Objective:Heterogeneity of participants in clinical trials distorts intervention efficacy.However,factors associated with participant heterogeneity in randomized clinical trials(RCTs)focusing on systemic sclerosis(SSc)are not clear.We conducted this systematic review to establish normative standards for future research and help develop management guidelines.Methods:Three databases and 4 registries were searched to identify characteristics of SSc RCTs across different countries.Risk of bias was assessed by the Cochrane Collaboration’s tool and logistic regression was performed to calculate crude and adjusted odds ratios.Results:In total,261 trials met our inclusion criteria.The quality of SSc RCTs worldwide was relatively poor,with no trend of improvement in recent years,and only 12.2%were ranked as having a low risk of bias.Trials with a low risk of bias as well as single-center,single-country,or open-label trials tended to have better participant adherence than trials with a high risk of bias and multiple-center,multiple-country,or double-blind trials.Interestingly,trial registration and primary outcome definition contributed to high withdrawal.National income was also relevant;participant adherence in high-income countries,but not in upper-and lower-middle-income countries,was significantly altered by different variables.Conclusion:Overall,the risk of bias,national income,and trial design may lead to participant heterogeneity of SSc RCTs and ultimately confound the general clinical utility of the results.Trials with a rigorous design and transparent conduction protocol are crucial for obtaining unbiased data that can serve as a reference and for maintaining the fundamental repeatability of SSc RCTs.
Li-Qing ShiShi-Hang ZhouPing-Lang RuanBo ZhangYue XinCheng ZhaoXu YaoJing-Ru TianQian-Jin Lu
Federated learning is an important distributed model training technique in Internet of Things(IoT),in which participant selection is a key component that plays a role in improving training efficiency and model accuracy.This module enables a central server to select a subset of participants to performmodel training based on data and device information.By doing so,selected participants are rewarded and actively perform model training,while participants that are detrimental to training efficiency and model accuracy are excluded.However,in practice,participants may suspect that the central server may have miscalculated and thus not made the selection honestly.This lack of trustworthiness problem,which can demotivate participants,has received little attention.Another problem that has received little attention is the leakage of participants’private information during the selection process.We will therefore propose a federated learning framework with auditable participant selection.It supports smart contracts in selecting a set of suitable participants based on their training loss without compromising the privacy.Considering the possibility of malicious campaigning and impersonation of participants,the framework employs commitment schemes and zero-knowledge proofs to counteract these malicious behaviors.Finally,we analyze the security of the framework and conduct a series of experiments to demonstrate that the framework can effectively improve the efficiency of federated learning.
Background: Neutrophile to lymphocyte ratio (NLR) is a well-established marker of inflammation. It has been reported to be high in chronic kidney disease (CKD) and it is described as a prognosis factor in hemodialysis patients. However, limited data are available about the normal range of NLR in healthy adults as well as CKD patients including hemodialysis black Africans in Sub-Saharan countries. We sought to study NLR in healthy and advanced CKD in a single Cameroonian health facility. Methods: Blood samples were obtained from blood donors, CKD stage 4 and non-dialysis stage 5, and hemodialysis patients for more than 6 months. Patients with confounding factors such as positive CRP, infection, and recent use of steroids were excluded. RNL means standard deviations (SDs), and 95% confidence intervals (95% CI) were determined. RNL range was defined as percentiles P2.5 to P97.5. Results: A total of 102 participants were included. Mean age was 40.45 ± 9.97 years and 58.8% were male. Age and sex distribution were similar in the three groups. Leucopenia and neutropenia were common in all the groups. Means NLR was 1.29 ± 0.57 (95% CI 1.08 - 1.49) range between 0.55 to 2.67;2.31 ± 1.3 (95% CI 1.75 - 2.88) with range between 0.69 to 4.31 and 2.14 ± 0.98 (95% CI 1.85 - 2.44) with range between 0.77 to 4.32 respectively in controls, CKD, and hemodialysis participants. NLR was comparable in CKD and hemodialysis patients (p = 0.99). Compared to controls, NLR was significantly elevated in CKD (p = 0.043) and hemodialysis patients (p Conclusion: Our data suggest that the normal range for NLR in adult nongeriatric healthy and advanced CKD patients including those on chronic hemodialysis may vary between 0.55 to 2.67 and 0.69 to 4.32 respectively.
Objective:To explore the effects of Tai Chi on body mass index(BMI),exercise capacity,and mental health of overweight/obese adults,and investigate factors influencing adherence to enhance adherence of Tai Chi as a sustainable exercise method.Methods:A randomized,controlled,exploratory clinical trial was conducted paired with a qualitative study of adherence management.A total of 20 overweight/obese participants were randomly assigned to a standard Tai Chi group(experimental)and a simplified Tai Chi group(control)for an 8-week intervention,10 patients in each group,with a 12-month follow-up.BMI was calculated and exercise capacity including an isokinetic muscle strength and balance ability test were evaluated.Mental health was assessed using the General Well-Being Schedule(GWB),Pittsburgh Sleep Quality Index(PSQI),and Coping Self Efficacy Scale(CSES)at baseline,4th week,and 8th week,respectively.The qualitative research included open-interviews with Tai Chi practitioners and semi-structured interviews with subjects.Results:The intervention was conducted in Haidian Park,Beijing,China from October 6,2022,to January 1,2023,without dropouts.After an 8-week intervention,the participants in the experimental group exhibited a significant decrease in BMI(P<0.05).Both groups demonstrated significant improvements in exercise capacity(P<0.05).The experimental group exhibited a significant enhancement in the GWB,PSQI and CSES(P<0.05).Only GWB had significant difference in the control group(P<0.05).The experimental group surpassed the control group in GWB and CSES(P<0.05).The adherence rate was 87.5%in the experimental group and 57.9%in the control group after8 weeks intervention.Analysis on adherence identified 15 themes,the top 3 themes mentioned were as follows:mind-body effects,online and on-site guidance,training schedule(for subjects);mind-body effects,difficulties in practicing,and understanding of Tai Chi(for practitioners).Conclusions:Both interventions were effective in improving exercise capacity.Standard Tai Chi,in
