Ti4+ functionalized β-cyclodextrin covalent organic framework as a new immobilized metal ion affinity chromatography platform for selective capture of phosphorylated peptides and exosomes

A Ti4+ functionalized β-cyclodextrin covalent organic framework nanoparticle (named as β-CD-COF@Ti4+) was synthesized using a one-pot method successfully realizing the enrichment of phosphorylated peptides and exosomes based on the immobilized metal ion affinity chromatography strategy. The functionalized β-CD-COF@Ti4+ exhibited superior performance on the enrichment of phosphopeptides, including high selectivity (1:1000), low detection limit (0.5 fmol), and loading capacity for phosphopeptides (100 mg·g-1). After treatment with β-CD-COF@Ti4+, 9 phosphopeptides from defatted milk, 29 phosphopeptides related to 23 phosphoproteins from normal group serum, and 24 phosphopeptides related to 22 phosphoproteins from the serum of uremia patients were captured. Through the analysis of Gene Ontology, the captured phosphoprotein is closely related to kidney disease, including lipoprotein metabolism, very-low-density lipoprotein particle, high-density lipoprotein particle, and lipid binding activity process. Furthermore, western blot verification showed that this nanoparticle could successfully capture exosomes from human serum. This study demonstrates great prospects for the enrichment of phosphopeptides and exosomes from actual bio-samples.

[Research progress of vitamin D in inflammatory skin disease]

It is well known that vitamin D is engaged in calcium and phosphorus metabolism. However, vitamin D also plays an important role in other aspects over the past decades, such as immune response. Vitamin D has thus aroused the interest of the scientific community, especially the field of dermatology. The major source of vitamin D comes from the exposure of the skin to ultraviolet B. In turn, vitamin D regulates the proliferation and differentiation of keratinocytes, prevents opportunistic infection, and regulates the inflammatory response and immune response of the skin. Acne, psoriasis, atopic dermatitis, and other inflammatory skin diseases have been found to have a certain relationship with vitamin D. This article review the correlation between vitamin D and inflammatory skin diseases.

A novel hydrophilic polymer-coated magnetic nanomaterial based on the HILIC strategy for fast separation of glycopeptides and glycosylated exosomes

Novel hydrophilic poly(N, N-methylenebisacrylamide/1,2-epoxy-5-hexene) coated magnetic nanospheres functionalized with 2-aminopurine (denoted as Fe3O4@poly(MBA/EH)@2AP) for enriching glycopeptides and glycosylated exosomes were successfully obtained using a simple and green method on the basis of the HILIC (hydrophilic interaction liquid chromatography) enrichment strategy. The high density of polar groups endows the material with amazing hydrophilicity, enabling the nanomaterial to successfully capture glycopeptides and glycosylated exosomes within 1 min. Meanwhile, the materials demonstrated great sensitivity (0.01 fmol/μL), good loading capability (125 μg/mg), high selectivity (BSA:HRP = 1000:1), and repeatability (more than 10 times). Besides, the material was applied in the analysis of bio-samples, a total of 290 glycosylated peptides and 184 glycosylation sites mapping to 185 glycoproteins were identified in the serum of uremic patients. Besides, 42 glycopeptides were enriched from the saliva of healthy people. At the same time, it was verified by TEM and western blot that the complete glycosylated exosomes were successfully captured from the serum of the uremic patients. All experiments have demonstrated that Fe3O4@poly(MBA/EH)@2AP has a promising future in practical applications.

[Effect of the varicella vaccination on the clinical characteristics of herpes zoster cases aged 20 years and under]

To discuss the effect of varicella vaccination on the clinical characteristics of herpes zoster (shingles) cases aged 20 years and under, and analyze its clinical features. Based on the Yichang Health Big Data Platform, a descriptive study was conducted to collect the information of cases aged 20 years and under in three medical institutions of Yichang Central People's Hospital, Yichang First People's Hospital and Yichang Second People's Hospital from March 2019 to September 2020. According to the history of varicella vaccine, cases were divided into vaccination group and non-vaccination group, and their clinical features and outcomes were compared. The results showed that 46 shingles cases, aged from 7 to 20 years old, were included in this study. 26 males (56.5%), 20 females (43.5%), 15 cases in vaccination group (32.6%) and 31 cases in non-vaccination group (67.4%). 28 cases had thoracic involvement, followed by lumbar (n=8), cranial (n=7) involvements and extremities (n=7). The spread of herpes skin area: 2 cases involved too large area, 21 cases of 10 cm×10 cm, 14 cases of 5 cm×5 cm, 9 cases of 1 cm×1 cm. Herpes number: 26 cases had 10-49 herpes, followed by <10 herpes (n=9), uncountable herpes (n=7) and 50-99 herpes (n=4). The clinical course[M(Q₁,Q₃)] lasted 20.5 (13.5,24.8) d averagely, 5 cases had postherpetic neuralgia (PHN) and 1 case had respiratory complications. Shingles decrustation time was significantly shorter in vaccination group (Z=-2.01, P<0.05), and there was no significant difference in other characteristics by vaccination. In conclusion, the number and spread of shingles in most children and adolescents are less, and the complications such as PHN are less. Varicella vaccination can reduce the decrustation time and relieve shingles cases with some clinical symptoms.

Self-assembly of hydrazide-linked porous organic polymers rich in titanium for efficient enrichment of glycopeptides and phosphopeptides from human serum

In this work, titanium-rich hydrazide-linked porous organic polymers (hydrazide-POPs-Ti⁴⁺) were synthesized using hydrazine, 2,3-dihydroxyterephthalaldehyde (DHTA) and trimethyl 1,3,5-benzenetricarboxylate (TP) as the ligands. Hydrazide-POPs-Ti⁴⁺ combined with HILIC and IMAC can be used for simultaneous enrichment of glycopeptides and phosphopeptides. The detection limit of this protocol is 0.1 fmol μL^-1 for glycopeptides and 0.005 fmol μL^-1 for phosphopeptides, and the selectivities are 1 : 1000 and 1 : 2000 for glycopeptides and phosphopeptides, respectively. For practical bio-sample analysis, 201 glycopeptides associated with 129 glycoproteins and 26 phosphopeptides associated with 21 phosphoproteins were selectively captured from healthy human serum, and 186 glycopeptides associated with 117 glycoproteins and 60 phosphopeptides associated with 50 phosphoproteins were enriched in the serum of breast cancer patients. Gene Ontology analysis indicated that the identified glycoproteins and phosphoproteins were linked to breast cancer, including the binding of complement component C1q and low-density lipoprotein particles, protein oxidation and complement activation, suggesting that these connected pathways are probably engaged in the disease pathology of breast cancer.

[Development and validation of risk prediction model for new-onset cardiovascular diseases among breast cancer patients: Based on regional medical data of Inner Mongolia]

OBJECTIVE

To develop and validate a three-year risk prediction model for new-onset cardiovascular diseases (CVD) among female patients with breast cancer.

METHODS

Based on the data from Inner Mongolia Regional Healthcare Information Platform, female breast cancer patients over 18 years old who had received anti-tumor treatments were included. The candidate predictors were selected by Lasso regression after being included according to the results of the multivariate Fine & Gray model. Cox proportional hazard model, Logistic regression model, Fine & Gray model, random forest model, and XGBoost model were trained on the training set, and the model performance was evaluated on the testing set. The discrimination was evaluated by the area under the curve (AUC) of the receiver operator characteristic curve (ROC), and the calibration was evaluated by the calibration curve.

RESULTS

A total of 19 325 breast cancer patients were identified, with an average age of (52.76±10.44) years. The median follow-up was 1.18 [interquartile range (IQR): 2.71] years. In the study, 7 856 patients (40.65%) developed CVD within 3 years after the diagnosis of breast cancer. The final selected variables included age at diagnosis of breast cancer, gross domestic product (GDP) of residence, tumor stage, history of hypertension, ischemic heart disease, and cerebrovascular disease, type of surgery, type of chemotherapy and radiotherapy. In terms of model discrimination, when not considering survival time, the AUC of the XGBoost model was significantly higher than that of the random forest model [0.660 (95%CI: 0.644-0.675) vs. 0.608 (95%CI: 0.591-0.624), P < 0.001] and Logistic regression model [0.609 (95%CI: 0.593-0.625), P < 0.001]. The Logistic regression model and the XGBoost model showed better calibration. When considering survival time, Cox proportional hazard model and Fine & Gray model showed no significant difference for AUC [0.600 (95%CI: 0.584-0.616) vs. 0.615 (95%CI: 0.599-0.631), P=0.188], but Fine & Gray model showed better calibration.

CONCLUSION

It is feasible to develop a risk prediction model for new-onset CVD of breast cancer based on regional medical data in China. When not considering survival time, the XGBoost model and the Logistic regression model both showed better performance; Fine & Gray model showed better performance in consideration of survival time.

Facile preparation of porphyrin-based porous organic polymers for specific enrichment and isolation of phosphopeptides and phosphorylated exosomes

Exosomes, which can be used to investigate various disease processes, are novel disease markers that have been extensively studied in recent years. In this work, zirconium-rich porphyrin-based porous organic polymers (Imi-Pops-Zr) were synthesized by a facile and low-cost strategy for specific enrichment and isolation of phosphorylated peptides and exosomes. The proposed material demonstrates a low detection limit (0.5 fmol), a high selectivity (bovine serum albumin (BSA): β-casein = 1000:1), and a loading capability of 100 mg/g for phosphopeptides. For complex practical samples, after enrichment with Imi-Pops-Zr, 4 characteristic phosphopeptides from human serum, 20 and 12 phosphopeptides from human saliva and defatted milk were detected, respectively. Besides, 74 phosphorylated peptides with 67 phosphorylation sites belonging to 61 phosphoproteins and 67 phosphorylated peptides with 63 phosphorylation sites belonging to 65 phosphoproteins were detected from the serum of normal controls and uremic patients, respectively. Biological processes, cellular components and molecular functions revealed that interleukin-6, tumor necrosis factor, high density lipoprotein and proteases binding may be associated with uremia. Furthermore, Imi-Pops-Zr was successfully used to enrich and isolate exosomes from human serum. The experimental results show that Imi-Pops-Zr has promising application in the specific enrichment of phosphorylated peptides and exosomes in complex bio-samples.

One-step preparation of boronic acid-rich hydrothermal spheres for N-glycopeptide analysis from preeclampsia serum

In this study, we developed a green, one-step hydrothermal carbonization (HTC) method that used water as the sole solvent to create boronic acid group-rich carbonaceous spheres (BCS). When the abundant boronic acid groups on the carbonaceous spheres react with the hydroxyl groups on the glycans in an alkaline environment, the glycopeptides are specifically captured. The results showed that BCS had excellent detection limits (0.1 fmol μL^-1), selectivity (1 : 1000), and stability (10 cycles). In addition, the BCS also demonstrated excellent glycopeptide enrichment capabilities in complex biological samples; 219 glycopeptides attributed to 167 glycoproteins and 235 glycopeptides related to 166 glycoproteins in PE patient and normal pregnancy control serum were identified by nano LC-MS/MS, respectively. In addition, the molecular function of heparin binding and biological process of complement activation, positive regulation of immune response, and positive regulation of tumor necrosis factor production were significantly different between PE patients and healthy pregnant women according to gene ontology analysis, indicating that these may be associated with the development of PE.

Application of Microscopic Highly Hydrophilic Silica-Based Nanocomposites with High Surface Exposure in the Efficient Identification of Intact N-Glycopeptides

Glycosylation of proteins regulates the life activities of organisms, while abnormalities of glycosylation sites and glycan structures occur in various serious diseases such as cancer. A separation and enrichment procedure is necessary to realize the analysis of the glycoproteins/peptides by mass spectrometry, for which the surface hydrophilicity of the material is an important factor for the separation and enrichment performance. In the present work, under the premise of an obvious increase of the surface silicon exposure (79.6%), the amount of surface polar silanol is remarkably generated accompanying the introduction of the active amino groups on the surface of silica. The microscopic hydrophilicity, which is determined with water physical-adsorption measurements and can directly reflect the interaction of water molecules and the intrinsic surface of the material, maximally increases by 44%. This microscopically highly hydrophilic material shows excellent enrichment ability for glycopeptides, such as extremely low detection limits (0.01 fmol μL^-1), remarkable selectivity (1:8000), and size exclusion effects (1:8000). A total of 677 quantifiable intact N-glycopeptides were identified from the serum of patients with cervical cancer, and the glycosylation site and glycan structure were analyzed in depth, indicating that this novel material can show a broad practical application in cervical cancer diagnosis.

Surface functionalization modification of ultra-hydrophilic magnetic spheres with mesoporous silica for specific identification of glycopeptides in serum exosomes

Protein glycosylation of human serum exosomes can reveal significant physiological information, and the development of large-scale identification strategies is crucial for the in-depth investigation of the serum exosome glycoproteome. In this study, using surface functionalization techniques, an ultra-hydrophilic mesoporous silica magnetic nanosphere (denoted as Fe₃O₄-CG@mSiO₂) was synthesized for the quick and accurate detection of glycopeptides from HRP digests. The Fe₃O₄-CG@mSiO₂ nanospheres demonstrated outstanding enrichment capability, high sensitivity (5 amol/μL), good size exclusion effect (HRP digests/BSA proteins, 1:10,000), stable reusability (at least 10 times), and an excellent recovery rate (108.6 ± 5.5%). Additionally, after enrichment by Fe₃O₄-CG@mSiO₂, 156 glycopeptides assigned to 64 proteins derived from human serum exosomes were successfully identified, which demonstrates that the nanospheres have great potential for the research of the large-scale serum exosome glycoproteome.

[Clinical application of a quantitative method of atlantoaxial reduction angle in basilar invagination]

Objectives: To investigate the clinical application effect of a quantitative method of atlantoaxial reduction angle in basilar invagination. Methods: A retrospective analysis of clinical and radiographic data was conducted of 38 patients with complicated atlantoaxial dislocation and basilar invagination admitted to the Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University from May 2020 to May 2022. There were 5 males and 33 females, aged (53.5±9.9) years (range: 38 to 80 years). All patients underwent C_1-2 interarticular fusion cage implantation+occipital-cervical fixation by pressing rob with the cantilever technique. The atlantoaxial reduction model of previous studies by our team was used to calculate the reduction angles before surgery. Then titanium rods of prebending angle were prepared according to the calculation before the operation. After that quantitative reduction of angle was performed during the operation. The paired t-test was used to compare the difference between the theoretical and actual reset value. Results: The theoretical reduction angle of all patients was (10.62±1.78)° (range: 6.40° to 13.20°), the actual reduction angle was (10.53±1.63)° (range: 6.70° to 13.30°) and there was no statistical difference between them (t=1.688, P=0.100). The theoretical posterior occipitocervical angle after the operation of all patients was (117.37±5.88)° (range: 107.00° to 133.00°), the actual posterior occipitocervical angle after the operation was (118.25±6.77)° (range: 105.40° to 135.80°) and there was no statistical difference between them (t=-0.737, P=0.466). The postoperative follow-up time of the patients was more than 6 months and the symptoms of all patients were relieved. All patients had satisfactory fusion between small joints without incision infection, internal fixation fracture, displacement, atlantoaxial redislocation, and other long-term complications. Conclusion: The quantitative method of atlantoaxial reduction angle in basilar invagination can calculate the theoretical reduction angle of the clivus axis angle and guide the preparation of the pre-bending titanium rod before surgery, so as to realize the quantification of the atlantoaxial reduction angle.

Selective enrichment of glycopeptides using ground eggshell materials

The current research of protein glycosylation is focused on develop various functionalized hydrophilic materials that can effectively enrich glycopeptides. However, most of these materials require complex synthesis steps, plenty of chemical reagents, and high cost. In this study, we employed the natural eggshell for glycopeptides enrichment for the first time. Using horseradish peroxidase (HRP) tryptic digest as a standard sample, eggshell exhibited excellent sensitivity (0.05 fmol μL^-1), good selectivity [HRP tryptic digest:bovine serum albumin (BSA) tryptic digest = 1:1000], excellent size-exclusion effect (HRP tryptic digest:BSA protein = 1:10,000), good loading capacity (75 mg g^-1), and recovery (97.6 ± 0.3%). In addition, 153 and 114 glycopeptides were captured by eggshell from the serum tryptic digests of normal humans and diabetic patients, respectively. Benefiting from the singular porous structure and abundant biomass, eggshell performed excellently in the capture and separation of glycopeptides. These results demonstrated the potential of environmentally friendly eggshell in glycosylation proteomics analysis.

Safety and efficacy of cobimetinib plus atezolizumab in patients with solid tumors: a phase II, open-label, multicenter, multicohort study

BACKGROUND

Although introduction of immune checkpoint inhibitors has revolutionized the treatment of cancer, their response rates are generally low. Preclinical and early phase clinical data suggest that MEK inhibition may sensitize tumors to immune checkpoint inhibitors by upregulating tumor antigen expression, programmed death-ligand 1 (PD-L1) expression, and tumor T-cell infiltration. We evaluated the efficacy and safety of cobimetinib plus atezolizumab in patients with advanced solid tumors in the open-label, multicohort phase II COTEST study.

PATIENTS AND METHODS

This analysis of the COTEST trial included patients from cohorts 1-4 [1-3: anti-programmed cell death protein 1 (PD-1)/PD-L1 treatment-naive patients; 4: patients with disease progression on anti-PD-1/anti-PD-L1 treatment] who received cobimetinib 60 mg once daily for the first 21 days and intravenous infusions of atezolizumab 840 mg on days 1 and 15 of each 28-day cycle. Efficacy endpoints included objective response rate, overall survival, progression-free survival (PFS), and disease control rate.

RESULTS

Overall, 77 patients were enrolled in cohorts 1-4 (78% male; median age 62.8 years). Objective response rate was 20% in cohort 1 [squamous cell carcinoma of the head and neck (SCCHN)], 30% in cohort 2 (urothelial carcinoma), and 18% in cohort 3 (renal cell carcinoma); there were no responders among 20 patients in cohort 4 (SCCHN). The disease control rates in cohorts 1-4 were 50%, 40%, 24%, and 25%, respectively. The median PFS was 5.5, 3.4, 3.4, and 3.6 months in cohorts 1-4, respectively, and the median overall survival was 16.8, 18.7, 21.7, and 7.7 months, respectively. Most adverse events were of grade 1/2 and were manageable.

CONCLUSIONS

Cobimetinib plus atezolizumab had moderate activity in patients with anti-PD-1/PD-L1 treatment-naive SCCHN and urothelial carcinoma, and weak activity in anti-PD-1/PD-L1 treatment-naive renal cell carcinoma, and no activity in checkpoint inhibitor-treated patients.

Multifunctional magnesium-organic framework doped biodegradable bone cement for antibacterial growth, inflammatory regulation and osteogenic differentiation

Degradable bone cement has superior osteoconductivity and plasticity and is commonly used to treat defects greater than the critical-size. Magnesium gallate metal-organic frameworks (MOFs) (Mg-MOF), with antibacterial and anti-inflammatory properties, are doped into a composite cement composed of calcium sulfate, calcium citrate, and dicalcium hydrogen phosphate anhydrous (CS/CC/DCPA). The doping of the Mg-MOF slightly influences the microstructure and curing properties of the composite cement, with the mechanical strength of the cement displaying a significant increase from 27 to 32 MPa. Antibacterial tests reveal that the Mg-MOF bone cement has excellent antibacterial characteristics and can effectively inhibit bacterial growth in 4 h (Staphyloccocus aureus survival rate <10%). Herein, lipopolysaccharide (LPS)-induced macrophage models are used to investigate the anti-inflammatory characteristics of composite cement. The Mg-MOF bone cement can regulate the inflammatory factors and polarization of macrophages (M1 and M2). In addition, the composite cement promotes cell proliferation and osteo-differentiation of mBMSCs, and the activity of alkaline phosphatase and calcium nodules are increased. The bone related transcription factor and specific proteins, such as runt-related transcription factor 2 (Runx2), bone morphogenetic protein 2, osteocalcin (OCN), osteopontin (OPN), and collagen type 1 (COL1), were highly expressed by the Mg-MOF bone cements. Therefore, Mg-MOF doped CS/CC/DCPA bone cement is multifunctional for bone repair, which will promote bone formation and avoid the infection of wounds, and it is suitable for use with non-load-bearing bone defects.

Author Correction: Experimental study on thioredoxin redox inhibitor 1-methylpropyl 2-imidazolyl disulfide promoting apoptosis of multiple myeloma cells in vitro and in vivo

Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (4): 1283-1292. DOI: 10.26355/eurrev_202202_28121-PMID: 35253185-published online on December 15, 2022. After publication, the authors corrected the order of the author's affiliations as follows: Q.-D. Lin1,2,3,4, L.-N. Liu1,2,3,4, X.-Y. Liu1,2, Y. Yan1,2, B.-J. Fang1,2,3,4, Y.-L. Zhang1,2,3,4, J. Zhou1,2,3,4, Y.-F. Li1,2,3,4, W.-L. Zuo1,2,3,4, Y.-P. Song1,2,3,4 1Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou City, Henan Province, China 2Henan Cancer Hospital, Zhengzhou City, Henan Province, China 3Henan Key Lab of Experimental Hematology, Zhengzhou City, Henan Province, China 4Henan Institute of Hematology, Zhengzhou City, Henan Province, China There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/28121.

Hydrophilic, dual amino acid-functionalized zinc sulfide quantum dot for specific identification of N-glycopeptides from biological samples

RATIONALE

Glycosylation of proteins is one of the most significant and complex post-translational modifications, and N-glycosylation plays a crucial role in life activities. Mass spectrometry (MS) has been a powerful technique in the analysis of protein glycosylation. However, the direct detection of glycoproteins in biological samples based on MS still suffers from huge challenges. Therefore, enrichment and purification of samples before MS analysis is an essential prerequisite.

METHODS

Hydrophilic interaction liquid chromatography (HILIC) has significantly developed for selective enrichment of glycopeptides due to its simple operation process and unbiased enrichment. Herein, hydrophilic, dual amino acid-functionalized zinc sulfide quantum dots (ZnS QDs) were prepared to enrich glycopeptides using an easy procedure. The enriched glycopeptides were detected using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS).

RESULTS

The obtained material exhibited high selectivity (1:2000), low detection limit (0.1 fmol/μl), good repeatability (10 times), and excellent recovery (89.8%) in glycopeptide enrichment. In the actual application in biological samples, 71 N-glycopeptides and 161 N-glycopeptides were detected from human saliva and serum, respectively.

CONCLUSIONS

ZnS-Au-GC was successfully prepared using an easy method. The results showed that the obtained material exhibited excellent performance in glycopeptide enrichment. Furthermore, it had showed great potential for glycopeptide enrichment in complex biological samples.

BCL11B Upregulates the Expression of RelA in T Cells Stimulated with Staphylococcal Enterotoxin A

We explored the potential link between RelA and BCL11B transcription factors. To this end, Jurkat and Raji cells (Jurkat:Raji 10:1), as well as normal human peripheral blood T cells, were activated by staphylococcal enterotoxin A (SEA) and the expressions of both BCL11B and RelA mRNA and proteins were detected. BCL11B small interfering RNA was then transduced into Jurkat cells. Under the effect of SEA stimulation, the expression of BCL11B and RelA mRNA increased in two types of T cell lines over time, and the results were comparable with the levels of expression of BCL11B and RelA proteins. In the BCL11B-knockdown cells, the expression of RelA protein did not increase. These findings suggest that BCL11B regulates RelA expression in Jurkat cells and human peripheral blood T cells from healthy donors via the T-cell receptor signaling pathway.

Advances in proteomics sample preparation and enrichment for phosphorylation and glycosylation analysis

As the common and significant chemical modifications, post-translational modifications (PTMs) play a key role in the functional proteome. Affected by the signal interference, low concentration, and insufficient ionization efficiency of impurities, the direct detection of PTMs by mass spectrometry (MS) still faces many challenges. Therefore, sample preparation and enrichment are an indispensable link before MS analysis of PTMs in proteomics. The rapid development of functionalized materials with diverse morphologies and compositions provides an avenue for sample preparation and enrichment for PTMs analysis. In this review, we summarize recent advances in the application of novel functionalized materials in sample preparation for phosphoproteomes and glycoproteomes analysis. In addition, this review specifically discusses the design and preparation of functionalized materials based on different enrichment mechanisms, and proposes research directions and potential challenges for proteomic PTMs research.

[Surgical treatment strategy for difficult-reducible atlantoaxial dislocation]

Objective: To discuss the surgical strategy for difficult-reducible atlantoaxial dislocation. Methods: Clinical data of 82 patients with difficult-reducible atlantoaxial dislocation underwent surgical treatment in the Department of Neurosurgery, Xuanwu Hospital from January 2018 to February 2019 were retrospectively reviewed. Total of 32 men and 50 women were included, with a mean age of (41.8±12.9) years. Most cases (n=80) were treated with one-staged posterior atlantoaxial joint distraction and cage implantation, a few (n=2) underwent ventral decompression. All cases were followed up, postoperative improvement of clinical symptoms and radiology parameters were analyzed. Results: Of the patients, 80 cases (97.6%) received one-staged posterior atlantoaxial joint distraction and cage implantation; lateral facet joint bony fusion was found in 4 patients and was cut off with an osteotome. Transoral odontoidectomy was performed in 2 cases (2.4%) with fused atlanto-odontoid joint. All the patients were followed-up for (18.6±7.3) months. Postoperative CT showed complete reduction of ADI was achieved in 60 patients (75.0%). The ADI decreased significantly after the operation [(2.1±1.4) mm vs (5.0±1.5) mm, P<0.05]. The postoperative vertical distance between odontoid process and the Chamberlain line decreased significantly when compared with that before the operation [(3.9±3.8) mm vs (10.2±5.2) mm, P<0.05]. The mean JOA score at 6 months post operation improved significantly than that before the operation (13.7±1.5 vs 11.2±1.7, P<0.05). Seventy-five patients (93.8%) had atlantoaxial intra-articular bony fusion at 1 year follow-up. Conclusion: Most difficult-reducible atlantoaxial dislocations can be managed well by posterior one-staged atlantoaxial joint distraction and Cage implantation.

Hospitalist System under the Covid-19 Pandemic: The Perspective of Value Co-creation

Background

The core spirit of the Hospitalist system aims to set up dedicated wards, integrate physician manpower, focus on whole-person care, in order to cope with the aging population and Covid-19 pandemic, and to ensure that both parties, the medical personnel and patients, can provide or receive complete medical care. As the Taiwan medical system is facing a paradigm shift, the Taiwan hospitalist system will play an essential role in the transition as moving forward to provide professional care for inpatients.

Methods

Hospitalists from 12 hospitals across Taiwan completed a cross-sectional survey. The target population was identified through Taiwan Doctors and Nurses. Survey questionnaire was accessed by 342, incomplete response (18) were excluded and 324 completed responses were analysed.

Results

That the higher the cognition of medical staff on whole-person care, the higher the motivation to participate in cross-team cooperation (F = 35.914, p < 0.001); when the motivation to participate in cross-team cooperation was higher, the behavior of participating in whole-person care also increased. Will be higher (F = 36.483, p < 0.001); whole-person care behavior participation behavior has a significant impact on value creation (F = 21.068, p < 0.001)

Conclusions

As the Taiwan medical system is facing a paradigm shift, the Taiwan hospitalist system will play an essential role in the transition as moving forward to provide professional care for inpatients. This change will make possible the improvement of patient safety and quality medical care. The research results can be provided for reference in European and American countries.

Key messages

• A hospitalist support system is essential for establishing an efficient medical environment and reducing administrative work, which can help hospitals introduce a hospitalist system.

• To build a more stable and sustainable system, it is necessary to create a systemic operational foundation for proceeding with this new hospitalist system.

Comparative effectiveness of exercise-based cardiac rehabilitation for heart failure: a Bayesian network analysis of 44 randomized trials and 5896 patients

Introduction

The prevalence of heart failure (HF) is increasing nowadays. Exercise-based cardiac rehabilitation (CR) reduces mortality and further improves the outcome of patients with HF. However, the effect of different types of CR on HF remains unclear. Data comparing these CR have not been synthesized. Thus, the purpose of this study is to determine the relative efficacy of different types of exercise-based CR for individuals with HF using a Bayesian network meta-analysis.

Methods

We followed a pre-specified protocol (PROSPERO: CRD42021278351). We conducted a systematic literature review of any randomized controlled trials which evaluated exercise-based CR for patients with HF. Databases including Embase, Medline, the Cochrane Central Register of Controlled Trials, and Web of Science were screened up to 31 December 2021. The primary outcomes focus on functional capacity (peak oxygen uptake and 6-minute walk distance) and health-related quality of life (hr-QOL). The main analysis was complemented by network subanalysis, standard pairwise comparisons, and subgroup and sensitivity analyses. The pooled estimates were quantified as mean differences (MD) or standardized mean difference (SMD)where appropriate, at 95% confidence intervals (CI).

Results

We identified 44 randomized controlled trials with a total of 5896 HF participants. Among 23 studies that compared exercise-based CR and usual care, participants in center-based CR (CBCR) had improvement of peak oxygen uptake (MD: 2.30 mL/kg per minute; 95% CI, 0.43–4.40) and 6-minute walk distance (MD: 33 meters; 95% CI, 11.00–58.00).18 studies that compared exercise-based CR with usual care showed that CBCR and cardiac telerehabilitation (CTR) had greater improvements in hr-QOL (SMD: −0.38; 95% CI, −0.49 to −0.15 and SMD: −0.18,95% CI, −0.36 to −0.00 respectively). Treatment ranking indicated CTR has the highest probability (46.0%, 50.2%) of being the most effective CR for peak oxygen uptake and hr-QOL elevation respectively. CBCR was similarly indicated as the most effective treatment for 6-min walk distance (38.7%).

Conclusion

Exercise-based CR programs provide broader cardiovascular benefits compared with UC. CBCR significantly improved functional capacity. CBCR and CTR have favorable effects on hr-QOL.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): China Scholarship Council

Ameliorating effect of Trigonella foenum-graecum L. (fenugreek) extract tablet on exhaustive exercise-induced fatigue in rats by suppressing mitophagy in skeletal muscle

OBJECTIVE

Trigonella foenum-graecum L. (fenugreek) is widely used as a leafy vegetable and spice in China and North Africa. Recent studies have reported that fenugreek can reduce fatigue; however, its antifatigue mechanism remains unclear. Therefore, this study aimed to investigate the potential antifatigue effects of fenugreek extract (FE) on mitophagy and the underlying mechanisms.

MATERIALS AND METHODS

We evaluated the potential effects of FE tablet on an exhaustive exercise-induced fatigue (EEF) rat model. Oxidative stress indicators and fatigue biomarkers in the serum and skeletal muscle were detected. Mitophagy and mitochondrial morphology were observed using transmission electron microscopy. The expression levels of mitochondrial autophagy-related proteins were detected using western blot and immunofluorescence.

RESULTS

Compared with the model group, FE enhanced the activities of the antioxidant enzymes superoxide dismutase and glutathione peroxidase as well as total antioxidant capacity; however, it decreased the level of malondialdehyde in the serum and skeletal muscle after a 7-day treatment. Moreover, certain indicators of mitochondrial function, such as reactive oxygen species levels, ATP levels, cellular and mitochondrial Ca2+ levels, and ATPase activity, were significantly improved in the FE group compared with the model group. Finally, we found that mitophagy was induced by exhaustive exercise and inhibited by FE. Regarding mitochondrial autophagy-related proteins, the expression levels of LC3B, FUNDC1, PGAM5, PARKIN, and PINK1 in the skeletal muscle tissue were increased in the EEF group compared with the control group. After administration of FE and a positive control drug, a significant reversal in the expression of the above-mentioned proteins was noted.

CONCLUSIONS

Our findings demonstrate that FE exerted antifatigue effects in the EEF rat model by regulating the mitophagy-related FUNDC1/LC3B signaling pathway rather than the PINK1/PARKIN signaling pathway.