Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries

Background: Sex differences in clinical profiles and prognosis after acute myocardial infarction have been addressed for decades. However, the sex-based disparities among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remain largely unreported. Here, we investigated sex-specific characteristics and long-term outcomes in MINOCA population.Methods: A total of 1,179 MINOCA patients were enrolled, including 867 men and 312 women. The mean follow-up was 41.7 months. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal reinfarction, revascularization, non-fatal stroke, and hospitalization for unstable angina or heart failure. Baseline data and outcomes were compared. Kaplan-Meier curves and Cox regression analyses were used to identify association between sex and prognosis.Results: Female patients with MINOCA had more risk profiles with regard to older age and higher prevalence of hypertension and diabetes compared with men. The evidence-based medical treatment was similar in men and women. The incidence of MACE (men vs. women: 13.8 vs. 15.3%, p = 0.504) did not differ significantly between the sexes. The Kaplan-Meier analysis also indicated that women had a similar incidence of MACE compared to men (log rank p = 0.385). After multivariate adjustment, female sex was not associated with the risk of MACE in overall (adjusted hazard ratio 1.02, 95% confidence interval: 0.72–1.44, p = 0.916) and in subgroups of MINOCA patients.Conclusion: The long-term outcomes were similar for men and women presenting with MINOCA despite older age and more comorbidities in women. Future research should aim to improve in-hospital and post-discharge care for both sexes with MINOCA

A potential predictor of multi - season droughts in Southwest China: soil moisture and its memory

During the last decade, several high intensity and long duration droughts happened in Southwest China (SWC) and resulted in tremendous socioeconomic losses. Meanwhile, it is well known that soil moisture (SM) plays a key role in land–atmosphere interaction and weather/climate prediction and is a direct drought index. Thus, a general analysis of SM is beneficial to drought research and prediction over this region. Based on the SM data of Global Land Data Assimilation System V2.0, we examined the temporal variations in SM in SWC during 1961–2012. Results show that significant soil drying trend happened in autumn accompanied by an evident abrupt change in 1991. Moreover, SM exhibits a strong and season-dependent persistence. Particularly, the autumn SM anomaly shows the strongest memory that can be sustained to the next spring. Along with the decadal shift of SM, the memory time of autumn SM can extend from 3 months before 1991 to 6 months in recent years. We further used the Standardized Precipitation Evapotranspiration Index (SPEI) at multiple time scales to identify the droughts in different seasons over SWC, and the inter-annual change patterns of autumn SM and SPEIs are generally in agreement with each other, which confirms that SM is suitable for indicating the droughts. Our results suggest that the autumn SM can be a potential predictor of persistent droughts over SWC, especially for those multi-season persistent drought events started in autumn

Case Report: Septic arthritis in children caused by Streptococcus pyogenes–rational use of antibiotics

To investigate the clinical characteristics and treatment of septic arthritis caused by Streptococcus pyogenes(S. pyogenes) in children, we retrospectively analyzed the clinical data, laboratory results, treatments and outcomes of three pediatric cases of septic arthritis caused by S. pyogenes occurring from 2016–2018. The three cases of septic arthritis included 1 boy and 2 girls, aged from 2–7 years. Two patients experienced fever, and in all three cases, the affected joints showed redness, swelling, an increased local skin temperature, tenderness and restricted limb movement. At the first visit, all three cases showed a significantly increased white blood cell count [(27.68–32.02)×109/mL] and a significantly increased erythrocyte sedimentation rate (113–134 mm/h). The C-reactive protein level was significantly increased in two cases (67 mg/L, 147.7 mg/L) and normal in one case. The procalcitonin level was normal in 1 case, elevated in 1 case, and undetected in 1 case. S. pyogenes isolated from cases 1 and 2 were emm1/ST28 and from case 3 was emm12/ST36. All patients were treated by abscess incision and drainage, and S. pyogenes was cultured in the abscess puncture fluid. All patients were treated with intravenous antibiotics after admission, and all patients were cured and discharged. The patients were followed up for 2 months, and their condition was improved and stable. No sequelae such as heart and kidney damage were detected. In conclusion, for children with septic arthritis, early diagnosis and timely treatment with incision and drainage followed by culture of the abscess puncture fluid are important. Once S. pyogenes infection is confirmed, β-lactam antibiotics provide effective treatment, avoiding use of broad-spectrum antibiotics

Wafer-scale heterogeneous integration InP on trenched Si with a bubble-free interface

Heterogeneous integration of compound semiconductors on a Si platform leads to advanced device applications in the field of Si photonics and high frequency electronics. However, the unavoidable bubbles formed at the bonding interface are detrimental for achieving a high yield of dissimilar semiconductor integration by the direct wafer bonding technology. In this work, lateral outgassing surface trenches (LOTs) are introduced to efficiently inhibit the bubbles. It is found that the chemical reactions in InP-Si bonding are similar to those in Si-Si bonding, and the generated gas can escape via the LOTs. The outgassing efficiency is dominated by LOTs\u27 spacing, and moreover, the relationship between bubble formation and the LOT\u27s structure is well described by a thermodynamic model. With the method explored in this work, a 2-in. bubble-free crystalline InP thin film integrated on the Si substrate with LOTs is obtained by the ion-slicing and wafer bonding technology. The quantum well active region grown on this Si-based InP film shows a superior photoemission efficiency, and it is found to be 65% as compared to its bulk counterpart

Prognostic value of inflammatory markers for in-hospital mortality in intensive care patients with acute ischemic stroke: a retrospective observational study based on MIMIC-IV

BackgroundAcute ischemic stroke (AIS) is a primary cause of death and disability worldwide. Four markers that can be readily determined from peripheral blood, namely, the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and total bilirubin, were measured in this study. We examined the relationship between the SII and in-hospital mortality after AIS and evaluated which of the above four indicators was most accurate for predicting in-hospital mortality after AIS.MethodsWe selected patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database who were aged >18 years and who were diagnosed with AIS on admission. We collected the patients’ baseline characteristics, including various clinical and laboratory data. To investigate the relationship between the SII and in-hospital mortality in patients with AIS, we employed the generalized additive model (GAM). Differences in in-hospital mortality between the groups were summarized by the Kaplan–Meier survival analysis and the log-rank test. The receiver operating characteristic (ROC) curve analysis was used to assess the accuracy of the four indicators (SII, NLR, PLR, and total bilirubin) for predicting in-hospital mortality in patients with AIS.ResultsThe study included 463 patients, and the in-hospital mortality rate was 12.31%. The GAM analysis showed a positive correlation between the SII and in-hospital mortality in patients with AIS, but the correlation was not linear. Unadjusted Cox regression identified a link between a high SII and an increased probability of in-hospital mortality. We also found that patients with an SII of >1,232 (Q2 group) had a considerably higher chance of in-hospital mortality than those with a low SII (Q1 group). The Kaplan–Meier analysis demonstrated that patients with an elevated SII had a significantly lower chance of surviving their hospital stay than those with a low SII. According to the results of the ROC curve analysis, the in-hospital mortality of patients with AIS predicted by the SII had an area under the ROC curve of 0.65, which revealed that the SII had a better discriminative ability than the NLR, PLR, and total bilirubin.ConclusionThe in-hospital mortality of patients with AIS and the SII were positively correlated, but not linearly. A high SII was associated with a worse prognosis in patients with AIS. The SII had a modest level of discrimination for forecasting in-hospital mortality. The SII was slightly better than the NLR and significantly better than the PLR and total bilirubin for predicting in-hospital mortality in patients with AIS

Sin1 phosphorylation impairs mTORC2 complex integrity and inhibits downstream Akt signaling to suppress tumorigenesis

The mechanistic target of rapamycin (mTOR) functions as a critical regulator of cellular growth and metabolism by forming multi-component, yet functionally distinct complexes mTORC1 and mTORC2. Although mTORC2 has been implicated in mTORC1 activation, little is known about how mTORC2 is regulated. Here we report that phosphorylation of Sin1 at T86 and T398 suppresses mTORC2 kinase activity by dissociating Sin1 from mTORC2. Importantly, Sin1 phosphorylation, triggered by S6K or Akt, in a cellular context-dependent manner, inhibits not only insulin/IGF-1-mediated, but also PDGF or EGF-induced Akt phosphorylation by mTORC2, demonstrating a negative regulation of mTORC2 independent of IRS-1 and Grb10. Lastly, a cancer patient-derived Sin1-R81T mutation impairs Sin1 phosphorylation, leading to hyper-mTORC2 activation via bypassing this negative regulation. Together, our work reveals a Sin1 phosphorylation-dependent mTORC2 regulation, providing a potential molecular mechanism by which mutations in the mTORC1/S6K/Sin1 signaling axis might cause aberrant hyper-activation of mTORC2/Akt that facilitates tumorigenesis

Effects of mulberry twig alkaloids(Sangzhi alkaloids) and metformin on blood glucose fluctuations in combination with premixed insulin-treated patients with type 2 diabetes

IntroductionWe aimed to evaluated the effect of premixed insulin (Ins), premixed insulin combined with metformin (Ins+Met) or mulberry twig alkaloids(Ins+SZ-A) on blood glucose fluctuations in patients with type 2 diabetes (T2DM) using continuous glucose monitors (CGM).MethodsThirty patients with T2DM and poor blood glucose control using drugs were evaluated for eligibility during the screening period. Subsequently, their original hypoglycemic drugs were discontinued during the lead-in period, and after receiving Ins intensive treatment for 2 weeks, they were randomly assigned to receive either Ins, Ins+Met, or Ins+SZ-A treatment for the following 12 weeks. The main efficacy endpoint comprised changes in their CGM indicators changes (mean blood glucose level [MBG], standard deviation of blood glucose [SDBG], mean amplitude of glycemic excursions [MAGE], postprandial glucose excursions [PPGE], the largest amplitude of glycemic excursions [LAGE], mean of daily difference [MODD], time in range between 3.9–10.0 mmol/L [TIR] and area under the curve for each meal [AUCpp]) during the screening, lead-in, and after 12-week treatment period. Changes in glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), 1-h postprandial blood glucose (1h-PBG), 2-h postprandial blood glucose (2h-PBG), fasting blood lipids and postprandial blood lipids were also measured at baseline and after 12 weeks of treatmentResultsThe CGM indicators of the three groups during the lead-in period all showed significant improvements compared to the screening period (P<0.05). Compared with those in the lead-in period, all of the CGM indicators improved in the the Ins+Met and Ins+SZ-A groups after 12 weeks of treatment (P<0.05), except for MODD. After 12-week treatment, compared with the Ins group, Ins+Met and Ins+SZ-A groups showed improved MBG, SDBG, TIR, breakfast AUCpp,lunch AUCpp, HbA1c, FBG, 1h-PBG, fasting blood lipid and postprandial blood lipid indicators (P<0.05). Further, the LAGE, PPGE, MAGE, dinner AUCpp and 2h-PBG levels of the Ins+SZ-A group were significantly lower than those of the Ins+Met and Ins groups (P<0.05).ConclusionOur findings highlight the efficacy of combination therapy (Ins+SZ-A or Ins+Met) in improving blood glucose fluctuations, as well as blood glucose and lipid levels. Ins+SZ-A reduces postprandial blood glucose fluctuations more than Ins+Met and Ins groups.Trial registration numberISRCTN20835488

A Facile Strategy for In Situ Core-Template-Functionalizing Siliceous Hollow Nanospheres for Guest Species Entrapment

The shell wall-functionalized siliceous hollow nanospheres (SHNs) with functional molecules represent an important class of nanocarriers for a rich range of potential applications. Herein, a self-templated approach has been developed for the synthesis of in situ functionalized SHNs, in which the biocompatible long-chain polycarboxylates (i.e., polyacrylate, polyaspartate, gelatin) provide the framework for silica precursor deposition by simply controlling chain conformation with divalent metal ions (i.e., Ca2+, Sr2+), without the intervention of any external templates. Metal ions play crucial roles in the formation of organic vesicle templates by modulating the long chains of polymers and preventing them from separation by washing process. We also show that, by in situ functionalizing the shell wall of SHNs, it is capable of entrapping nearly an eightfold quantity of vitamin Bc in comparison to the bare bulk silica nanospheres. These results confirm the feasibility of guest species entrapment in the functionalized shell wall, and SHNs are effective carriers of guest (bio-)molecules potentially for a variety of biomedical applications. By rationally choosing the functional (self-templating) molecules, this concept may represent a general strategy for the production of functionalized silica hollow structures