Comparison between the effect of Empagliflozin and Pioglitazone added to metformin in patients with type 2 diabetes and nonalcoholic fatty liver disease.

BACKGROUND/AIMS: Non-alcoholic fatty liver disease (NAFLD), defined as the accumulation of >5% fat in the liver, is the most frequently co-exist disease with diabetics up to 70%. Current study was conducted to compare efficacy of combination therapy of empagliflozin (EMPA) or pioglitazone (PGZ) with metformin (MET) in patients with T2DM and NAFLD. METHODS: In this open label, prospective clinical trial, sixty patients were randomly assigned to receive EMPA 10 mg/day or PGZ 30 mg/day in combination Metformin (at least 1500 mg) for six months. NAFLD grade and liver stiffness were defined and measured at the beginning and after 6 months. As the secondary outcomes, anthropometric characteristics, lipid profile, plasma glucose test, and liver enzymes test were measured at the baseline and endpoint. RESULTS: The results showed that both combination therapy with EMPA+ MET or PGZ+MET significantly reversed fibrosis stage of NAFLD (P<0.05). Significant reduction in lipid profile test, and liver enzymes test were seen in both groups (P<0.05). However, the greater reduction in waist circumference was observed in EMPA groups compared to PGZ (-4.4 ± 2.39 vs -2.05±1.28, p<0.001), meanwhile weight and BMI decreased significantly only in the patients receiving EMPA (-5.78 ± 3.6 kg vs 0.93 ± 0.33 kg and -2.01± 3.19 kg/m2 vs 0.33 ± 0.12 kg/m2, respectively, P<0.001). CONCLUSION: combination of EMPA or PGZ with metformin equally improved liver fibrosis stage and stiffness in T2DM patients with NAFLD. The improvements of laboratory tests were observed in the both groups, while, regarding weight reduction, only the regimen containing EMPA was effective.

An interpretable deep learning approach for designing nanoporous silicon nitride membranes with tunable mechanical properties.

The high permeability and strong selectivity of nanoporous silicon nitride (NPN) membranes make them attractive in a broad range of applications. Despite their growing use, the strength of NPN membranes needs to be improved for further extending their biomedical applications. In this work, we implement a deep learning framework to design NPN membranes with improved or prescribed strength values. We examine the predictions of our framework using physics-based simulations. Our results confirm that the proposed framework is not only able to predict the strength of NPN membranes with a wide range of microstructures, but also can design NPN membranes with prescribed or improved strength. Our simulations further demonstrate that the microstructural heterogeneity that our framework suggests for the optimized design, lowers the stress concentration around the pores and leads to the strength improvement of NPN membranes as compared to conventional membranes with homogenous microstructures.

Coexistence of vitreous and crystalline phases of H2O at ambient temperature.

Formation of vitreous ice during rapid compression of water at room temperature is important for biology and the study of biological systems. Here, we show that Raman spectra of rapidly compressed water at greater than 1 GPa at room temperature exhibits the signature of high-density amorphous ice, whereas the X-ray diffraction (XRD) pattern is dominated by crystalline ice VI. To resolve this apparent contradiction, we used molecular dynamics simulations to calculate full vibrational spectra and diffraction patterns of mixtures of vitreous ice and ice VI, including embedded interfaces between the two phases. We show quantitatively that Raman spectra, which probe the local polarizability with respect to atomic displacements, are dominated by the vitreous phase, whereas a small amount of the crystalline component is readily apparent by XRD. The results of our combined experimental and theoretical studies have implications for detecting vitreous phases of water, survival of biological systems under extreme conditions, and biological imaging. The results provide additional insight into the stable and metastable phases of H2O as a function of pressure and temperature, as well as of other materials undergoing pressure-induced amorphization and other metastable transitions.

Non-diabetic Hyperglycemia and Some of Its Correlates in ICU Hospitalized Patients Receiving Enteral Nutrition.

INTRODUCTION: Hyperglycemia is a common occurrence in critically ill patients, and its prevalence in patients receiving nutritional support is much higher than in other patients. The non-diabetic form is associated with more undesirable outcomes. This study was performed to determine the prevalence of non-diabetic hyperglycemia and its correlates in patients receiving enteral nutrition. MATERIAL AND METHODS: This cross-sectional study was performed between March and December 2015. Seven hundred forty eight (748) patients were reviewed to see if they met the inclusion criteria. After random sequence numbering, 414 patients who were eligible for further assessment and data gathering were selected. Hyperglycemia was defined as the blood glucose levels higher than either 126 mg/dL, in the fasting state, or 180 mg/dL, in a random state. Blood glucose was measured by an ACCU-CHECK glucometer (Roche diagnostics, Mannheim, Germany) three times, after ICU admission, in both fasting and random state. A pre-prepared form was used to extract data from hospital records. Data analysis was performed by SPSS 21 software. RESULTS: In this group of hospitalized patients, the prevalence of non-diabetic hyperglycemia was 14/49 (60/414). In the hyperglycemic subgroup, mean FBS was 228.00±36.42, mean random BS was 183.19±43.94 and mean blood sugar on the first day of hospitalization was 203.60 ± 60.79. The mean age of patients was 56.64±19.79 years and the mean duration of hospitalization was 19.24±15.33 days. There was no significant relationship between enteral nutrition feeding volume and hyperglycemia. Majorly, patients aged above 60 years were hyperglycemic. The prevalence was higher in men than in women. Most patients were internal cases, but with the highest prevalence of hyperglycemia in surgical patients. CONCLUSIONS: Since among different studied variables just diagnosed disease and the level of provided calorie showed significant differences between subgroup categories, so it can be suggested that designing on-time appropriate management programs based them can be effective on the administration of non-diabetic hyperglycemia and its undesirable consequences in such patients.