Dose response

剂量反应
  • 文章类型: Journal Article
    人诱导多能干细胞衍生的感觉神经元(iPSC-dSN)模型是研究神经毒性的宝贵资源,但受复制性和可重复性差的影响。通常是由于缺乏优化。这里,我们确定了与培养条件相关的实验因素,这些因素会对体外细胞药物反应产生重大影响,并确定了改善复制性和可重复性的最佳条件。治疗时间和细胞接种密度都是重要因素,而细胞系的差异也促成了变异。在暴露于多西他赛或紫杉醇48小时后,证明了活力的可复制剂量反应。此外,证明了神经突生长的可复制剂量依赖性减少,证明该模型对其他表型检查的适用性。总的来说,我们建立了一个优化的iPSC-dSN模型,用于研究紫杉烷诱导的神经毒性。
    Human induced pluripotent stem cell-derived sensory neuron (iPSC-dSN) models are a valuable resource for the study of neurotoxicity but are affected by poor replicability and reproducibility, often due to a lack of optimization. Here, we identify experimental factors related to culture conditions that substantially impact cellular drug response in vitro and determine optimal conditions for improved replicability and reproducibility. Treatment duration and cell seeding density were both found to be significant factors, while cell line differences also contributed to variation. A replicable dose-response in viability was demonstrated after 48-h exposure to docetaxel or paclitaxel. Additionally, a replicable dose-dependent reduction in neurite outgrowth was demonstrated, demonstrating the applicability of the model for the examination of additional phenotypes. Overall, we have established an optimized iPSC-dSN model for the study of taxane-induced neurotoxicity.
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  • 文章类型: Journal Article
    等距运动是一种非药物干预措施,可改善人体肌肉血液动力学反应和血压。然而,强度的影响,持续时间,等长运动对局部肌肉血流动力学反应和全身血压调节的影响因素尚未研究。这项研究的目的是评估各种等距运动方式是否会引起与血压变化有关的各种水平的肌肉血液动力学反应。近红外光谱用于评估20名健康成年人在4次等距运动方案后的肌肉血液动力学反应。使用重复测量的单向方差分析(ANOVA)来评估等距运动因素对氧合血红蛋白的影响,脱氧血红蛋白,血容量,和氧合。对于氧合,在MVC的30%进行2分钟的单侧等距握把运动的平均值最低(-0.317±0.379μM),而等距壁深蹲的平均值最高(1.496±0.498μM,P<0.05)。此外,在30%MVC下进行1分钟的双侧等距手握锻炼(1.340±0.711μM,P<0.05)和在20%MVC下进行3分钟(0.798±0.324μM,P<0.05)显着高于2分钟MVC的30%。血压与前臂肌肉的氧合变化呈相反的趋势。研究表明,等距运动的持续时间和肌肉质量对氧合反应和系统的血压调节更有效,并表明局部肌肉氧合因子在等轴收缩后可能介导系统的血压调节。
    Isometric exercise is a non-pharmacologic intervention to improve muscle hemodynamic responses and blood pressure in humans. However, the effects of intensity, duration, and muscle mass factors of isometric exercise on local muscle hemodynamic responses and systemic blood pressure regulation have not been studied. The purpose of this study was to assess whether various modes of isometric exercise could induce various levels of muscle hemodynamic responses that are related to the blood pressure changes. Near-infrared spectroscopy was used to assess muscle hemodynamic responses after 4 isometric exercise protocols in 20 healthy adults. One-way analysis of variance (ANOVA) with repeated measures was used to assess the effect of factors of isometric exercise on oxyhemoglobin, deoxy-hemoglobin, blood volume, and oxygenation. For oxygenation, the lowest mean was recorded for the unilateral isometric handgrip exercise at 30% of MVC for 2 min (-0.317 ± 0.379 μM) while the highest mean was observed for the isometric wall squat (1.496 ± 0.498 μM, P < 0.05). Additionally, both the bilateral isometric handgrip exercise at 30% MVC for 1 min (1.340 ± 0.711 μM, P < 0.05) and the unilateral isometric handgrip exercise at 20% MVC for 3 min (0.798 ± 0.324 μM, P < 0.05) are significantly higher than 30% of MVC for 2 min. Blood pressure showed an inverse trend with oxygenation changes of the forearm muscle. The study indicates that the duration and muscle mass of isometric exercise are more effective on oxygenation responses and systematic blood pressure regulation, and suggests that the local muscle oxygenation factor following isometric contractions may mediate systematic blood pressure regulation.
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  • 文章类型: Journal Article
    饮食成分可以影响结直肠癌(CRC)的发病率。叶酸是在DNA结构形成中起重要作用的化合物之一,可以导致或预防肿瘤发生。本研究是队列研究的第一个系统评价和剂量反应荟萃分析,评估膳食叶酸摄入量与CRC风险之间的关系。
    PubMed/Medline,Scopus,和ISIWebofScience数据库在2024年1月之前系统搜索了评估叶酸摄入量与CRC相关性的队列研究.使用随机效应模型计算汇总相对风险(RR)和95%置信区间(CI)。此外,我们对叶酸摄入量与CRC风险之间的剂量-反应相关性进行了线性和非线性剂量-反应分析.
    18项前瞻性队列研究,931,469名参与者,14,860例CRC患者,3536例结肠癌(CC)患者,1075例直肠癌(RC)患者被纳入分析。饮食叶酸摄入量每增加100μg,CRC的总RR为0.97(95%CI:0.95-0.99,I2:0.0%,P-异质性:0.616),这可能与BMI相关(0.97(95%CI:0.95-0.99));在饮酒(0.97(95%CI:0.95-0.99))和吸烟(0.97(95%CI:0.95-0.99))的受试者中也观察到了更多的保护作用。此外,与CC风险降低7%呈正相关(0.93(95%CI:0.87-0.99,I2:33.7%,P-异质性:0.159)),RC的零关系为0.98(95%CI:0.90-1.08),I2:16.6%,P-异质性:0.309)。有非线性的证据表明,每天摄入高达500μg的叶酸与CC成反比(P非线性=0.04)。
    研究结果表明,膳食叶酸摄入量与CRC风险呈负相关,尤其是高危人群,那些BMI较高的人,酗酒者,和吸烟者。
    UNASSIGNED: Dietary components can influence the incidence of colorectal cancer (CRC). Folate is one of the compounds that plays an essential role in the formation of DNA structures, which can lead to or prevent tumorigenesis. The present study is the first systematic review and dose-response meta-analysis of cohort studies evaluating the association between dietary folate intake and the risk of CRC.
    UNASSIGNED: The PubMed/Medline, Scopus, and ISI Web of Science databases were systematically searched for cohort studies that assessed the association between folate intake and CRC up to January 2024. Summary relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using a random effects model. Also, linear and nonlinear dose-response analyses were conducted for the dose-response associations between folate intake and risk of CRC.
    UNASSIGNED: Eighteen prospective cohort studies with 931,469 participants, 14,860 CRC patients, 3536 colon cancer (CC) patients, and 1075 rectal cancer (RC) patients were included in the analysis. The summary RR of CRC for each 100-μg increase in dietary folate intake was 0.97 (95 % CI: 0.95-0.99, I2: 0.0 %, P-heterogeneity: 0.616), which can be related to BMI (0.97 (95 % CI: 0.95-0.99)); a more protective effect was also observed in subjects who drank alcohol (0.97 (95 % CI: 0.95-0.99)) and those who smoked (0.97 (95 % CI: 0.95-0.99)). Additionally, it was positively related to a 7 % lower risk of CC (0.93 (95 % CI: 0.87-0.99, I2: 33.7 %, P-heterogeneity: 0.159)), and the null relation for RC was 0.98 (95 % CI: 0.90-1.08), I2: 16.6 %, P-heterogeneity: 0.309). There was evidence of nonlinearity in which up to 500 μg/day dietary folate intake was inversely associated with CC (P nonlinearity = 0.04).
    UNASSIGNED: The findings showed an inverse association between dietary folate intake and the risk of CRC, especially in high-risk persons, those who have a higher BMI, alcohol drinkers, and smokers.
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  • 文章类型: Journal Article
    在临床环境中使用的许多治疗和诊断方法取决于通过全身递送施用化合物。纳米尺度的生物材料,作为树枝状聚合物,通过提高货物的生物利用度作为输送系统,循环时间,和特定组织的靶向。尽管评估基于纳米材料的药物的功效至关重要,对生物材料进行毒理学评估对于推进临床转化至关重要。这里,探索了斑马鱼幼虫模型来评估聚(酰胺基胺)(PAMAM)的生物相容性,用于药物递送的最受欢迎的树枝状聚合物之一。我们报告了全身注射聚乙二醇(PEG)修饰的G4PAMAM结合罗丹明(Rho)作为模拟药物(PEG-PAMAM-Rho)对存活率的影响,动物发育,炎症,和神经毒性。观察到对死亡率的浓度和时间依赖性影响,发育形态学,和先天免疫系统激活(巨噬细胞)。早在注射后48小时,最高测试浓度(50mg/mLPEG-PAMAM-Rho)就报告了毒理学指标的显着影响。此外,发现较低浓度的PEG-PAMAM-Rho(5mg/mL)是安全的,随后通过行为学试验检测了其神经毒性.InAccording,没有检测到明显的毒性迹象。总之,评估动物的剂量反应,并确定了将来用于治疗诊断的安全剂量。此外,建立了新的方法,可以适应使用其他纳米系统进行全身给药的毒理学的进一步研究。
    Numerous therapeutic and diagnostic approaches used within a clinical setting depend on the administration of compounds via systemic delivery. Biomaterials at the nanometer scale, as dendrimers, act as delivery systems by improving cargo bioavailability, circulation time, and the targeting of specific tissues. Although evaluating the efficacy of pharmacological agents based on nanobiomaterials is crucial, conducting toxicological assessments of biomaterials is essential for advancing clinical translation. Here, a zebrafish larvae model was explored to assess the biocompatibility of poly(amido amine) (PAMAM), one of the most exploited dendrimers for drug delivery. We report the impact of a systemic injection of polyethylene glycol (PEG)-modified G4 PAMAM conjugated with rhodamine (Rho) as a mimetic drug (PEG-PAMAM-Rho) on survival, animal development, inflammation, and neurotoxicity. A concentration- and time-dependent effect was observed on mortality, developmental morphology, and innate immune system activation (macrophages). Significant effects in toxicological indicators were reported in the highest tested concentration (50 mg/mL PEG-PAMAM-Rho) as early as 48 h post-injection. Additionally, a lower concentration of PEG-PAMAM-Rho (5 mg/mL) was found to be safe and subsequently tested for neurotoxicity through behavioral assays. In accordance, no significative signs of toxicity were detected. In conclusion, the dose response of the animal was assessed, and the safe dosage for future use in theragnostics was defined. Additionally, new methodologies were established that can be adapted to further studies in toxicology using other nanosystems for systemic delivery.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: Journal Article
    他汀类药物可降低低密度脂蛋白胆固醇(LDL-C),可有效预防动脉粥样硬化性心血管疾病(ASCVD)。他汀类药物的剂量反应因患者而异,可以使用三种不同的药理学特性进行建模:(1)E0(基线LDL-C),(2)ED50(效力:实现LDL-C降低50%的中值剂量);和(3)Emax(功效:最大LDL-C降低)。然而,个体化剂量反应及其与ASCVD事件的关联尚不清楚.
    我们分析了ED50和Emax与真实世界心血管疾病结局之间的关系。
    我们利用去识别的电子健康记录数据来识别暴露于多剂量三种最常用的他汀类药物(阿托伐他汀,辛伐他汀,或瑞舒伐他汀)在其纵向医疗保健的背景下。我们推导了ED50和Emax来量化与ASCVD事件和全因死亡率的复合结局的关系。
    我们估计了3,033个独特个体的ED50和Emax(阿托伐他汀:1,632,辛伐他汀:1,089和瑞舒伐他汀:312)使用非线性,混合效应剂量-反应模型。事件时间分析显示ED50和Emax与主要终点独立相关。危险比为0.85(p<0.01),0.83(p<0.01),ED50和1.13(p<0.001)为0.87(p=0.10),1.06(p<0.001),阿托伐他汀的Emax为1.15(p=0.009),辛伐他汀,和瑞舒伐他汀队列,分别。
    ED50和Emax与临床结局的全类关联表明,这些指标影响他汀类药物患者发生ASCVD事件的风险。
    UNASSIGNED: Statins reduce low-density lipoprotein cholesterol (LDL-C) and are efficacious in the prevention of atherosclerotic cardiovascular disease (ASCVD). Dose-response to statins varies among patients and can be modeled using three distinct pharmacological properties: (1) E0 (baseline LDL-C), (2) ED50 (potency: median dose achieving 50% reduction in LDL-C); and (3) Emax (efficacy: maximum LDL-C reduction). However, individualized dose-response and its association with ASCVD events remains unknown.
    UNASSIGNED: We analyze the relationship between ED50 and Emax with real-world cardiovascular disease outcomes.
    UNASSIGNED: We leveraged de-identified electronic health record data to identify individuals exposed to multiple doses of the three most commonly prescribed statins (atorvastatin, simvastatin, or rosuvastatin) within the context of their longitudinal healthcare. We derived ED50 and Emax to quantify the relationship with a composite outcome of ASCVD events and all-cause mortality.
    UNASSIGNED: We estimated ED50 and Emax for 3,033 unique individuals (atorvastatin: 1,632, simvastatin: 1,089, and rosuvastatin: 312) using a nonlinear, mixed effects dose-response model. Time-to-event analyses revealed that ED50 and Emax are independently associated with the primary endpoint. Hazard ratios were 0.85 (p < 0.01), 0.83 (p < 0.01), and 0.87 (p = 0.10) for ED50 and 1.13 (p < 0.001), 1.06 (p < 0.001), and 1.15 (p = 0.009) for Emax in the atorvastatin, simvastatin, and rosuvastatin cohorts, respectively.
    UNASSIGNED: The class-wide association of ED50 and Emax with clinical outcomes indicates that these measures influence the risk for ASCVD events in patients on statins.
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  • 文章类型: Journal Article
    背景:哮喘治疗指南将吸入性皮质类固醇(ICS)方案分类为低,中等,或高剂量。然而,疗效和安全性没有独立评估。此外,在选择给药方案时,不考虑ICS作用持续时间的差异.我们研究了这些限制对可用ICS分子的功效和安全性影响。
    方法:使用已发布的药效学和药代动力学参数,除了生理学和药理学原理,评估可用ICS分子的疗效和安全性。估计了肺中糖皮质激素受体(GR)占据的程度和持续时间(功效)和皮质醇抑制(全身暴露和安全性)。
    结果:一些ICS方案(例如,糠酸氟替卡松,丙酸氟替卡松,和环索奈德)的疗效较高,但对于全身暴露,与目前如何看待ICS剂量等效相反。疗效和全身暴露的剂量-反应关系的差异对于每个ICS方案是独特的,并反映在它们的治疗指数中。值得注意的是,即使低剂量的大多数ICSs可以在稳定状态的整个剂量间隔内产生高GR占有率(≥90%),这可能解释了先前报道的在临床剂量范围内获得剂量反应的困难,以及观察到大多数临床益处通常发生在低剂量。ICS分子的肺GR占用的估计剂量后持续时间被分类为4-6小时(短),14-16小时(中等),25-40小时(长),或>80小时(超长),提示抗炎作用持续时间可能存在较大差异。
    结论:在现实世界的临床环境中,对处方治疗的依从性可能较差,我们的研究结果表明,在哮喘患者中,长效ICS分子具有显著的治疗优势.
    哮喘患者通常依赖吸入糖皮质激素通过控制肺部炎症来控制症状。吸入皮质类固醇可以在低,中等,或高剂量;然而,的有效性,安全,选择时,不考虑特定吸入皮质类固醇分子的作用持续多长时间。这项研究调查了不同吸入皮质类固醇分子的安全性和有效性。利用已发表的关于抗炎作用模式的数据,以及这些分子从体内吸收和消除的速率,我们估计了它们的有效性和安全性,包括在肺部的作用持续时间和全身暴露水平。一些吸入的皮质类固醇分子,例如糠酸氟替卡松,丙酸氟替卡松,和环索奈德被发现在肺部表现出高度的抗炎效果与最小的全身暴露,对比目前使用的药物分子之间的感知相似性。对于每个吸入的皮质类固醇分子,身体其余部分中不需要的全身作用的抗炎持续时间是独特的。值得注意的是,即使是最低剂量的大多数吸入性皮质类固醇被发现在肺部有效时,支持先前的观察,即临床获益大多在较低剂量下实现。此外,不同吸入性皮质类固醇分子的估计剂量后有效性持续时间在不同分子之间差异很大,有些持续几个小时,有些持续超过80小时,表明他们的作用时间存在显著差异。总的来说,这些发现证明了使用长效吸入性糖皮质激素的潜在优势,特别是对于在坚持处方治疗方案方面可能面临挑战的哮喘患者。
    BACKGROUND: Asthma treatment guidelines classify inhaled corticosteroid (ICS) regimens as low, medium, or high dose. However, efficacy and safety are not independently assessed accordingly. Moreover, differences in ICS duration of action are not considered when a dose regimen is selected. We investigated the efficacy and safety implications of these limitations for available ICS molecules.
    METHODS: Published pharmacodynamic and pharmacokinetic parameters were used, alongside physiological and pharmacological principles, to estimate the efficacy and safety of available ICS molecules. Extent and duration of glucocorticoid receptor (GR) occupancy in the lung (efficacy) and cortisol suppression (systemic exposure and safety) were estimated.
    RESULTS: Some ICS regimens (e.g., fluticasone furoate, fluticasone propionate, and ciclesonide) rank high for efficacy but low for systemic exposure, contrary to how ICS dose equivalence is currently viewed. Differences in dose-response relationships for efficacy and systemic exposure were unique for each ICS regimen and reflected in their therapeutic indices. Notably, even low doses of most ICSs can generate high GR occupancy (≥ 90%) across the entire dose interval at steady state, which may explain previously reported difficulties in obtaining dose responses within the clinical dose range and observations that most clinical benefit typically occurs at low doses. The estimated post dose duration of lung GR occupancy for ICS molecules was categorized as 4-6 h (short), 14-16 h (medium), 25-40 h (long), or > 80 h (ultra-long), suggesting potentially large differences in anti-inflammatory duration of action.
    CONCLUSIONS: In a real-world clinical setting where there may be poor adherence to prescribed therapy, our findings suggest a significant therapeutic advantage for longer-acting ICS molecules in patients with asthma.
    Patients with asthma often rely on inhaled corticosteroids to manage their symptoms by controlling lung inflammation. Inhaled corticosteroids can be used at low, medium, or high doses; however, the effectiveness, safety, and how long the effects last for a particular inhaled corticosteroid molecule are not considered when choosing them. This study investigated the safety and efficacy of different inhaled corticosteroid molecules. Leveraging published data on the mode of anti-inflammatory action and the rates these molecules are absorbed and eliminated from the body, we estimated their effectiveness and safety profiles, including duration of action in the lungs and systemic exposure levels. Some inhaled corticosteroid molecules such as fluticasone furoate, fluticasone propionate, and ciclesonide were found to exhibit high anti-inflammatory effectiveness in the lungs with minimal systemic exposure, contrasting the perceived similarities among currently used drug molecules. Anti-inflammatory duration of the unwanted systemic effect in the rest of the body was unique for each inhaled corticosteroid molecule. Notably, even the lowest doses of most inhaled corticosteroids were found to be effective in the lungs when taken as prescribed, supporting previous observations that clinical benefits are mostly realized at lower doses. Furthermore, estimated post dose durations of effectiveness for different inhaled corticosteroid molecules varied widely among different molecules, with some lasting a few hours and others lasting more than 80 h, suggesting significant differences in their duration of action. Overall, these findings demonstrate the potential advantage of using longer-acting inhaled corticosteroids, particularly for patients with asthma who may face challenges in adhering to prescribed regimens.
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  • 文章类型: Journal Article
    建立了在任意光环境下估算植物色素光稳定状态(PSS)时间过程的模型。微分方程的解使用先前报道的植物色素的活性和非活性形式之间的转化率。该模型估计,90%的PSS变化是使用大约3.4mmolm-2的综合末远红光照射完成的,99%的变化是在大约6.9mmolm-2辐射下完成的。尽管这些值受远红光的光谱光子通量密度的影响。它们与先前检查远红照射剂量要求的结果一致。PSS变化接近平衡的速率在红灯下最大化,其次是远红色,绿色,和蓝光。这种估计方法可用于通过人工照明控制园艺的植物色素响应。
    A model to estimate the time course of a phytochrome photostationary state (PSS) under an arbitrary light environment was developed. It is the solution of differential equations that use conversion rates between active and inactive forms of previously reported phytochromes. The model estimated that 90% of the PSS changes were completed using approximately 3.4 mmol m-2 of integrated end-of-day far-red light irradiation, and 99% of the changes were completed with approximately 6.9 mmol m-2 irradiation. Although these values were affected by the spectral photon flux density of the far-red light. They were consistent with previous results that examined dose requirements of far-red irradiation. The rate at which the PSS changes approached equilibrium was maximized under a red light, followed by far-red, green, and blue light. This estimation method could be used to control phytochrome responses for horticulture via artificial lighting.
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  • 文章类型: Meta-Analysis
    经验证据表明,光疗(LT)可以通过刺激昼夜节律来减轻抑郁症状。然而,有怀疑和不确定的结果,以及关于剂量的困惑。这项研究的目的是量化光作为昼夜节律系统的刺激,并创建剂量-反应关系,可以帮助减少青少年和年轻人(AYAs)的疾病。这将为光照和神经反应提供参考,这在光干预的神经心理学机制中至关重要。该研究还旨在为临床应用提供指导。
    CLA(昼夜节律光)和CSt的最新定量模型,采用f(昼夜节律刺激)来量化光剂量,以在青年抑郁症相关的光疗中进行昼夜节律光转导。通过WebofScience发表到2023年的文章,科克伦图书馆,Medline(OVID),CINAHL,APAPsycINFO,Embase,学者们被找回了。使用Stata17.0,CMA3.0(综合荟萃分析3.0版)软件对31篇文章(1,031名受试者)进行荟萃分析,和Python3.9平台,用于光疗法疗效比较和剂量反应量化。
    在各种昼夜节律刺激条件下(0.11,500分钟的持续时间,表明实践指导的门槛。
    结果基于有限的样品,并受到小样品效应的影响。安慰剂效应不容忽视。
    尽管具有较高昼夜节律刺激的LT相对于调光控制的优越性仍未得到证实,在AYAs中已经注意到昼夜节律活跃的BLT具有更大的响应潜力,服用联合用药,疾病严重程度,时间模式,和视觉特征的考虑。已在各种条件下详细阐述了与定量昼夜节律刺激和时间模式的剂量反应关系,以支持大流行后时代的临床抑郁症治疗和LT设备应用。
    Empirical evidence has shown that light therapy (LT) can reduce depression symptoms by stimulating circadian rhythms. However, there is skepticism and inconclusive results, along with confusion regarding dosing. The purpose of this study is to quantify light as a stimulus for the circadian system and create a dose-response relationship that can help reduce maladies among adolescents and young adults (AYAs). This will provide a reference for light exposure and neural response, which are crucial in the neuropsychological mechanism of light intervention. The study also aims to provide guidance for clinical application.
    The latest quantitative model of CLA (circadian light) and CSt,f (circadian stimulus) was adopted to quantify light dose for circadian phototransduction in youth depression-related light therapy. Articles published up to 2023 through Web of Science, Cochrane Library, Medline (OVID), CINAHL, APA PsycINFO, Embase, and Scholars were retrieved. A meta-analysis of 31 articles (1,031 subjects) was performed using Stata17.0, CMA3.0 (comprehensive meta-analysis version 3.0) software, and Python 3.9 platform for light therapy efficacy comparison and dose-response quantification.
    Under various circadian stimulus conditions (0.1 < CSt,f < 0.7) of light therapy (LT), malady reductions among AYAs were observed (pooled SMD = -1.59, 95%CI = -1.86 to -1.32; z = -11.654, p = 0.000; I2 = 92.8%), with temporal pattern (p = 0.044) and co-medication (p = 0.000) suggested as main heterogeneity sources. For the efficacy advantage of LT with a higher circadian stimulus that is assumed to be influenced by visualization, co-medication, disease severity, and time pattern, sets of meta-analysis among random-controlled trials (RCTs) found evidence for significant efficacy of circadian-active bright light therapy (BLT) over circadian-inactive dim red light (SMD = -0.65, 95% CI = -0.96 to -0.34; z = -4.101, p = 0.000; I2 = 84.9%) or circadian-active dimmer white light (SMD = -0.37, 95% CI = -0.68 to -0.06; z = -2.318, p = 0.02; I2 = 33.8%), whereas green-blue, circadian-active BLT showed no significant superiority over circadian-inactive red/amber light controls (SMD = -0.21, 95% CI = -0.45 to 0.04; z = -2.318, p = 0.099; I2 = 0%). Overall, circadian-active BLT showed a greater likelihood of clinical response than dim light controls, with increased superiority observed with co-medication. For pre-to-post-treatment amelioration and corresponding dose-response relationship, cumulative duration was found more influential than other categorical (co-medication, severity, study design) or continuous (CSt,f) variables. Dose-response fitting indicated that the therapeutic effect would reach saturation among co-medicated patients at 32-42 days (900-1,000 min) and 58-59 days (1,100-1,500 min) among non-medicated AYAs. When exerting high circadian stimulus of light therapy (0.6 < CSt,f < 0.7), there was a significantly greater effect size in 1,000-1,500 min of accumulative duration than <1,000 or >1,500 min of duration, indicating a threshold for practical guidance.
    The results have been based on limited samples and influenced by a small sample effect. The placebo effect could not be ignored.
    Although the superiority of LT with higher circadian stimulus over dimmer light controls remains unproven, greater response potentials of circadian-active BLT have been noticed among AYAs, taking co-medication, disease severity, time pattern, and visual characteristics into consideration. The dose-response relationship with quantified circadian stimulus and temporal pattern had been elaborated under various conditions to support clinical depression treatment and LT device application in the post-pandemic era.
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  • 文章类型: Journal Article
    背景:我们评估了英国国家卫生服务糖尿病预防计划(DPP)的出勤水平与参与该计划的个体进展为2型糖尿病的风险之间的剂量-反应关系。
    方法:我们链接了2016年6月1日至2018年3月31日期间参加该计划并参加了至少一次计划会议的51,803名个人的DPP出勤数据。截至2020年3月31日,来自国家糖尿病审计的2型糖尿病诊断的初级保健记录。Weibull生存回归用于估计参加的项目会议次数与进展为2型糖尿病的风险之间的关联。
    结果:参加13个项目中的7个项目的个体患2型糖尿病的风险显著下降,并在12个项目中继续下降。参加完整的13个疗程与风险降低45.5%相关(HR:0.54595%CI:0.455至0.652)。与仅部分参加该计划的个人相比,参加60%或更多的课程与2型糖尿病风险降低30.7%相关(HR:0.69395%CI:0.645~0.745).
    结论:通过糖尿病预防计划降低2型糖尿病进展的风险需要在13个计划课程中的7个课程中达到最低出勤率(54%)。保留超过此最低水平的参与者可在降低糖尿病风险方面进一步受益。专员可能希望考虑更改提供商的付款时间表,以激励超过计划会议60%的更高保留水平。
    BACKGROUND: We evaluated the dose-response relationship between the level of attendance at the English National Health Service Diabetes Prevention Programme (DPP) and risk of progression to type 2 diabetes amongst individuals participating in the programme.
    METHODS: We linked data on DPP attendance for 51,803 individuals that were referred to the programme between 1st June 2016 and 31st March 2018 and attended at least one programme session, with primary care records of type 2 diabetes diagnoses from the National Diabetes Audit up to 31st March 2020. Weibull survival regressions were used to estimate the association between the number of programme sessions attended and risk of progression to type 2 diabetes.
    RESULTS: Risk of developing type 2 diabetes declined significantly for individuals attending seven of the 13 programme sessions and continued to decline further up to 12 sessions. Attending the full 13 sessions was associated with a 45.5% lower risk (HR: 0.545 95% CI: 0.455 to 0.652). Compared to individuals that only partially attended the programme, attendance at 60% or more of the sessions was associated with a 30.7% lower risk of type 2 diabetes (HR: 0.693 95% CI: 0.645 to 0.745).
    CONCLUSIONS: Reducing the risk of progression to type 2 diabetes through diabetes prevention programmes requires a minimum attendance level at seven of the 13 programme sessions (54%). Retaining participants beyond this minimum level yields further benefits in diabetes risk reduction. Commissioners may wish to consider altering provider payment schedules to incentivise higher retention levels beyond 60% of programme sessions.
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