the water-richness of clastic rock aquifer is the basic work of coal seam roof water disaster prevention. This article took the 4th coal seam in Huafeng mine field as an example. It combined the empirical formula method and generalized regression neural network (GRNN) to calculate the development height of water-conducting fracture zone, determined the vertical spatial range of water-richness evaluation. Depth of the sandstone floor, brittle rock ratio, lithological structure index, fault strength index, and fault intersections and endpoints density were selected as the main controlling factors. A combination weighting method based on the analytic hierarchy process (AHP), rough set theory (RS), and minimum deviation method (MD) was proposed to determine the weight of the main controlling factors. Introduced the theory of unascertained measures and confidence recognition criteria to construct an evaluation model for the water-richness of clastic rock aquifers, the study area was divided into three zones: relatively weak water-richness zones, medium water-richness zones, and relatively strong water-richness zones. By comparing with the water inrush points and the water inflow of workfaces, the evaluation model's water yield zoning was consistent with the actual situation, and the prediction effect was good. This provided a new idea for the evaluation of the water-richness of the clastic rock aquifer on the roof of the mining coal seam.

Water-inrush mechanism from the head-on working face roof in a Jurassic coal seam in the Ordos Basin

When Chinese coal mines are mining Carboniferous Permian coal seams, the mechanism of water inrush from the roof of the working face usually conforms to the "Upper Three Zones" or "Upper Four Zones" theory. The water inrush passageway is water-conducting fracture zone, and the water inrush position is located in the goaf. However, when mining Jurassic coal seams in Chinese coal mines, the location of water inrush often appears at the head-on working face, above the coal mining machine. Due to the support of the fully mechanized mining support, the roof rock layer cannot collapse and therefore cannot form water-conducting fracture zone. Therefore, the water inrush mechanism cannot be explained by the above two theories. This paper is guided by the Practical Mine Pressure Control Theory, and based on the explanation of the motion forms of bending (pulling) failure movement and shearing (cutting) failure movement, and combined with on-site examples, it is revealed that the passageways leading to from the head-on working face roof in a Jurassic coal seam in the Ordos Basin are splitting zones type, fracture line type and structural fracture type, respectively. Taking the changes in water inflow during the mining process of the 3301 and 3302 working faces in Zhujiamao Coal Mine as examples, this paper reveals the mechanism of water inrush from the head-on working face roof caused by splitting zones type, and proves the existence of this passageway through on-site 3D high-density electrical detection and tracing experiments. Taking two catastrophic water inrush accidents that occurred head-on in the 1309 working face of Guojiahe Coal Industry Co., Ltd. as examples, the water inrush mechanism of the fracture line type and the water inrush mechanism of the structural fracture type were respectively revealed. Based on mechanism of water inrush from head-on roof of working face and the analysis of the on-site water inrush process, a method for distinguishing the type of water inrush passageway from the front roof of the working face is proposed. The results indicate that the Jurassic coal seam mining in the Ordos Basin is prone to shearing (cutting) failure movement, resulting in the frequent formation of the three types of water inrush passageways mentioned above.

L-Cysteine hydrochloride inhibits Aspergillus flavus growth and AFB1 synthesis by disrupting cell structure and antioxidant system balance

Aflatoxin B1 (AFB1) is the most potent known naturally occurring carcinogen and pose an immense threat to food safety and human health. L-Cysteine hydrochloride (L-CH) is a food additive often used as a fruit and vegetable preservative and also to approved bread consistency. In this study, we investigated the effects and mechanisms of L-CH as an antimicrobial on the growth of Aspergillus flavus (A. flavus) and AFB1 biosynthesis. L-CH significantly inhibited A. flavus mycelial growth, affected mycelial morphology and AFB1 synthesis. Furthermore, L-CH induced glutathione (GSH) synthesis which scavenged intracellular reactive oxygen species (ROS). RNA-Seq indicated that L-CH inhibited hyphal branching, and spore and sclerotia formation by controlling cell wall and spore development-related genes. Activation of the GSH metabolic pathway eliminated intracellular ROS, leading to hyphal dwarfing. L-CH treatment downregulated most of the Aflatoxin (AF) cluster genes and aflS, aflR, AFLA_091090 transcription factors. This study provides new insights into the molecular mechanism of L-CH control of A. flavus and AFB1 foundation. We believe that L-CH could be used as a food additive to control AFB1 in foods and also in the environment.

Evaluation of QSAR models for predicting mutagenicity: outcome of the Second Ames/QSAR international challenge project

Quantitative structure-activity relationship (QSAR) models are powerful in silico tools for predicting the mutagenicity of unstable compounds, impurities and metabolites that are difficult to examine using the Ames test. Ideally, Ames/QSAR models for regulatory use should demonstrate high sensitivity, low false-negative rate and wide coverage of chemical space. To promote superior model development, the Division of Genetics and Mutagenesis, National Institute of Health Sciences, Japan (DGM/NIHS), conducted the Second Ames/QSAR International Challenge Project (2020-2022) as a successor to the First Project (2014-2017), with 21 teams from 11 countries participating. The DGM/NIHS provided a curated training dataset of approximately 12,000 chemicals and a trial dataset of approximately 1,600 chemicals, and each participating team predicted the Ames mutagenicity of each trial chemical using various Ames/QSAR models. The DGM/NIHS then provided the Ames test results for trial chemicals to assist in model improvement. Although overall model performance on the Second Project was not superior to that on the First, models from the eight teams participating in both projects achieved higher sensitivity than models from teams participating in only the Second Project. Thus, these evaluations have facilitated the development of QSAR models.

Iturin A Strongly Inhibits the Growth and T-2 Toxin Synthesis of Fusarium oxysporum: A Morphological, Cellular, and Transcriptomics Study

Fusarium oxysporum (F. oxysporum) is a common contaminant of dried fish, and the T-2 synthesis by this organism in dried fish products poses a serious public health risk. In this study, we investigated the effects of iturin A, a cyclic lipopeptide produced by Bacillus subtilis, on the growth and synthesis of the T-2 toxin of F. oxysporum, and transcriptomics was conducted. Results showed that the inhibitory effect of iturin A on F. oxysporum was significantly enhanced with an increase in iturin A concentrations. More specifically, compared with the control group, all indexes in the iturin A treatment group with 50 μg/mL were decreased to 24.84 mm, 0.33 × 106 cfu/mL, and 5.86 ng/mL for the colony diameter, number of spores, and concentration of T-2 toxin, respectively. Furthermore, iturin A was proven to destroy the integrity of cell membranes and cause a significant increase in ROS at 25 μg/mL or 50 μg/mL. Transcriptomic analysis revealed that with the treatment of iturin A, the genes of the oxidation-reduction process were up-regulated, while the gene expression of mycelial growth, cell integrity, transmembrane transport, energy metabolism, and others were down-regulated. More importantly, the Tri5 gene cluster was significantly inhibited. This study provided new insights into the mechanism for the inhibitory effect of iturin A on the growth and T-2 toxin synthesis of F. oxysporum and theoretical guidance for the application of iturin A in the preservation of dried aquatic products.

Multifactor Prediction of the Water Richness of Coal Roof Aquifers Based on the Combination Weighting Method and TOPSIS Model: A Case Study in the Changcheng No. 1 Coal Mine

Identifying the water richness of coal roof aquifers is an important and difficult goal of hydrogeological research to prevent and control roof water disasters. To evaluate the water richness of roof sandstone aquifers of the No. 1 coal seam in the Changcheng No. 1 coal mine, a multifactor prediction method based on the fuzzy Delphi analytic hierarchy process (FDAHP), entropy weight method (EWM), sum of squared deviations (SSD), and Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) was proposed. Multisource geological data, including sandstone thickness, burial depth, lithological composition index, core recovery, fault scale index, fault intersections and endpoint density, and fold fractal dimension, were chosen as the primary indicators for evaluating the water richness of roof sandstone aquifers. The FDAHP and EWM were used to scientifically determine the subjective and objective weight vectors of these seven main factors, and the SSD was used to determine the optimal combination weights based on the objective and subjective weight vectors. On this basis, the water richness index (WRI) model was developed using the TOPSIS method to rank the water richness of samples in the study area. A water richness zoning map was created using the WRI values, revealing three zones: the weak water richness zone, moderate water richness zone, and strong water richness zone. Additionally, the map was refined by incorporating hydrogeologic data collected during mining operations, including pumping tests and actual water inrushes from roadways and working faces. It is believed that the proposed WRI model is effective for predicting the water richness of the roof sandstone aquifers of the No. 1 coal seam in the Changcheng No. 1 coal mine based on the engineering practice data used to validate the WRI model.

Protective mechanisms of three antioxidants against T-2 toxin-induced muscle protein deterioration in shrimp

BACKGROUND

Quercetin (Q), tea polyphenols (TP), and rutin (R) are widely used plant-derived active ingredients. They possess antioxidant, anti-inflammatory, and anti-tumor properties, and can reduce the muscle damage caused by mycotoxins. However, few studies have examined the protective mechanisms of quercetin, tea polyphenols, and rutin on muscle quality. To elucidate their protective mechanisms, shrimp were exposed to both T-2 toxin and these three antioxidants for 20 days in a dose-escalating trial. The changes in the protein composition of shrimp muscle were measured. The target proteins associated with T-2 and antioxidants were screened and identified by non-labeled quantitative proteomics.

RESULTS

The T-2 toxin induced abnormal expression of 21 target proteins, leading to the deterioration of muscle proteins in shrimp. The three antioxidants ameliorated the T-2 toxin-induced damage to muscle proteins by increasing the sarcoplasmic and myofibrillar protein content and decreasing the alkali-soluble protein content. Quercetin had the strongest protective effect. The protective processes of these antioxidants involved the upregulation of target proteins involved in carbohydrate metabolism (enolase, malate dehydrogenase), protein translation (elongation factor 1-alpha and eukaryotic translation initiation factor 2 subunit alpha), and cytoskeleton component (actin 2, fast-type skeletal muscle actin 1). Quercetin regulated the largest number of target proteins, making it the best protective agent against T-2 toxin.

CONCLUSION

The T-2 toxin (4.80-24.30 mg/kg feed) induced changes in target proteins and muscle composition of shrimp, leading to a deterioration in muscle proteins. Quercetin (2.00-32.00 g/kg feed) had significant protective effects against this deterioration in muscle protein in shrimp. © 2022 Society of Chemical Industry.

Novel application of anti‐human Fc nanobody for screening high‐producing CHO cells for monoclonal antibody

Animal‐derived anti‐IgG secondary antibodies are currently employed to stain and screen of human monoclonal antibody(mAb)‐producing cells, but using animal‐derived antibodies may raise the concerns of high cost, complicated operations and biological safety issues in biopharmaceutical manufacturing. Nanobodies(VHHs) are attractive forms of antibodies for their straightforward engineering and expression in both eukaryotic and prokaryotic systems. Using phage‐displayed immune llama VHH library, we identified new anti‐Fc VHHs that could bind to human Fc with high affinity. In GFP fusion format, the anti‐Fc VHH‐GFP generated dramatically stronger FACS signals than AF488 conjugated anti‐IgG antibodies when used for staining mAb‐producing CHO cells. Furthermore, preparative sorting of CHO cells based on anti‐Fc VHH‐GFP staining resulted in the enrichment of cell lines capable of synthesizing mAb at high productivity. This safe and cost‐efficient anti‐Fc VHH‐GFP may optimize the process of generating highly productive cell lines for therapeutic mAb production compared to conventional animal‐derived fluorescent antibodies.

[Clinical outcomes of transoral endoscopic thyroidectomy vestibular approach assisted with submental mini-incision for early thyroid papillary carcinoma]

Objective: To investigate the efficacy of transoral endoscopic thyroidectomy vestibular approach (TOETVA) assisted with submental mini-incision in early thyroid papillary carcinoma. Methods: A total of 63 patients with early papillary thyroid carcinoma (cT1N0M0) were included who underwent TOETVA from December 2019 to May 2021 in Department of Thyroid Surgery of the Affiliated Hospital of Jining Medical University. There were 4 males and 59 females, aged from 17 to 46 years old. Of those 36 patients received traditional TOETVA as control and 27 patients accepted modified TOETVA assisted with submental mini-incision. The clinical outcomes of patients in two groups were compared. Chi-square test and t test were used in statistical analyses. Results: Compared to control group, modified TOETVA group had the less mean operation time [(146.63±38.62) minutes vs. (167.78±36.71) minutes, t=-2.21, P=0.031], the shorter time required for returning to normal diet after operation [(2.11±0.89) days vs. (2.72±1.16) days, t=-2.28, P=0.026], and the lower probability of mandibular numbness (0 vs. 16.67%, χ²=4.97, P=0.026). There was no significant difference between two groups in intraoperative blood loss, postoperative drainage volume, number of central lymph nodes dissection, and postoperative complications such as gas embolism, postoperative bleeding, postoperative infection, skin burns, subcutaneous effusion and so on(all P>0.05). After 6 months of operation, the thyroid ultrasound of the patients in two groups showed no recurrence, and the patients were satisfied with their surgical incision appearances. Conclusion: Both the modified and traditional TOETVA show similar efficacies for treatments of early thyroid papillary carcinoma, but the modified TOETVA can reduce the operation time and improve the quality of life.

Output Enhancement of Triboelectric Nanogenerators Based on Hierarchically Regular Cadmium Coordination Polymers for Photocycloaddition

Exploiting the well-arranged and tunable frameworks of crystalline materials, we herein report coordination polymers (CPs) with modulated hierarchical structures as triboelectric materials to construct and extend the application scope of triboelectric nanogenerators (TENGs). Different lengths and shapes of bridging ligands [4,4'-bpa = 1,2-bis(4-pyridyl)ethane, 4,4'-bpe = 1,2-bis(4-pyridyl)ethene, and 4,4'-bpp = 1,3-di(2-pyridyl)propane for 1, 2, and 3, respectively] were used to construct Cd-CP-based hierarchical frameworks. These compounds were used as triboelectric materials, and their electronic structure contributions were determined by the output of the corresponding TENGs. The results indicated that 2-TENG with the 4,4'-bpe ligand had the highest output, attributed to the improvement in the electron activity due to the π-conjugation group in the bridging ligand, which was further verified by density functional theory calculations. Furthermore, 2@PVDF (PVDF = polyvinylidene fluoride) composite films with different concentrations of Cd-CP were prepared. Detailed electrical characterizations revealed that the arrangement of 12% active constituents of Cd-CP-2 effectively enhanced the output performance of 2@PVDF-TENG, which could light up an ultraviolet lamp plate to successfully execute the [2 + 2] photocycloaddition.

Particle trapped at the isotropic-nematic liquid crystal interface: Elastocapillary phenomena and drag forces

We present numerical simulations of a particle trapped at the isotropic-nematic liquid crystal (Iso-N) interface. We use our recent model, based on a phase-field approach [see Qiu et al., Phys. Rev. E 103, 022706 (2021)10.1103/PhysRevE.103.022706], to couple the capillary forces acting on the interface with the elastic stresses in the nematic phase along with topological defects. A range of floating configurations are first investigated as a function of the contact angle and various anchoring conditions at the fluid interface. The results show that the response of the system is driven by the existence of an anchoring conflict at the contact line. Substantial particle displacements and/or interfacial deformations may occur in this case even for moderate anchoring strengths. These findings highlight the coupling between elastic and capillary forces. In a second part, we compute drag forces exerted on a particle that moves along the Iso-N interface for several contact angles and a moderate Ericksen number. Because of the coupling between the velocity and order parameter fields, topological defects are swept downstream of the particle by the flow and sometimes escape from the particle or merge with the interface. We also find linear force-velocity laws, with drag forces at the Iso-N interface being slightly greater than their isotropic counterparts due to director distortions. We discuss these results in light of past studies on the behavior of particles being dragged in the bulk of a liquid crystal matrix.

Comparative Efficacy of Five SGLT2i on Cardiorenal Events: A Network Meta-analysis Based on Ten CVOTs

BACKGROUND

The relative efficacy of different sodium-glucose transporter 2 inhibitors (SGLT2i) on cardiorenal outcomes is unclear.

METHODS

We included cardiovascular outcome trials (CVOTs) of SGLT2i. The eight endpoints of interest were major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, cardiovascular death (CVD), CVD or hospitalization for heart failure (HHF), HHF, kidney function progression (KFP), and all-cause death (ACD). We conducted a Bayesian network meta-analysis and calculated the surface under the cumulative ranking curve (SUCRA) probability to rank treatments.

RESULTS

We included ten CVOTs involving five SGLT2i. Canagliflozin (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.53-0.77), dapagliflozin (HR 0.70; 95% CI 0.62-0.79), empagliflozin (HR 0.68; 95% CI 0.59-0.78), ertugliflozin (HR 0.70; 95% CI 0.54-0.90), and sotagliflozin (HR 0.66; 95% CI 0.56-0.77) versus placebo reduced HHF, whereas none reduced MI and stroke. Empagliflozin reduced CVD or HHF (HR 0.81; 95% CI 0.67-0.99) and KFP (HR 0.65; 95% CI 0.45-0.93), and dapagliflozin reduced KFP (HR 0.69; 95% CI 0.52-0.92), versus ertugliflozin. Canagliflozin had the greatest SUCRA values for the reduction of MACE, stroke, and HHF, whereas empagliflozin had the greatest SUCRA values for the reduction of MI, CVD, CVD or HHF, KFP, and ACD.

CONCLUSIONS

Canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, and sotagliflozin versus placebo reduce HHF but none reduces MI and stroke. Canagliflozin is most effective in reducing MACE and HHF, and empagliflozin is most effective in reducing CVD, CVD or HHF, KFP, and ACD. These findings will guide the use of specific SGLT2i in the prevention of different cardiorenal events.

SGLT2is vs. GLP1RAs Reduce Cardiovascular and All-Cause Mortality

Lin et al. recently did a network meta-analysis based on cardiovascular (CV) outcome trials (CVOTs) of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and those of glucagon-like peptide-1 receptor agonists (GLP1RAs). Due to the absence of CVOTs directly comparing SGLT2is with GLP1RAs, Lin et al.'s network meta-analysis identified the indirect evidence that SGLT2is vs. GLP1RAs reduced hospitalization for heart failure (HHF) but did not reduce CV death and all-cause mortality (ACM) in patients with type 2 diabetes (T2D). We did another meta-analysis incorporating those CV outcome cohort studies directly comparing SGLT2is with GLP1RAs, and identified that SGLT2is vs. GLP1RAs were significantly associated with the lower risks of not only HHF but also CV death and ACM. These findings may suggest that SGLT2is should be considered over GLP1RAs in terms of preventing CV and all-cause death and HHF in T2D patients.

Fatty Acids and Oxylipins as Antifungal and Anti-Mycotoxin Agents in Food: A Review

Fungal contamination of food, especially by mycotoxigenic fungi, not only reduces the quality of the food, but can also cause serious diseases, thus posing a major food safety challenge to humans. Apart from sound food control systems, there is also a continual need to explore antifungal agents that can inhibit fungal growth and mycotoxin production in food. Many types of fatty acids (FAs) and their oxidized derivatives, oxylipins, have been found to exhibit such effects. In this review, we provide an update on the most recent literature on the occurrence and formation of FAs and oxylipins in food, their effects on fungal growth and mycotoxin synthesis, as well as the genetic and molecular mechanisms of actions. Research gaps in the field and needs for further studies in order to realizing the potential of FAs and oxylipins as natural antifungal preservatives in food are also discussed.

Clinical progress and advanced research of red blood cells based drug delivery system

Red blood cells (RBCs) are biocompatible carriers that can be employed to deliver different bioactive substances. In the past few decades, many strategies have been developed to encapsulate or attach drugs to RBCs. Osmotic-based encapsulation methods have been industrialized recently, and some encapsulated RBC formulations have reached the clinical stage for treating tumors and neurological diseases. Inspired by the intrinsic properties of intact RBCs, some advanced delivery strategies have also been proposed. These delivery systems combine RBCs with other novel systems to further exploit and expand the application of RBCs. This review summarizes the clinical progress of drugs encapsulated into intact RBCs, focusing on the loading and clinical trials. It also introduces the latest advanced research based on developing prospects and limitations of intact RBCs drug delivery system (DDS), hoping to provide a reference for related research fields and further application potential of intact RBCs based drug delivery system.

Energy Band Alignment and Redox-Active Sites in Metalloporphyrin-Spaced Metal-Catechol Frameworks for Enhanced CO2 Photoreduction

Two new chemically stable metalloporphyrin-bridged metal-catechol frameworks, InTCP-Co and FeTCP-Co, were constructed to achieve artificial photosynthesis without additional sacrificial agents and photosensitizers. The CO₂ photoreduction rate over FeTCP-Co considerably exceeds that obtained over InTCP-Co, and the incorporation of uncoordinated hydroxyl groups, associated with catechol, into the network further promotes the photocatalytic activity. The iron-oxo coordination chain assists energy band alignment and provides a redox-active site, and the uncoordinated hydroxyl group contributes to the visible-light absorptance, charge-carrier transfer, and CO₂ -scaffold affinity. With a formic acid selectivity of 97.8 %, FeTCP-OH-Co affords CO₂ photoconversion with a reaction rate 4.3 and 15.7 times higher than those of FeTCP- Co and InTCP-Co, respectively. These findings are also consistent with the spectroscopic study and DFT calculation.

Gliflozins for the prevention of stroke in diabetes and cardiorenal diseases: A meta-analysis of cardiovascular outcome trials

BACKGROUND

Individual randomized trials are not powered to assess the relationship between use of sodium-glucose transporter 2 inhibitors and risk of stroke. We sought to explore this issue by a meta-analysis incorporating relevant trials including several latest trials.

METHODS

Cardiovascular outcome trials of gliflozins were included. Primary outcome was stroke, while secondary outcome was major adverse cardiovascular events (MACE), which was a composite of stroke, myocardial infarction, or cardiovascular death. Meta-analysis was conducted stratified by with/without chronic kidney disease (CKD), with/without heart failure (HF), and with/without atherosclerotic cardiovascular disease (ASCVD), and stratified by different gliflozins.

RESULTS

We included 9 trials in this meta-analysis. Compared with placebo, gliflozins significantly lowered stroke (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.55-0.84) and MACE (HR 0.77, 95% CI 0.69-0.86) in type 2 diabetes (T2D) patients with CKD, but did not significantly affect stroke (HR 1.00, 95% CI 0.86-1.16) and MACE (HR 0.94, 95% CI 0.86-1.02) in T2D patients without CKD. Gliflozins had no significant effects on the stroke risk (HR 0.94, 95% CI 0.82-1.07) in T2D patients regardless of HF status (Psubgroup = .684) and ASCVD status (Psubgroup = .915), but significantly lowered MACE (HR 0.89, 95% CI 0.83-0.96) in T2D patients regardless of HF status (Psubgroup = .428) and ASCVD status (Psubgroup = .423). Canagliflozin (HR 0.84, 95% CI 0.69-1.01) showed the trend of a reduction in the stroke risk versus placebo, and sotagliflozin (HR 0.73, 95% CI 0.54-0.98) significantly lowered the stroke risk; whereas the other 3 gliflozins did not significantly affect that risk. Ertugliflozin (HR 0.97, 95% CI 0.85-1.11) had no significant effects on the MACE risk, whereas the other 4 gliflozins significantly lowered that risk.

CONCLUSIONS

Gliflozins, especially canagliflozin and sotagliflozin, should be recommended in T2D patients with CKD to prevent stroke. Most gliflozins lower the risk of MACE in T2D patients regardless of HF status and ASCVD status, whereas ertugliflozin is not observed to lower that risk.

Association Between SGLT2is and Cardiovascular and Respiratory Diseases: A Meta-Analysis of Large Trials

The association between sodium-glucose cotransporter 2 inhibitors (SGLT2is) and various cardiovascular and respiratory diseases is unestablished. This meta-analysis aimed to explore whether use of SGLT2is is significantly associated with the occurrences of 80 types of cardiovascular diseases and 55 types of respiratory diseases. Large randomized trials of SGLT2is were included in analysis. Meta-analysis was conducted to synthesize risk ratio (RR) and 95% confidence interval (CI). Nine large trials were included in analysis. Compared to placebo, SGLT2is were associated with the reduced risks of 9 types of cardiovascular diseases (e.g., atrial fibrillation [RR 0.78, 95% CI 0.67-0.91], bradycardia [RR 0.60, 95% CI 0.40-0.89], and hypertensive emergency [RR 0.29, 95% CI 0.12-0.72]) and 11 types of respiratory diseases (e.g., chronic obstructive pulmonary disease [RR 0.77, 95% CI 0.61-0.97], asthma [RR 0.57, 95% CI 0.35-0.95], and sleep apnoea syndrome [RR 0.36, 95% CI 0.15-0.87]). The results of random-effects meta-analysis were similar with those of fixed-effects meta-analysis. No heterogeneity or only little heterogeneity was found in most meta-analyses. No publication bias was observed in most of the meta-analyses conducted in this study. SGLT2is were not significantly associated with the other 115 cardiovascular and respiratory diseases. SGLT2is are associated with the reduced risks of 9 types of cardiovascular diseases (e.g., atrial fibrillation, bradycardia, and hypertensive emergency) and 11 types of respiratory diseases (e.g., chronic obstructive pulmonary disease, asthma, and sleep apnoea syndrome). This proposes the potential of SGLT2is to be used for prevention of these cardiovascular and respiratory diseases.

Meta-analyzing the factors affecting the efficacy of gliflozins in patients with heart failure based on heart failure trials

BACKGROUND

The factors affecting the efficacy of gliflozins in patients with heart failure (HF) are not clear. We aimed to evaluate the effects of 11 important factors on the efficacy of gliflozins in HF patients.

METHODS

Randomized trials assessing gliflozins in HF patients were included. The outcome of interest was composite HF outcome, a composite of cardiovascular death, or hospitalization for HF. Meta-analysis was done according to 11 factors: status of type 2 diabetes, sex, use of angiotensin receptor-neprilysin inhibitor, age, history of hospitalization for HF, estimated glomerular filtration rate, body mass index, New York Heart Association (NYHA) class, race, region, and left ventricular ejection fraction.

RESULTS

Compared with placebo, gliflozins reduced the risk of composite HF outcome by 14% in the subgroup of patients with NYHA class III or IV (hazard ratios [HR] 0.86, 95% confidence intervals [CI] 0.75-0.99), by 34% in the subgroup of patients with NYHA class II (HR 0.66, 95% CI 0.59-0.74), and by 85% in the subgroup of patients with NYHA class I (HR 0.15, 95% CI 0.03-0.73). This between-group difference was approximate to statistical significance (Psubgroup = .06). The benefit of gliflozins in HF patients was not affected by the other 10 factors (Psubgroup ≥ .123).

CONCLUSIONS

Gliflozins are applicable for a broad population of HF patients as for preventing HF events, while gliflozins may lead to greater benefits in patients with mild HF than in those with moderate to severe HF.

Use of SGLT2 inhibitors and occurrence of noninfectious respiratory disorders: a meta-analysis of large randomized trials of SGLT2 inhibitors

PURPOSE

The impact of use of sodium-glucose transporter 2 (SGLT2) inhibitors on occurrence of various kinds of respiratory disorders has not been established. We aimed at evaluating the relationship between use of SGLT2 inhibitors and occurrence of 9 kinds of noninfectious respiratory disorders.

METHODS

Large randomized controlled trials (RCTs) of SGLT2 inhibitors were included in this study. We conducted fixed-effects meta-analysis to synthesize risk ratios (RRs) and 95% confidence intervals (CIs). We did subgroup analysis respectively stratified by type of underlying diseases and type of SGLT2 inhibitors.

RESULTS

Nine Large RCTs were included for analysis. Compared with placebo, SGLT2 inhibitors significantly reduced the occurrence of overall respiratory disorders (RR 0.75, 95% CI 0.62-0.91), acute pulmonary oedema (RR 0.51, 95% CI 0.29-0.88), asthma (RR 0.57, 95% CI 0.33-0.995), and sleep apnoea syndrome (RR 0.35, 95% CI 0.12-0.99). SGLT2 inhibitors showed the reduced trends in the risks of chronic obstructive pulmonary disease (COPD) (RR 0.79, 95% CI 0.61-1.02; P = 0.073) and pulmonary hypertension (RR 0.43, 95% CI 0.16-1.17; P = 0.098). SGLT2 inhibitors had no significant effects on three other respiratory disorders. These effects exhibited by SGLT2 inhibitors were consistent across different underlying diseases (P_subgroup ≥0.209) and different SGLT2 inhibitors (P_subgroup ≥0.192).

CONCLUSIONS

SGLT2 inhibitors can significantly reduce the occurrence of acute pulmonary oedema, asthma, and sleep apnoea syndrome; and produce the reduced trends in the risks of COPD and pulmonary hypertension. These findings will prompt further investigation on SGLT2 inhibitors for primary and secondary prevention of various respiratory disorders.

Meta-Analysis on the Safety and Cardiorenal Efficacy of SGLT2 Inhibitors in Patients Without T2DM

The cardiorenal benefits of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM) are established, whereas those in patients without T2DM are not established. We sought to assess the cardiorenal efficacy and safety of SGLT2 inhibitors in non-T2DM patients by performing a meta-analysis based on the subgroup data of non-T2DM patients from relevant secondary analysis articles in which subgroup analyses were done according to the status of diabetes. Compared to placebo, SGLT2 inhibitors significantly reduced heart failure hospitalization [risk ratio (RR) 0.70, 95% confidence interval (CI) 0.59–0.83] and kidney-specific composite outcome (RR 0.55, 95% CI 0.40–0.75) and increased Kansas City Cardiomyopathy Questionnaire total score by 1.15 (95% CI 1.05–1.25) in patients without T2DM with heart failure (HF) or chronic kidney disease (CKD), whereas gliflozins did not significantly affect cardiovascular death, all-cause mortality, volume depletion, fracture, and amputation in this vulnerable population. There was no event of major hypoglycemia or diabetic ketoacidosis observed in the non-T2DM subgroup in included trials. These findings will further prompt gliflozins to be used for the prevention of HF and renal failure events and for the improvement of life quality in patients without T2DM with HF or CKD.

Comprehensive analysis of the safety of semaglutide in type 2 diabetes: a meta-analysis of the SUSTAIN and PIONEER trials

The PIONEER and SUSTAIN serial trials are designed to assess the efficacy outcomes with semaglutide in patients with type 2 diabetes, but are not powered to assess various safety outcomes. We sought to assess the risk of semaglutide in leading to various serious adverse events (SAEs) in patients with type 2 diabetes. Studies eligible for inclusion were the PIONEER and SUSTAIN trials of semaglutide. We conducted meta-analysis to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Meta-analysis was performed using both random-effects and fixed-effects model to evaluate the robustness of pooled results. We implemented subgroup analysis according to drug dosages and routes of administration and type of comparators. Twenty-one trials were included. Semaglutide versus control significantly reduced total SAEs (RR 0.92, 95% CI 0.87-0.97; I² = 0) and atrial fibrillation (RR 0.69, 95% CI 0.50-0.95; I² = 0), but significantly increased deep vein thrombosis (RR 3.66, 95% CI 1.09-12.25; I² = 0) and diarrhoea (RR 2.66, 95% CI 1.19-5.95; I² = 0). Semaglutide had no significant effects on 248 other kinds of SAEs. No statistically significant subgroup effects were observed. Semaglutide has a good safety profile in general and reduces atrial fibrillation by 31%, but increases diarrhoea by 166% and deep vein thrombosis by 266%. These findings may guide that semaglutide should be preferred or avoided in T2D patients with specific susceptibility factors.

Effects of patient characteristics on the efficacy of complete revascularization for treatment of ST-segment elevation myocardial infarction with multivessel disease: A meta-analysis

BACKGROUND

Several randomized controlled trials (RCTs) have evaluated the efficacy of complete vs culprit-only revascularization for treatment of ST-segment elevation myocardial infarction (STEMI) with multivessel disease. However, the efficacy of complete revascularization vs culprit-only revascularization in some STEMI patient subgroups remains unclear.

METHODS

We searched PubMed and Embase for related RCTs from the start date of databases to January 3, 2020. The endpoint assessed in this meta-analysis was major adverse cardiac events (MACE). Random-effects meta-analysis was conducted stratified by each of the 5 factors of interest (i.e., sex, age, history of diabetes, ECG infarct location, and the number of arteries with stenosis) to estimate pooled hazard ratio and 95% confidence interval. Random-effects meta-regression was conducted to assess subgroup differences. We examined publication bias by drawing funnel plots and performing Egger test. This meta-analysis is reported according to the PRISMA statement.

RESULTS

Six RCTs were included for pooled analysis. Compared with culprit-only revascularization, complete revascularization significantly reduced the risk of MACE (hazard ratio 0.48, 95% confidence interval 0.42-0.55; I2 = 0%; P for relative effect < .001). This significant reduction in the risk of MACE exhibited by complete revascularization was observed in most of the subgroups of interest. All of the subgroup effects based on the 5 factors of interest were not statistically significant (Psubgroup ranged from 0.198 to 0.556). Publication bias was not suggested by funnel plots and Egger test.

CONCLUSIONS

Compared with culprit-only revascularization, complete revascularization significantly reduces the MACE risk in patients with STEMI and multivessel disease, which is independent of sex, age, history of diabetes, ECG infarct location, and the number of arteries with stenosis.