Risk of Diabetic Retinopathy between Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists

Tzu-Yi Lin,Eugene Yu-Chuan Kang,Shih-Chieh Shao,Edward Chia-Cheng Lai,Sunir J. Garg,Kuan-Jen Chen,Je-Ho Kang,Wei-Chi Wu,Chi-Chun Lai,Yih-Shiou Hwang 대한당뇨병학회 2023 Diabetes and Metabolism Journal Vol.47 No.3

Background: To compare risk of diabetic retinopathy (DR) between patients taking sodium-glucose cotransporter-2 inhibitors (SGLT2is) and those taking glucagon-like peptide-1 receptor agonists (GLP1-RAs) in routine care.Methods: This retrospective cohort study emulating a target trial included patient data from the multi-institutional Chang Gung Research Database in Taiwan. Totally, 33,021 patients with type 2 diabetes mellitus using SGLT2is and GLP1-RAs between 2016 and 2019 were identified. 3,249 patients were excluded due to missing demographics, age <40 years, prior use of any study drug, a diagnosis of retinal disorders, a history of receiving vitreoretinal procedure, no baseline glycosylated hemoglobin, or no follow-up data. Baseline characteristics were balanced using inverse probability of treatment weighting with propensity scores. DR diagnoses and vitreoretinal interventions served as the primary outcomes. Occurrence of proliferative DR and DR receiving vitreoretinal interventions were regarded as vision-threatening DR.Results: There were 21,491 SGLT2i and 1,887 GLP1-RA users included for the analysis. Patients receiving SGLT2is and GLP-1 RAs exhibited comparable rate of any DR (subdistribution hazard ratio [SHR], 0.90; 95% confidence interval [CI], 0.79 to 1.03), whereas the rate of proliferative DR (SHR, 0.53; 95% CI, 0.42 to 0.68) was significantly lower in the SGLT2i group. Also, SGLT2i users showed significantly reduced risk of composite surgical outcome (SHR, 0.58; 95% CI, 0.48 to 0.70).Conclusion: Compared to those taking GLP1-RAs, patients receiving SGLT2is had a lower risk of proliferative DR and vitreoretinal interventions, although the rate of any DR was comparable between the SGLT2i and GLP1-RA groups. Thus, SGLT2is may be associated with a lower risk of vision-threatening DR but not DR development.

Semi-active leverage-type isolation system considering minimum structural energy

Tzu-Kang Lin,Lyan-Ywan Lu,Chi-Jen Chen 국제구조공학회 2018 Smart Structures and Systems, An International Jou Vol.21 No.3

Semi-active isolation systems based on leverage-type stiffness control strategies have been widely studied. The main concept behind this type of system is to adjust the stiffness in the isolator to match the fundamental period of the isolated system by using a simple leverage mechanism. Although this system achieves high performance under far-field earthquakes, it is unsuitable for near-fault strong ground motion. To overcome this problem, this study considers the potential energy effect in the control law of the semi-active isolation system. The minimal energy weighting (MEW) between the potential energy and kinetic energy was first optimized through a series of numerical simulations. Two MEW algorithms, namely generic and near-fault MEW control, were then developed to efficiently reduce the structural displacement responses. To demonstrate the performance of the proposed method, a two-degree-of-freedom structure was employed as a benchmark. Numerical results indicate that the dynamic response of the structure can be effectively dampened by the proposed MEW control under both far-field and near-fault earthquakes, whereas the structural responses resulting from conventional control methods may be greater than those for the purely passive control method. Moreover, according to experimental verifications, both the generic and near-fault MEW control modes yielded promising results under impulse-like earthquakes. The practicability of the proposed control algorithm was verified.

Semi-active leverage-type isolation system considering minimum structural energy

Lin, Tzu-Kang,Lu, Lyan-Ywan,Chen, Chi-Jen Techno-Press 2018 Smart Structures and Systems, An International Jou Vol.21 No.3

Semi-active isolation systems based on leverage-type stiffness control strategies have been widely studied. The main concept behind this type of system is to adjust the stiffness in the isolator to match the fundamental period of the isolated system by using a simple leverage mechanism. Although this system achieves high performance under far-field earthquakes, it is unsuitable for near-fault strong ground motion. To overcome this problem, this study considers the potential energy effect in the control law of the semi-active isolation system. The minimal energy weighting (MEW) between the potential energy and kinetic energy was first optimized through a series of numerical simulations. Two MEW algorithms, namely generic and near-fault MEW control, were then developed to efficiently reduce the structural displacement responses. To demonstrate the performance of the proposed method, a two-degree-of-freedom structure was employed as a benchmark. Numerical results indicate that the dynamic response of the structure can be effectively dampened by the proposed MEW control under both far-field and near-fault earthquakes, whereas the structural responses resulting from conventional control methods may be greater than those for the purely passive control method. Moreover, according to experimental verifications, both the generic and near-fault MEW control modes yielded promising results under impulse-like earthquakes. The practicability of the proposed control algorithm was verified.

Implementation of a bio-inspired two-mode structural health monitoring system

Tzu-Kang Lin,Li-Chen Yu,Kuo-Chun Chang,Anne Kiremidjian,Chang-Hung Ku 국제구조공학회 2011 Smart Structures and Systems, An International Jou Vol.8 No.1

A bio-inspired two-mode structural health monitoring (SHM) system based on the Naïve Bayes (NB) classification method is discussed in this paper. To implement the molecular biology based Deoxyribonucleic acid (DNA) array concept in structural health monitoring, which has been demonstrated to be superior in disease detection, two types of array expression data have been proposed for the development of the SHM algorithm. For the micro-vibration mode, a two-tier auto-regression with exogenous (AR-ARX)process is used to extract the expression array from the recorded structural time history while an ARX process is applied for the analysis of the earthquake mode. The health condition of the structure is then determined using the NB classification method. In addition, the union concept in probability is used to improve the accuracy of the system. To verify the performance and reliability of the SHM algorithm, a downscaled eight-storey steel building located at the shaking table of the National Center for Research on Earthquake Engineering (NCREE) was used as the benchmark structure. The structural response from different damage levels and locations was collected and incorporated in the database to aid the structural health monitoring process. Preliminary verification has demonstrated that the structure health condition can be precisely detected by the proposed algorithm. To implement the developed SHM system in a practical application, a SHM prototype consisting of the input sensing module, the transmission module, and the SHM platform was developed. The vibration data were first measured by the deployed sensor, and subsequently the SHM mode corresponding to the desired excitation is chosen automatically to quickly evaluate the health condition of the structure. Test results from the ambient vibration and shaking table test showed that the condition and location of the benchmark structure damage can be successfully detected by the proposed SHM prototype system, and the information is instantaneously transmitted to a remote server to facilitate real-time monitoring. Implementing the bio-inspired two-mode SHM practically has been successfully demonstrated.

A structural health monitoring system based on multifractal detrended cross-correlation analysis

Tzu-Kang Lin,Yi-Hsiu Chien 국제구조공학회 2017 Structural Engineering and Mechanics, An Int'l Jou Vol.63 No.6

In recent years, multifractal-based analysis methods have been widely applied in engineering. Among these methods, multifractal detrended cross-correlation analysis (MFDXA), a branch of fractal analysis, has been successfully applied in the fields of finance and biomedicine. For its great potential in reflecting the subtle characteristic among signals, a structural health monitoring (SHM) system based on MFDXA is proposed. In this system, damage assessment is conducted by exploiting the concept of multifractal theory to quantify the complexity of the vibration signal measured from a structure. According to the proposed algorithm, the damage condition is first distinguished by multifractal detrended fluctuation analysis. Subsequently, the relationship between the q-order, q-order detrended covariance, and length of segment is further explored. The dissimilarity between damaged and undamaged cases is visualized on contour diagrams, and the damage location can thus be detected using signals measured from different floors. Moreover, a damage index is proposed to efficiently enhance the SHM process. A sevenstory benchmark structure, located at the National Center for Research on Earthquake Engineering (NCREE) , was employed for an experimental verification to demonstrate the performance of the proposed SHM algorithm. According to the results, the damage condition and orientation could be correctly identified using the MFDXA algorithm and the proposed damage index. Since only the ambient vibration signal is required along with a set of initial reference measurements, the proposed SHM system can provide a lower cost, efficient, and reliable monitoring process.

Implementation of a bio-inspired two-mode structural health monitoring system

Lin, Tzu-Kang,Yu, Li-Chen,Ku, Chang-Hung,Chang, Kuo-Chun,Kiremidjian, Anne Techno-Press 2011 Smart Structures and Systems, An International Jou Vol.8 No.1

A bio-inspired two-mode structural health monitoring (SHM) system based on the Na$\ddot{i}$ve Bayes (NB) classification method is discussed in this paper. To implement the molecular biology based Deoxyribonucleic acid (DNA) array concept in structural health monitoring, which has been demonstrated to be superior in disease detection, two types of array expression data have been proposed for the development of the SHM algorithm. For the micro-vibration mode, a two-tier auto-regression with exogenous (AR-ARX) process is used to extract the expression array from the recorded structural time history while an ARX process is applied for the analysis of the earthquake mode. The health condition of the structure is then determined using the NB classification method. In addition, the union concept in probability is used to improve the accuracy of the system. To verify the performance and reliability of the SHM algorithm, a downscaled eight-storey steel building located at the shaking table of the National Center for Research on Earthquake Engineering (NCREE) was used as the benchmark structure. The structural response from different damage levels and locations was collected and incorporated in the database to aid the structural health monitoring process. Preliminary verification has demonstrated that the structure health condition can be precisely detected by the proposed algorithm. To implement the developed SHM system in a practical application, a SHM prototype consisting of the input sensing module, the transmission module, and the SHM platform was developed. The vibration data were first measured by the deployed sensor, and subsequently the SHM mode corresponding to the desired excitation is chosen automatically to quickly evaluate the health condition of the structure. Test results from the ambient vibration and shaking table test showed that the condition and location of the benchmark structure damage can be successfully detected by the proposed SHM prototype system, and the information is instantaneously transmitted to a remote server to facilitate real-time monitoring. Implementing the bio-inspired two-mode SHM practically has been successfully demonstrated.

Integration of in-situ load experiments and numerical modeling in a long-term bridge monitoring system on a newly-constructed widened section of freeway in Taiwan

Chiu, Yi-Tsung,Lin, Tzu-Kang,Hung, Hsiao-Hui,Sung, Yu-Chi,Chang, Kuo-Chun Techno-Press 2014 Smart Structures and Systems, An International Jou Vol.13 No.6

The widening project on Freeway No.1 in Taiwan has a total length of roughly 14 kilometers, and includes three special bridges, namely a 216 m long-span bridge crossing the original freeway, an F-bent double decked bridge in a co-constructed section, and a steel and prestressed concrete composite bridge. This study employed in-situ monitoring in conjunction with numerical modeling to establish a real-time monitoring system for the three bridges. In order to determine the initial static and dynamic behavior of the real bridges, forced vibration experiments, in-situ static load experiments, and dynamic load experiments were first carried out on the newly-constructed bridges before they went into use. Structural models of the bridges were then established using the finite element method, and in-situ vehicle load weight, arrangement, and speed were taken into consideration when performing comparisons employing data obtained from experimental measurements. The results showed consistency between the analytical simulations and experimental data. After determining a bridge's initial state, the proposed in-situ monitoring system, which is employed in conjunction with the established finite element model, can be utilized to assess the safety of a bridge's members, providing useful reference information to bridge management agencies.

Integration of in-situ load experiments and numerical modeling in a long-term bridge monitoring system on a newly-constructed widened section of freeway in Taiwan

Yi-Tsung Chiu,Tzu-Kang Lin,Hsiao-Hui Hung,Kuo-Chun Chang,Yu-Chi Sung 국제구조공학회 2014 Smart Structures and Systems, An International Jou Vol.13 No.6

The widening project on Freeway No.1 in Taiwan has a total length of roughly 14 kilometers,and includes three special bridges, namely a 216 m long-span bridge crossing the original freeway, an F-bentdouble decked bridge in a co-constructed section, and a steel and prestressed concrete composite bridge. This study employed in-situ monitoring in conjunction with numerical modeling to establish a real-timemonitoring system for the three bridges. In order to determine the initial static and dynamic behavior of thereal bridges, forced vibration experiments, in-situ static load experiments, and dynamic load experimentswere first carried out on the newly-constructed bridges before they went into use. Structural models of thebridges were then established using the finite element method, and in-situ vehicle load weight, arrangement,and speed were taken into consideration when performing comparisons employing data obtained fromexperimental measurements. The results showed consistency between the analytical simulations andexperimental data. After determining a bridge's initial state, the proposed in-situ monitoring system, which isemployed in conjunction with the established finite element model, can be utilized to assess the safety of abridge's members, providing useful reference information to bridge management agencies.

Damage identification of isolators in base-isolated torsionally coupled buildings

Wang, Jer-Fu,Huang, Ming-Chih,Lin, Chi-Chang,Lin, Tzu-Kang Techno-Press 2013 Smart Structures and Systems, An International Jou Vol.11 No.4

This paper deals with the damage assessment for isolators of base-isolated building systems considering the torsion-coupling (TC) effect by establishing damage indices. The damage indices can indicate the reduction in lateral stiffness of the isolator story as explicit formulas in terms of modal parameters. In addition, the damage location, expressed in terms of the estimated damage index and eccentricities before and after damage, is also presented. Numerical analysis shows that the proposed algorithms are applicable for general base-isolated multi-story TC buildings. A procedure from the analysis of seismic response to the implementation of damage indices is demonstrated by using a numerical case. A system identification technique is employed to extract modal parameters from seismic responses of a building. Results show that the proposed indices are capable of detecting the occurrence of damage and preliminarily estimating the location of damaged isolator.

Damage identification of isolators in base-isolated torsionally coupled buildings

Jer-Fu Wang,Chi-Chang Lin,Ming-Chih Huang,Tzu-Kang Lin 국제구조공학회 2013 Smart Structures and Systems, An International Jou Vol.11 No.4

This paper deals with the damage assessment for isolators of base-isolated building systems considering the torsion-coupling (TC) effect by establishing damage indices. The damage indices can indicate the reduction in lateral stiffness of the isolator story as explicit formulas in terms of modal parameters. In addition, the damage location, expressed in terms of the estimated damage index and eccentricities before and after damage, is also presented. Numerical analysis shows that the proposed algorithms are applicable for general base-isolated multi-story TC buildings. A procedure from the analysis of seismic response to the implementation of damage indices is demonstrated by using a numerical case. A system identification technique is employed to extract modal parameters from seismic responses of a building. Results show that the proposed indices are capable of detecting the occurrence of damage and preliminarily estimating the location of damaged isolator.