The association between the triglyceride-glucose index and sarcopenia: data from the NHANES 2011-2018.

BACKGROUND: The Triglyceride-glucose (TyG) index is a marker of insulin resistance, but its role in sarcopenia is controversial. The purpose of this study was to investigate the association of the TyG index with sarcopenia. METHODS: 4030 participants aged 20 years and above were selected from National Health and Nutrition Examination Survey for cross sectional study. Weighted logistic regression model was used to estimate the association between TyG index and sarcopenia. Threshold effect analysis and restricted cubic spline were employed to describe nonlinear link, with interaction tests and subgroup analyses performed. RESULTS: It was found in the fully adjusted model that the TyG index was positively associated with sarcopenia (per 1-unit increase in the TyG index: OR = 1.31, 95%CI: 1.07, 1.60). This association was further highlighted in groups characterized by the absence of MetS or diabetes, as well as the absence of vigorous or moderate work activity. Furthermore, analysis of the curve fitting and threshold effects indicated a nonlinear relationship, which exhibited a turning point at 9.14. CONCLUSION: The study results indicated that the TyG index was positively associated with sarcopenia. Enhancing the management of insulin resistance could help reduce the risk of developing sarcopenia.

Efficacy, tolerability and safety of add-on third-generation antiseizure medications in treating focal seizures worldwide: a network meta-analysis of randomised, placebo-controlled trials.

Background: Adjunctive newer antiseizure medications (ASMs) are being used in patients with treatment-resistant focal-onset seizures (FOS). An updated network meta-analysis (NMA) was necessary to compile evidence in this critical area. Methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus from their inception until 17 January 2024, evaluating the efficacy, tolerability, and safety of rufinamide (RUF), brivaracetam (BRV), cenobamate (CNB), eslicarbazepine (ESL), lacosamide (LCM), retigabine (RTG), and perampanel (PER) as adjunctive treatments for FOS. Efficacy outcomes included seizure response and seizure freedom. Tolerability was assessed by discontinuation due to adverse events (AEs). Safety outcomes were evaluated based on the number of patients experiencing at least one AE and serious adverse events (SAEs). This review is registered with PROSPERO (CRD42023485130). Findings: A total of 29 studies involving 11,750 participants were included. For seizure response, all ASMs were significantly superior to placebo, with RTG ranking highest, followed by CNB. Considering dosage, CNB 400 mg/d was top-ranked, followed by RTG 1200 mg/d. For seizure freedom, BRV was highest-ranked, followed by CNB, with BRV 100 mg/d leading, followed by CNB 400 mg/d. Regarding tolerability, LCM 600 mg/d had the lowest ranking, followed by CNB 400 mg/d. For the safety outcome of AEs, ESL 1200 mg/d was ranked lowest, followed by CNB 400 mg/d. Regarding SAEs, LCM 400 mg/d was ranked lowest, followed by RTG 1200 mg/d. Interpretation: ASMs at different dosages have varying efficacy and tolerability profiles. We have provided hierarchical rankings of ASMs for efficacy and safety outcomes. Our findings offer the most comprehensive evidence available to inform patients, families, physicians, guideline developers, and policymakers about the choice of ASMs in patients with treatment-resistant FOS. Funding: None.

Molecular and metabolic mechanisms of bufalin against lung adenocarcinoma: New and comprehensive evidences from network pharmacology, metabolomics and molecular biology experiment.

BACKGROUND: This study aims to evaluate the efficacy and therapeutic mechanism of bufalin on lung adenocarcinoma (LUAD) through a comprehensive strategy integrating network pharmacology, metabolomics and molecular biology verification. METHODS: The putative targets of bufalin were discerned from PharmMapper and Swiss Target Prediction database. LUAD-related targets were obtained by target filtering of GeneCard database and data mining of GEO database. PPI network was constructed to screen the core targets, and their clinical significance was assessed through several public databases. GO and KEGG pathway analyses were performed to identify possible enrichment of genes with specific biological themes. Molecular docking and molecular dynamics (MD) simulation were employed to determine the correlation and binding pattern between bufalin and core targets. The potential mechanisms of bufalin acting on LUAD, as predicted by network pharmacology analyses, were experimentally validated using in-vitro and in-vivo models. Finally, the effects of bufalin intervention on metabolite profile and metabolic pathway in LUAD nude mice were investigated by non-targeted metabolomics. RESULTS: 209 bufalin targets and 1082 LUAD-associated targets were harvested, of which 51 intersection targets were identified. 10 core targets including Akt1, STAT3, EGFR, CASP3 and SRC were picked out through network topology analysis, and they had a potent binding activity with bufalin as indicated by molecular docking and MD simulation. Hub module of PPI network was closely related to cell proliferation and apoptosis. GO and KEGG enrichment analyses suggested that bufalin exerted therapeutic effects on LUAD possibly by inhibiting proliferation and promoting apoptosis via PI3K/Akt, FoxO1 and MAPK/ERK pathways, which were confirmed by a series of in-vitro studies as well as HE, TUNEL and Ki-67 staining of tumor tissues. Further metabolomics analysis revealed that bufalin mainly regulated ABC transporter and remodeled AA metabolism, thereby contributing to the treatment of LUAD. CONCLUSION: From molecular and metabolic perspective, the present study not only provided a unique insight into the possible mechanisms of bufalin against LUAD after successfully filtering out associated key target genes, differential endogenous metabolites, and signaling pathways, but also proposed a novel promising therapeutic strategy for LUAD.

[Short term clinical observation of cervical anterior Hybrid surgery].

OBJECTIVE: To investigate the short-term clinical effect of the cervical anterior Hybrid surgery in the treatment of two-segment and three-segment cervical spondylosis. METHODS: From January 2018 to January 2019, 108 patients who were performed anterior Hybrid surgery with cervical degenerative diseases were collected. The patients were divided into a two-segment group with 52 patients and a three-segment group with 56 patients according to surgical segments. In two-segment group, there were 24 males and 28 females, aged from 35 to 67 years old with an average of(45.94±14.67) years old. In three-segment group, there were 23 males and 33 females, aged from 32 to 65 years old with an average of (47.54±15.34) years old. The outcome indicators of the two groups were compared. Clinical indicators:neck disability index(NDI) was used to evaluate daily life ability, Japanese Orthopedic Association(JOA) score was used to evaluate neurological function improvement, visual analogue scale(VAS) was used to evaluate pain intensity, and general clinical results were graded according to Odom's score. Cervical range of motion (ROM), fusion and complications were measured by X-ray, CT and MRI. RESULTS: All operations were successfully completed and all patients were followed up for more than 12 months. The operation time of two-segment group and three-segment group were 95 to 180 min with an average of(152.30±44.74) min and 110 to 210 min with an average of (165.18±45.86) mins, the blood loss were 20 to 100 ml with an average of (32.88±8.75) ml and 20 to 150 ml with an average of(34.64±10.63) ml respectively which has no statistical differences between the two groups (P>0.05). Compared with those before surgery, NDI, JOA, VAS and Odom's scores between two groups were significantly improved at 12 months after operation(P<0.05). However, there was no significant difference in the NDI, JOA and Odom's scores between two groups (P>0.05), and VAS in three-segment group was higher than that in two-segment group. There was no significant difference in C3-C7 cervical mobility between two groups. Surgical incisions healed smoothly in all patients without complication such as spinal cord injury and cerebrospinal fluid leakage. The bone fusion of the two groups were 43 cases (82.69%) and 45 cases(80.35%) respectively. In two-segment group, there were 2 cases of adjacent segmental hyperosteogeny, and there were 3 cases of adjacent segmental hyperosteogeny and 1 case of adjacent posterior longitudinal ligament ossification in the three-segment group. In addition, in three-segment group, there was 1 case of looseness of implants with no obvious clinical symptoms. CONCLUSION: The anterior Hybrid surgery in treating multi-level cervical spondylosis could not only improve clinical symptoms of patients but also preserve mobility. Meanwhile, the efficacy and safety of Hybrid surgery in different multi-level cervical disc diseases are confirmed, proving its value in clinical practice.

Distributed Multi-Antenna Positioning for Automatic-Guided Vehicle.

Radio-based positioning systems are typically utilized to provide high-precision position information for automatic-guided vehicles (AGVs). However, the presence of obstacles in harsh environments, as well as carried cargoes on the AGV, will degrade the localization performance, since they block the propagation of radio signals. In this paper, a distributed multi-antenna positioning system is proposed, where multiple synchronous antennas are equipped on corners of an AGV to improve the availability and accuracy of positioning. An estimator based on the Levenberg-Marquardt algorithm is introduced to solve the nonlinear pseudo-range equations. To obtain the global optimal solutions, we propose a coarse estimator that utilizes the displacement knowledge of the antennas to provide a rough initial guess. Simulation results show a better availability of our system compared with the single antenna positioning system. Decimeter accuracy can be obtained under a Gaussian measurement noise with a standard deviation of 0.2 m. The results also demonstrate that the proposed algorithm can achieve positioning accuracy close to the theoretical Cramer-Rao lower bound. Furthermore, given prior information of the yaw angle, the same level of accuracy can be obtained by the proposed algorithm without the coarse estimation step.

A Tightly Coupled RTK/INS Algorithm with Ambiguity Resolution in the Position Domain for Ground Vehicles in Harsh Urban Environments.

Vehicles driving in urban canyons are always confronted with a degraded Global Navigation Satellite System (GNSS) signal environment. The surrounding obstacles may cause signal reflections or blockages, which lead to large multipath noises and intermittent GNSS reception. Under these circumstances, it is not feasible to use conventional real-time kinematic (RTK) algorithms to maintain high-precision performance for positioning. In order to meet the special requirements of safety-critical applications under non-ideal observation conditions, a novel tightly coupled RTK/Inertial Navigation System (INS) algorithm is proposed in this paper, which can provide accurate and reliable positioning results continuously. Our integrated RTK/INS algorithm has three features. Firstly, INS measurements are used to help search for integer ambiguities in the position domain. INS solutions can provide a more accurate initial location and a more efficient search region. Secondly, the criterion for determining whether a candidate position is the correct solution is only related to the fractional value of the carrier-phase measurement. Thus, the new algorithm is immune to cycle slips as well as large pseudorange noises. Thirdly, our algorithm can provide more accurate ranging information than the pseudorange, even though it may not necessarily be fixed successfully, because it selects the weighted ambiguity solution as the result rather than the candidate point with maximum probability. The proposed algorithm is demonstrated on both simulated and real datasets. Compared with single epoch RTK and conventional tightly coupled RTK/INS integrations that search integer ambiguities in the ambiguity domain, our method attains better accuracy and stability in a simulated environment. Moreover, the real experimental results are presented to validate the performance of the new integrated navigation algorithm.

A Low-Cost INS-Integratable GNSS Ultra-Short Baseline Attitude Determination System.

Traditional attitude determination using global navigation satellite system (GNSS) carrier phases is mostly applied on geodetic-grade receivers with sufficient baseline length. However, for some special applications such as mobile communication base station smart antenna attitude determination, only low-cost receivers with ultra-short baselines can be employed, and the environments are more challenging. When solving the ambiguity resolution (AR) problem with low-cost receivers, it is hard for the traditional methods in ambiguity domain to estimate float ambiguities accurately due to the large code pseudorange noises; thus, such systems fail to determine the correct ambiguities. Aiming at improving the AR success rate for ultra-short baselines attitude determination with low-cost receivers, we provide an objective function named Mean Square Residual (MSR) based on the geometrical relationship among the position spherical search space, the fractional carrier phases, and the possible ambiguities. The method can be calculated without code pseudoranges, and thus, can provide a higher AR success rate when using low-cost receivers. The corresponding analysis and acceptance test method are discussed in this contribution, and further, as an extension for more complicated urban dynamic applications, a GNSS/Inertial Navigation System (INS) integrated system is introduced. Several experiments have been conducted to verify performance.

Asymmetric Dual-Band Tracking Technique for Optimal Joint Processing of BDS B1I and B1C Signals.

Along with the rapid development of the Global Navigation Satellite System (GNSS), satellite navigation signals have become more diversified, complex, and agile in adapting to increasing market demands. Various techniques have been developed for processing multiple navigation signals to achieve better performance in terms of accuracy, sensitivity, and robustness. This paper focuses on a technique for processing two signals with separate but adjacent center frequencies, such as B1I and B1C signals in the BeiDou global system. The two signals may differ in modulation scheme, power, and initial phase relation and can be processed independently by user receivers; however, the propagation delays of the two signals from a satellite are nearly identical as they are modulated on adjacent frequencies, share the same reference clock, and undergo nearly identical propagation paths to the receiver, resulting in strong coherence between the two signals. Joint processing of these signals can achieve optimal measurement performance due to the increased Gabor bandwidth and power. In this paper, we propose a universal scheme of asymmetric dual-band tracking (ASYM-DBT) to take advantage of the strong coherence, the increased Gabor bandwidth, and power of the two signals in achieving much-reduced thermal noise and more accurate ranging results when compared with the traditional single-band algorithm.

Mitigating Multipath Bias Using a Dual-Polarization Antenna: Theoretical Performance, Algorithm Design, and Simulation.

It is well known that multipath effect remains a dominant error source that affects the positioning accuracy of Global Navigation Satellite System (GNSS) receivers. Significant efforts have been made by researchers and receiver manufacturers to mitigate multipath error in the past decades. Recently, a multipath mitigation technique using dual-polarization antennas has become a research hotspot for it provides another degree of freedom to distinguish the line-of-sight (LOS) signal from the LOS and multipath composite signal without extensively increasing the complexity of the receiver. Numbers of multipath mitigation techniques using dual-polarization antennas have been proposed and all of them report performance improvement over the single-polarization methods. However, due to the unpredictability of multipath, multipath mitigation techniques based on dual-polarization are not always effective while few studies discuss the condition under which the multipath mitigation using a dual-polarization antenna can outperform that using a single-polarization antenna, which is a fundamental question for dual-polarization multipath mitigation (DPMM) and the design of multipath mitigation algorithms. In this paper we analyze the characteristics of the signal received by a dual-polarization antenna and use the maximum likelihood estimation (MLE) to assess the theoretical performance of DPMM in different received signal cases. Based on the assessment we answer this fundamental question and find the dual-polarization antenna's capability in mitigating short delay multipath-the most challenging one among all types of multipath for the majority of the multipath mitigation techniques. Considering these effective conditions, we propose a dual-polarization sequential iterative maximum likelihood estimation (DP-SIMLE) algorithm for DPMM. The simulation results verify our theory and show superior performance of the proposed DP-SIMLE algorithm over the traditional one using only an RHCP antenna.

Molecular genotyping of placental site and epithelioid trophoblastic tumours; female predominance.

OBJECTIVE: To investigate a large series of placental site trophoblastic tumours (PSTT) and epithelioid trophoblastic tumours (ETT) and determine the relationship between their development and the type and sex of both the immediately antecedent and causative pregnancies. METHODS: The antecedent pregnancy was determined from patient records in 92 cases with a confirmed diagnosis of PSTT, ETT or mixed PSTT/ETT. In a subset of 57 cases, type and sex of the causative pregnancy was established by molecular genotyping of tumour tissue microdissected from formalin-fixed, paraffin-embedded blocks. RESULTS: The antecedent pregnancy was a normal live birth in 59 (64%) cases, a hydatidiform mole in 19 (21%) and other pregnancy loss in 14 (15%). Where the sex was recorded, 36 (78%) of 46 antecedent normal pregnancies were female, a significantly greater proportion than expected (p<0.0001). Genotyping of 57 cases found 15 (26%) to derive from hydatidiform moles while 42 (74%) arose in non-molar pregnancies. Where the causative pregnancy was non-molar, 38 (91%) tumours arose in female conceptions, significantly greater than expected (p<0.0001). Analysis of short tandem repeats on the X chromosome in three tumours with an XY chromosomal constitution confirmed that the X chromosome was maternal in origin. CONCLUSIONS: PSTT and ETT predominantly arise in female pregnancies but can develop in male pregnancies. A male derived X chromosome is not required for the development of these tumours. While these tumours are predominantly female it is not because most originate in complete hydatidiform moles.

A Kalman filter-based short baseline RTK algorithm for single-frequency combination of GPS and BDS.

The emerging Global Navigation Satellite Systems (GNSS) including the BeiDou Navigation Satellite System (BDS) offer more visible satellites for positioning users. To employ those new satellites in a real-time kinematic (RTK) algorithm to enhance positioning precision and availability, a data processing model for the dual constellation of GPS and BDS is proposed and analyzed. A Kalman filter-based algorithm is developed to estimate the float ambiguities for short baseline scenarios. The entire work process of the high-precision algorithm based on the proposed model is deeply investigated in detail. The model is validated with real GPS and BDS data recorded from one zero and two short baseline experiments. Results show that the proposed algorithm can generate fixed baseline output with the same precision level as that of either a single GPS or BDS RTK algorithm. The significantly improved fixed rate and time to first fix of the proposed method demonstrates a better availability and effectiveness on processing multi-GNSSs.