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The Representation of Soil Moisture−Atmosphere Feedbacks across the Tibetan Plateau in CMIP6

Advances in Atmospheric Sciences 2023年第11期40卷 2063-2081页

作者： joshua TALIB Omar V.MÜLLER emma j.BARTON Christopher M.TAYLOR Pier Luigi VIDALE U.K.Centre of Ecology and Hydrology WallingfordOX108BBU.K. National Centre for Atmospheric Science ReadingRG66BBU.K. Consejo Nacional de Investigaciones Científicas y Técnicas(CONICET) Centro de Estudios de Variabilidad y Cambio Climático(CEVARCAM)Facultad de Ingeniería y Ciencias HídricasUniversidad Nacional del LitoralSanta FeArgentina National Centre for Earth Observation WallingfordOX108BBU.K. Department of Meteorology University of ReadingReadingRG66BBU.K.

Thermal processes on the Tibetan Plateau(TP)influence atmospheric conditions on regional and global *** this,previous work has shown that soil moisture−driven surface flux variations feed back onto the *** soil moisture is a source of atmospheric predictability,no study has evaluated soil moisture−atmosphere coupling on the TP in general circulation models(GCMs).In this study,we use several analysis techniques to assess soil moisture−atmosphere coupling in CMIP6 simulations including:instantaneous coupling indices;analysis of flux and atmospheric behaviour during dry spells;and a quantification of the preference for convection over drier *** these metrics we partition feedbacks into their atmospheric and terrestrial *** with previous global studies,we conclude substantial inter-model differences in the representation of soil moisture−atmosphere coupling,and that most models underestimate such *** on dry spell analysis,most models underestimate increased sensible heat during periods of rainfall *** example,the model-mean bias in anomalous sensible heat flux is 10 W m−2(≈25%)smaller compared to *** dry-spell sensible heat fluxes lead to a weaker atmospheric *** also find that most GCMs fail to capture the negative feedback between soil moisture and deep *** poor simulation of feedbacks in CMIP6 experiments suggests that forecast models also struggle to exploit soil moisture−driven *** improve the representation of land−atmosphere feedbacks requires developments in not only atmospheric modelling,but also surface processes,as we find weak relationships between rainfall biases and coupling indexes.

关键词： model evaluation land-atmosphere feedbacks Tibetan Plateau precipitation surface energy balance

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Age at diagnosis of type 2 diabetes and cardiovascular risk factor profile:A pooled analysis

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World journal of Diabetes 2022年第3期13卷 260-271页

作者： Mary M Barker Francesco Zaccardi Emer M Brady Gaurav S Gulsin Andrew P Hall joseph Henson Zin ZinHtike Kamlesh Khunti Gerald P McCann emma L Redman David R Webb emma G Wilmot Tom Yates jian Yeo Melanie j Davies jack A Sargeant Diabetes Research Centre University of LeicesterLeicester General HospitalLeicester LE54PWUnited Kingdom Department of Cardiovascular Sciences Glenfield HospitalUniversity of LeicesterLeicester LE39QPUnited Kingdom The Hanning Sleep Laboratory University Hospitals of Leicester NHS TrustUniversity of LeicesterLeicester LE54PWUnited Kingdom National Institute for Health Research Leicester Biomedical Research CentreLeicester LE54PWUnited Kingdom Leicester Diabetes Centre University Hospitals of Leicester NHS TrustLeicester LE54PWUnited Kingdom National Institute for Health Research Applied Research Collaboration East MidlandsLeicester LE54PWUnited Kingdom Department of Diabetes University Hospitals of Derby and Burton NHS Foundation TrustDerby DE223NEUnited Kingdom

BACKGROUND The diagnosis of type 2 diabetes(T2D)in younger adults,an increasingly common public health issue,is associated with a higher risk of cardiovascular complications and mortality,which may be due to a more adverse cardiovascular risk profile in individuals diagnosed at a younger *** To investigate the association between age at diagnosis and the cardiovascular risk profile in adults with *** A pooled dataset was used,comprised of data from five previous studies of adults with T2D,including 1409 participants of whom 196 were diagnosed with T2D under the age of 40 *** and blood biomarker measurements included body weight,body mass index(BMI),waist circumference,body fat percentage,glycaemic control(HbA1c),lipid profile and blood *** and multivariable linear regression models,adjusted for diabetes duration,sex,ethnicity and smoking status,were used to investigate the association between age at diagnosis and each cardiovascular risk *** A higher proportion of participants diagnosed with T2D under the age of 40 were female,current smokers and treated with glucose-lowering medications,compared to participants diagnosed later in *** diagnosed with T2D under the age of 40 also had higher body weight,BMI,waist circumference and body fat percentage,in addition to a more adverse lipid profile,compared to participants diagnosed at an older *** results showed that each one year reduction in age at diagnosis was significantly associated with 0.67 kg higher body weight[95%confidence interval(CI):0.52-0.82 kg],0.18 kg/m^(2) higher BMI(95%CI:0.10-0.25)and 0.32 cm higher waist circumference(95%CI:0.14-0.49),after adjustment for duration of diabetes and other *** age at diagnosis was also significantly associated with higher HbA1c,total cholesterol,low-density lipoprotein cholesterol and *** The diagnosis of T2D earlier in life is associated with a worse cardi

关键词： Type 2 diabetes mellitus Early-onset adult type 2 diabetes Age of onset Cardiovascular risk Young adults Glycaemic control Obesity

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钠-葡萄糖共转运蛋白-2抑制剂或胰高血糖素样肽-1受体激动剂治疗成人2型糖尿病:临床实践指南

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英国医学杂志中文版 2021年第9期24卷 523-531页

作者： Sheyu Li Per Olav Vandvik Lyubov Lytvyn Gordon H Guyatt Suetonia C Palmer Rene Rodriguez-Gutierrez Farid Foroutan Thomas Agoritsas Reed A C Siemieniuk Michael Walsh Lawrie Frere David j Tunnicliffe Evi V Nagler Veena Manja Bjφrn Olav Asvold Vivekanand jha Mieke Vermandere Karim Gariani Qian Zhao Yan Ren emma j.ne cartwright Patrick Gee Alan Wickes Linda Fems Robin Wright Ling Li Qiukui Hao Reem A Mustafa 无郭鹤鸣(译) Chengdu China Chinese Evidencebased Medicine Center Cochrane China Center and MAGIC China CenterWest China HospitalSichuan UniversityChengduChina University of Oslo OsloNorway MAGIC Evidence Ecosystem Foundation Department of Health Research Methods Evidence and ImpactMcMaster UniversityHamiltonONCanada Department of Medicine McMaster UniversityHamiltonONCanada Department of Medicine University of OtagoChristchurchNew Zealand Plataforma INVEST Medicina UANL-KER Unit(KER Unit Mexico) Subdireccion de InvestigacionUniversidad Autonoma de Nuevo LeonMonterrey64460Mexico Knowledge and Evaluation Research Endocrinology Mayo ClinicRochesterMN55905USA Endocrinology Division Department of Internal MedicineUniversity Hospital"Dr.Jose E.Gonzalez"Universidad Autonoma de Nuevo LeonMonterrey64460Mexico Ted Rogers Center for Heart Research Canada Service of Endocrinology DiabetesNutrition and Patient Therapeutic EducationGeneva University HospitalsGenevaSwitzerland newbridge Surgery BathUK Sydney School of Public Health The University of SydneySydneyAustralia Centre for Kidney Research The Children's Hospital at WestmeadSydneyAustralia Renal Division Ghent University HospitalBelgium University of California Davis USA Department of Endocrinology Clinic of MedicineSt Olavs HospitalTrondheim University HospitalTrondheimNorway K.G.jebsen Center for Genetic Epidemiology Department of Public Health and NursingNTNUNorwegian University of Science and TechnologyTrondheimNorway The George Institute for Global Health UNSWIndia School of Public Health Imperial CollegeLondonUK Prasanna School of Public Health Manipal Academy of Higher EducationManipalIndia Department of Public Health and Primary Care KU LeuvenLeuvenBelgium International Medical Center/Ward of General Practice West China HospitalSichuan UniversityChengduChina London UK Founder&CEHD iAdvorateInc.VirginiaPatient partner Patient partner The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatr

临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病... 详细信息

临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病的治疗决策都以控制血糖为主导。SGLT-2抑制剂和GLP-1受体激动剂在传统观念中常被用于二甲双胍治疗后血糖仍控制不佳的患者。目前这一现状已经发生了改变,这得益于多项临床研究结果。研究显示SGLT-2抑制剂和GLP-1受体激动剂拥有独立于药物降糖作用之外的对于动脉粥样硬化性心血管病(CVD)和慢性肾脏病(CKD)的获益。建议本指南阐述了针对不同风险分层的成人2型糖尿病患者使用SGLT-2抑制剂或GLP-1受体激动剂的建议。•伴有3种或更少的心血管风险因素且不存在CVD或CKD:不建议启动SGLT-2抑制剂或GLP-1受体激动剂治疗。(推荐等级:弱)•伴有3种以上心血管风险因素且不存在CVD或CKD:建议启动SGLT-2抑制剂治疗,不建议启动GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD或CKD:建议启动SGLT-2抑制剂治疗和GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD和CKD:建议启动SGLT-2抑制剂治疗(推荐等级:强)和GLP-1受体激动剂治疗。(推荐等级:弱)•对于那些想要进一步降低CVD和CKD结局风险的患者:推荐优先启用SGLT-2抑制剂治疗而非GLP-1受体激动剂治疗。(推荐等级:弱)这项指南是如何制订的一个由患者、临床医生和方法学家共同组成的国际小组提出了这些推荐意见。这些推荐意见基于可信度较高的指南的标准,并使用GRADE分级方法进行评估。该小组采用了息者个体化的观点。证据一项关于获益与风险的系统综述和网络meta分析(764项随机对照研究,包括421346例参与者)发现SGLT-2抑制剂和GLP-1受体激动剂可以降低总体死亡率、心肌梗死发生率、终末期肾病或肾衰竭的发生率(中等至高等质量的证据)。在不同的亚组中这些药物对卒中、因心力衰竭所致住院和其他主要不良事件有不同的影响。药物绝对获益的程度因患者个体风险的不同有很大的差异。(例如,对于接受了超过5年药物治疗的1000例患者,在最低风险人群中死亡人数减少了5人,在最高风险人群中死亡人数减少了48人)。一项关于预后的综述确认了14种风险预测模型,其中一种(RECODe)在证据总结中报告了大部分基线风险评估数据,小组利用该模型以支持风险分层的建议。考虑到患者的价值观及个体差异,指南推荐的支撑证据包括一项对已发表论文的系统综述、一项患者焦点小组研究、一项临床问题总结,以及一项指南调查。指南解读我们依据不同的CVD和CKD风险水平,综合考虑获益、风险和其他因素的平衡,以及每一个风险组别的实际问题,来对推荐意见进行分层。本指南强烈建议CVD和CKD患者使用SGLT-2抑制剂治疗,这说明专家组认为其具有显著的获益。而对于其他成人2型糖尿病患者,推荐等级较弱,这说明专家组想要在获益、风险及治疗花费上取得一个更好的平衡。临床医生通过该指南可以使用可靠的风险计算模型,如RECODe,来明确其患者的个体心血管和肾脏疾病风险。医患交互式总结临床证据和制订决策有助于患者知晓治疗选择,包括进行共同决策。2型糖尿病人群(全球患病率不断增长1-2)正面临着不断增加的心血管疾病、肾脏病和其他并发症的风险3。数十年来,2型糖尿病的管理始终以控制血糖及糖化血红蛋白(HbA1c)为治疗目标4-5,但是,最近的高质量随机对照研究已经对这种以血糖为中心的治疗模式发起了挑战。研究结果显示,强化血糖控制未必会降低大血管不良事件,它还可能带来不利影响监管机构现在要求新型糖尿病药物必须证明其具有心血管和肾脏获益才能获得批准。对两类新药--钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂(见框图1)的临床试验结果显示,在现有治疗方案(常规治疗)之上加用这些药物,对死亡、心肌梗死、卒中、心力衰竭和肾脏的结局(如进展为终末期肾病)都有获益8-12。

关键词：胰高血糖素样肽1 终末期肾病临床研究结果心血管风险 meta分析临床试验结果临床证据控制血糖

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Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID- 19 pandemic

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Stroke & Vascular neurology 2021年第4期6卷 542-552,I0026-I0032页

作者： Thanh N Nguyen Diogo C Haussen Muhammad M Qureshi Hiroshi Yamagami Toshiyuki Fujinaka Ossama Y Mansour Mohamad Abdalkader Michael Frankel Zhongming Qiu Allan Taylor Pedro Lylyk Omer F Eker Laura Mechtouff Michel Piotin Fabricio Oliveira Lima Francisco Mont'Alverne Wazim Izzath Nobuyuki Sakai Mahmoud Mohammaden Alhamza R Al-Bayati Leonardo Renieri Salvatore Mangiafico David Ozretic Vanessa Chalumeau Saima Ahmad Umair Rashid Syed Irteza Hussain Seby john emma Griffin john Thornton jose Antonio Fiorot Rodrigo Rivera Nadia Hammami Anna M Cervantes-Arslanian Hormuzdiyar H Dasenbrock Huynh Le Vu Viet Quy Nguyen Steven Hetts Romain Bourcier Romain Guile Melanie Walker Malveeka Sharma Don Frei Pascal jabbour Nabeel Herial Fawaz Al-Mufti Atilla Ozcan Ozdemir Ozlem Aykac Dheeraj Gandhi Chandril Chugh Charles Matouk Pascale Lavoie Randall Edgell Andre Beer-Furlan Michael Chen Monika Killer-Oberpfalzer Vitor Mendes Pereira Patrick Nicholson Vikram Huded Nobuyuki Ohara Daisuke Watanabe Dong Hun Shin Pedro SC Magalhaes Raghid Kikano Santiago Ortega-Gutierrez Mudassir Farooqui Amal Abou-Hamden Tatsuo Amano Ryoo Yamamoto Adrienne Weeks Elena A Cora Rotem Sivan-Hoffmann Roberto Crosa Markus Möhlenbruch Simon Nagel Hosam Al-jehani Sunil A Sheth Victor S Lopez Rivera james E Siegler Achmad Fidaus Sani Ajit S Puri Anna Luisa Kuhn Gianmarco Bernava Paolo Machi Daniel G Abud Octavio M Pontes-neto Ajay K Wakhloo Barbara Voetsch Eytan Raz Shadi Yaghi Brijesh P Mehta Naoto Kimura Mamoru Murakami jin Soo Lee ji Man Hong Robert Fahed Gregory Walker Eiji Hagashi Steve M Cordina Hong Gee Roh Ken Wong juan F Arenillas Mario Martinez-Galdamez jordi Blasco Alejandro Rodriguez Vasquez Luisa Fonseca M Luis Silva Teddy Y Wu Simon john Alex Brehm Marios Psychogios William j Mack Matthew Tenser Tatemi Todaka Miki Fujimura Roberta Novakovic jun Deguchi Yuri Sugiura Hiroshi Tokimura Rakesh Khatri Michael Kelly Lissa Peeling Yuichi Murayama Hugh Stephen Winters johnny Wong Mohamed Teleb jeremy Payne Hiroki Fukuda Kosuke Miyake junsuke Shimbo Yusuke Sug neurology RadiologyBoston Medical CenterBostonMassachusettsUSA neurology Marcus Stroke&Neuroscience CenterGrady Memorial HospitalEmory University School of MedicineAtlantaGAUSA Radiology Radiation OncologyBoston University School of MedicineBostonMassachusettsUSA neurology National Hospital Organization Osaka National HospitalOsakaJapan neurosurgery National Hospital Organization Osaka National HospitalOsakaJapan neurology Alexandria UniversityAlexandriaEgypt Radiology Boston Medical CenterBostonMassachusettsUSA Department of neurology Xinqiao HospitalChongqingChina neurosurgery University of Cape TownRondeboschWestern CapeSouth Africa neurosurgery Interventional NeuroradiologyClinica La Sagrada FamiliaBuenos AiresArgentina neuroradiologie Neurologie VasculaireHospices Civils de LyonLyonAuvergne-Rhône AlpesFrance neurologie Vasculaire Hospices Civils de LyonLyonAuvergne-Rhône AlpesFrance Interventional neuroradiology Fondation Ophtalmologique Adolphe de RothschildParisÎle-de FranceFrance neurology Hospital Geral de FortalezaFortalezaBrazil Interventional neuroradiology Hospital Geral de FortalezaFortalezaBrazil neuroradiology Nottingham University Hospitals NHS TrustNottinghamUK Department of neurosurgery Kobe City Medical Center General HospitalKobeHyogoJapan Interventional neurovascular Unit University Hospital CareggiFirenzeToscanaItaly neuroradiology University Hospital Centre ZagrebZagrebCroatia Interventional neuroradiology Hopital BicetreLe Kremlin-BicetreFrance Stroke and Interventional neuroradiology Lahore General HospitalLahorePakistan neurological Institute Cleveland Clinic Abu DhabiAbu DhabiUAE Department of Radiology Beaumont HospitalDublinIreland neurology Stroke UnitHospital-Estadual CentralVitoriaBrazil neuroradiology Instituto de Neurocirugia Dr AsengoSantiagoChile Interventional neuroradiology Institut National de NeurologieTunisTunisia neurology Boston Medical CenterBostonMassachusettsUSA neurosurgery Boston Medical Center

Background During the COVID-19 pandemic,decreased volumes of stroke admissions and mechanical thrombectomy were *** study’s objective was to examine whether subarachnoid haemorrhage(SAH)hospitalisations and ruptured aneurysm coiling interventions demonstrated similar *** We conducted a cross-sectional,retrospective,observational study across 6 continents,37 countries and 140 comprehensive stroke *** with the diagnosis of SAH,aneurysmal SAH,ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases,10th Revision,*** 3-month cumulative volume,monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before(1 year and immediately before)and during the pandemic,defined as 1 March-31 May *** prior 1-year control period(1 March-31 May 2019)was obtained to account for seasonal *** There was a significant decline in SAH hospitalisations,with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic,representing a relative decline of 22.5%(95%CI−24.3%to−20.7%,pneurysms declined with 1170-1035 procedures,respectively,representing an 11.5%(95%CI−13.5%to−9.8%,p=0.002)relative *** analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations,a 24.9%relative decline(95%CI−28.0%to−22.1%,pneurysm coiling was noted in low coiling volume hospitals of 41.1%(95%CI 32.3%to 50.6%,p=0.008)despite a decrease in SAH admissions in this *** There was a relative decrease in the volume of SAH hospitalisations,aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 *** findings in SAH are consistent with a decrease in other emergencies,such as stroke and myocardial infarction.

关键词： diagnosis representing subarachnoid

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