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Showing papers by "Qingdao University published in 2009"


Journal ArticleDOI
TL;DR: This paper focuses on adaptive fuzzy tracking control for a class of uncertain single-input /single-output nonlinear strict-feedback systems and a novel direct adaptive fuzzy Tracking controller is constructed via backstepping.

603 citations


Journal ArticleDOI
01 Feb 2009
TL;DR: Based on Lyapunov-Krasovskii stability theory and linear matrix inequality approach, stability conditions are proposed in terms of the upper and lower bounds of the delays of the nonlinear delayed HNNs.
Abstract: This paper is concerned with the problem of the robust stability of nonlinear delayed Hopfield neural networks (HNNs) with Markovian jumping parameters by Takagi-Sugeno (T-S) fuzzy model. The nonlinear delayed HNNs are first established as a modified T-S fuzzy model in which the consequent parts are composed of a set of Markovian jumping HNNs with interval delays. Time delays here are assumed to be time-varying and belong to the given intervals. Based on Lyapunov-Krasovskii stability theory and linear matrix inequality approach, stability conditions are proposed in terms of the upper and lower bounds of the delays. Finally, numerical examples are used to illustrate the effectiveness of the proposed method.

289 citations


Journal ArticleDOI
TL;DR: A novel adaptive neural controller is obtained by constructing a novel quadratic-type Lyapunov-Krasovskii functional, which not only efficiently avoids the controller singularity, but also relaxes the restriction on unknown virtual control coefficients.

234 citations


Journal ArticleDOI
TL;DR: In this article, the combustion behavior of biomass and coal blends under typical heating conditions was investigated, and the effects of a cold molding procedure for wheat straw on the burning properties were investigated.
Abstract: The combustion behavior of biomass and biomass–coal blends under typical heating conditions was investigated. Thermogravimetric analyses were performed on bituminite coal, aspen strawdust and wheat straw used alone and blended with different coal weight ratios. The behavior of biomass fuels in the burning process (different rates of volatilization, char burning and heat production) was analyzed, and the effects of a cold molding procedure for wheat straw on the burning properties were investigated. In addition, the kinetic parameters for the thermal conversion of each fuel were determined. Cold molding led to easier firing, and 5% coal was identified as the ideal ratio to achieve similar heat release characteristics to strawdust. Such a mixed pellet fuel with burning characteristics similar to aspen wood can be produced to take advantage of the wide design basis for wood-fired boilers.

222 citations


Journal ArticleDOI
TL;DR: It is shown that the controllability of a multi-agent system can be uniquely determined by the topology structure of interconnection graph, for which the investigation comes down to that for a multi -agent system with the interconnectiongraph being connected.

209 citations


Journal ArticleDOI
TL;DR: A design scheme for the observer-based output feedback controller is proposed to render the closed-loop networked system exponentially mean-square stable with H"~ performance requirement.

202 citations


Journal ArticleDOI
TL;DR: In this paper, the photocatalytic performance of Bismuth vanadate (BiVO 4 ) by a facile and inexpensive approach was reported, where an amorphous BiVO 4 was first prepared by a co-precipitation process from aqueous solutions of Bi(NO 3 ) 3 and NH 4 VO 3 using ammonia.

201 citations


Journal ArticleDOI
TL;DR: High iodine intake seems to be a significant risk factors for the occurrence of BRAF mutation in thyroid gland and may therefore be a risk factor for the development of PTC.
Abstract: Context: Epidemiological studies have indicated that high iodine intake might be a risk factor for papillary thyroid cancer (PTC), which commonly harbors the oncogenic T1799A BRAF mutation. Objective: The objective of the study was to investigate the relationship between BRAF mutation in PTC and iodine intake in patients. Subjects and Methods: We analyzed and compared the prevalences of the T1799A BRAF mutation in classical PTC of 1032 patients from five regions in China that uniquely harbor different iodine contents in natural drinking water, ranging from normal (10–21 μg/liter) to high (104–287 μg/liter). The BRAF mutation was identified by direct DNA sequencing. Results: The prevalence of BRAF mutation was significantly higher in any of the regions with high iodine content than any of the regions with normal iodine content. Overall, BRAF mutation was found in 387 of 559 PTC with high iodine content (69%) vs. 252 of 473 PTC with normal iodine content (53%), with an odds ratio of 1.97 (95% confidence int...

185 citations


Journal ArticleDOI
TL;DR: An overview of the current understanding of the molecular mechanisms involved in calcium dysregulation in AD, and an insight on how to exploit calcium regulation as therapeutic opportunities in AD are provided.

147 citations


Journal ArticleDOI
TL;DR: The results suggest that the neuroprotective effects of curcumin are attributed to the antioxidative properties and the modulation of nuclear factor-kappaB translocation.

128 citations


Journal ArticleDOI
Huiqun Zhang1
TL;DR: In this paper, the G ′ G -expansion method was used to construct exact travelling wave solutions of nonlinear evolution equations, the balance numbers of which are not positive integers.

Journal ArticleDOI
TL;DR: The mechanisms by whichCD4 T cells contribute to activation of CD8 T cells and the signal pathways of the down-streaming events after CD4 T cell help are evaluated.

Journal ArticleDOI
TL;DR: The parameters of wave intensity analysis are calculated from incremental changes in pressure and velocity, and the pressure generated by the filling and emptying of the reservoir, Otto Frank’s Windkessel must be excluded.
Abstract: The parameters of wave intensity analysis are calculated from incremental changes in pressure and velocity. While it is clear that forward- and backward-traveling waves induce incremental changes in pressure, not all incremental changes in pressure are due to waves; changes in pressure may also be due to changes in the volume of a compliant structure. When the left ventricular ejects blood rapidly into the aorta, aortic pressure increases, in part, because of the increase in aortic volume: aortic inflow is momentarily greater than aortic outflow. Therefore, to properly quantify the effects of forward or backward waves on arterial pressure and velocity (flow), the component of the incremental change in arterial pressure that is due only to this increase in arterial volume--and not, fundamentally, due to waves--first must be excluded. This component is the pressure generated by the filling and emptying of the reservoir, Otto Frank's Windkessel.

Journal ArticleDOI
Kang Sun1, Shaoqi Tian1, Jihua Zhang1, Changsuo Xia1, Cailong Zhang1, Tengbo Yu1 
TL;DR: Patients undergoing ACL reconstruction with BPTB non-irradiated allograft or autograft had similar clinical outcomes and gamma irradiation as a secondary sterilizing method is a reasonable alternative, according to the overall IKDC, functional, subjective evaluations and activity level testing.
Abstract: The effect of using gamma irradiation to sterilize bone-patellar tendon-bone (BPTB) allograft on the clinical outcomes of anterior cruciate ligament (ACL) reconstruction with irradiated allograft remains controversial. Our study was aimed to analyze the clinical outcomes of arthroscopic ACL reconstruction with irradiated BPTB allograft compared with non-irradiated allograft and autograft. All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 Mrad of irradiation prior to distribution. A total of 102 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into three groups. The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months follow-up (range 24-47 months) patients were evaluated by the same observer according to objective and subjective clinical evaluations. Of these patients, 99 (autograft 33, non-irradiated allograft 34, irradiated allograft 32) were available for full evaluation. When compared the irradiated allograft group to non-irradiated allograft group or autograft group at 31 months follow-up by the Lachman test, ADT, pivot shift test and KT-2000 arthrometer testing, statistically significant differences were found. Most importantly, 87.8% of patients in the Auto group, 85.3% in the Non-Ir-Auto group and just only 31.3% in the Ir-Allo group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%) and non-irradiated allograft (8.8%). The anterior and rotational stability decreased significantly in the irradiated allograft group. According to the overall IKDC, functional, subjective evaluations and activity level testing, no statistically significant differences were found between the three groups. However, there was a trend that the functional and activity level decreased and the patients felt uncomfortable more often in the irradiated allograft group. The statistical analysis showed no significant difference between the non-irradiated allograft group and the autograft group according to the aforementioned evaluations, except that patients in the allograft group had a shorter operation time and a longer duration of postoperative fever. When comparing the postoperative duration of fever of the two allograft groups, there was also a trend that the irradiated allograft group was longer than the non-irradiated allograft group, but no significant difference was found. When the patients had a fever, the laboratory examinations of all patients were almost normal (Blood routine was normal, the values of ESR were 5 - 16 mm/h, CRP were 3 - 10 mg/l). On the basis of our study, we concluded that patients undergoing ACL reconstruction with BPTB non-irradiated allograft or autograft had similar clinical outcomes. Non-irradiated BPTB allograft is a reasonable alternative to autograft for ACL reconstruction. While the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected with an increased failure rate. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate that gamma irradiation be used as a secondary sterilizing method. Further research into alternatives to gamma irradiation is needed.

Journal ArticleDOI
TL;DR: The data suggest that urban Chinese girls are actually experiencing earlier breast development than currently used norms, and the up-to-date reference for normal pubertal development in urban ChineseGirls needs to be established for the purpose of determining precocious puberty or Pubertal delay.
Abstract: Objectives To determine the current prevalence and mean ages of onset of pubertal characteristics in healthy urban Chinese girls. Methods A cross-sectional study of sexual maturation of healthy Chinese girls was conducted in 9 representative cities of the eastern, western, southern, and northern parts and central region of China between 2003 and 2005. At examination, stages of breast and pubic hair development were rated on girls 3 through 19.83 years of age, and height and weight were also recorded. Data on menses were collected by the status quo method. Probit analysis was used to calculate the median age and 95% confidence interval (CI) for onset of breast and pubic hair development and menarche. Results Data were analyzed for 20654 apparently healthy girls. At age 8 years, 19.57% of these girls had evidence of breast development. The median ages of onset of Tanner stages 2 and 3 for breast development were 9.20 (95% CI: 9.06-9.32) years and 10.37 (95% CI: 10.28-10.45) years, respectively. The median ages of onset of Tanner stages 2 and 3 for pubic hair development were 11.16 (95% CI: 11.03-11.29) years and 12.40 (95% CI: 12.25-12.55) years, respectively. Menses occurred at 12.27 years (95% CI: 12.16-12.39). Conclusions These data suggest that urban Chinese girls are actually experiencing earlier breast development than currently used norms. The up-to-date reference for normal pubertal development in urban Chinese girls needs to be established for the purpose of determining precocious puberty or pubertal delay.

Journal ArticleDOI
TL;DR: This paper addresses the robust H"~ fuzzy control problem for nonlinear uncertain systems with state and input time delays through Takagi-Sugeno (T-S) fuzzy model approach through delay-dependent sufficient conditions in linear matrix inequality (LMI) format.

Journal ArticleDOI
TL;DR: It is proved that, under the same topology and same prescribed leaders, a network of high-order dynamic agents is completely controllable if and only if so is anetwork of single-integrator agents.
Abstract: This paper investigates the controllability of multi-agent systems based on agreement protocols. First, for a group of single-integrator agents, the controllability is studied in a unified framework for both networks with leader-following structure and networks with undirected graph. Some new necessary/sufficient conditions for the controllability of networks of single-integrator agents are established. Second, we prove that, under the same topology and same prescribed leaders, a network of high-order dynamic agents is completely controllable if and only if so is a network of single-integrator agents. Third, how the selection of leaders and the coupling weights of graphs affect the controllability is analyzed. Finally, some numerical simulations are presented to demonstrate the effectiveness of the theoretical results.

Journal ArticleDOI
TL;DR: A direct and efficient Brønsted acid-promoted arylation of tri- and difluoromethyl ketones, as well perfluoroalkyl Ketones, has been developed; good to excellent enantioselectivities were achieved.

Journal ArticleDOI
TL;DR: CMTM3 exerts tumor-suppressive functions in tumor cells, with frequent epigenetic inactivation by promoter CpG methylation in common carcinomas, which could be reversed by pharmacologic demethylation.
Abstract: Closely located at the tumor suppressor locus 16q22.1, CKLF-like MARVEL transmembrane domain-containing member 3 and 4 (CMTM3 and CMTM4) encode two CMTM family proteins, which link chemokines and the transmembrane-4 superfamily. In contrast to the broad expression of both CMTM3 and CMTM4 in normal human adult tissues, only CMTM3 is silenced or down-regulated in common carcinoma (gastric, breast, nasopharyngeal, esophageal, and colon) cell lines and primary tumors. CMTM3 methylation was not detected in normal epithelial cell lines and tissues, with weak methylation present in only 5 of 35 (14%) gastric cancer adjacent normal tissues. Furthermore, immunohistochemistry showed that CMTM3 protein was absent in 12 of 35 (34%) gastric and 1 of 2 colorectal tumors, which was well correlated with its methylation status. The silencing of CMTM3 is due to aberrant promoter CpG methylation that could be reversed by pharmacologic demethylation. Ectopic expression of CMTM3 strongly suppressed the colony formation of carcinoma cell lines. In addition, CMTM3 inhibited tumor cell growth and induced apoptosis with caspase-3 activation. Thus, CMTM3 exerts tumor-suppressive functions in tumor cells, with frequent epigenetic inactivation by promoter CpG methylation in common carcinomas.

Journal ArticleDOI
TL;DR: In this article, the authors prepared thermosensitive hydrogels by adding α-β-glycerophosphate (α-β -GP) to chitosan (CS) solutions.

Journal ArticleDOI
Shuzhen Zhang1, Jun Wang1, Ning Song1, Jun Xia Xie1, Hong Jiang1 
TL;DR: The data suggest that although DMT1 mRNA contains an iron responsive element, its expression is not totally controlled by this, and MPP(+) could up-regulate the expression of D MT1 (-IRE) in an IRE/IRP-independent manner.

Journal ArticleDOI
TL;DR: The morphology and structure of Nn .

Journal ArticleDOI
TL;DR: An efficient cell-targeting and intracellular controlled-release drug delivery system based on a MSN-PEM-aptamer conjugate that may offer much needed efficacy in cancer therapy.
Abstract: The current work demonstrates an efficient cell-targeting and intracellular controlled-release drug delivery system based on a MSN-PEM-aptamer conjugate. In this system, mesoporous silica nanoparticles (MSN) were employed as drug containers for their high surface area and high loading efficacy. Polyelectrolyte multilayers (PEM) were used to prevent the premature leakage of drugs during the delivery process and controllably released drugs under reducing conditions. Finally, a cancer cell-specific DNA aptamer was selected as the targeting recognition molecule for its high cell recognition. By taking the advantages of high payload, stimuli-response to intracellular environment and high cell recognition ability, this type of delivery vehicle could be used as a promising drug delivery system for specific intracellular delivery and may offer much needed efficacy in cancer therapy.

Journal ArticleDOI
TL;DR: The results suggested that a detection of exon 4 before the assay of the whole PALB2 gene might be a cost-effective approach to the screening of Chinese population.
Abstract: PALB2 has been recently identified as breast cancer susceptibility gene in western populations. To investigate the contribution of PALB2 mutations to Chinese non-BRCA1/BRCA2 hereditary breast cancer, we screened all coding exons and intron-exon boundaries of PALB2 in 360 Chinese women with early-onset breast cancer or affected relatives from five breast disease clinical centers in China by utilizing PCR-DHPLC and DNA sequencing analysis. Some genetic variants identified in the cases were then studied in 864 normal controls with no personal or family history of breast cancer. Two protein-truncating PALB2 mutations, 751C>T and 1050_1051delAAinsTCT, were identified in three separate families, and 751C>T was a recurrent mutation. Neither of them, however, were present in the controls (P = 0.025). All the truncating mutations occured in exon 4 of PALB2, and there were still three unclassified variants were detected in the same fragment. We found that exon 4 accounted for 44.1% (15/34) of the person-times carrying with any variant in our study. PALB2 mutations were responsible for approximately 1% of Chinese women with early-onset breast cancer and affected relatives. Our results suggested that a detection of exon 4 before the assay of the whole PALB2 gene might be a cost-effective approach to the screening of Chinese population.

Journal ArticleDOI
TL;DR: It is found that miR-146a was significantly upregulated upon a 48-h cyclic stretch of 5% elongation/10cycles/min and predicted to base-pair with sequences in the 3' UTR of Numb, which promotes satellite cell differentiation towards muscle cells by inhibiting Notch signaling.

Journal ArticleDOI
TL;DR: It is shown that lack of miRNAs after the deletion of Dicer by Tie2-Cre (expressed in hematopoietic cells and endothelial cells) interrupted the development and maturation of iNKT cells in the thymus and significantly decreased the number ofiNKT Cells in different immune organs.
Abstract: MicroRNAs (miRNAs) are a class of evolutionarily conserved small noncoding RNAs that are increasingly being recognized as important regulators of gene expression. The ribonuclease III enzyme Dicer is essential for the processing of miRNAs. CD1d-restricted invariant natural killer T (iNKT) cells are potent regulators of diverse immune responses. The role of Dicer-generated miRNAs in the development and function of immune regulatory iNKT cells is unknown. Here, we generated a mouse strain with a tissue-specific disruption of Dicer, and showed that lack of miRNAs after the deletion of Dicer by Tie2-Cre (expressed in hematopoietic cells and endothelial cells) interrupted the development and maturation of iNKT cells in the thymus and significantly decreased the number of iNKT cells in different immune organs. Thymic and peripheral iNKT cell compartments were changed in miRNA-deficient mice, with a significantly increased frequency of CD4(+)CD8(+) iNKT cells in the thymus and a significantly decreased frequency of CD4(+) iNKT cells in the spleen. MiRNA-deficient iNKT cells display profound defects in alpha-GalCer-induced activation and cytokine production. Bone marrow (BM) from miRNA-deficient mice poorly reconstituted iNKT cells compared to BM from WT mice. Also, using a thymic iNKT cell transfer model, we found that iNKT cell homeostasis was impaired in miRNA-deficient recipient mice. Our data indicate that miRNAs expressed in hematopoietic cells and endothelial cells are potent regulators of iNKT cell development, function, and homeostasis.

Journal ArticleDOI
TL;DR: In this paper, the authors showed that ginsenoside Rg1 is a novel class of potent phytoestrogen and activates insulin-like growth factor-I receptor (IGF-IR) signalling pathway in human breast cancer MCF-7 cells.
Abstract: Background and purpose: We have shown that ginsenoside Rg1 is a novel class of potent phytoestrogen and activates insulin-like growth factor-I receptor (IGF-IR) signalling pathway in human breast cancer MCF-7 cells. The present study tested the hypothesis that the neuroprotective actions of Rg1 involved activation of the IGF-IR signalling pathway in a rat model of Parkinson's disease, induced by 6-hydroxydopamine (6-OHDA). Experimental approach: Ovariectomized rats were infused unilaterally with 6-OHDA into the medial forebrain bundle to lesion the nigrostriatal dopamine pathway and treated with Rg1 (1.5 h after 6-OHDA injections) in the absence or presence of the IGF-IR antagonist JB-1 (1 h before Rg1 injections). The rotational behaviour induced by apomorphine and the dopamine content in the striatum were studied. Protein and gene expression of tyrosine hydroxylase, dopamine transporter and Bcl-2 in the substantia nigra were also determined. Key results: Rg1 treatment ameliorated the rotational behaviour induced by apomorphine in our model of nigrostriatal injury. This effect was partly blocked by JB-1. 6-OHDA significantly decreased the dopamine content of the striatum and treatment with Rg1 reversed this decrease. Treatment with Rg1 of 6-OHDA-lesioned rats reduced neurotoxicity, as measured by tyrosine hydroxylase, dopamine transporter and Bcl-2 protein and gene level in the substantia nigra. These effects were abolished by JB-1. Conclusions and implications: These data provide the first evidence that Rg1 has neuroprotective effects on dopaminergic neurons in the 6-OHDA model of nigrostriatal injury and its actions might involve activation of the IGF-IR signalling pathway.

Journal ArticleDOI
Kang Sun1, Shaoqi Tian1, Jihua Zhang1, Changsuo Xia1, Cailong Zhang1, Tengbo Yu1 
TL;DR: Allograft is a reasonable alternative to autograft for ACL reconstruction and no significant difference was found in the development of osteoarthritis between the operated knee in comparison to the contralateral knee according to radiographs.
Abstract: Purpose The purpose of this study was to analyze the clinical outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with bone–patellar tendon–bone autograft versus allograft. Methods Between May 2000 and June 2004, 172 patients undergoing arthroscopic bone–patellar tendon–bone ACL reconstruction were prospectively randomized into autograft (n = 86) or allograft (n = 86) groups. The senior surgeon performed all operations using the same surgical technique. Each fixation was performed by means of an interference screw. Patients were evaluated preoperatively and postoperatively at follow-up. Of the patients, 156 (76 in the autograft group and 80 in the allograft group) were available for full evaluation. Evaluations included a detailed history, physical examination, functional knee ligament testing, KT-2000 arthrometer testing (MEDmetric, San Diego, CA), Harner's vertical jump and Daniel's 1-leg hop tests, Lysholm score, Tegner score, International Knee Documentation Committee standard evaluation form, Cincinnati knee score, and radiograph. Results Demographic data were comparable between groups. The mean follow-up was 5.6 years for both groups. There were no statistically significant differences according to evaluations of outcome between the 2 groups except that patients in the allograft group had a shorter operation time and longer fever time postoperatively compared with the autograft group. The postoperative infection rates were 0% and 1.25% for the autograft group and allograft group, respectively. There was a significant difference ( P P > .05). Conclusions Both groups of patients achieved almost the same satisfactory outcomes after a mean of 5.6 years of follow-up. Allograft is a reasonable alternative to autograft for ACL reconstruction. Level of Evidence Level II, prospective comparative study.

Journal ArticleDOI
TL;DR: In this paper, the passivity problem of uncertain neural networks with discrete and distributed time-varying delays is investigated and new delay-dependent conditions for this problem are obtained by using a novel Lyapunov functional together with the linear matrix inequality (LMI) approach.

Journal ArticleDOI
TL;DR: A systematic review of all included published, randomized controlled trials to evaluate the effects of thyroxin alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism found no significant statistical differences in biochemical variables, mood states clinical variables, adverse effects, and drop-out.
Abstract: Standard therapy for patients with hypothyroidism is replacement with synthetic thyroxine (T4) However, thyroxine plus triiodothyronine (T3) replacement therapy resulted in marked improvements in several items of the Profile of Mood States and in a few indices of psychometric function and quality of life The adequacy of thyroxine alone versus thyroxine plus triiodothyronine to treat hypothyroidism has yielded conflicting results Therefore, we conducted a systematic review of all included published, randomized controlled trials to evaluate the effects of thyroxine alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism We electronically searched Medline, Embase, the Cochrane Library, and China National Infrastructure We also manually searched the Chinese Journal of Isotopes, Radiologia pratica, and the Chinese Journal of Endocrinology and Metabolism A total of 10 randomized, double-blind trials (six crossovers, four parallel trials) were identified Pooled analyses were suggestive of a statistically significant increase of free and total triiodothyronine, significant decrease of serum-free and total thyroxine in patients treated with thyroxine plus triiodothyronine, weighted mean difference (WMD) 003, -3125, 219, 300; 95% confidence interval (CI) -014 to 020, -4704 to -1547, 046-392, 164-436, respectively Thyroxin alone indicated significant benefits for psychological or physical well-being in terms of the General Health Questionnaire-28 (WMD: -290; 95% CI: -318 to -263), general health (WMD: -038; 95% CI: -071 to -005), physical component summary (WMD: 07; 95% CI: 053-087), and mental component summary (WMD: 058; 95% CI: 025-075); physical functioning (WMD: 160; 95% CI: 129-190), role-physical test (WMD: 360; 95% CI: 266-454), bodily pain (WMD: 250; 95% CI: 211-288), role-emotional (WMD: 208; 95% CI: 117-299), mental health (WMD: 130; 95% CI: 097-164) in items of the Short Form-36 Health Survey; general well-being in items of the Thyroid Symptom Questionnaire (WMD: -190; 95% CI: -248 to -132); better performance in the Letter Number Sequencing-working memory test in items of cognitive performance scores (WMD: 110; 95% CI: 008-213), significant treatment effect for blurred vision, aches, and pain (WMD: -466, -080; 95% CI: -5339 to -400, -134 to -026, respectively) However, T4 plus T3 replacement improved cognitive performance (WMD: -049; 95% CI: -090 to -008) No significant statistical differences were found in biochemical variables, mood states clinical variables, adverse effects, and drop-out In subgroup analysis, two included studies examined the relationship between mental improvement and causes of hypothyroidism, autoimmune, and nonautoimmune hypothyroidism, respectively T4 alone suggested significantly higher total T4 (autoimmune and nonautoimmune thyroid, WMD: 45, 37; 95% CI: 224-676, 166-574, respectively), and significantly decreased thyroid-stimulating hormone (WMD: -005; 95% CI: -009 to -001) Statistically significant improvement occurred in pairs correctly recalled in the Digit Symbol Test for T4 plus T3 replacement (WMD: -160; 95% CI: -297 to -023) for nonautoimmune thyroid In conclusion, on the basis of data from recent studies, we conclude that combined T4 and T3 treatment does not improve well-being, cognitive function, or quality of life compared with T4 alone T4 alone may be beneficial in improving psychological or physical well-being According to the current evidence, T4 alone replacement may remain the drug of choice for hypothyroid patients