Sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis in COVID-19-infected patients: A systematic review of case reports

BACKGROUND Diabetic ketoacidosis(DKA)manifests as hyperglycemia,metabolic acidosis,and ketosis.However,euglycemic DKA(eu-DKA)conceals severe DKA with glucose levels below 200 mg/dL.Sodium-glucose cotransporter-2(SGLT2)inhibitors can induce eu-DKA in diabetic patients.Notably,coronavirus disease 2019(COVID-19)-infected individuals with diabetes using SGLT2 inhibitors face an augmented risk of eu-DKA due to the direct toxic impact of the virus on pancreatic islets.This study aims to comprehensively investigate the association between SGLT2 inhibitors and eu-DKA in COVID-19 patients through meticulous case report analysis.Additionally,we endeavor to examine the outcomes and treatment approaches for COVID-19-infected diabetics receiving SGLT2 inhibitors,providing indispensable insights for healthcare professionals managing this specific patient population.AIM To investigate the connection between SGLT2 inhibitors and euglycemic DKA in COVID-19 patients through a meticulous analysis of case reports.METHODS We conducted an exhaustive search across prominent electronic databases,including PubMed,SCOPUS,Web of Science,and Google Scholar.This search encompassed the period from December 2019 to May 2022,incorporating published studies and pre-prints.The search terms employed encompassed“SGLT2 inhibitors”,“euglycemic DKA”,“COVID-19”,and related variations.By incorporating these diverse sources,our objective was to ensure a thorough exploration of the existing literature on this subject,thereby augmenting the validity and robustness of our findings.RESULTS Our search yielded a total of seven case reports and one case series,collectively comprising a cohort of twelve patients.These reports detailed instances of eu-DKA in individuals with COVID-19.Crucially,all twelve patients were utilizing SGLT2 as their primary anti-diabetic medication.Upon admission,all oral medications were promptly discontinued,and the patients were initiated on intravenous insulin therapy to effectively manage the DKA.Encouragingly,eleven patients demonstrated a favorable outcome,while regrettably,one patient succumbed to the condition.Subsequently,SGLT2 were discontinued for all patients upon their discharge from the hospital.These findings provide valuable insights into the clinical management and outcomes of eu-DKA cases associated with COVID-19 and SGLT2,underscoring the critical importance of prompt intervention and vigilant medication adjustments.CONCLUSION Our study sheds light on the possibility of diabetic patients developing both drug-related and unrelated DKA,as well as encountering adverse outcomes in the context of COVID-19,despite maintaining satisfactory glycemic control.The relationship between glycemic control and clinical outcomes in COVID-19 remains ambiguous.Consequently,this systematic review proposes that COVID-19-infected diabetic patients using SGLT2 should contemplate alternative treatment protocols until their recovery from the disease.

Linking strategies to optimize the robustness of multimodal transport network

In view of the problem that the multimodal transport network is vulnerable to attack and faces the risk of cascading failure,three low polarization linking strategies considering the characteristics of the multimodal transport network are proposed to optimize network robustness.They are the low polarization linking strategy based on the degree of nodes(D_LPLS),low polarization linking strategy based on the betweenness of nodes(B_LPLS),and low polarization linking strategy based on the closeness of nodes(C_LPLS).The multimodal transport network in the Sichuan-Tibet region is analyzed,and the optimization effects of these three strategies are compared with the random linking strategy under random attacks and intentional attacks.The results show that C_LPLS can effectively optimize the robustness of the network.Under random attacks,the advantages of C_LPLS are obvious when the ratio of increased links is less than 15%,but it has fewer advantages compared with B_LPLS when the ratio of increased links is 15%to 30%.Under intentional attacks,as the ratio of increased links goes up,the advantages of C_LPLS become more obvious.Therefore,the increase of links by C_LPLS is conducive to the risk control of the network,which can provide theoretical support for the optimization of future multimodal transport network structures.

Determining capacity of multimodal multi-commodities freight transportation network from critical link volumes

The commodity transportation capacity between all origin-destination （ OD ） pairs over the multimodal multi-commodities freight transportation network （MMFTN） is determined. A multi-ob- jectives mathematical model is formulated for determining the OD capacity over the MMFTN accord- ing to a transporting capacity matrix that increased from the reference matrixes. The corresponding incremental factor for estimating the capacity matrix is obtained via the maximal likelihood estima- tion method that samples data of differences between the estimated commodity volumes and carrying capacities of the critical links. The proposed formulations are tested by an experimental highway and railroad freight transportation network in an existing literature. The relevant results of OD capacities are displayed and applicability of the algorithm is certified.

Linking a Simulated Annealing Based Optimization Model with PHT3D Simulation Model for Chemically Reactive Transport Processes to Optimally Characterize Unknown Contaminant Sources in a Former Mine Site in Australia

Historical mining activities often lead to continuing wide spread contaminants in both groundwater and surface water in previously operational mine site areas. The contamination may continue for many years after closing down the mining activities. The essential first step for sustainable management of groundwater and development of remediation strategies is the unknown contaminant source characterization. In a mining site, there are multiple species of contaminants involving complex geochemical processes. It is difficult to identify the potential sources and pathways incorporating the chemically reactive multiple species of contaminants making the source characterization process more challenging. To address this issue, a reactive transport simulation model PHT3D is linked to a Simulated Annealing based the optimum decision model. The numerical simulation model PHT3D is utilized for numerically simulating the reactive transport process involving multiple species in the former mine site area. The simulation results from the calibrated PHT3D model are illustrated, with and without incorporating the chemical reactions. These comparisons show the utility of using a reactive, geochemical transport process’ simulation model. Performance evaluation of the linked simulation optimization methodology is evaluated for a contamination scenario in a former mine site in Queensland, Australia. These performance evaluation results illustrate the applicability of linked simulation optimization model to identify the source characteristics while using PHT3D as a numerical reactive chemical species’ transport simulation model for the hydro-geochemically complex aquifer study area.

Linking axon transport to regeneration using in vitro laser axotomy

Spinal cord injury has devastating consequences because adult central nervous system （CNS） neurons do not regenerate their axons after injury. Two key reasons for axon regeneration fail- ure are extrinsic inhibitory factors and a low intrinsic capacity for axon regrowth. Research has therefore focused on overcom- ing extrinsic growth inhibition, and enhancing intrinsic regeneration capacity. Both of these issues will need to be addressed to enable optimal repair of the injured sp＋inal cord.

Association of serotonin transporter gene polymorphisms and major depressive disorder in Chinese Han population

BACKGROUND： Serotonin transporter （5-HTT） polymorphisms comprise 5-HTT gene-linked polymorphism region （5-HTTLPR） and variable number of tandem repeats （VNTR）. Studies have revealed an association between 5-HTT polymorphism and major depressive disorder, which suggests that the ＂S＂ allele of 5-HTTLPR and Stin2.9 of 5-HTTVNTR are associated with major depressive disorder. However, there are a number of studies that do not support the 5-HTT polymorphism effect in major depressive disorder. OBJECTIVE： To study the relationship between 5-HTT gene polymorphism and major depressive disorder in Chinese Han population. DESIGN, TIME AND SETTING： Case-controlled study of 5-HTT gene polymorphism. The experiment was performed at the Central Laboratory, Third Affiliated Hospital of Sun Yat-sen University, China from March 2005 to January 2006. PARTICIPANTS： A total of 99 depressive patients of Chinese Han nationality were recruited for this study. All patients met DSM-IV diagnostic criteria for major depressive disorder and had a total score of Hamilton Depression Scale （24 items） ≥21 points. In addition, 101 healthy subjects, matched for age and gender, served as the control group. METHODS： Venous blood was collected from all subjects. 5-HTT genotypes and alleles were determined by polymerase chain reaction. Consistent with the Hardy-Weinberg equilibrium, the association between 5-HTT gene polymorphism and major depressive disorder were analyzed by Chi-square test. MAIN OUTCOME MEASURES： 5-HTTLPR and 5-HTTVNTR genotypes and allele frequencies were measured. RESULTS： No significant differences in 5-HTTLPR genotypes and allele frequencies were determined between patients and controls （P 〉 0.05）. However, significant differences in 5-HTTVNTR genotypes and allele frequencies were detected （P 〈 0.01 ）. The Stin2.10 allele and 10/10 genotype associated with major depressive disorder （OR = 2.61,7.7, P 〈 0.05; analysis of dose-response relationships Х^2 = 12.35, P 〈 0.01）. CONCLUSION： Results from the present study revealed no association between 5-HTTLPR and major depressive disorder. However, a significant association between 5-HTTVNTR and major depressive disorder existed in a population of Chinese Han. The presence of Stin2.10 and 10/10 genotypes increased the risk for major depressive disorder in a dose-dependent manner.

Association between serotonin transporter gene polymorphisms and non-lesional temporal lobe epilepsy in a Chinese Han population

Serotonin （5-hydroxytryptamine, 5-HT） influences the cortical and subcortical excitatory/inhibitory balance and participates in the pathophysiological processes of epilepsy. The serotonin transporter （5-HTT） is the most important factor in serotonin inactivation. We tested whether 5-HTT polymorphisms are involved in the pathogenesis of epilepsy in Chinese Han population. We did not find a significant difference in the frequencies of genotypes and alleles in the 5-HTT gene-linked poLymorphic region （5-H-I-FLPR） in patients with non-lesional temporal lobe epilepsy and normal controls （P〉 0.05）. Frequencies of the 5-H1-1- intron 2 variable number tandem repeat （5-HTTVNTR） 12/12 genotype and allele 12 were higher in the patients with non-lesional temporal lobe epilepsy than normal controls （P 〈 0.01）. The odds ratio of affecting non-lesional temporal lobe epilepsy was 1.435 （95% Cl, 1.096 1.880） in patients carrying allele 12 （P 〈 0.05）. Although the 5-HTTLPR may not be a genetic locus of non-lesional temporal lobe epilepsy in Chinese Hart population, allele 12 in the 5-HTTVNTR may correlate with non-lesional temporal lobe epilepsy. The Stin2.12 allele and 12/12 genotype could be predisposing to non-lesional temporal lobe epilepsy.

基于复杂网络的中国与东盟航空运输联系研究

为探究我国同东盟航空运输联系发展水平,采用修正的引力模型对联系强度进行测算,基于测算结果构建中国与东盟城市航空运输联系空间网络,运用复杂网络方法对网络总体特征和节点中心性进行分析,发现我国与东盟航空联系强度较弱,整体呈上升趋势,联系的不均衡性较为明显;整体网络结构较为松散,呈现出“核心—边缘”的分布特点;度分布表现出多级分化现象,网络由少数核心城市主导,接近中心性总体分布均衡。

基于Q系列PLC和CC-Link总线的煤矿井电机车运输监控系统设计

针对煤矿井下运输数字化、信息化、安全性的要求,采用三菱Q系列PLC和CC-Link现场总线技术,组建煤矿井单轨电机车运输监控系统,实现了电机车运输的实时监控和自动调度。该系统在某煤矿得到了成功应用,有效避免了井下电机车运输事故的发生,提高了运输效率。

基于加边策略的城市群客运网络韧性优化

研究城市群客运网络韧性及韧性优化的问题有助于提高城市群应对突发事件的能力。以韧性城市和复杂网络理论构建考虑城市群客运网络吸收、适应、恢复3种能力的模型,以呼包鄂乌城市群路网数据为基础,利用不同攻击策略与加边策略考虑城市群客运网络韧性的优化问题,借助Python分析,找到最佳的加边策略。结果表明:不同的攻击方式对城市群客运网络韧性的影响不同,按低度数加边对韧性提升较为显著,为之后城市群韧性的提高提出了建议。

新四联方案治疗心力衰竭医疗成本和临床效果的评价研究

目的探讨加用钠-葡萄糖耦联转运体2(sodium-glucose linked transporter 2,SGLT2)抑制剂的新四联方案治疗心力衰竭(heart failure,HF)的医疗成本和临床效果,为HF患者选择治疗药物提供经济学参考。方法回顾性选取2022年1月至2023年1月于宁波市医疗中心李惠利医院住院的86例患者为研究对象,根据患者实际接受的HF治疗方案将其分为试验组和对照组,每组各43例。试验组患者接受新四联治疗方案,对照组患者接受经典治疗方案。比较两组患者的临床疗效、心血管事件及1年内的直接医疗成本,计算增量成本-效果比(incremental cost-effectiveness ratio,iCER),并对结果进行敏感度分析。结果试验组患者的直接医疗成本略高于对照组,但两组比较差异无统计学意义(12513.0元vs.11508.9元,t=–0.079,P=0.125);试验组和对照组患者的治疗总有效率比较差异无统计学意义(81.40%vs.74.4%,χ^(2)=1.237,P=0.539);两组患者1年内的心血管事件比较差异无统计学意义(χ^(2)=0.073,P=0.787);试验组和对照组患者的成本-效果比(cost-effectiveness ratio,C/E)分别为15372.3和15468.9,iCER为143.5;敏感度分析显示研究结果稳健。结论对照组和试验组治疗HF的临床效果相当,但试验组较对照组的C/E略高,加用SGLT2抑制剂的新四联方案更具药物经济学优势。

钠-葡萄糖协同转运蛋白2抑制剂治疗心力衰竭的临床综合评价体系构建与实践

目的:建立钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗心力衰竭的临床综合评价体系,并进行实证评价,旨在为其抗心力衰竭的临床价值提供参考。方法:通过文献分析、专家访谈、安全信号挖掘等手段,结合德尔菲法,根据相关文件及指南,围绕药学特性、安全性、有效性、可及性、经济性和其他属性形成SGLT2抑制剂治疗心力衰竭的综合评价体系,并开展多维度的数据整合与分析研判。结果:构建了一套科学、客观、可量化的SGLT2抑制剂抗心力衰竭的临床综合评价体系。对各维度评价结果加权综合分析后,达格列净得分为83.14分,恩格列净为78.36分,艾托格列净为73.70分,卡格列净为70.18分。结论:基于目前的证据,SGLT2抑制剂各品种在心力衰竭治疗中有不同的优势。该评价体系及实证结果可为SGLT2抑制剂用于心力衰竭的临床治疗提供科学、有效、安全、经济的直观证据。

Link-11数据链及其对抗方法研究

作为美国海军和空军采用的一种战术数据通信方式,Link 11数据链是一个采用网络通信技术和标准信息格式进行数字信息交换的战术数据链,广泛应用于美军飞机、陆基和舰艇战术数据系统之间的情报交换,对Link 11信号进行干扰和破解是电子对抗中的一项重要课题。对Link 11链的工作原理、设备组成、工作模式等进行了分析,对有效对抗Link 11数据链系统进行了深入的研究,提出了一些可行的攻击方法。

基于MATLABGUI的自动化转运装置可靠度预计计算

根据自动化转运装置的结构组成与机构功能,首先建立了自动化转运装置的可靠性模型;利用应力强度干涉理论法、经验公式法、厂家提供寿命法将自动化转运装置的零部件进行分类,获取各个零部件寿命值;根据自动化转运装置设计使用工况,计算出各个传动系及零部件工作量;假设自动化转运装置零部件的可靠性服从指数分布,进行可靠度预计。利用MATLAB GUI编制自动化转运装置各个零部件、各个传动系工作量及可靠度预计计算界面,方便自动化转运装置可靠度预计的迭代,减少反复迭代过程中人为操作带来的输入错误。最终得到自动化转运装置各个零部件、各个传动系及整体的可靠度预计计算结果,为找出自动化转运装置的薄弱环节及后续运行过程中需关注的问题提供了数据支撑。

交通区位优势与双循环枢纽链接优势测度及转化对策研究

枢纽城市作为连接全国综合交通网络的重要节点,发挥其辐射带动作用,积极融入双循环新发展格局是必然要求。以我国20个国际性枢纽城市为研究对象,构建交通区位优势与双循环枢纽链接优势评价体系,采用极值法对数据进行标准化后测算各城市的交通区位优势,运用熵权-TOPSIS法测算双循环枢纽链接优势,同时研究二者转化的因果关系以及耦合协调度。经计算,深圳、北京与上海3座城市在交通区位优势与双循环枢纽链接优势测算中均排名前3,且耦合协调度处于高水平耦合与优质协调,协调度处于中低水平的城市可从通道建设、枢纽能级以及枢纽经济入手,提升交通区位对经济发展的支撑作用,加快将自身交通区位优势转化为双循环枢纽链接优势。

基于图卷积的动态航线网络链路预测模型研究

为了克服航线网络传统链路预测模型的局限性,考虑网络拓扑特征和时间特性,提出一种基于图卷积网络(Graph Convolution Network,GCN)的动态航线网络链路预测模型。通过图卷积、图池化操作聚合节点及邻域信息,更新节点特征表示,识别节点间潜在联系。实验表明,GCN模型相较于传统链路预测模型具有更高的预测精度、预测效率和性能稳定性,是进行动态航线网络链路预测的一种有效工具。

“双循环”发展格局下中老铁路黄金通道发展对策研究

通道作为现代流通体系的重要组成部分,对于畅通国内国际双循环、稳定产业链供应链、推进通道经济高质量发展具有重要作用。作为连接国内市场和南亚东南亚市场的黄金线路,中老铁路不断激发沿线活力,正成为畅通“双循环”的重要力量。基于中老铁路运营数据、沿线区域社会经济数据等,对中老铁路黄金通道的运输联系特征进行分析。结果表明:中老铁路沿线大部分站点货源处于双向不均衡状态,中老铁路货运分布呈现出向日益均衡方向演变的发展趋势,中老铁路货运空间联系呈现出以滇中城市群和环万象经济圈为主的“双中心”发展格局。在此基础上,进一步从“畅通道、织网络”“育品牌、融产业”“强合作、建生态”“优环境、提效率”四方面,提出释放中老铁路通道效能的对策建议,为“双循环”背景下国际大通道的发展路径提供参考。

钠-葡萄糖耦联转运体2抑制剂对代谢综合征相关代谢紊乱的作用研究进展

代谢综合征是一组复杂的代谢紊乱症候群,其全球发病率不断升高,严重威胁人类的健康,但临床上尚无特效药。钠-葡萄糖耦联转运体2(SGLT2)抑制剂是一种新型口服降糖药物,它不仅可以通过抑制肾脏近曲小管上皮细胞对葡萄糖的重吸收促进尿糖排泄这种非胰岛素依赖方式降低血糖,还可以通过改善胰岛β细胞功能、降低炎症反应、抑制氧化应激来降低血糖。此外,SGLT2抑制剂还可以通过渗透性利尿、增加脂肪代谢以减轻体重;通过抑制交感神经系统过度激活、改善血管功能等作用降低血压;通过增加三酰甘油降解进而改善血脂;通过促进肾脏及肠道尿酸排泄和减少尿酸合成来降低血尿酸。本文就SGLT2抑制剂对代谢综合征相关代谢紊乱的改善作用及其相关调控机制进行综述。

气田无人机巡检系统应用探讨

某气田集输管网分布广、地理环境恶劣,巡检工作量大,给人工巡检带来了较大难度。为进一步提高应急处置能力,提出了采用无人机代替部分人工进行智能化巡检的方案;介绍了无人机巡检系统的组成,给出了飞行平台、传输链路、手持遥控系统、移动无人机机场、无人机自助机场和地面站操作系统等无人机巡检主要设备的技术参数和功能。应用无人机巡检系统可以有效提升气田管理的数字化水平和应急处置能力。