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Objectives This meta-analysis aimed to evaluate the association between the Geriatric Nutritional Risk Index (GNRI) and survival outcomes in patients with urological cancer.Design Systematic review and meta-analysis of observational studies.Data sources A comprehensive literature search was conducted in Medline, EMBASE, Google Scholar and the Cochrane Library from inception to 7 July 2024.Eligibility criteria Studies were included if they examined the correlation between the GNRI and long-term survival outcomes in adult patients (≥18 years old) with urological cancers.Data extraction and synthesis Two researchers independently extracted data and assessed study quality using the Newcastle-Ottawa Scale and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Publication bias was evaluated using funnel plots and Egger’s test for outcomes with more than 10 studies. Pooled HRs and 95% CIs were calculated using a random-effects model. Subgroup analyses, meta-regression and sensitivity analyses were performed.Results 17 studies involving 8816 patients were included. Study quality assessment showed that 15 studies had a low risk of bias (scores 7–9) and two had a high risk (scores 5–6). Low GNRI was significantly associated with poor overall survival (OS) (HR: 2.6, 95% CI: 2.0 to 3.38, p

Abstract Background Remimazolam is a novel ultra-short-acting benzodiazepine that has been recently introduced as an alternative to propofol for general anesthesia. While both agents have been compared in terms of safety and efficacy, their relative effects on postoperative quality of recovery (QoR) remain unclear. Therefore, this meta-analysis aimed to compare the effects of remimazolam and propofol on subjective QoR in surgical patients who underwent general anesthesia. Methods Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched from inception to May 28, 2024 to identify randomized controlled trials comparing remimazolam and propofol in terms of postoperative QoR. The Cochrane risk-of-bias tool (RoB 2) was used to assess study quality. QoR score on postoperative day (POD) 1 (primary outcome), QoR scores on PODs 2–3, QoR dimensions, time to loss of consciousness, other recovery characteristics, and rescue analgesia requirement were evaluated using random-effects meta-analyses. Results This meta-analysis included 13 studies published between 2022 and 2024 involving 1,418 patients. QoR was evaluated using either the QoR-15 (10 studies) or QoR-40 (3 studies) questionnaire. The pooled results indicated no significant difference in the QoR scores on POD 1 (standardized mean difference: 0.02, 95% confidence interval [CI]: − 0.20, 0.23, P = 0.88, I2 = 73%) and PODs 2–3 between remimazolam and propofol. Furthermore, no significant differences were observed in QoR dimensions, length of postanesthesia care unit (PACU) stay, and time to extubation as well as in the risks of agitation and postoperative nausea and vomiting. Patients administered remimazolam exhibited slower anesthetic induction (mean difference (MD): 32.27 s) but faster recovery of consciousness (MD: − 1.60 min) than those administered propofol. Moreover, remimazolam was associated with a lower risk of rescue analgesia requirement in the PACU (risk ratio: 0.62, 95% CI: 0.43, 0.89, P = 0.009, I 2 = 0%) but not in the ward. Conclusion Remimazolam is a potential alternative to propofol for general anesthesia as it offers similar QoR to the latter and has advantages in terms of consciousness recovery and immediate postoperative analgesia requirement.

Abstract This study demonstrates a novel use of the U-Net convolutional neural network (CNN) for modeling pixel-based electrostatic potential distributions in GaN metal–insulator-semiconductor high-electron mobility transistors (MIS-HEMTs) with various gate and source field plate designs and drain voltages. The pixel-based images of the potential distribution are successfully modeled from the developed U-Net CNN with an error of less than 1% error relative to a TCAD simulated reference of a 500-V electrostatic potential distribution in the AlGaN/GaN interface. Furthermore, the modeling time of potential distributions by U-Net takes about 80 ms. Therefore, the U-Net CNN is a promising approach to efficiently model the pixel-based distributions characteristics in GaN power devices.

ObjectiveThis meta-analysis aimed to compare videolaryngoscope (VL)-assisted transesophageal echocardiography (TEE) probe insertion with conventional methods in terms of efficacy and safety.MethodsSeveral major databases such as Medline and Embase were systematically searched to identified relevant studies from inception to June 2024. The primary outcome was complication rate, defined as the proportion of patients experiencing complications related to TEE probe insertion. Injuries at specific sites (e.g., posterior hypopharyngeal wall) from both groups were also analyzed. The secondary outcomes included the first-attempt success rate and total insertion time of VL and conventional methods.ResultsSeven trials involving 716 participants were identified. The use of VL was found to significantly reduce the complication rate (risk ratio[RR]:0.28, 95% confidence interval[CI]:0.17-0.46, P < 0.00001) and increased the first-attempt success rate [FASR] (RR:1.33, 95%CI: 1.10-1.60, P = 0.003) compared with conventional methods. These findings were confirmed by trial sequential analysis. No significant difference was found in the TEE insertion time among the two techniques (mean difference: -2.94s, 95%CI: -10.28-4.4, P = 0.43). VL significantly reduced the risk of trauma to the hypopharyngeal wall but showed no significant benefits in other areas (e.g., pyriform sinus). The certainty of evidence was moderate for the complication rate, very low for the FAS rate, and low for the TEE insertion time.ConclusionThe use of VL for TEE probe insertion is associated with a significantly lower complication rate and higher FAS rate than conventional methods. These findings suggest that VL enhances patient safety and improves the efficiency of TEE probe insertion.

Abstract Hypertension and pain are both prevalent conditions in the older adult population. We aimed to report the prevalence of pain discomforts and investigated the association between hypertension and pain discomforts among older adults in the United States. Data from the 2011 National Health and Aging Trends Study were analyzed. In-person interviews were conducted in 7601 adults ages ≥ 65 years. Prevalence of bothersome pain, activity-limiting pain, locations of pain and usage of pain medicine were evaluated. Demographics, comorbidities, and other covariates were compared between older adults with hypertension and those without. Multivariate regression was further performed to yield adjusted odd ratios. Among 6825 older adults, 4533 of them had a history of hypertension while 2272 of them had not. Prevalence of bothersome pain (57.12% versus 44.81%, p

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines based on variant strains have been in use as booster doses to update immunity against circulating variants. Here we present the results of a phase one prospective, randomized, and open-labeled trial to study the safety and immunogenicity of a booster dose consisting of a subunit vaccine based on the stabilized prefusion SARS-CoV-2 spike protein, MVC-COV1901, or its Beta version, MVC-COV1901-Beta. Participants aged ≥18 and

Abstract The COVID-19 pandemic presents an unprecedented challenge to global public health. Rapid development and deployment of safe and effective vaccines are imperative to control the pandemic. In the current study, we applied our adjuvanted stable prefusion SARS-CoV-2 spike (S-2P)-based vaccine, MVC-COV1901, to hamster models to demonstrate immunogenicity and protection from virus challenge. Golden Syrian hamsters immunized intramuscularly with two injections of 1 µg or 5 µg of S-2P adjuvanted with CpG 1018 and aluminum hydroxide (alum) were challenged intranasally with SARS-CoV-2. Prior to virus challenge, the vaccine induced high levels of neutralizing antibodies with 10,000-fold higher IgG level and an average of 50-fold higher pseudovirus neutralizing titers in either dose groups than vehicle or adjuvant control groups. Six days after infection, vaccinated hamsters did not display any weight loss associated with infection and had significantly reduced lung pathology and most importantly, lung viral load levels were reduced to lower than detection limit compared to unvaccinated animals. Vaccination with either 1 μg or 5 μg of adjuvanted S-2P produced comparable immunogenicity and protection from infection. This study builds upon our previous results to support the clinical development of MVC-COV1901 as a safe, highly immunogenic, and protective COVID-19 vaccine.

Although several studies have investigated the back-muscle flexion-relaxation phenomenon (FRP), the effect of individual flexibility on the FRP has been discussed infrequently, with very limited data on the influence of flexibility training on the FRP. This study thus examined the effect of flexibility training on the change of back-muscle FRP pattern in relatively inflexible young men. We collected and analyzed the valid data from 20 male participants (10 each with high and low flexibility included in the control and trained groups, respectively) when flexing their trunks at seven trunk flexion positions (0°-90°, in increments of 15°); their erector spinae and hamstring activation, pelvic tilt, and lumbosacral angle were then recorded. After 7 weeks of flexibility training for the low-flexibility group, no difference in flexibility was discovered between this group and the control (originally high-flexibility) group. The trunk flexion experiment was then repeated. The results showed that before the training stage, the low-flexibility group had lower erector spinae and higher hamstring activation, a larger pelvic tilt, and a smaller lumbosacral angle. By contrast, after training, the erector spinae and hamstring activation, pelvic tilt, and lumbosacral angle were significantly changed, and no intergroup differences were observed in FRP patterns. The study results suggest that flexibility training changes lumbopelvic movement and thereby reduces the degree of the back-muscle FRP when trunk flexion is performed.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is characterized by impaired insulin sensitivity (Si) and insulin secretion. Previous studies may have underestimated differences in the incidence of risk factors in insulin-sensitive diabetes mellitus (IS-DM) and insultin-resistant diabetes mellitus (IR-DM) patients and have not been conducted in the Chinese population. OBJECTIVES: We explored differences in metabolic risk factors between Chinese patients with newly diagnosed, insulin-resistant (IR) and insulin-sensitive (IS) T2DM. DESIGN: Cross-sectional study. SETTING: Cardinal Tien Hospital, Taiwan in 2011. METHODS: All participants received a frequently sampled intravenous glucose tolerance test. The acute insulin response after a glucose load (AIRg), Si, disposition index (DI), and glucose effectiveness (GE) were determined. Using the median Si value from 90 people without diabetes as a cutoff (1.19 ×10-4 mU/L/min), patients were divided into two groups, IS-DM and IR-DM. Multivariate regression analysis was used to examine the independent influence of MetS components on Si and AIRg. MAIN OUTCOME MEASURE(S): Insulin sensitivity. RESULTS: We enrolled 122 participants. In addition to higher probabilities of having MetS, IR-DM patients had a significantly higher body mass index (BMI), AIRg, and GE but a lower DI than IS-DM patients. Si correlated with BMI and triglycerides, and AIRg correlated with BMI and high-density lipoprotein cholesterol. BMI was the only component related to Si in the multivariate analysis. Furthermore, the AIRg was associated with BMI and fasting plasma glucose. Because BMI was the most critical factor, a cutoff value (25.0 kg/m2) was obtained from the receiver operating characteristic curve for predicting IR-DM. It showed a sensitivity and specificity of 60.8% and 60.9%, respectively. CONCLUSIONS: IR-DM patients had more MetS components than IS-DM patients. In Chinese patients obesity is the most critical factor for discriminating IR-DM from IS-DM. Patients with a BMI higher than 25 kg/m2 were prone to develop IR-DM. LIMITATIONS: The size of our study cohort was relatively small, which may weaken the statistical power of the study.

BackgroundAlthough much attention has been focused on the association between chronic hyperglycemia and cerebrovascular diseases in type 2 diabetes mellitus (DM) patients, there is no data regarding the risk of ischemic stroke after a hyperosmolar hyperglycemic state (HHS) attack. The objective of this study was to investigate the risk of ischemic stroke in type 2 DM patients after an HHS attack.MethodsFrom 2004 to 2008, this retrospective observational study was conducted on a large cohort of Taiwanese using Taiwan's National Health Insurance Research Database (NHIRD). We identified 19,031 type 2 DM patients who were discharged with a diagnosis of HHS and 521,229 type 2 DM patients without an HHS diagnosis. Using the propensity score generated from logistic regression models, conditional on baseline covariates, we matched 19,031 type 2 DM patients with an HHS diagnosis with the same number from the comparison cohort. The one-year cumulative rate for ischemic stroke was estimated using the Kaplan-Meier method. After adjusting covariates, Cox proportional hazard regression was used to compute the adjusted one-year rate of ischemic stroke.ResultsOf the patients sampled, 1,810 (9.5%) of the type 2 DM patients with HHS and 996 (5.2%) of the comparison cohort developed ischemic stroke during the one-year follow-up period. After adjusting for covariates, the adjusted HR for developing ischemic stroke during the one-year follow-up period was 1.8 (95% C.I., 1.67 to 1.95, PConclusionAlthough DM is a well-recognized risk factor for atherosclerosis, type 2 DM patients that have suffered a HHS attacks are at an increased risk of developing ischemic stroke compared with those without HHS.

BACKGROUND: This population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and mortality rates for major cancers in Taiwan. METHODS: A population-based follow-up study was conducted with 20,488 cancer patients diagnosed in 2002. Each patient was traced to death or for 5 years. The individual income-related insurance payment amount was used as a proxy measure of individual SES for patients. Neighborhood SES was defined by income, and neighborhoods were grouped as living in advantaged or disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding and risk factors. RESULTS: After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score, urbanization, and area of residence), tumor extent, treatment modalities (operation and adjuvant therapy), and hospital characteristics (ownership and teaching level), colorectal cancer, and head and neck cancer patients under 65 years old with low individual SES in disadvantaged neighborhoods conferred a 1.5 to 2-fold higher risk of mortality, compared with patients with high individual SES in advantaged neighborhoods. A cross-level interaction effect was found in lung cancer and breast cancer. Lung cancer and breast cancer patients less than 65 years old with low SES in advantaged neighborhoods carried the highest risk of mortality. Prostate cancer patients aged 65 and above with low SES in disadvantaged neighborhoods incurred the highest risk of mortality. There was no association between SES and mortality for cervical cancer and pancreatic cancer. CONCLUSIONS: Our findings indicate that cancer patients with low individual SES have the highest risk of mortality even under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.