Introduction 2021 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Reports recommends that patients with clinically significant symptoms and exacerbations of chronic obstructive pulmonary disease (COPD) should escalate to triple therapy, a combined use of inhaled corticosteroids (ICS), long-acting muscarinic antagonists (LAMA) and long-acting b2-agonists (LABA)(ICS/LAMA/LABA). Triple therapy in fixed-dose combinations (FDCs), i.e., combining ICS, LABA with LAMA and administrating by a single inhalation device, has appeared in recent years. This study aims to compare the efficacy of triple therapy in FDCs in treating patients with moderate to severe COPD. Methods and analyses Literature search will be conducted on PubMed, Embase and Web of science, according to pre-specified and corresponding search strategies, for relevant reports published since the inception dates of the databases. Randomised controlled trials (RCT) which compared the triple therapy in FDCs with other pharmacological therapies will be included. The Cochrane risk of bias assessment tool (RoB 2) will be used to assess the RCT quality. The outcomes will be analyzed as rate ratios and mean differences under a random-effects model in a frequentist network meta-analysis (NMA). Additional statistical analyses including subgroup analysis, sensitivity analysis, and publication bias analysis will be performed to assess the evidential heterogeneity and robustness. The strength of evidence from the NMA will be evaluated with the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) methods. Ethics and dissemination No ethics approval is required as this systematic review and network meta-analysis do not collect confidential personal data and do not carry out interventions in treating patients. Protocol registration number CRD42021240823 .
<p>Stock volatility, an adverse psychological stressor, has been linked to cardiovascular mortality or hospitalization. However, no studies had quantified the risk of acute coronary syndrome (ACS) onset from stock market fluctuation. Using the time-stratified case-crossover design, which could control for the potential confounding from time-invariant, we conducted the analysis based on a nationwide registry comprising of 2,113,728 ACS patients in China from January, 2015 to December, 2021. We obtained daily returns (%) of three main stock indexes in Chinese Mainland, and matched the case and control days of ACS onset on hourly level. The data were analyzed using conditional logistic regression models. The associations between daily stock returns and ACS onset were U-shaped with stock rise and fall both increasing the risk of ACS onset. The excess risks associated with each 1%-decrease of daily stock returns for Shanghai, Shenzhen and ChiNext index were 0.96% (95%CI: 0.40,1.51), 0.65% (95%CI: 0.27,1.03) and 0.87% (95%CI: 0.52,1.21) at the concurrent day, respectively; and a 1%-increase of daily stock returns was associated with 1.06% (95%CI: 0.61,1.52), 0.45% (95%CI: 0.11,0.80) and 0.17% (95%CI: -0.08,0.41) increases of ACS onset, respectively. Thereafter, most of the associations gradually attenuated, disappeared after 3 days. The associations were significant for unstable angina and ST-segment-elevation myocardial infarction, but not for non-ST-segment-elevation myocardial infarction. This nationwide study provides novel and robust evidence that both stock rise and fall could increase the risk of ACS onset, highlighting the importance of heart care and psychological support during fluctuations of stock market.</p>
In the ever-evolving landscape of digital signal processing technology, the ubiquitous presence of digital signal filters has become a cornerstone across a myriad of domains including radar, computing, and communications. Amidst the relentless pursuit of more efficient solutions, a pivotal development emerges - the creation of a low-power multiplier tailored explicitly for digital signal filters. This innovation hinges upon the judicious selection of a carry-lookahead adder as a fundamental building block within the multiplier, ushering in enhancements that ripple through its operation. This transformative leap doesn't halt at the component level; it extends its reach further by delving into meticulous optimizations encompassing logic gate dimensions and set voltage parameters. These refinements, executed with precision, culminate in a substantial reduction in the energy consumption of the multiplier, effectively setting it apart from conventional counterparts. Remarkably, these advances don't merely remain theoretical; they find their footing in practical industry applications, thus birthing a new era in the creation of low-power digital signal filters. The profound implications of this development reverberate far and wide, notably benefiting the realm of low-power digital signal processing and its associated applications.
Short-term exposure to ambient air pollution has been linked with daily hospitalization and mortality from acute coronary syndrome (ACS); however, the associations of subdaily (hourly) levels of criteria air pollutants with the onset of ACS and its subtypes have rarely been evaluated. We conducted a time-stratified case-crossover study among 1 292 880 patients with ACS from 2239 hospitals in 318 Chinese cities between January 1, 2015, and September 30, 2020. Hourly concentrations of fine particulate matter (PM2.5), coarse particulate matter (PM2.5-10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were collected. Hourly onset data of ACS and its subtypes, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, were also obtained. Conditional logistic regressions combined with polynomial distributed lag models were applied. Acute exposures to PM2.5, NO2, SO2, and CO were each associated with the onset of ACS and its subtypes. These associations were strongest in the concurrent hour of exposure and were attenuated thereafter, with the weakest effects observed after 15 to 29 hours. There were no apparent thresholds in the concentration-response curves. An interquartile range increase in concentrations of PM2.5 (36.0 μg/m3), NO2 (29.0 µg/m3), SO2 (9.0 µg/m3), and CO (0.6 mg/m3) over the 0 to 24 hours before onset was significantly associated with 1.32%, 3.89%, 0.67%, and 1.55% higher risks of ACS onset, respectively. For a given pollutant, the associations were comparable in magnitude across different subtypes of ACS. NO2 showed the strongest associations with all 3 subtypes, followed by PM2.5, CO, and SO2. Greater magnitude of associations was observed among patients older than 65 years and in the cold season. Null associations of exposure to either PM2.5-10 or O3 with ACS onset were observed. The results suggest that transient exposure to the air pollutants PM2.5, NO2, SO2, or CO, but not PM2.5-10 or O3, may trigger the onset of ACS, even at concentrations below the World Health Organization air quality guidelines.
Accurate individual exposure assessment is crucial for evaluating the health effects of particulate matter (PM). Various portable monitors built upon low-cost optical sensors have emerged. However, the main challenge for their application is to guarantee accuracy of measurements. To assess the performance of a newly developed PM sensor, and to develop methods for post-hoc data calibration to optimize its data quality. We conducted a series of laboratory experiments and field evaluations to quantify the reproducibility within Plantower PM sensors 7003 (PMS 7003) and the consistency between sensors and two established PM2.5 measurement methods [tapered element oscillating microbalances (TEOM) and gravimetric method (GM)]. Post-hoc data calibration methods for sensors were based on a multiple linear regression model (MLRM) and a random forest model (RFM). Ratios of raw and calibrated readings over the data of reference methods were calculated to examine the improvement after calibration. Strong correlations (≥0.82) and relatively small relative standard deviations (16–21%) between sensors were found during the laboratory and the field sampling. Compared with the reference methods, moderate to strong coefficients of determination (0.56–0.83) were observed; however, significant deviations were presented. After calibration, the ratios of PMS measurements over that of two reference methods both became convergent. Our study validated low-cost optical PM sensors under a wide range of PM2.5 concentrations (8–167 μg/m3). Our findings indicated potential applicability of PM sensors in PM2.5 exposure assessment, and confirmed a need of calibration. Linear calibration methods may be sufficient for ambient monitoring using TEOM as a reference, while nonlinear calibration methods may be more appropriate for indoor monitoring using GM as a reference.
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