Urbanization and non-communicable disease mortality in Thailand: an ecological correlation study.

This study provides strong evidence from an LMIC that urbanization is associated with mortality from three lifestyle-associated diseases at an ecological level. Furthermore, our data suggest that both average household income and number of doctors per population are important factors to consider in ecological analyses of mortality

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Discrepancy between short-term and long-term effects of bone marrow-derived cell therapy in acute myocardial infarction: a systematic review and meta-analysis

Abstract Background Bone marrow-derived cell therapy has been used to treat acute myocardial infarction. However, the therapeutic efficacy of this approach remains controversial. Here, we performed a systematic review and meta-analysis to evaluate short-term and long-term effectiveness of bone marrow-derived therapy. Methods We searched eight databases (Ovid-Medline, Ovid-EMBASE, Cochrane Library, KoreaMed, KMBASE, KISS, RISS, and KisTi) up to December 2014. Demographic characteristics, clinical outcomes, and adverse events were analyzed. We identified 5534 potentially relevant studies; 405 were subjected to a full-text review. Forty-three studies with 2635 patients were included in this review. Results No safety issues related to cell injection were reported during follow-up. At 6 months, cell-injected patients showed modest improvements in left ventricular ejection fraction (LVEF) compared with the control group. However, there were no differences between groups at other time points. In the cardiac MRI analysis, there were no significant differences in infarct size reduction between groups. Interestingly, mortality tended to be reduced at the 3-year follow-up, and at the 5-year follow-up, cell injection significantly decreased all-cause mortality. Conclusions This meta-analysis demonstrated discrepancies between short-term LV functional improvement and long-term all-cause mortality. Future clinical trials should include long-term follow-up outcomes to validate the therapeutic efficacy of cell therapy

廃棄漁網からのリサイクルナイロン繊維を混入したモルタル補修材料による鉄筋腐食コンクリートはりの性能回復効果

Marine ecosystems are deteriorating due to derelict fishing gears (DFG) including fishing nets. Fishing nets that were discarded or lost in the ocean become traps, leading to the deaths to many of marine species especially sea lions, whales and turtles. It is estimated that 705,000 tons of DFG are lost in the ocean and kill more than 380,000 lives annually. It is also reported that entanglement of ships’ propellers in DFG causes economic losses over 90 million USD in Korean Sea. Fishing nets are usually made of very strong and durable materials, such as nylon, high-density polyethylene (HDPE) and polyamide, which are non-biodegradable. Even though many used fishing nets are recycled or utilized, applications of recycled fishing nets are still limited. In addition, recycling fishing nets, especially made of nylon, consumes lots of resources and energy, as well as emits greenhouse gases. Therefore, finding suitable solutions for collecting and recycling fishing nets is an urgent issue to mitigate environmental impact. This research investigates the application of used fishing nets as reinforcement fibers in cement mortar from the viewpoints of mechanical properties and durability. Two main objectives were appointed, 1) application of recycled nylon fiber from used fishing nets (RN fiber) for the repair of corroded RC beams and 2) long-term durability of the mortar reinforced with the RN fibers subjected to the chloride ion ingress. Four types of fiber were used as a reinforcing material in polymer cement mortar (PCM): two kinds of RN fiber from used fishing nets, manufactured fibrillated polyethylene (PE) microfiber, and manufactured polyvinyl alcohol (PVA) fiber. Reinforced concrete (RC) beams were placed in the tidal zone for 2 years to induce steel corrosion, then repairs were carried out by spraying PCM reinforced with those fibers on the repair section of the beams. The repairs were taken for the normal RC beams at the end of the exposure period. The upgraded RC beams underwent repair operations before starting the exposure and were not further repaired even after the exposure. Repairability of the RC beams was extensively investigated, such as load-carrying capacities after the repair, failure behavior, stain distributions, cracks formation, and chloride ion penetrability. The effectiveness of the reinforcement with RN fibers was compared with that of PE and PVA fibers. In addition, mechanical properties of the reinforced PCM as well as compatibility of RN fibers under high alkalinity in concrete were also studied. Experimental results confirmed that RN fibers along with the manufactured PE microfiber and PVA fiber have great potential to be used as reinforcement in cement mortar and for the repair of lightly corroded RC beams. The addition of RN and PVA fibers seems to have no noticeable effect on the flowability of fresh PCM, but the addition of PE fiber results in a considerable reduction of flowability because of its geometry and the surface property. Adding RN and PVA fibers does not show visible effect on the compressive strength, but the flexural capacity of the PCM is reduced. In contrast, adding PE fibers increases both the compressive and flexural strengths of PCM. It is concluded that fiber reinforcement contributes to post-peak flexural capacity and helps prevent abrupt failure. Flexural capacity of the RC beams that was deteriorated due to the corrosion of tensile rebar can be compensated with the sprayed PCM. The effectiveness of the RN fiber is comparable with that of the PVA fibers but inferior PE microfibers. Adding fibers helps distribute stresses throughout the beam under the bending load. RN fibers helps transfer stresses through wide cracks and spreads the cracks toward the support of the beams. PE fibers prevents severe damage of the beams by distributing damage from a wide crack to many small cracks. It is confirmed that RN fiber is stable under high alkalinity in mortar without any sign of deterioration; however, surface characteristics of RN fiber may cause poor bonding between fibers and mortar substrates. For the long-term durability, mortar reinforced with RN and PE fibers subjected to chloride ion ingress were evaluated. RN fibers and PE fibers were mixed into ordinary Portland cement (OPC) mortar and PCM. Two groups of specimens were made: non-exposed specimens that were kept in laboratory and the specimens that were exposed to seawater for 3 months and 12 months. Chloride ion diffusion coefficients of non-exposed specimens were also evaluated using chloride migration tests. The spatial distribution of chloride ions, chloride penetration depth and the effective diffusion coefficient of exposed specimens were examined with electron probe microanalyzer (EPMA). Based on the chloride migration test, the effective diffusion coefficient of the reinforced mortar seems to be improved with the addition of RN and PE fibers, but the tendency is still unclear. The type of mortar mix (e.g. OPC or PCM) and water-to-binder ratio are still dominant factors to govern the effective diffusion coefficient of mortar. EPMA analysis results confirm that chloride ion penetration depth and chloride ion profile of exposed specimens are identical regardless of the type of fiber or fiber content. Changes in chloride ions ingress because of the addition of fiber seems to be negligible. It is concluded that the recycled nylon fiber from used fishing nets tested in this study has been proven effective for reinforcing cementitious materials, and for repairing lightly corroded RC beams. RN fiber has comparable performance to that of the manufactured PVA and PR fibers. Application of recycled fiber for construction materials is a possible way to promote utilizing waste fishing nets

Cost-effective system for detection and quantification of concrete surface cracks by combination of convolutional neural network and image processing techniques

This study proposed a semi-automated system for crack detection and quantification, based on the com-bination of a trained convolutional neural network (CNN) and a developed application. Specifically, we tested four commonly used CNNs and determined GoogLeNet for this study. Then, the transfer learning and fully training of GoogLeNet were further tested on our testing dataset and a public dataset. The results show that the transfer learning GoogLeNet has relatively balanced performances on these two datasets, with accuracy of 96.69% and 88.39%, respectively. A new sliding window technique (neighbor-hood scanning) was proposed and shown almost equivalent performance to the previous dual scanning method. A method for calculating crack width was presented. The average relative error of this method is 14.58% (0.05 mm), i.e., much smaller than the 36.37% (i.e., 0.14 mm) of the previous method. An appli-cation was then developed to integrate the proposed methods and other techniques such as edge detec-tors, boundary tracking, and threshold segmentation to segment, quantify, and analyze cracks. Verifications on 23 untrained raw images (eleven with 10240 x 2048 pixels, twelve with 2592 x 4608 pixels) show that: (1) the developed system and a previous pixel-level segmentation system require an average of 9.48 s and 10.35 s; (2) these two systems show an 80.40% and a 78.64% average Intersection over Union (IoU). Therefore, the proposed system is a cost-effective solution for detecting and analyzing cracks on concrete surfaces considering its practical performance and time cost. Practically, the proposed system could be used to analyze the images collected from onsite inspection or from experiment