A nomogram to predict recurrence of RA patients in clinical remission within one year

OBJECTIVE

Some patients with rheumatoid arthritis (RA) will recur despite they have achieved clinical remission after treatment. The subclinical synovitis detected by ultrasonography (US) may be one of the main causes of the RA recurrence. The aim of this study is to establish a nomogram for predicting the outcome of RA patients with disease in clinical remission.

PATIENTS AND METHODS

One hundred and sixty-seven RA patients who achieved clinical remission and were willing to receive a 1-year follow-up were included in this study. Their demographic, clinical, and laboratory characteristics were recorded at baseline. 7-joints ultrasound (US7) synovitis score (simplified from US7 score) were evaluated at baseline and at the end of follow-up (or when RA recurrence confirmed). All patients were divided into recurrence group and non-recurrence group after the follow-up. Multivariable regression was applied to link the predictors that were significant at p < 0.05 in the univariate analysis and the recurrence of RA patients in clinical remission, which was served as the basis of the nomogram.

RESULTS

Fifty-one RA patients were included in the recurrence group and 116 patients in the non-recurrence group. All US7 synovitis scores in this study showed excellent reproducibility. Multivariable analysis revealed that high-titer positive anti-cyclic citrullinated peptide (anti-CCP), simplified clinical disease activity index (SDAI), baseline grayscale ultrasound (GSUS) score, and baseline power Doppler ultrasound (PDUS) score were the independent predictors for RA recurrence within 1 year. A nomogram incorporating the independent predictors was constructed to predict the risk of RA recurrence. The nomogram showed good discrimination (C-index=0.826) and good calibration.

CONCLUSIONS

The nomogram incorporating anti-CCP, SDAI, and subclinical synovitis helps to achieve complete remission and reduces the risk of short-term recurrence of RA patients.

Quality assessment of randomized controlled trial abstracts on drug therapy of periodontal disease from the abstracts published in dental Science Citation Indexed journals in the last ten years

Background

Randomized controlled trials (RCTs) provide the highest level of evidence and are likely to influence clinical decision-making. This study evaluated the reporting quality of RCT abstracts on drug therapy of periodontal disease and assessed the associated factors.

Material and Methods

The Pubmed database was searched for periodontal RCTs published in Science Citation Indexed (SCI) dental journals from 2010/01/01 to 2019/07/17. Information was extracted from the abstracts according to a modified Consolidated Standards of Reporting Trials (CONSORT) guideline checklist. The data was analyzed using descriptive statistical analysis and the statistical associations were examined using the linear regression analysis (P <0.05).

Results

This study retrieved 1715 articles and 249 of them were finally included. The average overall CONSORT score was 15.6 ± 3.4, which represented 40.9% (±0.6) of CONSORT criteria filling. The reporting rate of some items (trial design, numbers analyzed, confidence intervals, intention-to-treat analysis or per-protocol analysis, harms, registration) was less than 30%. The adequate reporting rate of some items (participants, randomization, numbers analyzed, confidence intervals, intention-to-treat analysis or per protocol analysis) was no more than 4%. None of the abstracts reported funding. According to the multivariable linear regression results, number of authors (P=0.030), word count (P <0.001), continent (P=0.003), structured format (P <0.001), type of periodontal disease (P <0.001) and international collaboration (P=0.023) have a significant association with reporting quality.

Conclusions

The quality of RCT abstracts on drug therapy of periodontal disease in SCI dental journals remained suboptimal. More efforts should be made to improve RCT abstracts reporting quality.

Key words:Abstracts, RCT, drug therapy, periodontal disease, CONSORT, reporting quality assessment.

Development of quantitative HPTLC methods for dolutegravir, lamivudine, and tenofovir disproxil fumarate in a combination pharmaceutical product using a model process published earlier for transfer of minilab TLC screening methods to HPTLC-densitometry

High-performance thin-layer chromatography (HPLTC)–densitometry methods are described for the analysis of the anti(retro)virals dolutegravir (D), lamivudine (L), and tenofovir disoproxil fumarate (TDF) in a pharmaceutical tablet product. To the best of our knowledge, no previous quantitative planar chromatography method has been reported in the literature for this combination formulation. The method for L was transferred from a thin-layer chromatography (TLC) screening method published in the Global Pharma Health Fund (GPHF) Minilab Manual designed for identification of counterfeit and substandard drug products using a model process published earlier. D and TDF are not included in the list of drugs for which TLC screening methods are published for the Minilab, but HPTLC–densitometry procedures were developed for them using the transfer process guidelines. L was analyzed simultaneously with TDF on Merck Premium Purity silica gel 60 F plates using the mobile phase ethyl acetate–methanol–acetone–concentrated ammonium hydroxide (30:7:3:1) and densitometric scanning at 254 nm. D was analyzed on a second plate by scanning at 366 nm after chromatography with the chloroform–methanol–formic acid (32:8:2) mobile phase. Data for all three drugs are shown to meet the requirements of the model transfer process for calibration curve r values, assay of tablets relative to their label values, peak purity/peak identity tests, and validation by standard addition analysis of samples spiked at 50%, 100%, and 150% of the label value of active ingredients. A TLC screening method for TDF in the combination product was developed and published online with open access.

Effect of rituximab combined with chemotherapy on the expression of serum exosome miR-451a in patients with diffuse large b-cell lymphoma

OBJECTIVE

The aim of this study was to investigate the influence of rituximab combined with chemotherapy on the expression of serum exosome micro ribonucleic acid 451a (miR-451a) in patients with diffuse large B-cell lymphoma (DLBCL), and to explore the possible underlying mechanism.

PATIENTS AND METHODS

89 DLBCL patients (DLBCL group) receiving rituximab combined with chemotherapy were enrolled in this study. Meanwhile, 48 healthy controls (control group) were enrolled as well. Serum samples were collected from all patients before and after treatment, respectively. At the same time, blood samples of healthy people were collected, and serum exosome was extracted. Real-Time fluorescence-quantitative Polymerase Chain Reaction (qRT-PCR) was applied to measure the expression level of serum exosome miR-451a. Receiver operating characteristics (ROC) curve was used to evaluate the diagnostic efficiency of miR-451a. Statistical Product and Service Solutions (SPSS) 22.0 was employed for statistical analysis. Two-sided 95% confidence interval (CI) was used for all tests, and p<0.05 was considered statistically significant.

RESULTS

The expression level of miR-451a in the DLBCL group was significantly lower than that of the control group. The area under the ROC curve (AUC) for the diagnostic efficacy of serum exosome miR-451a for DCBCL was 0.7147. After treatment, the level of serum exosome miR-451a in patients was significantly increased, whereas was still lower than the normal level. The AUC of ROC for evaluating the effect of serum exosome miR-451a in DCBCL was 0.8038.

CONCLUSIONS

Serum exosome miR-451a has moderate diagnostic efficiency for DLBCL. Moreover, miR-451a can act as an indicator for evaluating the efficacy of rituximab combined with chemotherapy in the DLBCL treatment.

Dietary fatty acids and risk of Alzheimer's disease and related dementias: Observations from the Washington Heights-Hamilton Heights-Inwood Columbia Aging Project (WHICAP)

Introduction:

High dietary intake of long chain, polyunsaturated fatty acids is associated with lower Alzheimer’s disease (AD) risk.

Methods:

Washington Heights-Hamilton Heights-Inwood Columbia Aging Project is a multiethnic, prospective observational study of aging and dementia among elderly (≥ 65 years). Dietary intake was measured using a food frequency questionnaire. Dietary short-, medium-, and long-chain fatty acid intakes were categorized by number of carbons and double bonds. Consensus AD diagnoses were made. Associations between AD risk and dietary fatty acid and cholesterol intakes were estimated using multivariable Cox proportional hazards regression models.

Results:

Of 2612 multiethnic women (67%) and men (baseline age 76.3 [6.4] years), 380 developed AD over an average 4.5 years follow-up. Lower risk of AD was associated with increasing intakes of docosahexaenoic acid (DHA; hazard ratio [HR] = 0.73, 95% confidence interval [CI]: 0.57 to 0.95, P = 0.018) and eicosapentaenoic acid (EPA; HR = 0.74, 95% CI: 0.57 to 0.95, P = 0.021), and longer AD-free survival (P < 0.05).

Discussion:

Higher intake of DHA and EPA are protective for AD.

Characterization of CD19+ CD24hi CD38hi B cells in Chinese adult patients with atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease. Human interleukin-10⁺ B cells (B10 cells) is one of regulatory B cells and is enriched in CD19⁺ CD24^hi CD38^hi B cells. A little is known about these cells in atopic dermatitis.

OBJECTIVE

To study CD19⁺ CD24^hi CD38^hi B cells and their clinical significance in Chinese adult patients with atopic dermatitis.

METHODS

Thirty-two adult patients with AD and nineteen healthy controls were enrolled. Peripheral blood mononuclear cells (PBMCs) were isolated and stained with fluorescein-conjugated monoclonal antibodies for CD19, CD24, CD27, CD38 and Annexin V. The stained PBMCs were analysed by flow cytometry. B10 cells were prepared by stimulating PBMCs with CpG, LPS and CD40L followed by restimulation with phorbol12-myristate 13-acetate (PMA) and ionomycin. Serum IL-10, B-cell-activating factor (BAFF) and a proliferation-inducing ligand (APRIL) levels were measured by using the ELISA. Apoptosis and proliferation of CD19⁺ CD24^hi CD38^hi B cells were measured by flow cytometry. 4/P-signal transducer and activator of transcription 3 (STAT3) and extracellular signal-regulated kinase 1/2 (Erk) phosphorylation were also studied.

RESULTS

The number of CD19⁺ CD24^hi CD38^hi B cells in patients with AD was similar to that in healthy controls. However, B10 cells were decreased in patients with AD. The proportion of B10 cells was negatively associated with blood basophil counts but not associated with disease activity. CD19⁺ CD24^hi CD38^hi B cells from AD patients were more susceptible to apoptosis upon stimulation with CpG, LPS and CD40L. B cells from AD patients showed lower STAT3 and Erk phosphorylation.

CONCLUSIONS

CD19⁺ CD24^hi CD38^hi B cells were unchanged in atopic dermatitis while B10 cells were decreased. The increased B-cell apoptosis, decreased STAT3 and Erk phosphorylation might contribute to these changes.

[Preliminary study of the relationship between novel coronavirus pneumonia and liver function damage: a multicenter study]

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34 ~ 21.15) μmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31 ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) μmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) μmol/L, respectively. Conclusion: The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

Akt2 Affects Periodontal Inflammation via Altering the M1/M2 Ratio

Periodontitis is a bacteria-driven inflammatory destructive disease that leads to attachment loss, bone resorption, and even tooth loss. Accumulating studies revealed that macrophages might play an nonnegligible role during the processes of periodontitis. However, the underlying mechanism remains largely unknown. In this study, we found novel Akt2/JNK1/2/c-Jun and Akt2/miR-155-5p/DET1/c-Jun signaling pathways that regulated the polarization of macrophages and altered periodontal inflammatory status. Through hematoxylin and eosin, immunostaining, and immunofluorescence staining of clinical specimens, a higher number of M1 phenotype macrophage infiltration was found in periodontitis than in normal controls. Flow cytometry and immunofluorescence showed that overexpression of Akt2 in RAW 264.7 cells induced M1 macrophage polarization and decreased M2 polarization, while knockdown of Akt2 exerted an opposite effect. Furthermore, overexpression of Akt2 activated the JNK pathway and then increased the release of proinflammatory mediators, while knockdown of Akt2 downregulated the above genes accordingly. Importantly, the macrophage polarization and the subsequent alteration of pathway molecules induced by overexpression of Akt2 could be rescued by Akt2 and JNK inhibitors. Moreover, JNK inhibition could facilitate M2 polarization of macrophages. In a mouse periodontitis model, the novel signaling pathway as well as clinical phenotype was further verified. Inhibition of Akt2 facilitated macrophage M2 polarization and rescued the bone loss due to periodontitis. Collectively, we identified novel Akt2/JNK1/2/c-Jun and Akt2/miR-155-5p/DET1/c-Jun signaling pathways that regulate macrophage polarization and highlight that Akt2 inhibition promotes M2 polarization of macrophages and can be a novel potential candidate in the treatment of periodontitis.

Prediction and Visualisation of Bony Impingement for Subject Specific Total Hip Arthroplasty

Bony impingement (BI) may contribute to restricted hip joint motion, and recurrent dislocation after total hip arthroplasty (THA), and therefore, should be avoided where possible. However, BI risk assessment is generally performed intra-operatively by surgeons, which is partially subjective and qualitative. Therefore, the aim of the study was to develop a method for identifying subject-specific BI, and subsequently, visualising BI area on native bone anatomy to highlight the amount of bone should be resected. Activity definitions and subject-specific bone geometries, constructed from CT scans, with planned implants were used as inputs for the method. For each activity, a conical clearance angle (CCA) was checked between femur and pelvis through simulation. Simultaneously, BI boundary and area were automatically calculated using ray intersection and region growing algorithm respectively. The potential use of the developed method was explained through a case study using an anonymised pre-THA patient data. Two pure (flexion, and extension) and two combined hip joint motions (internal and external rotation at flexion and extension respectively) were considered as activities. BI area were represented in two ways: (a) CCA specific where BI area for each activity with different CCAs was highlighted, (b) activity specific where BI area for all activities with a particular CCA was presented. Result showed that BI area between the femoral and pelvic parts was clearly identified so that the pre-operative surgical plan could be adjusted to minimise impingement. Therefore, this method could potentially be used to examine the effect of different preoperative plans and hip motion on BI, and to guide bony resection during THA surgery.

Sitagliptin improves cardiac function after myocardial infarction through activation of autophagy in streptozotocin-induced diabetic mice

OBJECTIVE

The aim of this study was to investigate the protective effect of sitagliptin on cardiac function in mice with diabetes and myocardial infarction (MI), and to explore its possible mechanism using the mouse models of diabetes and MI.

MATERIALS AND METHODS

The models of diabetes and MI were established using C57BL/6 mice. All mice were randomly divided into 5 groups, including the control sham (CS) group, the control MI (CMI) group, the diabetes sham (DS) group, diabetes + MI (DMI) group and the DMI + sitagliptin (DMI+SGL) group. After modeling, mice in the DMI+SGL group were intragastrically administrated with sitagliptin (10 mg/kg/day) for 21 d and the survival rate of mice was recorded. Before and 7, 14, 21 days after MI, the cardiac function of mice in each group was detected via ultrasound. 21 days after MI, the area of MI was measured via 2,3,5-triphenyl tetrazolium chloride (TTC). Meanwhile, the degree of fibrosis in the peripheral region of MI was determined via Masson staining. Moreover, myocardial autophagosomes of mice in each group were observed by transmission electron microscope (TEM). 7 days after MI, the expressions of autophagy-related proteins LC3II and P65 were detected via Western blotting. The expressions of myocardial inflammatory factors, interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α (TNF-α) were detected via enzyme-linked immunosorbent assay (ELISA). In addition, the expression of nuclear factor-κB (NF-κB) was also detected via Western blotting.

RESULTS

Sitagliptin increased survival rate, improved cardiac function, reduced infarction area, alleviated myocardial fibrosis, enhanced autophagy in the peripheral region and inhibited inflammation in the peripheral region in mice with diabetes after MI.

CONCLUSIONS

Sitagliptin can improve cardiac function and reduce the mortality rate in diabetic rats after MI. The possible underlying mechanism may be related to the fact that sitagliptin activates autophagy and inhibits inflammatory response in diabetes after MI.

Hematopoietic and lymphatic cancers in patients with periodontitis: a systematic review and meta-analysis

Background

Numerous studies have explored the correlation of periodontal disease (PD) with risk of hematopoietic and lymphatic cancers, but the findings were inconsistent. Therefore, we did a meta-analysis to ascertain the correlation of PD with risk of incident hematopoietic and lymphatic cancers.

Material and Methods

The authors searched relevant studies in databases (PubMed, Web of Science, and MEDLINE). The summary relative risk (RR) along with 95% confidence interval (CI) was calculated by use of random or fixed effects models.

Results

Six studies were included in qualitative synthesis. The pooled analysis revealed that PD was significantly associated with an increased risk of hematopoietic and lymphatic cancers (RR = 1.17; 95% CI = 1.07–1.27; P = 0). Stratified analysis showed the association of PD with hematopoietic and lymphatic cancers remained significant in the never smokers (RR = 1.28; 95% CI = 1.07–1.54; P = 0.007), and in the American population (RR = 1.17; 95% CI = 1.05–1.30; P = 0.003), respectively.

Conclusions

Never smokers population and the American population with PD have a higher risk of developing hematopoietic and lymphatic cancers. PD might be considered as a risk factor for hematopoietic and lymphatic cancers.

Key words:Periodontal disease, hematopoietic and lymphatic cancer, meta-analysis, systematic review.

Characterization of peripheral blood mononuclear cells isolated using two kinds of leukocyte filters

OBJECTIVE

The objective of this study was to compare the activity and biological function of leukocytes isolated using apheresis platelet leukoreduction system chambers (LRSC), whole blood leukoreduction filters (LRF), and leukocytes in unfiltered peripheral whole blood (WB).

METHODS

Peripheral blood mononuclear cells (PBMCs) and granulocytes were obtained by density gradient centrifugation using recovery filters and WB. Flow cytometry was used to detect the activity, phenotype, and apoptosis ratio of each cell subtype.

RESULTS

The proportion of lymphocytes obtained from PBMCs was similar when using the two different filters as compared to traditional isolation; however, there were significant differences between the monocytes and granulocytes. The phenotypic frequency of lymphocytes was similar, but the apoptosis rate of lymphocytes from the two filters was slightly higher. Additionally, monocytes isolated via the three sources were able to be induced into dendritic cells expressing specific molecules; Granulocytes isolated from the LRF showed a lower purity and a higher level of apoptosis than granulocytes isolated from the WB.

CONCLUSION

Compared with WB, the PBMCs isolated from the filters used in our blood center had no statistical difference in their activity and biological function, but they did differ in the proportion and quantity of monocytes and granulocytes. Our results show that the two filters can be used as an alternative method to collect leukocytes, which solves the problem of an insufficient blood supply for clinical and basic science research. Thus, these filters have significant value beyond their practical use in clinics.

[Cone-beam CT analysis on the treatment efficacy in the vertically impacted maxillary central incisors]

Objective: To analyze the treatment efficacy in the vertically impacted maxillary central incisors using cone-beam CT (CBCT) and explore the treatment timing and the influence of orthodontic traction on the root development and alveolar bone height in the mixed dentition. Methods: Twenty-two patients with vertically impacted maxillary central incisor who were admitted to the Department of Orthodontics, Stomatological Hospital affiliated to Nanjing Medical University from December 2012 to December 2017 were selected [12 males and 10 females, (9.2±0.9) years]. Based on the dental age, patients were classified as early treatment group (teeth ranging from a third to two thirds of root formation, n=12) and late treatment group (teeth with nearly or fully complete root formation, n=10). The contralateral maxillary central incisor was used as the control. Three-dimensional reconstruction of CBCT before treatment, after treatment and one year after treatment was carried out to measure root length, tooth surface area, tooth volume, labial and lingual apical alveolar bone thickness, the loss of labial alveolar bone height and intraosseous root ratio. The clinical crown length was measured in the mouth. The difference values of the measurement variables between the impacted teeth and the control teeth were calculated and analyzed(measurement values of impacted teeth were subtracted from control values). Results: The values of root length difference beween the impacted teeth and the control teeth in the early and late treatment group were (1.58±1.56) mm and (2.57±1.00) mm, respectively after the treatment and the values were significantly less than those corresponding values before treatment [(3.47±1.40) and (3.36±0.79) mm] (P<0.05). After the treatment, the values of the surface area and volume difference between the impacted teeth and the control teeth in the early treatment group [(0±34) mm(2) and (-10±44) mm(3)] were significantly less than those corresponding values before treatment [(38±31) mm(2) and (55±70) mm(3)] (P<0.05). The value differences of any measurement variables between the early and late treatment group were not significantly different after the treatment (P>0.05). The root length and intraosseous root ratio of the impacted teeth after the treatment in the early and late treatment group were significantly less than those of the control teeth after the treatment (P<0.05). The clinical crown length, the loss of labial alveolar bone height of the impacted teeth after the treatment were significantly larger than those of the control teeth after the treatment (P<0.05). Conclusions: Orthodontic traction promoted the root growth and development of the vertically impacted maxillary central incisors. However, the root length and alveolar bone height still cannot reach the normal level after treatment. Treatment timing had no effect on root development and alveolar bone height of vertically impacted maxillary central incisors in mixed dentition.

Excessive daytime sleepiness with snoring or witnessed apnea is associated with handgrip strength: a population-based study

BACKGROUND

Sarcopenia is emerging as an important public health problem, and evidences have determined that poor sleep is associated with muscle strength, but the potential effects of excessive daytime sleepiness (EDS), snoring and witnessed apnea on handgrip strength have not been evaluated.

AIM

We aimed to examine the association between EDS, snoring, witnessed apnea and muscle strength in an adult population.

DESIGN

Cross-sectional study.

METHODS

This cross-sectional study comprised 19 434 adults. Handgrip strength was measured using a handheld digital dynamometer. EDS was assessed by Epworth Sleepiness Scale, snoring and witnessed apnea during sleep were reported through simple yes/no questions. Analysis of covariance was carried out to determine the association between EDS with snoring or witnessed apnea and muscle strength.

RESULTS

The means (95% confidence interval) for average handgrip strength/body weight (kg/kg) across symptoms categories were 0.396 (0.333-0.472), 0.393 (0.330-0.467), 0.396 (0.333-0.471) and 0.386 (0.325-0.460) (P < 0.0001), respectively. Similar results were observed with maximal handgrip strength/body weight (kg/kg).

CONCLUSIONS

Self-reported EDS accompanied with snoring or apnea is associated with lowest handgrip strength, independently of confounding factors. Whether improvement of EDS, snoring and apnea, can ameliorate age-associated decline in muscle strength warrants further studies.