High serum osteopontin levels are associated with prevalent fractures and worse lipid profile in post-menopausal women with type 2 diabetes

Purpose: Patients with type 2 diabetes (T2DM) have increased fracture risk. Osteopontin (OPN) is a protein involved in bone remodeling and inflammation. The aim of this study was to evaluate the association of OPN with fracture prevalence and with metabolic parameters in post-menopausal women with T2DM. Methods: Sixty-four post-menopausal women with T2DM (age 67.0 ± 7.8 years, diabetes duration 8.9 ± 6.7 years), enrolled in a previous study, were followed up (3.6 ± 0.9 years). Previous fragility fractures were recorded. The FRAX score (without BMD) was calculated and biochemical parameters (plasma glucose, HbA1c, lipid profile and renal function) were assessed. Serum 25OH-vitamin D, calcium, PTH and OPN were evaluated at baseline. The association between OPN and fracture prevalence at baseline was evaluated by a logistic model. Results: OPN levels were higher in patients with previous fractures (n.25) than in patients without previous fractures at baseline (n.39) (p = 0.006). The odds of having fractures at baseline increased by 6.7 (1.9–31.4, 95% CI, p = 0.007) for each increase of 1 ng/ml in OPN levels, after adjustment for vitamin D and HbA1c levels. Fracture incidence was 4.7%. Higher OPN associated with a decrease in HDL-cholesterol (p = 0.048), after adjustment for age, basal HDL-cholesterol, basal and follow-up HbA1c and follow-up duration. 25OH-vitamin D associated with an increase in FRAX-estimated probability of hip fracture at follow-up (p = 0.029), after adjustment for age, 25OH-vitamin D and time. Conclusions: In post-menopausal women with T2DM, OPN might be a useful marker of fracture and worse lipid profile

Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation

Introduction: Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.Methods: Patients who sustained blunt or penetrating trauma with signs of hemorrhagic shock from June 2014 through July 2018 were considered for TXA treatment. A retrospective control group was formed from patients seen in the same past five years who were not administered TXA and matched based on age, gender, Injury Severity Score (ISS), and mechanism of injury (blunt vs penetrating trauma). The primary outcome of this study was mortality measured at 24 hours, 48 hours, and 28 days. Secondary outcomes included total blood products transfused, hospital length of stay (LOS), intensive care unit LOS, and adverse events. We conducted three pre-specified subgroup analyses to assess outcomes of patients, including (1) those who were severely injured (ISS >15), (2) those who sustained significant blood loss (≥10 units of total blood products transfused), and (3) those who sustained blunt vs penetrating trauma.Results: Propensity matching yielded two cohorts: the hospital TXA group (n = 280) and a control group (n = 280). The hospital TXA group had statistically lower mortality at 28 days (1.1% vs 5%, odds ratio [OR] [0.21], (95% confidence interval [CI], 0.06, 0.72)) and used fewer units of blood products (median = 4 units, interquartile range (IQR) = [1, 10] vs median=7 units, IQR = [2, 12.5] for the hospital TXA and control groups, respectively, (95% CI for the difference in median, -3 to -1). There were no statistically significant differences between groups with regard to 24-hour mortality (1.1% vs 1.1%, OR = 1, 95% CI, 0.20, 5.00), 48-hour mortality (1.1% vs 1.4%, OR [0.74], 95% CI, 0.17, 3.37), hospital LOS (median= 9 days, IQR = (5, 16) vs median =12 days IQR = (6, 22.5) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-5 to 0)), and incidence of thromboembolic events (eg, deep vein thrombosis, pulmonary embolism) during hospital stay (0.7% vs 0.7% for the hospital TXA and control group, respectively, OR [1], 95% CI, 0.14 to 7.15). We conducted subgroup analyses on patients with ISS>15, patients transfused with ≥10 units of blood products, and blunt vs penetrating trauma. The results indicated lower 28-day mortality for ISS>15 (1.8% vs 7.1%, OR [0.23], 95% CI, 0.06 to 0.81) and blunt trauma  (0.6% vs 6.3%, OR [0.09], 95% CI, 0.01 to 0.75); fewer units of blood products for penetrating trauma (median = 2 units, IQR = (1, 8) vs median = 8 units, IQR = (5, 15) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-6 to -3)), and ISS>15 (median = 7 units, IQR = (2, 14) vs median = 8.5 units, IQR = (4, 16) for the hospital TXA and control groups, respectively, 95% CI for the difference in median, -3 to 0).Conclusion: The current study demonstrates a statistically significant reduction in mortality after TXA administration at 28 days, but not at 24 and 48 hours, in patients with traumatic hemorrhagic shock

Symmetrical nine-phase drives with a single neutral-point: common-mode voltage analysis and reduction

Power converters generate switching common mode voltage (CMV) through the pulse width modulation (PWM). Several problems occur in the drive systems due to the generated CMV. These problems can be dangerous to the insulation and bearings of the electric machine windings. In recent years, many modulation methods have been developed to reduce the CMV in multiphase machines. Symmetrical nine-phase machines with single-neutral are considered in this paper. In this case, conventional PWM uses eight active vectors of different magnitudes in combination with two zero states in a switching cycle, and this generates maximum CMV. This paper proposes two PWM schemes to reduce the CMV in such a system. The first scheme is called active zero state (AZS). It replaces the zero vectors with suitable opposite active vectors. The second scheme uses ten large active vectors during switching and is called SVM-10L. Compared with conventional strategies, the AZS reduces the peak CMV by 22.2%, and the SVM-10L reduces the peak CMV by 88.8%. Moreover, this paper presents a carrier-based implementation of the proposed schemes to simplify the implementation. The proposed schemes are assessed using simulations and experimental studies for an induction motor load under different case studies

Multi-terminal Hvdc system with offshore wind farms under anomalous conditions: Stability assessment

Droop control is widely adopted to control Multi-Terminal high-voltage Direct Current (MTDC) systems with offshore wind farms. During permanent faults, the faulty line should be isolated promptly to preserve a high reliability of the MTDC system. This paper examines the MTDC system performance following a faulty line outage. This study aims to identify the outage types that may lead to a complete loss of system voltage stability and the outages that may have a secondary effect on the system. Moreover, strategies for dealing with outages that may lead to a complete shutdown of the system are also presented. Furthermore, the ranges of droop gains' values that can be employed following fault occurrence to preserve system transient stability are studied. Different scenarios are explored during faulty conditions such as surplus and sparsity of wind power, line overcurrent, outage of lines connected to wind farms, and outage of lines connected to AC grids to validate this study.MATLAB/Simulink platform has been employed to elucidate the presented concept.Qatar National Research FundScopu

Defect formation during binder removal in ethylene vinyl acetate filled system

This paper focuses on determining the criteria for defect formation during the early stages of thermal binder removal within an ethylene vinyl acetate (EVA) polymer filled with submicron SiC ceramic powder. The only product of the early stage thermal degradation reaction of EVA within an inert atmosphere is acetic acid. This single component and well characterized organic reaction product has allowed the defect forming criteria to be definitively examined. It will be shown that bloating occurs in the early stages of binder removal as a result of pressure build-up in the specimen resulting from acetic acid formed from the thermal elimination reaction of EVA. The first part of this paper examines defect formation occurring in the pure polymer within a hot-stage optical microscope. Bubble formation is observed in the pure polymer. Next, bloating occurring in the molded system is examined. The affect of mineral oil on bloating is also discussed as well as the effect that molding pressure has on bloating. It was found that molding pressure effects defect formation. Finally, this paper presents binder removal maps that were developed for specimens up to 8 mm thick. These bloating maps indicate the existence of two primary bloating regimes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44754/1/10853_2004_Article_232418.pd

Sorption of hydrophobic compounds by sediments, soils and suspended solids--II. Sorbent evaluation studies

Concepts underlying the sorption of hydrophobic compounds and models for representation of observed equilibrium relationships were presented in Part I of this series. The earlier paper also summarized and evaluated major factors which affect the sorption of pollutants in natural environmental systems. This second part of the series presents a detailed summary and evaluation of the sorption of a particular class of hydrophobic pollutants, polychlorinated biphenyls (PCB), on a variety of different types of sediments, soils, suspended solids, and microorganisms. Equilibrium models described in Part I are used here to describe and analyze the PCB sorption data.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25453/1/0000903.pd