Association between gut microbiota and elevated serum urate in two independent cohorts

OBJECTIVES

Hyperuricemia is a precursor to gout and is often present in other metabolic diseases that are promoted by microbiome dysbiosis; however, no study has examined the association of gut microbiota with hyperuricemia and serum urate in humans.

METHODS

Study participants were derived from a community-based observational study, the Xiangya Osteoarthritis Study (discovery cohort). Hyperuricemia was defined as the presence of serum urate level >357 μmol/L for women and >416 μmol/L for men. Gut microbiota was analyzed using 16S rRNA sequencing from stool samples. We examined the relation of microbiota dysbiosis (i.e., richness, diversity, composition, and relative abundance of microbiota taxa) and predicted functional pathways to prevalent hyperuricemia and serum urate levels. We verified the associations in an independent observational study, the Step Study (validation cohort).

RESULTS

The discovery cohort consisted of 1,392 rural participants (mean age: 61.3 years; women: 57.4%; hyperuricemia: 17.2%). Participants with hyperuricemia had decreased richness and diversity, altered composition of microbiota, and lower relative abundances of genus Coprococcus compared with those with normouricemia. Predicted Kyoto Encyclopedia of Genes and Genomes metabolism pathways belonged to amino acid and nucleotide metabolisms were significantly altered in individuals with hyperuricemia compared with those with normouricemia. Gut microbiota richness, diversity and low relative abundances of genus Coprococcus were also associated with high levels of serum urate. These findings were replicated in the validation cohort with 480 participants.

CONCLUSIONS

Gut microbiota dysbiosis was associated with elevated serum urate levels. Our study raises the possibility that microbiota dysbiosis may modulate serum urate levels.

Surgical Outcomes After Neoadjuvant Chemoimmunotherapy for Resectable Non-Small Cell Lung Cancer

Background

Neoadjuvant chemoimmunotherapy for resectable non-small cell lung cancer (NSCLC) represents an important research topic. Despite the potential benefits of this approach, the inflammatory responses and adverse events associated with neoadjuvant chemoimmunotherapy can present technical challenges and compromise a planned resection. This study assessed the safety and feasibility of neoadjuvant chemoimmunotherapy followed by surgery for resectable NSCLC.

Methods

The study was conducted from May 2019 to March 2021. Patients who were age 18 years or older, were diagnosed with stage Ib-IIIb NSCLC, and received neoadjuvant chemoimmunotherapy followed by surgery were included. Demographic information, clinical and pathologic characteristics, data about neoadjuvant therapy, and surgical details were collected by retrospective chart review. Toxicity profiles were collected retrospectively or by telephone follow-up.

Results

Twenty patients were included in this study. The median age was 56 years (range, 48-72 years), and 18 patients (90%) were men. Squamous carcinoma (14/20, 70%) was the most common cancer type, followed by adenocarcinoma (4/20, 20%), adenosquamous carcinoma (1/20, 5%), and large cell neuroendocrine carcinoma (1/20, 5%). All patients received two to four cycles of neoadjuvant therapy, and the median interval between final therapy and surgery was 49 days (range, 23-133 days). Computed tomography evaluation after neoadjuvant therapy showed partial response in 15 patients (75%) and stable disease in 5 (25%). Final pathologic examinations showed major pathologic response in eight patients, including pathologic complete response in five (25%). Most patients (18/20, 90%) had reduced pathologic staging. Twelve patients (60%) underwent open thoracotomy; the other eight patients underwent minimally invasive surgery, which was uneventful and without intraoperative conversion to open thoracotomy. No perioperative deaths occurred, and only seven patients (35%) developed postoperative complications. Most patients experienced only grade 1-2 adverse effects and laboratory abnormalities during neoadjuvant therapy, and no grade 3 or worse adverse effects or laboratory abnormalities occurred. No patients experienced surgical delays as a result of immune-related adverse events.

Conclusions

Preoperative administration of chemoimmunotherapy for patients with resectable NSCLC was safe and feasible.

Optimizing the Electronic Structure of ZnS via Cobalt Surface Doping for Promoted Photocatalytic Hydrogen Production

Developing highly efficient semiconductor photocatalysts for H₂ evolution is intriguing, but their efficiency is subjected to the following three critical issues: limited light absorption, low carrier separation efficiency, and sluggish H₂ evolution kinetics. Element surface doping is a feasible strategy to synchronously break through the above limitations. In this study, we prepared a series of Co-surface-doped ZnS photocatalysts to systematically investigate the effects of Co surface doping on photocatalytic activity and electronic structure. The implantation of Co results in the emergence of the impurity level above the valence band (VB) and the upshifted conduction band (CB) and enhances its visible light absorption. Co gradient doping inhibits the combination and facilitates the migration of carriers. S atoms are proven to be reactive active sites for photocatalytic H₂ evolution over both ZnS and Co-doped ZnS. Co doping alters the surface electronic structure and decreases the absolute value for the hydrogen binding free energy (ΔG_H) of the adsorbed hydrogen atom on the catalyst. As a consequence, Co-surface-doped ZnS shows boosted photocatalytic H₂ evolution activity relative to the undoped material. This work provides insights into the mechanistic understanding of the surface element doping modification strategy to developing efficient photocatalysts.

Impact of human gene annotations on RNA-seq differential expression analysis

BACKGROUND

Differential expression (DE) analysis of RNA-seq data typically depends on gene annotations. Different sets of gene annotations are available for the human genome and are continually updated-a process complicated with the development and application of high-throughput sequencing technologies. However, the impact of the complexity of gene annotations on DE analysis remains unclear.

RESULTS

Using "mappability", a metric of the complexity of gene annotation, we compared three distinct human gene annotations, GENCODE, RefSeq, and NONCODE, and evaluated how mappability affected DE analysis. We found that mappability was significantly different among the human gene annotations. We also found that increasing mappability improved the performance of DE analysis, and the impact of mappability mainly evident in the quantification step and propagated downstream of DE analysis systematically.

CONCLUSIONS

We assessed how the complexity of gene annotations affects DE analysis using mappability. Our findings indicate that the growth and complexity of gene annotations negatively impact the performance of DE analysis, suggesting that an approach that excludes unnecessary gene models from gene annotations improves the performance of DE analysis.

Association between bariatric surgery with long-term analgesic prescription and all-cause mortality among patients with osteoarthritis: a general population-based cohort study

OBJECTIVES

There is still a large unmet need for novel osteoarthritis (OA) treatments that could provide clinically important effects on long-term pain relief (≥12 months). We examined the relation of bariatric surgery along with weight loss to analgesic prescription and all-cause mortality among individuals with OA.

METHODS

We conducted a cohort study among individuals with OA using The Health Improvement Network. We compared the rate of no analgesic prescription ≥12 consecutive months and the risk of all-cause mortality using inverse probability weighting Cox-proportional hazard models and the difference in number of analgesic prescriptions (non-steroidal anti-inflammatory drugs, opioids, and paracetamol) in the 50^th, 75^th and 90^th percentiles using quantile regression model between bariatric and non-bariatric cohorts.

RESULTS

Included were 588,494 individuals (694 had bariatric surgery). Compared with non-bariatric group, the rate of no analgesic prescription ≥12 consecutive months was higher (HR = 1.23, 95% CI: 1.08-1.38) in bariatric surgery group, and the number of analgesic prescriptions was lower in the 75^th (44 vs 58) and 90^th (74 vs 106) percentiles during a mean follow-up of 4.3 years. All-cause mortality in bariatric surgery group was lower than comparison group (HR = 0.46, 95% CI: 0.41-0.51).

CONCLUSION

This study presents the first evidence that bariatric surgery was associated with decreased long-term analgesic prescription and decreased all-cause mortality among individuals with OA. However, our findings may be overestimated owing to intractable confounding by indication for bariatric surgery; thus, future studies (e.g., clinical trials) are warranted.

Comparative efficacy and safety of acetaminophen, topical and oral non-steroidal anti-inflammatory drugs for knee osteoarthritis: evidence from a network meta-analysis of randomized controlled trials and real-world data

OBJECTIVE

Current global guidelines regarding the first-line analgesics (acetaminophen, topical or oral non-steroidal anti-inflammatory drugs [NSAIDs]) for knee osteoarthritis remain controversial and their comparative risk-benefit profiles have yet to be adequately assessed.

DESIGN

Pubmed, Embase, Cochrane Library, and Web of Science were searched from database inception to March 2021 for randomized controlled trials (RCTs) comparing acetaminophen, topical NSAIDs and oral NSAIDs directly or indirectly in knee osteoarthritis. Bayesian network meta-analyses were conducted. A propensity-score matched cohort study was also conducted among patients with knee osteoarthritis in The Health Improvement Network database.

RESULTS

122 RCTs (47,113 participants) were networked. Topical NSAIDs were superior to acetaminophen (standardized mean difference [SMD] = -0.29, 95% credible interval [CrI]: -0.52 to -0.06) and not statistically different from oral NSAIDs (SMD = 0.03, 95% CrI: -0.16 to 0.22) for function. It had lower risk of gastrointestinal adverse effects (AEs) than acetaminophen (risk ratio [RR] = 0.52, 95%CrI: 0.35 to 0.76) and oral NSAIDs (RR = 0.46, 95%CrI: 0.34 to 0.61) in RCTs. In real-world data, topical NSAIDs showed lower risks of all-cause mortality (hazard ratio [HR] = 0.59, 95% confidence interval [CI]: 0.52 to 0.68), cardiovascular diseases (HR = 0.73, 95%CI: 0.63 to 0.85) and gastrointestinal bleeding (HR = 0.53, 95%CI: 0.41 to 0.69) than acetaminophen during the one-year follow-up (n = 22,158 participants/group). A better safety profile was also observed for topical than oral NSAIDs (n = 14,218 participants/group).

CONCLUSIONS

Topical NSAIDs are more effective than acetaminophen but not oral NSAIDs for function improvement in people with knee osteoarthritis. Topical NSAIDs are safer than acetaminophen or oral NSAIDs in trials and real-world data.

Identifying predictors of response to oral non-steroidal anti-inflammatory drugs and paracetamol in osteoarthritis: a hypothesis-driven protocol for an OA Trial Bank individual participant data meta-analysis

INTRODUCTION

Symptomatic treatments for osteoarthritis (OA) provide only small-to-moderate efficacy over placebo in randomised controlled trials (RCTs). Treatment guidelines therefore have emphasised the need to identify predictors of treatment response through subgroup and multiple regression analysis. Individual participant data (IPD) meta-analysis is recommended as an efficient approach for this purpose. To our knowledge, this has not been undertaken for oral non-steroidal anti-inflammatory drugs (NSAIDs), including paracetamol, in OA. In this IPD meta-analysis, we aim to identify RCTs with specific mechanistic features related to OA pain, such as joint inflammation. We hypothesise that NSAIDs may work better for participants with joint inflammation, whereas paracetamol may not.

METHODS AND ANALYSIS

A comprehensive literature search will be conducted on the databases of Web of Science, Embase, Medline, CINAHL, AMED and the Cochrane Library from 1 January 1998 to 1 December 2020. All RCTs related to oral NSAIDs or paracetamol including placebo-controlled trials in people with OA that have evaluated pain-related peripheral risk factors (eg, clinically detected knee effusion, synovial hypertrophy or effusion on imaging, knee morning stiffness, elevated serum C-reactive protein (CRP) level) and/or central pain risk factors (eg, pain elsewhere, depression, anxiety, sleep disturbance) will be retrieved. The outcome will be change in pain from baseline. Change in function and patient global assessment will also be included as outcomes if available. Investigators of all eligible trials will be contacted for IPD. Multilevel regression models will be used to identify predictors for the specific (active-placebo) and the overall treatment effect (change from baseline in active group).

ETHICS AND DISSEMINATION

No identifiable data will be included in this study and no formal ethics approval is required as no new data collection will be processed. Results of this hypothesis-driven IPD meta-analysis will be disseminated through conference presentations and publication in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42020165098.

Association Between Gut Microbiota and Symptomatic Hand Osteoarthritis: Data From the Xiangya Osteoarthritis Study

Objective

Systemic inflammatory factors have been implicated in symptomatic hand osteoarthritis (OA). Gut microbiome dysbiosis promotes systemic inflammation. The aim of this study was to examine the association between the gut microbiome and the presence of symptomatic hand OA in a population‐based study.

Methods

Study participants were subjects of the Xiangya Osteoarthritis Study, a community‐based observational study conducted in the Hunan Province of China. Symptomatic hand OA was defined as the presence of both symptoms and radiographic OA in the same hand. The gut microbiome was analyzed using 16S ribosomal RNA gene sequencing in stool samples. We examined the relation of α‐diversity, β‐diversity, relative abundance of taxa, and potential bacterial functional pathways to symptomatic hand OA.

Results

A total of 1,388 participants (mean age 61.3 years, 57.4% women) were included in the study, of whom 72 had symptomatic hand OA (prevalence of symptomatic hand OA 5.2%). Beta‐diversity of the gut microbiome, but not α‐diversity, was significantly associated with the presence of symptomatic hand OA (P = 0.003). Higher relative abundance of the genera Bilophila and Desulfovibrio as well as lower relative abundance of the genus Roseburia was associated with symptomatic hand OA. Most functional pathways (i.e., those annotated in the KEGG Ortholog hierarchy) that were observed to be altered in participants with symptomatic hand OA belonged to the amino acid, carbohydrate, and lipid metabolic pathways.

Conclusion

This large, population‐based study provides the first evidence that alterations in the composition of the gut microbiome were observed among study participants who had symptomatic hand OA, and a low relative abundance of Roseburia but high relative abundance of Bilophila and Desulfovibrio at the genus level were associated with prevalent symptomatic hand OA. These findings may help investigators understand the role of the microbiome in the development of symptomatic hand OA and could contribute to potential translational opportunities.

[The clinical effects of oral contraceptive pretreatment on the outcome of gonadotropin releasing hormone antagonist protocol in non-polycystic ovary syndrome patients]

Objective: To evaluate the clinical effect of oral contraceptive (OC) pretreatment on the outcome of gonadotropin releasing hormone antagonist (GnRH-a) protocol in patients with non-polycystic ovary syndrome. Methods: From January 2017 to May 2019, a total of 436 patients undergoing in vitro fertilization and embryo transfer/Intracytoplasmic sperm injection (IVF-ET/ICSI) treatment in Peking University First Hospital reproductive center clinic were included in this retrospective cohort study. A total of 144 patients (147 cycles) used OC pretreatment prior to GnRH-a protocol and 292 patients (306 cycles) used GnRH-a protocol without OC pretreatment. The drug usage as well as pregnant outcomes between groups were examined. The primary outcome was the cumulative clinical pregnancy rate of oocyte retrieval cycle and the secondary outcome included the number of oocytes, MⅡ oocytes, embryos and clinical pregnancy rate of fresh embryo transfer cycle. Results: The median ages (and Q₁, Q₃) of OC pretreatment group and non-OC group were 33 (30,36) and 34 (30,38) years old, respectively. The number of MⅡ oocytes was higher in OC pretreatment group (7/9) than in non-OC group (6/8) (P=0.002). The significant difference were not found in the cumulative clinical pregnancy rate of each oocyte retrieval cycle (61.7% vs 54.6%), the clinical pregnancy rate of fresh embryo transfer cycle (34.4% vs 35.6%), and the number of oocytes (9 vs 8) and embryos (6 vs 6) between groups. Conclusion: Our findings suggest that compared to non-OC pretreatment group, pretreatment with OC is associated with more MⅡ oocytes, and with an increasing trend of the cumulative clinical pregnancy rate in non-polycystic ovary syndrome patients undergoing fresh IVF-ET/ICSI.

Biliopancreatic Limb Length of Small Intestinal Bypass in Non-obese Goto-Kakizaki (GK) Rats Correlates with Gastrointestinal Hormones, Adipokines, and Improvement in Type 2 Diabetes

BACKGROUND

The purpose of this study was to explore the effects on type 2 diabetes, gastrointestinal hormones, and adipokines after the small intestinal bypass of different biliopancreatic limb (BPL) lengths in non-obese type 2 diabetic rats.

METHOD

Small intestinal bypass with the BPL length at 10cm, 20cm, 30cm, and 40cm, respectively, and sham surgery were performed in non-obese GK rats. Fasting serum was collected at 2 days preoperatively and 1, 3, 6, and 9 weeks postoperatively. Body weight and fasting blood glucose (FBG) were measured during the experiment. Glycated hemoglobin (GHb), fasting insulin (FINS), C-peptide, ghrelin, leptin, adiponectin, and somatostatin were measured postoperatively.

RESULT

Rats with a bypassed length of 40cm died within 5-9 weeks. No statistically significant was observed in body weight between the sham group and the bypass groups at the 9th week postoperatively. FBG, GHb, FINS, C-peptide, and HOMA-IR in the bypass groups were lower than those in the sham group postoperatively and were negatively correlated with BPL length. Ghrelin and leptin declined compared with preoperative but were not associated with BPL length. Adiponectin of the bypass groups increased after operation and was positively correlated with BPL length. Somatostatin remained stable among groups during the experiment.

CONCLUSION

Ghrelin and leptin of non-obese GK rats decreased postoperatively without a linear relationship with the BPL length, while adiponectin increased with positively correlation with the BPL length. In addition, somatostatin remained steady after small intestinal bypass. Further studies are expected to confirm the effect of the BPL length of small intestinal bypass on gastrointestinal hormones and adipokines.

Facile and effective repair of Pt/Nafion IPMC actuator by dip-coating of PVP@AgNPs

Ionic polymer metal composite (IPMC) always takes big risks of electrode cracking and peeling, which lead to energy wasting, waterloss, and uneven electric field distribution, thus hamper its commercial applications. To address this issue, we propose a facile and effective technique to repair the electrode fatigue by coating polyvinylpyrrolidone (PVP) encapsulated Ag nanoparticles (PVP@AgNPs) on the long-term used IPMC surface. To improve the electrochemical stability, the silver nanoparticles (Ag NPs) with a diameter of ∼34 nm are encapsulated by a 1.3 nm thick PVP film, thus forming a shell-core structure to resist corrosion from the electrolyte solution. Physiochemical investigations reveal that, PVP@AgNPs closely attach to the interior and exterior surfaces of the original Pt nanograin electrode, thus refreshing its electronic conductivity; the repaired IPMC actuator exhibits better electromechanical properties compared to its precursor actuator: 7.62 folds in displacement output, 9.38 folds in force output, and 9.73 folds in stable working time.

Binding patterns of RNA-binding proteins to repeat-derived RNA sequences reveal putative functional RNA elements

Recent reports have revealed that repeat-derived sequences embedded in introns or long noncoding RNAs (lncRNAs) are targets of RNA-binding proteins (RBPs) and contribute to biological processes such as RNA splicing or transcriptional regulation. These findings suggest that repeat-derived RNAs are important as scaffolds of RBPs and functional elements. However, the overall functional sequences of the repeat-derived RNAs are not fully understood. Here, we show the putative functional repeat-derived RNAs by analyzing the binding patterns of RBPs based on ENCODE eCLIP data. We mapped all eCLIP reads to repeat sequences and observed that 10.75 % and 7.04 % of reads on average were enriched (at least 2-fold over control) in the repeats in K562 and HepG2 cells, respectively. Using these data, we predicted functional RNA elements on the sense and antisense strands of long interspersed element 1 (LINE1) sequences. Furthermore, we found several new sets of RBPs on fragments derived from other transposable element (TE) families. Some of these fragments show specific and stable secondary structures and are found to be inserted into the introns of genes or lncRNAs. These results suggest that the repeat-derived RNA sequences are strong candidates for the functional RNA elements of endogenous noncoding RNAs.

Mechanisms of Transgelin-2 in Tumorigenesis

Actin-binding protein (transgelin, TAGLN) is a kind of protein that regulates actin polymerization, aggregating (or bundling), or cross-linking. As a member of the actin-binding protein complex, transgelin-2 is involved in the regulation of cytoskeleton. Transgelin-2 is widely expressed in various tissues and organs of the body, but its abnormal expression is often seen in all kinds of tumors, which is related to the occurrence and development, and especially the invasion, metastasis, and drug resistance in many kinds of malignant tumors. However, the signal pathway involved in the regulation of transgelin-2 and its mechanism have remained to be elucidated. In recent years, with a more in-depth study of transgelin-2, its relationship with tumorigenesis has become increasingly clear. Therefore, we review recent research progress in transgelin-2, which is helpful to provide ideas for further research and bring forth a new scheme for the diagnosis, treatment, and prognosis of tumors.

Prevalence of ultrasound-detected knee synovial abnormalities in a middle-aged and older general population-the Xiangya Osteoarthritis Study

Background

There is paucity of data on the prevalence of ultrasound-detected synovial abnormalities in the general population, and the relationship between synovial changes and knee pain remains unclear. We examined the prevalence of synovial abnormalities on ultrasound and the relationship of these features with knee pain and radiographic osteoarthritis (ROA) in a community sample.

Methods

Participants aged 50 years or over were from the Xiangya Osteoarthritis Study, a community-based cohort study. Participants were questioned about chronic knee pain and underwent (1) ultrasonography of both knees to determine presence of synovial hypertrophy (≥ 4 mm), effusion (≥ 4 mm), and Power Doppler signal [PDS; yes/no]; and (2) standard radiographs of both knees (tibiofemoral and patellofemoral views) to determine ROA.

Results

There were 3755 participants (mean age 64.4 years; women 57.4%). The prevalence of synovial hypertrophy, effusion, and PDS were 18.1% (men 20.2%; women 16.5%), 46.6% (men 49.9%; women 44.2%), and 4.9% (men 4.9%; women 5.0%), respectively, and increased with age (P for trend < 0.05). Synovial abnormalities were associated with knee pain, with adjusted odds ratios (aORs) of 2.39 (95% confidence interval [CI] 2.00–2.86) for synovial hypertrophy, 1.58 (95%CI 1.39–1.80) for effusion, and 4.36 (95%CI 3.09–6.17) for PDS. Similar associations with ROA were observed, the corresponding aORs being 4.03 (95%CI 3.38–4.82), 2.01 (95%CI 1.76–2.29), and 6.49 (95%CI 4.51–9.35), respectively. The associations between synovial hypertrophy and effusion with knee pain were more pronounced among knees with ROA than those without ROA, and the corresponding P for interaction were 0.004 and 0.067, respectively.

Conclusions

Knee synovial hypertrophy and effusion are more common and increase with age, affecting men more than women. All three ultrasound-detected synovial abnormalities associate both with knee pain and ROA, and knee synovial hypertrophy or effusion and ROA may interact to increase the risk of knee pain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-021-02539-2.

Methanol extract of Aruncus dioicus exerts antidiabetic effect via PCSK9/LDLR pathway

Purpose: To investigate the antidiabetic effect of methanol extract of Aruncus dioicus, and the underlying mechanism(s). Methods: Twenty-four adult female albino mice were randomly assigned to four groups of six mice each: normal control group, diabetic control group and two treatment groups. With the exception of normal control group, the diabetic control and treatment groups consisted of leptin receptor-deficient (db/db) type 2 diabetic mice. The diabetic control group was not treated, while the treatment groups received 200 or 400 mg/kg extract/day orally for 4 weeks. The effect of the extract on fasting blood glucose (FBG), proprotein convertase subtilisin/kexin type 9 (PCSK9), glycogen and lipid profiles were determined. The expressions of PCSK9, low-density lipoprotein receptor (LDL-R) and glucokinase (GCK) were determined in liver tissues using western blotting and real-time quantitative polymerase chain reaction (qRT-PCR). Results: Fasting blood glucose (FBG) was significantly and dose-dependently reduced in the treatment groups, relative to diabetic control group at different time-points (p < 0.05). Total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were significantly higher in the diabetic control group than in normal control group (p < 0.05). However, treatment with methanol extract of A. dioicus significantly and dose-dependently reversed the changes in the levels of these parameters (p < 0.05). The expressions of LDLR and GCK were significantly down-regulated in diabetic control group, when compared with normal control group, but their expressions were significantly dose-dependently upregulated in the treatment groups (p < 0.05). Treatment with the extract significantly and dose-dependently down-regulated PCSK9 expression (p < 0.05). Liver injury characterized by large distended lipid droplets and fat accumulation was seen in diabetic mice, but treatment with methanol extract of A. dioicus significantly reversed the histopathological changes induced by DM. Conclusion: These results indicate that the antidiabetic effect of methanol extract of A. dioicus is exerted via a mechanism involving PCSK9/LDLR pathway.

Reply to Non-coding RNAs, osteoarthritis and the microbiome: new therapeutic targets?

We appreciate the interest of Sirufo et al. in our manuscript describing the association between gut microbiota and symptomatic hand osteoarthritis (SHOA) (1). Hand osteoarthritis (OA) is a common joint disorder. Individuals with hand OA often reported pain symptom and functional limitation, including difficulty in undertaking daily activities. To date, few risk factors have been identified for hand OA and there is no effective treatment that can halt the disease progression. The common management of hand OA is to control pain and improve function.

Drivers' visual-distracted take-over performance model and its application on adaptive adjustment of time budget

There are certain situations that automated driving (AD) systems are still unable to handle, preventing the implementation of Level 5 AD. Thus, a transition of control, colloquially known as take-over of the vehicle, is required when the system sends a take-over request (TOR) upon exiting the operational design domain (ODD). An adaptive TOR along with good take-over performance requires adjusting the time budget (TB) to drivers' visual distraction state, adhering to a reliable visual-distraction-based take-over performance model. Based on a number of driving simulator experiments, the percentage of face orientation to distraction area (PFODA) and time to boundary at take-over timing (TTBT) were proposed to accurately evaluate the degree of visual distraction based on merely face orientation under naturalistic non-driving related tasks (NDRTs) and to evaluate take-over performance, respectively. In order to elucidate the safety boundary, this study also proposed an algorithm to set a suitable minimum value of the TTBT. Finally, a multiple regression model was built to describe the relationship among PFODA, TB and TTBT along with a corrected coefficient of determination of 0.748. Based on the model, this study proposed an adaptive TB adjustment method for the take-over system.

Does smoking cessation increase risk of knee replacement? a general population-based cohort study

OBJECTIVE

Smoking represents a major issue for global public health. Owing to methodologic challenges, findings of an association between smoking and risk of knee osteoarthritis (OA) are inconsistent. We sought to assess the relation of onset of smoking cessation to the risk of OA sequelae, i.e., knee replacement, and to perform sub-cohort analysis according to weight change after smoking cessation.

DESIGN

Using The Health Improvement Network, we conducted a cohort study to examine the association between smoking cessation and risk of knee replacement among patients with knee OA. Participants who stopped smoking were further grouped into three sub-cohorts: weight gain (body mass index [BMI] increased>1.14 kg/m²), no substantial weight change (absolute value of BMI change<1.14 kg/m²), and weight loss (BMI loss>1.14 kg/m²) after smoking cessation.

RESULTS

We identified 108 cases of knee replacement among 1,054 recent quitters (26.7/1,000 person-years) and 1,108 cases among 15,765 current smokers (17.4/1,000 person-years). The rate difference of knee replacement in recent quitter cohort vs current smoker cohort was 10.4 (95% confidence interval [CI]:5.3-15.6)/1,000 person-years and the adjusted hazard ratio (HR) was 1.30 (95%CI:1.05-1.59). Compared with current smokers, risk of knee replacement was higher among quitters with weight gain (HR = 1.42,95%CI:1.01-1.98), but not among those with no substantial weight change (HR = 1.29,95%CI:0.90-1.83) or those with weight loss (HR = 1.11,95%CI:0.71-1.75).

CONCLUSIONS

Our large population-based cohort study provides the first evidence that smoking cessation was associated with a higher risk of knee replacement among individuals with knee OA, and such an association was due to weight gain after smoking cessation.

Knee Osteoarthritis, Potential Mediators, and Risk of All-Cause Mortality: Data From the Osteoarthritis Initiative

OBJECTIVE

To assess the relation of symptomatic knee osteoarthritis (OA), knee pain, and radiographic knee OA to All-cause mortality and to identify mediators in the causal pathway.

METHODS

Participants from the Osteoarthritis Initiative were divided into 4 groups: 1) symptomatic knee OA (i.e., both radiographic knee OA [Kellgren/Lawrence grade ≥2] and knee pain); 2) knee pain only; 3) radiographic knee OA only; and 4) neither radiographic knee OA nor knee pain. We examined the relation of knee OA status to All-cause mortality using a multivariable Cox proportional hazards model and assessed the extent to which the association was mediated by disability, physical component summary (PCS) and mental component summary (MCS) scores for quality of life (QoL), and use of oral pain-relief medications (i.e., nonsteroidal antiinflammatory drugs and opioids).

RESULTS

Among 4,796 participants, 282 died over the 96-month follow-up period. Compared with those with neither radiographic knee OA nor knee pain, multivariable-adjusted hazard ratios (HRs) of mortality were 2.2 (95% confidence interval [95% CI] 1.6-3.1) for symptomatic knee OA, 0.9 (95% CI 0.6-1.4) for knee pain only, and 2.0 (95% CI 1.4-2.9) for radiographic knee OA only, respectively. Indirect effects (HRs) of symptomatic knee OA on mortality via disability and PCS of QoL were 1.1 (95% CI 1.0-1.4) and 1.2 (95% CI 1.0-1.4), respectively. No apparent mediation effect was observed through either MCS of QoL or oral pain-relief medications use.

CONCLUSION

Participants with either symptomatic or radiographic knee OA were at an increased risk of All-cause mortality. Increased risk of mortality from symptomatic knee OA was partially mediated through its effect on disability and PCS of QoL.

Statin use and risk of joint replacement due to osteoarthritis and rheumatoid arthritis: a propensity-score matched longitudinal cohort study

OBJECTIVE

Statins are reported to have a potential benefit on progression of OA and on disease activity in RA, but existing evidence is conflicting. Our objective was to examine whether statins associate with reduction in the risk for joint replacement due to OA and RA.

METHODS

This was a propensity score-matched cohort study. Electronic health records from the UK Clinical Practice Research Datalink were used. We selected people prescribed statins and people never prescribed statins. Each statin user was matched to a non-user by age, gender, practice and propensity score for statin prescription. The main outcome measures were knee or hip joint replacement overall, and specifically because of OA or RA. The association between statins and risk of joint replacement was assessed using Cox proportional hazard regression. Statin exposure was categorized according to the potency of reducing low-density lipoprotein as low (21-28%), medium (32-38%) or high (42-55%) intensity.

RESULTS

A total of 178 467 statin users were matched with 178 467 non-users by age, gender, practice and propensity score. Overall, statin was not associated with reduced risk of knee or hip replacement (hazard ratio 0.99, 95% CI: 0.97, 1.03), unless prescribed at high strength (0.86, 0.75-0.98). The reduced risk was only observed for joint replacement due to RA (0.77, 0.63-0.94) but not OA (0.97, 0.94-1.01).

CONCLUSION

Statins at high intensity may reduce the risk of hip or knee replacement. This effect may be RA specific. Further studies to investigate mechanisms of risk reduction and the impact in people with RA are warranted.

Association analysis of repetitive elements and R-loop formation across species

Background

Although recent studies have revealed the genome-wide distribution of R-loops, our understanding of R-loop formation is still limited. Genomes are known to have a large number of repetitive elements. Emerging evidence suggests that these sequences may play an important regulatory role. However, few studies have investigated the effect of repetitive elements on R-loop formation.

Results

We found different repetitive elements related to R-loop formation in various species. By controlling length and genomic distributions, we observed that satellite, long interspersed nuclear elements (LINEs), and DNA transposons were each specifically enriched for R-loops in humans, fruit flies, and Arabidopsis thaliana, respectively. R-loops also tended to arise in regions of low-complexity or simple repeats across species. We also found that the repetitive elements associated with R-loop formation differ according to developmental stage. For instance, LINEs and long terminal repeat retrotransposons (LTRs) are more likely to contain R-loops in embryos (fruit fly) and then turn out to be low-complexity and simple repeats in post-developmental S2 cells.

Conclusions

Our results indicate that repetitive elements may have species-specific or development-specific regulatory effects on R-loop formation. This work advances our understanding of repetitive elements and R-loop biology.

Supplementary Information

The online version contains supplementary material available at (10.1186/s13100-021-00231-5).

Detection and Characterization of Ribosome-Associated Long Noncoding RNAs

Ribosome profiling shows potential for studying the function of long noncoding RNAs (lncRNAs). We introduce a bioinformatics pipeline for detecting ribosome-associated lncRNAs (ribo-lncRNAs) from ribosome profiling data. Further, we describe a machine-learning approach for the characterization of ribo-lncRNAs based on their sequence features. Scripts for ribo-lncRNA analysis can be accessed at ( https://ribolnc.hamadalab.com/ ).

Hydrothermal synthesis of a CoIn2S4/g-C3N4 heterojunctional photocatalyst with enhanced photocatalytic H2 evolution activity under visible light illumination

CoIn₂S₄, a black semiconducting material, possesses an outstanding visible light response and is employed to modify g-C₃N₄. A series of CoIn₂S₄/g-C₃N₄ heterojunctional photocatalysts are synthesized via a hydrothermal method, whereby cubic CoIn₂S₄ nanosheets are in situ immobilized on the surfaces of porous g-C₃N₄ nanosheets. Compared with the pristine g-C₃N₄ and CoIn₂S₄, under visible light (λ > 420 nm) irradiation, the CoIn₂S₄/g-C₃N₄ composite samples show markedly enhanced photocatalytic activity in hydrogen evolution. Among all of the samples, the 30% CoIn₂S₄/g-C₃N₄ sample shows the maximum H₂ evolution rates, 5.2 and 23.9 times higher than those of g-C₃N₄ and CoIn₂S₄, respectively. The efficient photocatalytic activity of CoIn₂S₄/g-C₃N₄ composite photocatalysts is attributed to the formation of an intimate heterostructure, which not only significantly facilitates charge migration, but also enhances visible light absorption. Moreover, a plausible photocatalytic mechanism for the composite photocatalyst has been elucidated. This research provides a novel hint for fabricating visible-light-responsive heterojunction photocatalysts with high performance for energy production.

Risk of venous thromboembolism in knee, hip and hand osteoarthritis: a general population-based cohort study

OBJECTIVES

Osteoarthritis is a leading cause of immobility and joint replacement, two strong risk factors for venous thromboembolism (VTE). We aimed to examine the relation of knee, hip and hand osteoarthritis to the risk of VTE and investigate joint replacement as a potential mediator.

METHODS

We conducted three cohort studies using data from The Health Improvement Network. Up to five individuals without osteoarthritis were matched to each case of incident knee (n=20 696), hip (n=10 411) or hand (n=6329) osteoarthritis by age, sex, entry time and body mass index. We examined the relation of osteoarthritis to VTE (pulmonary embolism and deep vein thrombosis) using a multivariable Cox proportional hazard model.

RESULTS

VTE developed in 327 individuals with knee osteoarthritis and 951 individuals without osteoarthritis (2.7 vs 2.0 per 1000 person-years), with multivariable-adjusted HR being 1.38 (95% CI 1.23 to 1.56). The indirect effect (HR) of knee osteoarthritis on VTE through knee replacement was 1.07 (95% CI 1.01 to 1.15), explaining 24.8% of its total effect on VTE. Risk of VTE was higher in hip osteoarthritis than non-osteoarthritis (3.3 vs 1.8 per 1000 person-years; multivariable-adjusted HR=1.83, 95% CI 1.56 to 2.13). The indirect effect through hip replacement yielded an HR of 1.14 (95% CI 1.04 to 1.25), explaining 28.1% of the total effect. No statistically significant difference in VTE risk was observed between hand osteoarthritis and non-osteoarthritis (1.5 vs 1.6 per 1000 person-years; multivariable-adjusted HR=0.88, 95% CI 0.67 to 1.16).

CONCLUSION

Our large population-based cohort study provides the first evidence that knee or hip osteoarthritis, but not hand osteoarthritis, was associated with an increased risk of VTE, and such an association was partially mediated through knee or hip replacement.

Sex Differences in Time-Domain and Frequency-Domain Heart Rate Variability Measures of Fatigued Drivers

The effects of fatigue on a driver's autonomic nervous system (ANS) were investigated through heart rate variability (HRV) measures considering the difference of sex. Electrocardiogram (ECG) data from 18 drivers were recorded during a simulator-based driving experiment. Thirteen short-term HRV measures were extracted through time-domain and frequency-domain methods. First, differences in HRV measures related to mental state (alert or fatigued) were analyzed in all subjects. Then, sex-specific changes between alert and fatigued states were investigated. Finally, sex differences between alert and fatigued states were compared. For all subjects, ten measures showed significant differences (Mann-Whitney U test, p < 0.01) between different mental states. In male and female drivers, eight and four measures, respectively, showed significant differences between different mental states. Six measures showed significant differences between males and females in an alert state, while ten measures showed significant sex differences in a fatigued state. In conclusion, fatigue impacts drivers' ANS activity, and this impact differs by sex; more differences exist between male and female drivers' ANS activity in a fatigued state than in an alert state.

Novel variants and uncommon cases among southern Chinese children with X-linked hypophosphatemia

PURPOSE

X-linked hypophosphatemia (XLH) is the most common inherited renal phosphate wasting disorder and is often misdiagnosed as vitamin D deficiency. This study aims to provide clinical and mutational characteristics of 65 XLH pediatric patients in southern China.

METHODS

In this work, a combination of DNA sequencing and qPCR analysis was used to study the PHEX gene in 80 pediatric patients diagnosed with hypophosphatemia. The clinical and laboratory data of confirmed 65 XLH patients were assessed and analyzed retrospectively.

RESULTS

In 65 XLH patients from 61 families, 51 different variants in the PHEX gene were identified, including 23 previously reported variants and 28 novel variants. In this cohort of XLH patients, the c.1601C>T(p.Pro534Leu) variant appears more frequently. Fourteen uncommon XLH cases were described, including four boys with de novo mosaic variants, eight patients with large deletions and a pair of monozygotic twins. The clinical manifestations in this cohort are very similar to those previously reported.

CONCLUSION

This study extends the mutational spectrum of the PHEX gene, which will contribute to accurate diagnosis. This study also suggests a supplementary qPCR or MLPA assay may be performed along with classical sequencing to confirm the gross insertion/deletion.

Physical Distancing Measures and Walking Activity in Middle-aged and Older Residents in Changsha, China, During the COVID-19 Epidemic Period: Longitudinal Observational Study

BACKGROUND

Physical distancing measures taken to contain COVID-19 transmission may substantially reduce physical activity levels and cause individuals to adopt a more sedentary lifestyle.

OBJECTIVE

The objective of this study is to determine if there was any change in daily steps, an important component of daily physical activity, and examine risk factors for frequent low daily steps during the COVID-19 epidemic.

METHODS

We used data collected from the Step Study, a population-based longitudinal study of walking activity among residents aged ≥40 years in Changsha, China. Daily steps were collected via a smartphone linked to WeChat, a social networking platform. We plotted mean daily steps and the prevalence of low daily steps (≤1500 steps/day) 30 days before (reference period) and 30 days after (epidemic period) January 21, 2020 (date of the first COVID-19 case diagnosed in Changsha), and compared it with the same corresponding period from 2019. We examined the association of risk factors with the prevalence of frequent low daily steps (≤1500 steps/day for ≥14 days) using logistic regression.

RESULTS

Among 3544 participants (mean age 51.6 years; n=1226 females, 34.6%), mean daily steps dropped from 8097 to 5440 and the prevalence of low daily steps increased from 3% (2287/76,136 person-day) to 18.5% (12,951/70,183 person-day) during the reference and epidemic periods, respectively. No such phenomenon was observed during the corresponding period in 2019. Older age (P for interaction=.001) and female sex (P for interaction<.001) were both associated with a higher prevalence of frequent low daily steps and were more pronounced during the epidemic period. More education was associated with a lower prevalence of frequent low daily steps during the reference period but not the epidemic period (P for interaction=.34). Body mass index or comorbidity were not associated with frequent low daily steps during either period.

CONCLUSIONS

Daily steps of Changsha residents aged ≥40 years dropped significantly during the COVID-19 period, especially among older adults and females. Although successful physical distancing, measured by the rapid downward trend in daily step counts of residents, played a critical role in the containment of the COVID-19 epidemic, our findings of an increase in the prevalence of frequent low daily steps raise concerns about unintended effects on physical activity.

Delayed Denosumab Injections and Fracture Risk Among Patients With Osteoporosis : A Population-Based Cohort Study

BACKGROUND

Denosumab is effective for osteoporosis, but discontinuation leads to rapid reversal of its therapeutic effect.

OBJECTIVE

To estimate the risk for fracture among users of denosumab who delayed subsequent doses compared with users who received doses on time.

DESIGN

Population-based cohort study.

SETTING

The Health Improvement Network U.K. primary care database, 2010 to 2019.

PATIENTS

Persons aged 45 years or older who initiated denosumab therapy for osteoporosis.

MEASUREMENTS

Observational data were used to emulate an analysis of a hypothetical trial with 3 dosing intervals: subsequent denosumab injection given within 4 weeks after the recommended date ("on time"), delay by 4 to 16 weeks ("short delay"), and delay by more than 16 weeks ("long delay"). The primary outcome was a composite of all fracture types at 6 months after the recommended date. Secondary outcomes were major osteoporotic fracture, vertebral fracture, hip fracture, and nonvertebral fracture.

RESULTS

Investigators identified 2594 patients initiating denosumab therapy. The risk for composite fracture over 6 months was 27.3 in 1000 for on-time dosing, 32.2 in 1000 for short delay, and 42.4 in 1000 for long delay. Compared with on-time injections, short delay had a hazard ratio (HR) for composite fracture of 1.03 (95% CI, 0.63 to 1.69) and long delay an HR of 1.44 (CI, 0.96 to 2.17) (P for trend = 0.093). For vertebral fractures, short delay had an HR of 1.48 (CI, 0.58 to 3.79) and long delay an HR of 3.91 (CI, 1.62 to 9.45).

LIMITATION

Dosing schedules were not randomly assigned.

CONCLUSION

Although delayed administration of subsequent denosumab doses by more than 16 weeks is associated with increased risk for vertebral fracture compared with on-time dosing, evidence is insufficient to conclude that fracture risk is increased at other anatomical sites with long delay.

PRIMARY FUNDING SOURCE

National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation.

Association between proton pump inhibitors use and risk of hip fracture: A general population-based cohort study

Previous studies comparing risk of fracture among Proton Pump Inhibitors (PPIs) users with that among non-users were susceptible to confounding by indication. Epidemiologic studies of this association using an active medication as a comparator would appropriately address this bias. We conducted a propensity-score matched cohort study to compare the risk of incident fracture over five years among initiators of PPIs with initiators of histamine 2 receptor antagonist (H2RA) using data collected from The Health Improvement Network (THIN) database in the United Kingdom (2000-2016). The prevalence of PPIs prescription increased 3.8-fold from 2000 (7.9%) to 2012 (30.3%) and remained stable since then. Of the 50,265 propensity-score matched participants in each cohort (mean age was 65 years, and 57% were women), 370 (1.9/1000 person-years) incident hip fracture occurred in the PPIs initiators and 294 (1.5/1000 person-years) in the H2RA initiators during the follow-up period. The rate difference of incident hip fracture for PPIs initiation was 0.4 (95% confidence interval [CI]: 0.2-0.7)/1000 person-years compared with H2RA initiation and the corresponding hazard ratio (HR) was 1.27 (95%CI: 1.09-1.48). Compared with non-PPI use, multivariable-adjusted odds ratios (ORs) of hip fracture were 1.17 (95%CI: 0.94-1.46), 1.55 (95%CI: 1.23-1.96), and 1.67 (95%CI: 1.33-2.10) for 1-2, 3-9 and ≥ 10 prescriptions of PPIs, respectively (P for trend = 0.001). We found that PPIs prescription has been increasing rapidly over the past decade in the United Kingdom, and the initiation of PPIs was associated with a higher risk of hip fracture than initiation of H2RA.

Inflammatory potential of diet and risk of incident knee osteoarthritis: a prospective cohort study

Background

To examine the relation between inflammatory potential of diet and incident knee osteoarthritis (OA) and the role of BMI in the association of interest.

Methods

In the Osteoarthritis Initiative, the energy-adjusted dietary inflammatory index (E-DII™) scores were calculated based on the Block Brief 2000 Food Frequency Questionnaire and categorized into sex-specific quartiles. Outcomes were incident (1) radiographic knee OA (ROA) (i.e., a KL grade ≥ 2) and (2) symptomatic knee OA (SxOA) (i.e., a combination of frequent knee pain and ROA). We fitted generalized estimating equation models to examine the association between E-DII scores and incident knee OA. We performed mediation analyses to assess the potential mediation by BMI in the DII-OA relation.

Results

Over a 48-month follow-up period, 232 and 978 knees developed ROA and SxOA, respectively. Compared with the lowest (most anti-inflammatory) E-DII quartile, the odds ratio (OR) of incident ROA for the highest (most pro-inflammatory) E-DII quartile was 1.73 (95% confidence interval (CI) 1.15 to 2.62, P_trend = 0.007). The corresponding OR for SxOA was 1.43 (95% CI 1.16 to 1.76, P_trend = 0.001). The DII-OA association was significantly mediated via BMI with an indirect effect of 1.08 (95% CI 1.04, 1.13) for ROA and 1.13 (95% CI 1.09, 1.16) for SxOA, accounting for 20.4% and 44.5% of the total effect, respectively.

Conclusions

A higher inflammatory potential of diet increased the risk of knee OA. The association was significantly mediated via BMI. Targeting the inflammatory potential of diet may be beneficial to reduce the risk of knee OA.

Endogenous CCN5 Participates in Angiotensin II/TGF-β1 Networking of Cardiac Fibrosis in High Angiotensin II-Induced Hypertensive Heart Failure

Aberrant activation of angiotensin II (Ang II) accelerates hypertensive heart failure (HF); this has drawn worldwide attention. The complex Ang II/transforming growth factor (TGF)-β₁ networking consists of central mechanisms underlying pro-fibrotic effects; however, this networking still remains unclear. Cellular communication network 5 (CCN5), known as secreted matricellular protein, mediates anti-fibrotic activity by inhibiting fibroblast-to-myofibroblast transition and the TGF-β₁ signaling pathway. We hypothesized that endogenous CCN5 plays an essential role in TGF-β₁/Ang II networking-induced cardiac fibrosis (CF), which accelerates the development of hypertensive HF. This study aimed to investigate the potential role of CCN5 in TGF-β₁/Ang II networking-induced CF. Our clinical retrospective study demonstrated that serum CCN5 decreased in hypertensive patients, but significantly increased in hypertensive patients taking oral angiotensin-converting enzyme inhibitor (ACEI). A negative association was observed between CCN5 and Ang II in grade 2and 3 hypertensive patients receiving ACEI treatment. We further created an experimental model of high Ang II-induced hypertensive HF. CCN5 was downregulated in the spontaneously hypertensive rats (SHRs) and increased via the inhibition of Ang II production by ACEI. This CCN5 downregulation may activate the TGF-β₁ signaling pathway, which promotes direct deposition of the extracellular matrix (ECM) and fibroblast-to-myofibroblast transition via activated Smad-3. Double immunofluorescence staining of CCN5 and cell markers of cardiac tissue cell types suggested that CCN5 was mainly expressed in the cardiac fibroblasts. Isolated cardiac fibroblasts were exposed to Ang II and transfected with small interfering RNA targeting CCN5. The expression of TGF-β₁ together with Col Ia and Col IIIa was further promoted, and alpha-smooth muscle actin (α-SMA) was strongly expressed in the cardiac fibroblasts stimulated with Ang II and siRNA. In our study, we confirmed the anti-fibrotic ability of endogenous CCN5 in high Ang II-induced hypertensive HF. Elevated Ang II levels may decrease CCN5 expression, which subsequently activates TGF-β₁ and finally promotes the direct deposition of the ECM and fibroblast-to-myofibroblast transition via Smad-3 activation. CCN5 may serve as a potential biomarker for estimating CF in hypertensive patients. A novel therapeutic target should be developed for stimulating endogenous CCN5 production.

The Nature and Oxidative Reactivity of Urban Magnetic Nanoparticle Dust Provide New Insights into Potential Neurotoxicity Studies

The recent discovery of magnetic nanoparticles (NPs) in human brain tissue has raised concerns regarding their source and neurotoxicity. As previous studies have suggested that magnetite in urban dust may be the source, we collected urban magnetic dust and thoroughly characterized the nature of ambient urban magnetic dust particles prior to investigating their neurotoxic potential. In addition to magnetite, magnetic dust contained an abundance (∼40%) of elemental iron (Fe⁰). The coexistence of magnetite and elemental iron was found in magnetic dust particles of inhalable (<10 μm) and nanoscale (<200 nm) size ranges with these particles small enough to enter the human brain via the respiratory tract and olfactory bulbs. The magnetic dust also contained nonferrous water-soluble metals (particularly Cu) that can induce formation of reactive oxygen species (ROS). Previous studies used engineered pure-magnetite for in vitro ROS studies. However, while magnetite was present in all magnetic dust particles collected, engineered pure-magnetite was relatively unreactive and contributed minimally to the generation of ROS. We fill a critical knowledge gap between exposure to heterogeneous ambient iron-particles and in vitro experiments with engineered versus ambient, incidental iron-bearing nanoscale minerals. Our work points to the need to further investigate the presence and properties of magnetic NPs in respirable dust with respect to their potential role in neurodegeneration.

Adsorption of Arsenic Ions Transforms Surface Reactivity of Engineered Cerium Oxide Nanoparticles

Cerium oxide (CeO₂) nanoparticles (NPs) are massively used as abrasives in the chemical and mechanical polishing (CMP), an essential process to manufacture semiconductor wafers. The CMP process for arsenide-based semiconductor materials produces wastewater with co-occurring arsenic (As) ions and CeO₂ NPs. We found that CeO₂ NPs adsorbed both arsenite (As(III)) and arsenate (As(V)) ions and the adsorption isotherms suggested different adsorption energies and capacities of the two species. Applying the ferric reducing ability for nanoparticle assay, we revealed that the adsorbed As(III) and As(V) each reduced CeO₂ NP surface reactivity but followed different mechanisms. The adsorbed As(III) ions below a critical coverage (110 mmol/kg) increased occupation of Ce 4f orbitals and thus reduced electron mobility of the original CeO₂ NPs. The adsorbed As(V) ions withdrew electrons from Ce 4f orbitals and likely became oxidizing agents that greatly inhibited the original surface reducing ability. Electron paramagnetic resonance analysis further revealed that adsorbed As(III) and As(V) ions decreased the propensity of CeO₂ NPs to produce reactive oxygen species. This work highlights the importance of examining NPs in their post-use phases in which surface reactivity and hazard potential can be greatly altered by chemical exposure history and NP surface transformations.

Evaluation of the recovery outcome of poststroke cognitive impairment after cluster needling of scalp acupuncture therapy based on functional near-infrared spectroscopy

BACKGROUND

Cognitive impairment often arises in patients suffered from stroke. Acupuncture is a recommended treatment option for stroke by the World Health Organization (WHO) and has been shown to improve the cognitive function of patients with poststroke cognitive impairment (PSCI).

METHODS

In the present study, we assessed the efficacy of scalp acupuncture with cluster needling on PSCI patients. Fifty six PSCI patients were randomly separated into the reference group who received drug treatment only and the treatment group who received cluster needling of scalp acupuncture on top of drug treatment. Cognitive function was compared between the two groups before and after treatment. We also took the advantage of functional near-infrared spectroscopy to assess the cerebral hemoglobin levels.

RESULTS

We reveal that applying cluster needling of scalp acupuncture on top of drug treatment can significantly improve the cognitive function and elevate the cerebral hemoglobin levels compared to patients treated with drug only.

CONCLUSIONS

Our results suggest that cluster needling of scalp acupuncture is an effective treatment against PSCI and shed light on its application on other neurological disorders.

ADNCR modulates neural stem cell differentiation and proliferation through the regulation of TCF3 expression

Background

Neural stem cells (NSCs) are undifferentiated precursor cells that have the ability to self-renew and proliferate and have the capacity to become either glia (oligodendrocytes and astrocytes) or neurons. NSCs can act as beneficial adjuncts for many neurological disorders, such as cerebral infarction, spinal cord injuries, Alzheimer's disease, and Parkinson's disease. Long noncoding RNAs (lncRNAs) play essential roles during cell differentiation, proliferation, and metabolism. This study aimed to explore the role played by adipocyte differentiation-associated long noncoding RNA (ADNCR) in the self-renewal and multipotency of NSCs.

Methods

In this study, we identified NSCs and verified that these cells were able to regenerate and differentiate into both astrocytes and neurons. Then we studied the relation between expression of ADNCR and transcription factor 3 (TCF3) and proliferation of NSCs.

Results

ADNCR and TCF3 expression have been shown to decrease during the differentiation of NSCs into both neurons and astrocyte induction cells. However, the expression of the microRNA miR-204-5p increased over time during the differentiation of NSCs into both neurons and astrocyte induction cells. ADNCR acts as a competing endogenous RNA (ceRNA) for miR-204-5p, and the overexpression of ADNCR suppressed miR-204-5p expression and enhanced TCF3 expression in NSCs, which resulted in enhanced proliferation and suppressed neural differentiation.

Conclusions

These data suggested that the use of ADNCR may represent a new strategy for expanding the interventions used to treat neurological disorders.

RNA-Seq Analysis Reveals Localization-Associated Alternative Splicing across 13 Cell Lines

Alternative splicing, a ubiquitous phenomenon in eukaryotes, is a regulatory mechanism for the biological diversity of individual genes. Most studies have focused on the effects of alternative splicing for protein synthesis. However, the transcriptome-wide influence of alternative splicing on RNA subcellular localization has rarely been studied. By analyzing RNA-seq data obtained from subcellular fractions across 13 human cell lines, we identified 8720 switching genes between the cytoplasm and the nucleus. Consistent with previous reports, intron retention was observed to be enriched in the nuclear transcript variants. Interestingly, we found that short and structurally stable introns were positively correlated with nuclear localization. Motif analysis reveals that fourteen RNA-binding protein (RBPs) are prone to be preferentially bound with such introns. To our knowledge, this is the first transcriptome-wide study to analyze and evaluate the effect of alternative splicing on RNA subcellular localization. Our findings reveal that alternative splicing plays a promising role in regulating RNA subcellular localization.

Comparative Risk-Benefit Profiles of Individual Devices for Graft Fixation in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Network Meta-analysis

PURPOSE

To compare the efficacy and safety of individual devices for femoral and/or tibial graft fixation in anterior cruciate ligament (ACL) reconstruction.

METHODS

The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to December 12, 2018. Randomized controlled trials comparing individual devices for ACL graft fixation were included. Bayesian network meta-analysis was performed to assess the efficacy profile using the following outcomes: Lysholm score, International Knee Documentation Committee (IKDC) category, laxity, range of motion, and Tegner score. The incidence of infection, effusion, and graft rupture for each device was reported.

RESULTS

We included 57 randomized controlled trials involving 4,304 patients aged 23.8 to 40.9 years. The female proportion ranged from 0% to 100%. The length of follow-up ranged from 6 to 144 months. Of the 13 studied femoral fixation devices, none was significantly different from the others regarding the Lysholm score, IKDC category, range of motion, and Tegner score. Bioabsorbable interference screws (standardized mean difference, 1.3; 95% credible interval, 0.0-2.5) showed higher laxity than the EndoPearl at a borderline level of statistical significance, but the difference varied substantially within multiple sensitivity analyses. Infection (2.0%) was most commonly seen with the EndoPearl, whereas the bone mulch screw had the highest incidence of effusion (5.5%) and graft rupture (5.5%). For the 9 studied tibial fixation devices, no significant difference was observed in the aforementioned efficacy measurements. Bioabsorbable interference screws with staples had the highest incidence of infection (11.1%) and effusion (15.6%), whereas graft rupture was most commonly seen with the bone plug (4.0%).

CONCLUSIONS

Graft fixation devices in ACL reconstruction share a similar efficacy profile in terms of the Lysholm score, IKDC category, range of motion, and Tegner score but not laxity. On the other hand, safety profiles seem to vary among different devices. These findings can support surgeons, alongside their experience and preference, as well as the relative cost of each device, in delivering an individualized plan for an optimal operation.

LEVEL OF EVIDENCE

Level II, meta-analysis of Level I and II studies.

Initial analgesic prescriptions for osteoarthritis in the United Kingdom, 2000–2016

Objectives

To examine trends in the initial prescription of commonly-prescribed analgesics and patient- as well as practice-level factors related to their selection in incident OA.

Methods

Patients consulting with incident clinical OA between 2000–2016 were identified within The Health Improvement Network in the United Kingdom (UK) general practice. Excluded were patients who had history of cancer or were prescribed the analgesics of interest within 6 months before diagnosis of OA. Initial analgesic prescription included oral non-selective NSAID, oral selective cyclooxygenase-2 inhibitor, topical NSAID, paracetamol, topical salicylate or oral/transdermal opioid within 1 month after OA diagnosis.

Results

∼44% of patients with incident OA (n = 125 696) were prescribed one of these analgesics. Incidence of oral NSAID prescriptions decreased whereas other analgesic prescriptions, including oral opioid prescriptions, increased (all P-for-trend &lt; 0.001). Patients with a history of gastrointestinal disease were more likely to receive topical NSAIDs, paracetamol or oral/transdermal opioids. Only 38% of patients with history of gastrointestinal disease and 21% of patients without it had co-prescription of gastroprotective agent with oral NSAIDs. Oral/transdermal opioid prescription was higher among the elderly (≥65 years), women, obesity, current smoker, and patients with gastrointestinal, cardiovascular or chronic kidney disease. Prescription of oral opioids increased with social deprivation (P-for-trend &lt; 0.05) and was highest in Scotland, whereas transdermal opioid prescription was highest in Northern Ireland (all P-for-homogeneity-test &lt; 0.05).

Conclusion

The initial prescription pattern of analgesics for OA has changed over time in the UK. Co-prescription of gastroprotective agents with oral NSAIDs remains suboptimal, even among those with prior gastrointestinal disease.

Weighted Epworth sleepiness scale predicted the apnea-hypopnea index better

Background

The relationship between the Epworth sleepiness scale (ESS) and the apnea-hypopnea index (AHI) is uncertain and even poor. The major problem associated with the ESS might be a lack of consideration of weight in prediction in clinical practice. Would awarding different item-scores to the four scales of ESS items to develop a weighted ESS scoring system improve the accuracy of the AHI prediction? It is warranted to explore the intriguing hypotheses.

Methods

Seven hundred fifty-six adult patients with suspicion of obstructive sleep apnoea syndrome (OSAS) were prospectively recruited to a derivation cohort. This was tested against a prospective validation cohort of 810 adult patients with suspected OSAS. Each ESS item’s increased odds ratio for the corresponding AHI was calculated using univariate logistic regression. The receiver operating characteristic curves were created and the areas under the curves (AUCs) were calculated to illustrate and compare the accuracy of the indices.

Results

The higher the ESS item-score, the closer the relationship with the corresponding AHI. The odds ratios decreased as a result of the increased AHI. The ESS items were of unequal weight in predicting the corresponding AHI and a weighted ESS was developed. The coincidence rates with the corresponding AHI, body mass indices, and neck circumferences rose as the scores increased, whereas nocturnal nadir oxygen saturations decreased, and the weighted ESS was more strongly associated with these indices, compared with the ESS. The capability in predicting the patients without OSAS or with severe OSAS was strong, especially the latter, and the weighted ESS orchestrated manifest improvement in screening the patients with simple snoring. The patterns of sensitivities, specificities, and Youden’s indices of the four ranks of weighted ESS for predicting the corresponding AHI were better than those of the ESS, and the AUCs of weighted ESS were greater than the corresponding areas of ESS in the two cohorts.

Conclusions

The weighted ESS orchestrated significant improvement in predicting the AHI, indicating that the capability in predicting the patients without OSAS or with severe OSAS was strong, which might have implications for clinical triage decisions to prioritize patients for polysomnography.

SAT0453 DELAYED DENOSUMAB INJECTIONS AND FRACTURES RISK AMONG SUBJECTS WITH OSTEOPOROSIS: A POPULATION-BASED COHORT STUDY

Background:

Denosumab is effective for osteoporosis, but discontinuation leads to rapid reversal of its therapeutic effect[1].

Objectives:

To estimate the risk for fracture among users of denosumab who delayed subsequent dosages compared with users who received dosages on time.

Methods:

Population-based cohort study. We included patients aged over 45 years who initiated denosumab for osteoporosis from UK THIN database, 2010 to 2019. Observational data were used to “emulate a hypothetical trial”[2, 3] with three dosing intervals: subsequent denosumab injection 24-28 weeks after prior dose (“on time”), delay by 4-16 weeks (“short delay”), and delay by over 16 weeks (“long delay”). The primary outcome was a composite of all fracture types. Secondary outcomes included major osteoporotic fracture, vertebral fracture, and hip fracture.

Results:

The rate of composite fracture per 1000 person-years was 58.9 for on-time, 61.7 for short delay, and 85.4 for long delay of subsequent denosumab injections. Compared to on-time injections, short delay had a hazard ratio (HR) for composite fracture 1.03 (95% CI 0.63-1.69) and long delay HR 1.44 (95% CI 0.96-2.17; p for trend 0.093). For major osteoporotic fractures, short delay had an HR 0.94 (95% CI 0.57-1.55) and long delay an HR of 1.69 (95% CI 1.01-2.83; p for trend 0.056). For vertebral fractures, short delay had an HR 1.48 (95% CI 0.58-3.79) and long delay 3.91 (95% CI 1.62-9.45; p for trend 0.005).

Conclusion:

While delayed subsequent denosumab dosages over 16 weeks was associated with an increased risk of vertebral and major osteoporotic fracture compared to no delay, composite fracture risk was not increased with longer delays.

References:

[1]Cummings SR, Ferrari S, Eastell R, et al. Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension. J Bone Miner Res, 2017.

[2]Hernán MA. How to estimate the effect of treatment duration on survival outcomes using observational data. BMJ 2018.

[3]Hernán MA, Robins JM. Using Big Data to Emulate a Target Trial When a Randomized Trial Is Not Available. Am J Epidemiol 2016.

Table.

Rates and Adjusted Hazard Ratios of Fracture

On-timeShort delayLong delayP for linear trendComposite FractureRate (per 1000 person-years)5961.785.4-Unadjusted HR (95 %)Ref1.05 (0.62, 1.76)1.45 (0.95, 2.21)0.097Adjusted HR (95% CI)†Ref1.03 (0.63, 1.69)1.44 (0.96, 2.17)0.093Major Osteoporotic FractureRate (per 1000 person-years)34.831.958-Unadjusted HR (95 %)Ref0.92 (0.55, 1.53)1.67 (0.98, 2.84)0.074Adjusted HR (95% CI)†Ref0.94 (0.57, 1.55)1.69 (1.01, 2.83)0.056Vertebral FractureRate (per 1000 person-years)4.97.319.4-Unadjusted HR (95 %)Ref1.47 (0.58, 3.71)3.93 (1.59, 9.72)0.006Adjusted HR (95% CI)†Ref1.48 (0.58, 3.79)3.91 (1.62, 9.45)0.005Hip FractureRate (per 1000 person-years)10.29.618.3-Unadjusted HR (95 %)Ref0.94 (0.43, 2.04)1.78 (0.80, 3.97)0.18Adjusted HR (95% CI)†Ref0.97 (0.44, 2.12)1.75 (0.81, 3.79)0.173

†Adjusted model: adjusted by age, sex, baseline CCI index, major osteoporotic fracture, oral BP duration (years), 10-year risk of major osteoporotic fracture, prior denosumab doses.

Acknowledgments:

We acknowledge Dr. Dani Prieto-Alhambra for kindly providing Read codes.

Disclosure of Interests:

Houchen Lyu: None declared, Kazuki Yoshida: None declared, Sizheng Steven Zhao: None declared, Xabier García-Albéniz: None declared, Jie Wei: None declared, Chao Zeng: None declared, Sara Tedeschi: None declared, Benjamin Leder Grant/research support from: Research funding from Amgen, Guanghua Lei: None declared, Peifu Tang: None declared, Daniel Solomon Grant/research support from: Funding from Abbvie and Amgen unrelated to this work

LncRNA ILF3-AS1 mediated the occurrence of epilepsy through suppressing hippocampal miR-212 expression

Increased expression of some matrix metalloproteinases (MMPs) is closely associated with epilepsy. However, factors that promote their expression have not been clarified. Long noncoding RNAs (lncRNAs) play crucial roles in the development of human diseases, including various cancers, but its potential function in temporal lobe epilepsy (TLE) has remained unexplored. In this study, we showed that hippocampal and serum ILF3-AS1 levels are higher in TLE patients than in matched controls. Interleukin (IL)-1β and tumor necrosis factor (TNF)-α induced ILF3-AS1 expression in astrocytes, while ectopic expression of ILF3-AS1 enhanced IL-6 and TNF-α expression. Ectopic ILF3-AS1 in astrocytes also increased expression of MMP2, MMP3, MMP9 and MMP14, but suppressed expression of miR-212. Consistent with that finding, miR-212 levels were lower in the hippocampus and serum of TLE patients than their controls. This suggests that ILF3-AS1 promotes expression of inflammatory cytokines and MMPs by targeting miR-212 and that ILF3-AS1 plays a crucial role in the development of TLE.