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- 2019
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Tobias, Deirdre K, et al.
(författare)
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Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine
- 2023
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Ingår i: Nature Medicine. - 1546-170X. ; 29:10, s. 2438-2457
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Forskningsöversikt (refereegranskat)abstract
- Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.
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| 3. |
- Ahmad, Abrar, et al.
(författare)
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Precision Prognostics for Cardiovascular Disease in Type 2 Diabetes : A Systematic Review and Meta-analysis
- 2023
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with type 2 diabetes (T2D).METHODS: We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that could improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies.Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination on internal validation, with lower performance on external validation.CONCLUSIONS: Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.PLAIN LANGUAGE SUMMARY: Patients with T2D are at high risk for CVD but predicting who will experience a cardiac event is challenging. Current risk tools and prognostic factors, such as laboratory tests, may not accurately predict risk in different patient populations. There is a need for personalized risk prediction tools to identify patients more accurately so that CVD prevention can be targeted to those who need it most. This study examined novel biomarkers, genetic markers, and risk scores on the prediction of CVD in individuals with T2D. We found that four laboratory markers and a genetic risk score for CHD had high predictive utility beyond traditional CVD risk factors and that risk scores had modest predictive utility when tested in diverse populations, but more studies are needed to determine their usefulness in clinical practice. The highest strength of evidence was observed for NT-proBNP, a laboratory test currently used to monitor patients with heart failure but not currently used in clinical practice for the purpose of CVD prediction in T2D.
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| 4. |
- Ahmad, Abrar, et al.
(författare)
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Precision prognostics for cardiovascular disease in Type 2 diabetes : a systematic review and meta-analysis
- 2024
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Ingår i: Communications medicine. - 2730-664X. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with Type 2 diabetes (T2D).METHODS: We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies.RESULTS: Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort.CONCLUSIONS: Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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| 5. |
- An, Dong, et al.
(författare)
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Evidence of climate shift for temperature and precipitation extremes across Gansu Province in China
- 2020
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Ingår i: Theoretical and Applied Climatology. - : Springer Science and Business Media LLC. - 1434-4483 .- 0177-798X. ; 139:3-4, s. 1137-1149
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Tidskriftsartikel (refereegranskat)abstract
- Temperature and precipitation extremes are the dominant causes of natural disasters. In this study, seven indices of extreme temperature and precipitation events in Gansu Province, China, were analysed for the period 1961–2017. An abrupt climate shift was recorded during 1980–1981. Thus, the study period was divided into a preshift (before the climate shift) period 1961–1980 and an aftshift (after the climate shift) period 1981–2017. Comparison of mean extreme indices for preshift and aftshift periods was performed for the purpose of exploring possible increasing/decreasing patterns. Generalized extreme value (GEV) distribution was applied spatially to fit the extreme indices with return periods up to 100 years for preshift/aftshift periods. Singular value decomposition (SVD) was adopted to investigate possible correlation between the extreme climate events and indices of large-scale atmospheric circulation. The results indicate that changes in mean and return levels between the preshift and aftshift periods vary significantly in time and space for different extreme indices. Increase in extreme temperature regarding magnitude and frequency for the aftshift period as compared with the preshift period suggests a change to a warmer and more extreme climate during recent years. Changes in precipitation extremes were different in southern and northern parts of Gansu. The precipitation extremes in the north have increased that can result in more serious floods and droughts in the future. SVD analyses revealed a complex pattern of correlation between climate extremes and indices of large-scale atmospheric circulation. Strengthening of westerlies and weakening of the south summer monsoon contribute to the complex changing patterns of precipitation extremes. Results in this study will contribute to disaster risk prevention and better water management in this area.
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| 6. |
- Cui, Peng, et al.
(författare)
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Long-term androgen excess induces insulin resistance and non-alcoholic fatty liver disease in PCOS-like rats.
- 2021
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Ingår i: The Journal of steroid biochemistry and molecular biology. - : Elsevier BV. - 1879-1220 .- 0960-0760. ; 208
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Tidskriftsartikel (refereegranskat)abstract
- Women with polycystic ovary syndrome (PCOS) are at higher risk for metabolic disorders compared to healthy women, and about 51 % of women with PCOS suffer from non-alcoholic fatty liver disease (NAFLD). Investigation into the pathological mechanism behind this association will provide insights for the prevention and treatment of this complication.Dihydrotestosterone (DHT), a nonaromatic androgen, was used to mimic the pathological conditions of hyperandrogenism and insulin resistance. Hematoxylin and eosin staining, Oil Red O staining, immunofluorescent staining, Western blots, and qRT-PCR were used to verify the hepatic steatosis and inflammation, and the latter two methods were also used for energy and mitochondrion-related assays. ELISA was used to measure the level of reactive oxygen species.Twelve weeks of DHT exposure led to obesity and insulin resistance as well as hepatic steatosis, lipid deposition, and different degrees of inflammation. The expression of molecules involved in respiratory chain and aerobic respiration processes, such as electron transfer complex II, pyruvate dehydrogenase, and succinate dehydrogenase complex subunit A, was inhibited. In addition, molecules associated with apoptosis and autophagy were also abnormally expressed, such as increased Bak mRNA, an increased activated caspase-3 to caspase-3 ratio, and increased Atg12 protein expression. All of these changes are associated with the mitochondria and lead to lipid deposition and inflammation in the liver.Long-term androgen excess contributes to insulin resistance and hepatic steatosis by affecting mitochondrial function and causing an imbalance in apoptosis and autophagy, thus suggesting the pathogenesis of NAFLD in women with PCOS.
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| 7. |
- del Rey, Álvaro, et al.
(författare)
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Mid-Ludfordian uranium isotope records distinguish the role of expansive marine anoxia in global carbon cycle dynamics during the late Silurian Lau/Kozlowskii bioevent
- 2023
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Ingår i: Global and Planetary Change. - 0921-8181. ; 229
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Tidskriftsartikel (refereegranskat)abstract
- The late Silurian Lau/Kozlowskii bioevent marks a time interval with substantial loss in marine biodiversity linked to the largest positive carbon isotope excursion (Mid-Ludfordian CIE; MLCIE) recorded in the Phanerozoic (δ13Ccarb peaks at +8–10‰). The positive δ13C excursion and the extinctions have been linked to increased marine productivity (ocean eutrophication), leading to increased organic carbon burial, and expansion of marine anoxia in shallow continental seas. To explore this idea, we reconstruct the contemporaneous global extent of marine anoxia using uranium (U) isotopes from Ludfordian marine carbonates sampled from two widely spaced paleogeographic locations. Our δ238U results demonstrate that the overall MLCIE was not coupled to expanding marine anoxia and a presumed associated increased marine primary productivity. Instead, a time interval of widespread global anoxia occurred only before and during the onset of the MLCIE (up to end of P. siluricus conodont zone; ca. δ13C ∼ 2.6‰), which is when the extinctions took place. Strong climatic variability at this time suggests anoxia and climate change led to the extinctions of the Lau/Kozlowskii bioevent. The major part of the rise to the peak (δ13C ∼ 10‰) and falling limb of the MLCIE was not coupled with corresponding changes in δ238U values. Thus, increased marine primary productivity and marine anoxia may have caused the initial carbon cycle disturbance and the extinctions but was not a main driver for the continued growth and exceptional magnitude of the MLCIE.
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| 8. |
- Du, Yiheng, et al.
(författare)
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Hydrologic response of climate change in the source region of the Yangtze River, based on water balance analysis
- 2017
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- Due to the large amount of water resources stored in glaciers, permafrost, and lakes, the source region of the Yangtze River (SRYR) is of great importance for the overall basin water flow. For this purpose, a state of art review and calculations were made for the period 1957-2013 using observed hydrological and meteorological data with a water balance approach. Actual evapotranspiration was calculated and validated by empirical formulas. Water storage change analysis was conducted with uncertainty boundaries using a 10-year moving window. Results show that temperature, precipitation, and actual evapotranspiration in the SRYR increased by 0.34°C, 11.4 mm, and 7.6 mm per decade, respectively (significant at 0.05 probability level). Runoffappears to have increased at a rate of 3.3 mm per decade. The SRYR water storage in total has not changed significantly during the period, although the moving average is mostly below zero. Based on the water balance equation, the increase in calculated evapotranspiration is mainly due to the significantly increasing temperature. This in combination with increasing precipitation leads to a relatively stable water storage during the study period. Correlation analyses show that precipitation dominates runoffduring the warm season (May to October), while temperature anomalies dominate the runoffduring the cold season (November to April). The influence of temperature on runoffseems to enhance during the winter period.
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| 9. |
- du, Yiheng, et al.
(författare)
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Integrated large‐scale circulation impact on rainy season precipitation in the source region of the Yangtze River
- 2020
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Ingår i: International Journal of Climatology. - : Wiley. - 1097-0088 .- 0899-8418. ; 40:4, s. 2285-2295
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Tidskriftsartikel (refereegranskat)abstract
- Monthly precipitation data at regular grids of 0.5° × 0.5° derived from observations during June–August 1961–2016 were used to reveal characteristics of large‐scale circulations associated with rainy season precipitation over the source region of the Yangtze River (SRYR). The integrated impact of major influencing circulation patterns was examined by principal component analysis and composites. Results showed that the first rainy season precipitation mode associates with the Southern Oscillation Index (SOI) and the Pacific Decadal Oscillation (PDO), explaining 64% of spatial and temporal rainy season precipitation variance in the region. Composites of precipitation pattern under different phases of SOI and PDO revealed that the effect of PDO on precipitation varies with the SOI phase. When out of phase with the SOI, PDO‐induced precipitation anomalies are magnified. When they are in phase, anomalies weaken or even disappear. Composites of moisture flux patterns show that large‐scale atmospheric circulation affects the strength of westerlies that transport moisture to the study area and formation of convergence. In coming decades, the PDO is likely to continue in a negative phase with La Niña (positive SOI) events, implying more precipitation during the rainy season. Consequently, this knowledge can be used to improve decision making regarding water supply and flood risk management in the SRYR.
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| 10. |
- du, Yiheng, et al.
(författare)
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Multi-Space Seasonal Precipitation Prediction Model Applied to the Source Region of the Yangtze River, China
- 2019
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Ingår i: Water. - 2073-4441. ; 11:12
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Tidskriftsartikel (refereegranskat)abstract
- This paper developed a multi-space prediction model for seasonal precipitation using a high-resolution grid dataset (0.5° × 0.5°) together with climate indices. The model is based on principal component analyses (PCA) and artificial neural networks (ANN). Trend analyses show that mean annual and seasonal precipitation in the area is increasing depending on spatial location. For this reason, a multi-space model is especially suited for prediction purposes. The PCA-ANN model was examined using a 64-grid mesh over the source region of the Yangtze River (SRYR) and was compared to a traditional multiple regression model with a three-fold cross-validation method. Seasonal precipitation anomalies (1961–2015) were converted using PCA into principal components. Hierarchical lag relationships between principal components and each potential predictor were identified by Spearman rank correlation analyses. The performance was compared to observed precipitation and evaluated using mean absolute error, root mean squared error, and correlation coefficient. The proposed PCA-ANN model provides accurate seasonal precipitation prediction that is better than traditional regression techniques. The prediction results displayed good agreement with observations for all seasons with correlation coefficients in excess of 0.6 for all spatial locations.
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