Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials

BACKGROUND

Pharmacotherapy provides an option for adults with overweight and obesity to reduce their bodyweight if lifestyle modifications fail. We summarised the latest evidence for the benefits and harms of weight-lowering drugs.

METHODS

This systematic review and network meta-analysis included searches of PubMed, Embase, and Cochrane Library (CENTRAL) from inception to March 23, 2021, for randomised controlled trials of weight-lowering drugs in adults with overweight and obesity. We performed frequentist random-effect network meta-analyses to summarise the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence, calculate the absolute effects, categorise interventions, and present the findings. The study was registered with PROSPERO, CRD 42021245678.

FINDINGS

14 605 citations were identified by our search, of which 132 eligible trials enrolled 48 209 participants. All drugs lowered bodyweight compared with lifestyle modification alone; all subsequent numbers refer to comparisons with lifestyle modification. High to moderate certainty evidence established phentermine-topiramate as the most effective in lowering weight (odds ratio [OR] of ≥5% weight reduction 8·02, 95% CI 5·24 to 12·27; mean difference [MD] of percentage bodyweight change -7·98, 95% CI -9·27 to -6·69) followed by GLP-1 receptor agonists (OR 6·33, 95% CI 5·00 to 8·00; MD -5·79, 95% CI -6·34 to -5·25). Naltrexone-bupropion (OR 2·69, 95% CI 2·10 to 3·44), phentermine-topiramate (2·40, 1·68 to 3·44), GLP-1 receptor agonists (2·22, 1·74 to 2·84), and orlistat (1·71, 1·42 to 2·05) were associated with increased adverse events leading to drug discontinuation. In a post-hoc analysis, semaglutide, a GLP-1 receptor agonist, showed substantially larger benefits than other drugs with a similar risk of adverse events as other drugs for both likelihood of weight loss of 5% or more (OR 9·82, 95% CI 7·09 to 13·61) and percentage bodyweight change (MD -11·40, 95% CI -12·51 to -10·29).

INTERPRETATION

In adults with overweight and obesity, phentermine-topiramate and GLP-1 receptor agonists proved the best drugs in reducing weight; of the GLP-1 agonists, semaglutide might be the most effective.

FUNDING

1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.

[Interpretation of expert consensus for progressive collapsing foot deformity]

Adult flatfoot is a common foot deformity, mainly manifested as medial arch collapsing, hindfoot valgus and forefoot abduction. People have a more thorough understanding of the pathological changes and pathogenesis of flatfoot with further research. There is a new expert consensus for adult flatfoot published in Foot & Ankle Inter. in 2020. The expert panel reviewed the latest literature to develop consensus recommendations for flatfoot, including its nomenclature, diagnosis, classification and operative treatment. The consensus represents a new understanding of the disease and a new concept because of the authority of its authors and the comprehensiveness of its content, and it is also a phased summary of the theoretical and clinical progress of adult flatfoot. This article gives a detailed interpretation of the content in the consensus.

'Stress hyperglycemia ratio and in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes

OBJECTIVE

To evaluate the impact of stress hyperglycemia on the in-hospital prognosis in non-surgical patients with heart failure and type 2 diabetes.

RESEARCH DESIGN AND METHODS

We identified non-surgical hospitalized patients with heart failure and type 2 diabetes from a large electronic medical record-based database of diabetes in China (WECODe) from 2011 to 2019. We estimated stress hyperglycemia using the stress hyperglycemia ratio (SHR) and its equation, say admission blood glucose/[(28.7 × HbA1c)- 46.7]. The primary outcomes included the composite cardiac events (combination of death during hospitalization, requiring cardiopulmonary resuscitation, cardiogenic shock, and the new episode of acute heart failure during hospitalization), major acute kidney injury (AKI stage 2 or 3), and major systemic infection.

RESULTS

Of 2875 eligible Chinese adults, SHR showed U-shaped associations with composite cardiac events, major AKI, and major systemic infection. People with SHR in the third tertile (vs those with SHR in the second tertile) presented higher risks of composite cardiac events ([odds ratio, 95% confidence interval] 1.89, 1.26 to 2.87) and major AKI (1.86, 1.01 to 3.54). In patients with impaired kidney function at baseline, both SHR in the first and third tertiles anticipated higher risks of major AKI and major systemic infection.

CONCLUSIONS

Both high and low SHR indicates poor prognosis during hospitalization in non-surgical patients with heart failure and type 2 diabetes.

Glycated Haemoglobin A1c Variability Score Elicits Kidney Function Decline in Chinese People Living with Type 2 Diabetes

Our aim was to investigate the association of glycated haemoglobin A1c (HbA1c) variability score (HVS) with estimated glomerular filtration rate (eGFR) slope in Chinese adults living with type 2 diabetes. This cohort study included adults with type 2 diabetes attending outpatient clinics between 2011 and 2019 from a large electronic medical record-based database of diabetes in China (WECODe). We estimated the individual-level visit-to-visit HbA1c variability using HVS, a proportion of changes in HbA1c of ≥0.5% (5.5 mmol/mol). We estimated the odds of people experiencing a rapid eGFR annual decline using a logistic regression and differences across HVS categories in the mean eGFR slope using a mixed-effect model. The analysis involved 2397 individuals and a median follow-up of 4.7 years. Compared with people with HVS ≤ 20%, those with HVS of 60% to 80% had 11% higher odds of experiencing rapid eGFR annual decline, with an extra eGFR decline of 0.93 mL/min/1.73 m2 per year on average; those with HVS > 80% showed 26% higher odds of experiencing a rapid eGFR annual decline, with an extra decline of 1.83 mL/min/1.73 m2 per year on average. Chinese adults with type 2 diabetes and HVS > 60% could experience a more rapid eGFR decline.

Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes: a systematic review and meta-analysis

BACKGROUND

Current practice uses the latest measure of glycated hemoglobin (HbAlc) to facilitate clinical decision-making. Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes. However, the role of HbAlc variability is unclear in clinical practice. This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro- and macro-vascular complications and death in people with type 2 diabetes.

METHODS

We searched PubMed, EMBASE (via OVID), and Cochrane Central Register (CENTRAL, via OVID) for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation (SD), coefficient of variation (CV), and HbAlc variability score (HVS).

RESULTS

In people with type 2 diabetes, the highest quantile of all three HbAlc variability metrics (HbAlc-standard deviation [HbAlc-SD], HbAlc-coefficient of variance [HbAlc-CV], and HVS) is associated with increased risks of all-cause mortality, cardiovascular events, progression to chronic kidney disease, amputation, and peripheral neuropathy. For example, the hazard ratio of HbAlc-SD on all-cause mortality was l.89 with 95% confidence interval (95% CI) l.46-2.45 (HbAlc-CV l.47, 95% CI l.26-l.72; HVS l.67, 95% CI l.34-2.09).

CONCLUSIONS

High HbAlc variability leads to micro- and macro-vascular complications of type 2 diabetes and related death. People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.

Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials

BACKGROUND

Pharmacotherapy provides an option for adults with overweight and obesity to reduce their bodyweight if lifestyle modifications fail. We summarised the latest evidence for the benefits and harms of weight-lowering drugs.

METHODS

This systematic review and network meta-analysis included searches of PubMed, Embase, and Cochrane Library (CENTRAL) from inception to March 23, 2021, for randomised controlled trials of weight-lowering drugs in adults with overweight and obesity. We performed frequentist random-effect network meta-analyses to summarise the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence, calculate the absolute effects, categorise interventions, and present the findings. The study was registered with PROSPERO, CRD 42021245678.

FINDINGS

14 605 citations were identified by our search, of which 143 eligible trials enrolled 49 810 participants. Except for levocarnitine, all drugs lowered bodyweight compared with lifestyle modification alone; all subsequent numbers refer to comparisons with lifestyle modification. High to moderate certainty evidence established phentermine-topiramate as the most effective in lowering weight (odds ratio [OR] of ≥5% weight reduction 8·02, 95% CI 5·24 to 12·27; mean difference [MD] of percentage bodyweight change -7·97, 95% CI -9·28 to -6·66) followed by GLP-1 receptor agonists (OR 6·33, 95% CI 5·00 to 8·00; MD -5·76, 95% CI -6·30 to -5·21). Naltrexone-bupropion (OR 2·69, 95% CI 2·11 to 3·43), phentermine-topiramate (2·40, 1·69 to 3·42), GLP-1 receptor agonists (2·17, 1·71 to 2·77), and orlistat (1·72, 1·44 to 2·05) were associated with increased adverse events leading to drug discontinuation. In a post-hoc analysis, semaglutide, a GLP-1 receptor agonist, showed substantially larger benefits than other drugs with a similar risk of adverse events as other drugs for both likelihood of weight loss of 5% or more (OR 9·82, 95% CI 7·09 to 13·61) and percentage bodyweight change (MD -11·41, 95% CI -12·54 to -10·27).

INTERPRETATION

In adults with overweight and obesity, phentermine-topiramate and GLP-1 receptor agonists proved the best drugs in reducing weight; of the GLP-1 agonists, semaglutide might be the most effective.

FUNDING

1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.

Robust Topological Nodal-Line Semimetals from Periodic Vacancies in Two-Dimensional Materials

A nodal-line semimetal (NLSM) is suppressed in the presence of spin-orbit coupling unless it is protected by a nonsymmorphic symmetry. We show that two-dimensional (2D) materials can realize robust NLSMs when vacancies are introduced on the lattice. As a case study we investigate borophene, a boron honeycomb-like sheet. While the Dirac cones of pristine borophene are shown to be gapped out by spin-orbit coupling and by magnetic exchange, robust nodal lines (NLs) emerge in the spectrum when selected atoms are removed. We propose an effective 2D model and a symmetry analysis to demonstrate that these NLs are topological and protected by a nonsymmorphic glide plane. Our findings offer a paradigm shift to the design of NLSMs: instead of searching for nonsymmorphic materials, robust NLSMs may be realized simply by removing atoms from ordinary symmorphic crystals.

Reducing clinical review burden for insertable cardiac monitors

Funding Acknowledgements

Type of funding sources: None.

Background

The insertable cardiac monitor (ICM) is an essential tool for the ambulatory diagnosis of arrhythmias. However, definitive diagnoses still rely on time-consuming, manual adjudication of electrograms (EGMs) transmitted to the patient care network. This EGM review burden may be minimized by automatically selecting a subset of EGMs for fast review without delaying the diagnosis.

Purpose

Develop EGM selection strategies to reduce the EGM review burden without delaying diagnoses.

Methods

A retrospective analysis of 1,000 randomly selected Abbott Confirm Rx devices with 90+ days of remote transmission history was performed, regardless of transmission frequency, and all EGMs were adjudicated as either true or false positive (TP, FP). Up to 3 EGMs per day per arrhythmia type were prioritized for review based on ventricular rate and episode duration, with rules specific to each arrhythmia type: atrial fibrillation (AF), tachycardia, bradycardia, and pause. The resulting reduction in EGM review burden and TP days (patient-days with at least 1 TP EGM), as well as any diagnostic delay from the first transmitted TP, were calculated relative to reviewing all transmitted EGMs.

Results

In this population and transmission period, at least one AF, tachycardia, bradycardia, and pause EGM was transmitted by 424, 343, 190, and 325 unique devices, respectively, with a total of 35,723, 12,239, 19,752, and 28,002 EGMs, and a total of 6,163, 1,572, 1,438, and 646 TP days. For these patients with ≥1 EGM, the median [IQR] EGM transmission rate was 2.6 [0.7, 11.6], 1.1 [0.4, 4.7], 2.1 [0.6, 10.7], and 3.4 [0.6, 29.9] EGMs/patient/month, respectively. The optimal EGM selection strategy reduced this EGM review burden by 43%, 67%, 76%, and 50%, while only missing 3.4%, 2.2%, 0.3%, and 0.2% of TP days, respectively. Ultimately, 97%, 99%, 99%, and 99% of devices with a TP AF, tachycardia, bradycardia, or pause EGM exhibited no diagnostic delay vs. reviewing all transmitted EGMs.

Conclusion

EGM prioritization rules for selecting up to 3 episodes/day significantly reduced EGM burden across all patients, not just "frequent fliers," with no delay-to-diagnosis in >97% of patients who exhibited a true arrhythmia. Implementing these rules on the patient care network may improve clinical workflow and ICM patient management. Abstract Figure.

KCNMA1-AS1 attenuates apoptosis of epithelial ovarian cancer cells and serves as a risk factor for poor prognosis of epithelial ovarian cancer

OBJECTIVE

To explore the role of KCNMA1-AS1 in epithelial ovarian cancer (EOC) and its underlying mechanism.

PATIENTS AND METHODS

We first screened out the differentially expressed lncRNAs (KCNMA1-AS1) in the GEO (gene expression omnibus) database. The relationship between KCNMA1-AS1 expression and prognosis of EOC with different pathological types was analyzed by meta-analysis. Subsequently, KCNMA1-AS1 expressions in EOC tissues and normal ovarian tissues were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The correlation between KCNMA1-AS1 level with progression-free survival (PFS) and overall survival (OS) of EOC was analyzed. Furthermore, proliferation and migration of EOC cells transfected with the corresponding plasmids were analyzed by Cell Counting Kit-8 (CCK-8) and transwell assay, respectively. Apoptosis-related genes in EOC cells were detected by Western blot.

RESULTS

KCNMA1-AS1 was a risk factor for prognosis in high-grade, advanced and serous EOC. Upregulated KCNMA1-AS1 was found in EOC tissues than that of normal tissues, showing the diagnostic potential of KCNMA1-AS1 in EOC. Statistical analysis indicated that KCNMA1-AS1 was not correlated with the DFS, OS, age, histological type, lymph node metastasis and recurrence, but related to FIGO stage of EOC patients. For in vitro experiments, the proliferation and migration of were enhanced, and apoptosis of HO8910 cells overexpressing KCNMA1-AS1 was inhibited. Furthermore, elevated expressions of Caspase-3 and Caspase-9, as well as reduced expression of Bcl-xL, were observed after KCNMA1-AS1 knockdown in EOC cells.

CONCLUSIONS

KCNMA1-AS1 is overexpressed in EOC and negatively correlated with its prognosis. KCNMA1-AS1 participates in the occurrence and development of EOC by promoting proliferation, migration and inhibiting apoptosis of ovarian cancer cells via apoptosis pathway.

Pharmacologic therapy to induce weight loss in women who have obesity/overweight with polycystic ovary syndrome: a systematic review and network meta-analysis

BACKGROUND

Women with polycystic ovary syndrome (PCOS) are almost three times more likely to be obese than those without PCOS. However, we have no specific interventions to induce weight loss so far and rely on drugs used to treat other symptoms of the syndrome or obesity in the general population.

OBJECTIVE

The objective of this study is to compare the effectiveness of metformin, inositol, liraglutide and orlistat to induce weight loss in women with PCOS and overweight/obesity.

METHODS

A search was conducted using the MEDLINE, EMBASE, PubMed and CENTRAL databases. Individually randomized, parallel group trials that evaluated the effects of these pharmacological treatments among adults or adolescents with PCOS and overweight/obesity, compared with a placebo or metformin group, were considered eligible. Registration number: PROSPERO CRD 42017076625.

RESULTS

Twenty-three trials reporting on 941 women were included in the network meta-analysis. The amount of weight lost differed significantly among the drugs (in descending order): liraglutide, orlistat and metformin. Liraglutide alone, liraglutide/metformin and metformin alone significantly reduced waist circumference, but no change was found with orlistat. Data for waist-to-hip ratio were only available for metformin, which had no significant effect.

CONCLUSION

Liraglutide appears superior to the other drugs in reducing weight and waist circumference.

Comparison between a novel human cortical bone screw and bioabsorbable interference screw for graft fixation of ACL reconstruction

OBJECTIVE

To compare the mechanical behavior of a novel bioabsorbable cortical interference screw (BCIS) with bioabsorbable interference screw (BIS; Polylactate hydroxyapatite) used for anterior cruciate ligament (ACL) reconstruction in femoral and tibial fixation with doubled Achilles tendon graft in vitro.

PATIENTS AND METHODS

30 paired goat knee specimens were harvested from 15 male sheep aged 18 months. All soft tissues were stripped from the bones of 20 paired specimens, and the last 10 paired specimens were stripped all soft tissues besides ACL (femur-ACL-tibia complex). The Achilles tendon was harvested as graft for ACL reconstruction. The specimens were divided into several groups: BCIS femoral fixation (group A, n=10), BIS femoral fixation (group B, n=10), BCIS tibial fixation (group C, n=10), BIS tibial fixation (group D, n=10), Group E is femur-ACL-tibia complex (n=10). Cyclic loading test was performed from 50 to 250 N at 1 Hz for 1000 cycles and followed by a load-to-failure test at 25 mm/sec. A paired t-test was used to compare the biomechanical properties of group A, B, E and group C, D, E.

RESULTS

No fixation structures failed during the cyclic phase. Cyclic displacement for group B was superior to group A, and showed statistically significant difference after 30, 100, 500, 1000 cycles. Group E got minimum cyclic displacements compared with group A and group B, and showed statistically significant difference after 500, 1000 cycles compared with group A. Cyclic displacement for group D was superior to group C, and showed statistically significant difference after 100, 500, 1000 cycles. Group E got minimum cyclic displacements compared with group C and group D, and showed statistically significant difference after 500,1000 cycles compared with group C. Regarding MFL, group A was superior to group B (572.10±111.12 N vs. 413.96±34.56 N, p=0.118), group E was superior to group A (599.74±85.45N vs. 572.10±111.12 N, p=0.992), and group C was superior to group D (802.88±240.07 N vs. 415.63±51.9 N, p<0.001), group C was superior to group E (802.88±240.07 N vs. 599.74±85.45 N, p=0.024). Regarding YL, group A was superior to group B (521.57±93.96 N vs. 366.99±44.66 N, p=0.109), group E was superior to group A (565.37±66.05 N vs. 521.57±93.96 N, p=0.952), and group C was superior to group D (735.63±242.91 N vs. 394.49±31.90 N, p<0.001), group C was superior to group E (735.63±242.91 N vs. 565.37±66.05 N, p=0.063). Regarding stiffness, group A was superior to group B (157.36±34.31 N/mm vs. 91.98±25.57 N/mm, p=0.001), group E was superior to group A (181.35±25.42 N vs. 157.36±34.31 N/mm, p=0.529), and group C was superior to group D (175.28±43.19 N/mm vs. 128.24±18.92 N/mm, p=0.032), group E was superior to group C (181.35±25.42 N/mm vs. 175.28±43.19 N/mm, p=0.995).

CONCLUSIONS

In vitro, this experimental study suggested the biomechanical properties of novel bioabsorbable cortical interference screw (BCIS) were superior to bioabsorbable interference screw (BIS) used for femoral and tibial anterior cruciate ligament (ACL) reconstruction in a goat knee model.

Revealing the nature of low-temperature photoluminescence peaks by laser treatment in van der Waals epitaxially grown WS2 monolayers

Monolayers of transition metal dichalcogenides (TMD) are promising materials for optoelectronics devices. However, one of the challenges is to fabricate large-scale growth of high quality TMD monolayers with the desired properties in order to expand their use in potential applications. Here, we demonstrate large-scale tungsten disulfide (WS₂) monolayers grown by van der Waals Epitaxy (VdWE). We show that, in addition to the large structural uniformity and homogeneity of these samples, their optical properties are very sensitive to laser irradiation. We observe a time instability in the photoluminescence (PL) emission at low temperatures in the scale of seconds to minutes. Interestingly, this change of the PL spectra with time, which is due to laser induced carrier doping, is employed to successfully distinguish the emission of two negatively charged bright excitons. Furthermore, we also detect blinking sharp bound exciton emissions which are usually attractive for single photon sources. Our findings contribute to a deeper understanding of this complex carrier dynamics induced by laser irradiation which is very important for future optoelectronic devices based on large scale TMD monolayers.

Improved apple latent spherical virus-induced gene silencing in multiple soybean genotypes through direct inoculation of agro-infiltrated Nicotiana benthamiana extract

BACKGROUND

Virus induced gene silencing (VIGS) is a powerful genomics tool for interrogating the function of plant genes. Unfortunately, VIGS vectors often produce disease symptoms that interfere with the silencing phenotypes of target genes, or are frequently ineffective in certain plant genotypes or tissue types. This is especially true in crop plants like soybean [Glycine max (L.) Merr]. To address these shortcomings, we modified the inoculation procedure of a VIGS vector based on Apple latent spherical virus (ALSV). The efficacy of this new procedure was assessed in 19 soybean genotypes using a soybean Phytoene desaturase (GmPDS1) gene as the VIGS target. Silencing of GmPDS1 was easily scored as photo-bleached leaves and/or stems.

RESULTS

In this report, the ALSV VIGS vector was modified by mobilizing ALSV cDNAs into a binary vector compatible with Agrobacterium tumefaciens-mediated delivery, so that VIGS-triggering ALSV variants could be propagated in agro-infiltrated Nicotiana benthamiana leaves. Homogenate of these N. benthamiana leaves was then applied directly onto the unifoliate of young soybean seedlings to initiate systemic gene silencing. This rapid inoculation method bypassed the need for a particle bombardment apparatus. Among the 19 soybean genotypes evaluated with this new method, photo-bleaching indicative of GmPDS1 silencing was observed in nine, with two exhibiting photo-bleaching in 100% of the inoculated individuals. ALSV RNA was detected in pods, embryos, stems, leaves, and roots in symptomatic plants of four genotypes.

CONCLUSIONS

This modified protocol allowed for inoculation of soybean plants via simple mechanical rubbing with the homogenate of N. benthamiana leaves agro-infiltrated with ALSV VIGS constructs. More importantly, inoculated plants showed no apparent virus disease symptoms which could otherwise interfere with VIGS phenotypes. This streamlined procedure expanded this functional genomics tool to nine soybean genotypes.

The use and discontinuation of hormone replacement therapy in women in South China

OBJECTIVE

The use of hormone replacement therapy (HRT) started later in China than in European countries. The purpose of the present study was to investigate HRT patterns and reasons for the initiation and discontinuation of HRT among women in South China.

METHODS

A telephone survey about menopausal status, the use of HRT, reasons for HRT discontinuation and duration of HRT treatment was conducted in 2014.

RESULTS

A total of 825 telephone surveys were carried out, and 217 previous HRT users and 390 current users were recruited for this study. Among these 607 subjects, 50.7% of the women sought out HRT for hot flushes, 41.6% for fatigue and 41.5% for sleeplessness. Approximately one-third (35.9%) of the patients abandoned HRT during the following year. The reasons for stopping HRT were mainly fear of breast and uterine cancer (28.4%), reduced menopausal symptoms (22.9%) and the inconvenience of taking pills or seeing a doctor (17.9%). The factors related to HRT discontinuation were the age when HRT was initiated (odds ratio 1.59, 95% confidence interval 1.19-2.13) and education level (odds ratio 0.78, 95% confidence interval 0.62-0.98).

CONCLUSIONS

The duration of HRT use in women in south China was short, and a high proportion of the women discontinued HRT. Given the high discontinuation rate and the low medical compliance, Chinese health-care providers still have much to do to let women know about the advantages and disadvantages of HRT and to encourage the use of HRT appropriately.

Decreased γ-aminobutyric acid levels in the brainstem in patients with possible sleep bruxism: A pilot study

BACKGROUND

An increasing number of studies have indicated that the central and autonomic nervous systems play roles in the genesis of sleep bruxism (SB). The role of specific neurochemicals in SB has been a subject of interest.

OBJECTIVE

In this study, we use proton magnetic resonance spectroscopy (¹ H-MRS) to determine whether the levels of γ-aminobutyric acid (GABA) and glutamate (Glu) are different in the brainstem and bilateral cortical masticatory area (CMA) between possible sleep bruxism (SB) patients and controls, and discuss whether the brainstem or cortical networks which may affect the central masticatory pathways are under the genesis of SB.

METHODS

Twelve possible SB patients and twelve age- and gender-matched controls underwent ¹ H-MRS using the "MEGA-Point Resolved Spectroscopy Sequence" (MEGA-PRESS) technique in the brainstem and bilateral CMA. Proton magnetic resonance spectroscopy data were processed using LCModel. Because the signal detected by MEGA-PRESS includes contributions from GABA, macromolecules (primarily proteins) and homocarnosine, the GABA signal is referred to as "GABA+". The glutamate complex (Glx) signal contains both glutamate (Glu) and glutamine (Gln), which mainly reflect glutamatergic metabolism.

RESULTS

Edited spectra were successfully obtained from the bilateral CMA in all subjects. There were no significant differences in neurochemical levels between the left and right CMA in possible SB patients and controls. In the brainstem, significantly lower GABA+ levels were found in possible SB patients than in controls (P = .011), whereas there was no significant difference (P = .307) in Glx levels between the 2 groups.

CONCLUSIONS

SB patients may possess abnormalities in the GABAergic system of brainstem networks.

Correlation of insulin-like growth factor 1 and osteoarthritic cartilage degradation: a spontaneous osteoarthritis in guinea-pig

OBJECTIVE

The pathogenesis of osteoarthritis centers on the imbalance between catabolic and anabolic processes in cartilage metabolism. Insulin growth factor 1 (IGF-1) has been shown to have anabolic effects in cartilage in vitro. This study aim to determine whether IGF-1 on cartilage is associated with loss of chondrocyte and extracellular matrix breakdown using the Hartley guinea pig model.

MATERIALS AND METHODS

Cartilage from the medial and lateral tibial plateau of 6-month and 12-month old Hartley guinea pigs were used for this study. Histological analysis was performed with hematoxylin-eosin (HE) and toluidine blue staining. Safranin-O staining was used to quantify proteoglycan (PG) loss and the extent of cartilage damage by Modified Mankin score. Distribution of IGF-1 was demonstrated with in situ hybridization techniques. IGF-1 mRNA levels were assessed using Real-time PCR.

RESULTS

Histological loss of chondrocytes, and cartilage matrix and decreased IGF-1 distribution were demonstrated in a temporal and spatial manner. Compared to the 6-month old samples, the 12-month specimens had significantly cartilage degeneration and less cartilage matrix and PGs staining. Decreased level of IGF-1 was also observed in the 12-month samples. These observations were more pronounced in the medial tibial plateau when compared to the lateral plateau.

CONCLUSIONS

The decreased level of IGF-1 may play a critical role for maintaining the balance between catabolic and anabolic processes in cartilage metabolism during the development of osteoarthritis. Thus, the increase of IGF-1 may be applicable to developing OA therapy.

Bone turnover alterations across the menopausal transition in south-eastern Chinese women [corrected]

OBJECTIVES

To explore the serum levels of bone resorption marker C-terminal telopeptide of type I collagen (CTX) and bone formation marker N-amino terminal propeptide of type I collagen (PINP) in Chinese women across the menopausal transition and the correlation between follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol with the bone turnover markers.

METHODS

A cross-sectional study was conducted on 464 healthy Chinese women, separated into pre-, peri- and postmenopausal groups based on their menstruation changes. The serum levels of CTX, PINP, FSH, LH, and estradiol were measured.

RESULTS

The serum levels of CTX and PINP were significantly higher in women in the peri- and postmenopausal groups. The serum levels of FSH were significantly correlated with the serum levels of PINP in premenopausal women. Both serum FSH and LH were positively correlated with serum CTX in perimenopausal women and postmenopausal women. Estradiol was inversely correlated with CTX in the perimenopausal group. Multiple linear regression models show the serum FSH levels were independently related to the bone turnover markers CTX and PINP.

CONCLUSIONS

The elevated serum levels of FSH were independent risk factors for bone loss in peri- and postmenopausal women, and measurement of the serum FSH levels in mid-age women with irregular menses could be used in early diagnosis of postmenopausal osteoporosis.

A fluorometric assay for tyrosinase activity and its inhibitor screening based on graphene quantum dots

Pristine graphene quantum dots (GQDs) without any functionalization were used as probes to develop a sensitive and selective fluorescence sensing platform for the detection of tyrosinase (TYR) activity and its inhibitor screening for the first time.

Elevated plasma sphingomyelin (d18:1/22:0) is closely related to hepatic steatosis in patients with chronic hepatitis C virus infection

Hepatic steatosis affects disease progression in patients with chronic hepatitis C virus (HCV) infection. We investigated the plasma sphingolipid profile in patients with chronic hepatitis C (CHC) and whether there was an association between HCV-related steatosis and plasma sphingolipids. We used high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to analyze plasma sphingolipids in 120 interferon-naïve, non-diabetic, and non-obese CHC patients. Hepatic steatosis was defined as ≥5 % hepatocytes with fat based on histopathological analysis. Blood biochemical indicators and HCV load and genotype were also determined. Thirty-six (30.0 %) of 120 patients presented with hepatic steatosis Grades 1-3. Forty-four plasma sphingolipids were detected. Plasma sphingomyelin (SM) (d18:1/22:0) and ceramide (Cer) (d18:1/24:0)-1-P correlated with steatosis grade (r = 0.22, p = 0.015; r = -0.23, p = 0.012, respectively). SM (d18:1/22:0) [odds ratio (OR) = 1.12] and Cer (d18:1/24:0)-1-P (OR = 0.88) were independent factors for the presence of hepatic steatosis in CHC patients. The area under the curve (AUC) of SM (d18:1/22:0) and Cer (d18:1/24:0)-1-P was 0.637 and 0.638, respectively, to identify the presence of steatosis. Further analysis for genotype 2 CHC showed that only SM (d18:1/22:0) was independently linked to steatosis (OR = 1.21). The AUC of SM (d18:1/22:0) to identify hepatic steatosis in genotype 2 CHC was 0.726. Its sensitivity and negative predictive value reached 0.813 and 0.886, respectively. This study suggested that altered plasma SM (d18:1/22:0) was closely related to hepatic steatosis in chronic HCV infection, especially with genotype 2. Experimental studies are needed to determine further the underlying mechanisms responsible for these associations.

Short leukocyte telomere length predicts poor prognosis and indicates altered immune functions in colorectal cancer patients

BACKGROUND

Numerous studies indicate that the leukocyte telomere length is associated with the risk of cancers, including colorectal cancer (CRC). However, the prognostic value of leukocyte telomere length in CRC patients has not been investigated.

PATIENTS AND METHODS

Relative telomere length (RTL) of peripheral blood leukocytes (PBLs) from 571 CRC patients receiving surgical resection was measured using a polymerase chain reaction-based method. The Cox proportional hazards ratio model and the Kaplan-Meier curve were used to estimate the association between RTL and the clinical outcome of CRC patients in the training set (90 patients) and the testing set (86 patients). Finally, an independent cohort of 395 patients was used as an external validation set. The immunophenotype of PBLs and the plasma concentration of several immune-related cytokines were determined by flow cytometry and enzyme-linked immunosorbent assay, respectively.

RESULTS

Patients with shorter RTL had significantly poorer overall survival and relapse-free survival than those with longer RTL in the training, testing and validation sets. Furthermore, leukocyte RTL and Tumor-Node-Metastasis (TNM) stage exhibited a significant joint effect in the prognosis prediction of combined CRC patients, indicating that patients with both short RTL and advanced stages had the worst prognosis, when compared with other subgroups. In addition, patients with short RTL showed the higher percentage of CD4(+) T cell and the lower percentage of B cell in peripheral blood mononuclear cells, as well as the lower concentration of plasma transforming growth factor-β1, suggesting a possibility that the immune functions changed with RTL alteration.

CONCLUSIONS

Our study for the first time demonstrates that leukocyte RTL is an independent prognostic marker complementing TNM stage and associated with the immune functions in CRC patients.

First Report of Grapevine leaf roll-associated virus-2 and -3 in Ohio Vineyards

Grapevine leaf roll-associated viruses (GLRaVs) are a group of nine closely related viruses belonging to the Closteroviridae family that cause grapevine leaf roll disease in vineyards across the world (3). Within the continental United States, GLRaVs have been reported in the states of California, Michigan, Missouri, New York, Oregon, Washington, and Wisconsin, but not in Ohio (2,3). During 2012, grapevines with typical leaf roll symptoms were reported by owners of several Ohio vineyards. The symptoms included small, red leaves and downwardly rolled leaf margins, accompanied by tiny grape clusters with few fruits. A total of 20 symptomatic leaf samples were collected from two sites about 300 miles apart within Ohio, namely Valley Vineyards (cultivars Vidal Blanc and Fronterac) and South River Winery (cultivar Cabernet Franc). Total RNA was extracted from the samples using a previously reported procedure (1) and subjected to reverse transcription (RT)-PCR using specific primers for five known grapevine viruses including GLRaV-1 (1F: 5'-ACCTGGTTGAACGAGATCGCTT and 1R: 5'-GTAAACGGGTGTTCTTCAATTCTCT), GLRaV-2 [2F(FQ): 5'-GCTCCTAACGAGGGTATAGAAG and 2R(FQ): 5'-AGAGCGTACATACTCGCGAACAT], GLRaV-3 [3F(FQ): CAAGTGCTCTAGTTAAGGTCAG and 3R(FQ): 5'-CGGAACGTCGGTTCATTTAGA], Grapevine fan leaf virus (GFLVR1-F: 5'-TGAGATTAGTCATGGAGCAGCTT and GFLVR1-R: 5'-GGATAGACGTCTGGTTGATTTTG), and Tobacco ring spot virus (TRSVR1-1255F: 5'-GAGTGTTGTGCAATTATCT-GCATA and TRSVR1-1844R: 5'-CAAAGATGCCAAGAAAAGTTGCAAG). A 295-bp fragment of a grapevine actin cDNA (primers VvACT-F: 5'-ATCTCCATGTCAACCAAACTGAG and VvACT-R: 5'-GACAGAATGAGCAAGGAAATCAC) was used as a positive control for RT-PCR. The samples tested negative for GFLV, TRSV, or GLRaV-1 with our primer sets. However, four of the samples were positive for GLRaV-2, and 12 positive for GLRaV-3, as evidenced by the detection of PCR fragments of expected sizes (404 and 344 bp, respectively). All samples positive for GLRaV-2 were from a single field, whereas samples positive for GLRaV-3 were from both vineyards examined. The identities of GLRaV-2 and -3 were further confirmed by directly sequencing one GLRaV-2 and two GLRaV-3 (one from each location) PCR fragments from both ends. The 404 bp GLRaV-2-specific fragment shared 95 to 98% sequence identity with various GLRaV-2 isolates whose sequences were deposited at the GenBank. Similarly, the two 344-bp GLRaV-3 fragments share a 95 to 97% identity with known GLRaV-3 isolates. Notably, the sequences of the two GLRaV-3-specific fragments derived from two vineyards are not identical (97% identity), suggesting these two isolates might have different origins. As these viruses are known to be recalcitrant to mechanical transmission, we did not attempt to transmit these viruses to healthy plants. In summary, our results report for the first time the detection of GLRaV-2 and -3 in Ohio, suggesting that these two viruses are associated with the observed leaf roll symptoms, hence should be part of an effective management plan for grapevine viral diseases in the state. References: (1) C. Louime et al. Eur. J. Sci. Res. 22:232, 2008. (2) S. Lunden and W. Qiu. Plant Dis. 96:462, 2012. (3) A. M. Sharma et al. PLoS One 6:e26227, 2011.

Wheat mosaic virus (WMoV), the Causal Agent of High Plains Disease, is Present in Ohio Wheat Fields

High Plains disease was first described in wheat (Triticum aestivum) in Nebraska, Idaho, Texas, and other High Plains states in 1993 to 1994 (1). The causal agent is a negative sense RNA virus in the genus Emaravirus with at least three genome segments, which is transmitted by the wheat curl mite (Aceria tosichella Keifer) (2). This virus is variously referred to as High Plains virus (HPV), Maize red stripe virus (MRSV/MRStV), or Wheat mosaic virus (WMoV) in the literature. We adopt the name WMoV based on the latest recommendation (3). The presence of WMoV in Ohio was revealed through a comprehensive survey conducted in early spring 2012. Specifically, wheat plants exhibiting virus-like symptoms including chlorosis, reddening, stunting, spotting, or striping were collected from 27 wheat fields in 14 counties throughout Ohio, between March 20 and April 15, 2012. Total RNA was extracted from individual leaf samples, then pooled prior to ribosomal RNA removal and high throughput RNA-sequencing (RNA-Seq) using the Illumina HiSeq2000 platform (University of Illinois Biotechnology Center, Champaign-Urbana, IL). The resulting sequences were assembled and analyzed using CLC Genomics Workbench 5.5 software (CLC Bio, Cambridge, MA). One 983-nt contig was 99% identical to the nucleocapsid protein (NP)-coding RNA segment of WMoV (GenBank Accession DQ324466). We used reverse transcription (RT)-PCR to determine the distribution of WMoV in individual samples using WMoV-specific primers: WMoV NPf1 (TGCTATGTCATTGTTCAGGTGGTC), and WMoV NPr1 (TTAGGCAGTCCTTGATTGTGCTG). WMoV was identified in one sample each from Miami, Auglaize, and Paulding Counties, which are all in western Ohio. The WMoV-positive plants were chlorotic, with varying degrees of stunting and leaf striping. The presence of WMoV in the three samples was confirmed using protein A sandwich (PAS)-ELISA with WMoV-specific antiserum. Vascular puncture inoculation (VPI) (4) was used to inoculate germinating maize seed (cv. Spirit) with the extracts from the WMoV-positive samples. WMoV was detected in two of 378 surviving inoculated plants by RT-PCR and PAS-ELISA. These two WMoV-positive maize plants developed flecking mosaic symptoms on upper uninoculated leaves, consistent with reported WMoV symptoms. The WMoV-positive sample from Auglaize County also contained Wheat streak mosaic virus (WSMV), and 60 of the 120 surviving plants inoculated with this sample were positive for WSMV. This result suggests that, even with VPI, mechanical transmission of WMoV remains a great challenge. To our knowledge, this is the first report of WMoV in Ohio, and demonstrates that WMoV is more widespread than previously thought, reaching at least the eastern edge of the Midwest wheat production region. The expanding distribution of this emerging virus is significant because of its potential to cause additional yield losses in wheat. References: (1) S. G. Jensen et al. Plant Dis. 80:1387, 1996. (2) N. Mielke-Ehred and H.-P. Muhlbach. Viruses 4:1515, 2012. (3) J. M. Skare et al. Virology 347:343, 2006. (4) R. Louie et al. J. Virol. Methods 135:214, 2006.

First Report of Soybean vein necrosis-associated virus in Ohio Soybean Fields

Soybean vein necrosis-associated virus (SVNaV), a newly discovered tospovirus that infects soybean, was first described as widespread in a number of southern and midwestern states, but so far has not been reported in Ohio (1). Here we describe its occurrence in six different soybean leaf samples collected from five Ohio counties: Champaign, Hardin, Sandusky, Seneca, and Wyandot. Specifically, SVNaV was initially identified through a comprehensive survey during the summer of 2011 that used high throughput sequencing to detect genome sequences of viruses present in a pool of 110 field samples collected from 24 Ohio counties. Three assembled contigs, with sizes of 7,551, 4,937, and 1,554 nucleotides (nt) respectively, share 99% nt identity with the three SVNaV genomic RNAs (L, M, and S), and thus constitute partial sequences of the SVNaV Ohio (OH) isolate. The distribution of this virus was further delineated using reverse transcription (RT)-PCR with primers SVNaV-1734F (5' CCATCTTTCTTTCCAGGCATTTCA 3') and SVNaV-S-2421R (5' GATTCAAGTTCAGCGAGTTCTACAA 3'). All plants from which the SVNaV-positive samples were collected showed typical virus symptoms, including systemic mosaic accompanied by leaf deformation, chlorosis, vein necrosis, and rusty spots on mature leaves. These symptoms are largely consistent with the previous report by Zhou and colleagues (1). Intriguingly, further analysis with RT-PCR revealed that five out of the six SVNaV-positive samples also contained a second virus, with Bean pod mottle virus found in four of the samples, and Tobacco ringspot virus in the fifth. Since it is not yet possible to initiate SVNaV infection mechanically, it is difficult to determine whether the co-infecting viruses contribute to the disease symptoms and yield losses. It should be noted that SVNaV may have been in Ohio for some time since symptoms similar to those reported by Zhou and colleagues (1) have been observed in soybean fields of this state since at least 2009. Furthermore, while in 2011 these symptoms were observed in only a few fields, as reflected by the detection of SVNaV in six of the 110 samples, the 2012 growing season has seen a big jump of symptomatic plants and fields. The current report confirms its presence with molecular evidence and lays the groundwork for further assessment of its impact on soybean production. Reference: (1) J. Zhou et al. Virus Genes 43:289, 2011.

Con A-binding protein Zn-α2-glycoprotein on human sperm membrane is related to acrosome reaction and sperm fertility

Fertilization, the recognition and fusion between spermatozoa and oocyte, involves various molecules on the spermatozoa and oocyte membranes. Concanavalin A (ConA)-binding proteins may be one of the molecules involved in mammal spermatozoa fertilization; however, their structure and function remain largely unknown. Here, we initially identified a ConA-binding protein, Zn-α2-glycoprotein (ZAG), involved in regulating the acrosome reaction (AR) of human spermatozoa. ZAG is localized on the pre-equatorial region covering the acrosome, neck and tail (some parts of middle piece and principal piece respectively) regions of the acrosome intact human spermatozoa, and disappears in the acrosomal region of the acrosome-reacted spermatozoa. Polyclonal antibodies against human recombinant ZAG significantly reduced the AR and sperm capability binding to human zona pellucida or penetration into zona-free hamster oocytes. Furthermore, assessment of the signaling pathways regulated by ZAG revealed that ZAG affects sperm AR through both the cAMP/PKA and PKC pathways. These results indicate that ZAG, which is present on the human sperm membrane, plays a critical role in the AR and subsequently, may be involved in sperm fertility.

[Surveys on the conditions of Keshan disease and selenium levels of 15 counties in Shandong Province in 2008]

OBJECTIVE

To investigate the conditions of Keshan disease and the selenium nutritional status of residents in Keshan disease endemic area in Shandong Province.

METHODS

One site from each of 15 Keshan disease endemic counties in Shandong Province was selected for the survey and 700 subjects in each site were randomly selected for the investigation. Physical examination, electrocardiogram and X-ray radiography of the subjects and the selenium contents of hair, wheat, corn and dried sweet potato were surveyed.

RESULTS

A total of 10679 people were investigated in 15 counties and 315 patients were found, including 287 cases of latent type and 28 cases of chronic type, but no acute or subacute type patients were found. There were 1776 cases of abnormal electrocardiogram. Among the 461 cases checked up by radiography, the heart of 195 cases was enlarged. The selenium content of hair, wheat, corn and dried sweet potato were (0.5191 +/- 0.5538), (0.0268 +/- 0.0045), (0.0194 +/- 0.0052) and (0.0193 +/- 0.0039) mg/kg respectively.

CONCLUSION

The occurrence of Keshan disease is in a stable status in Shandong Province at present. Hair selenium of residents in Keshan disease endemic area has reached an appropriate level. The selenium nutritional status of residents has improved, and the prevalence of Keshan disease is expected to be decreased in these areas.

Hyperdense intracranial epidermoid cysts: a study of 15 cases

BACKGROUND

Although intracranial epidermoid cysts generally appear as hypodense lesions on CT scans, occasionally, they may appear hyperdense, making diagnosis difficult. The aim was to study clinical features and possible pathogenesis of hyperdense intracranial epidermoid cysts (HIECs).

METHODS

Fifteen patients with HIECs were surgically treated in our department during a 21-year period (1985 up to 2005). We reviewed each patient's clinical records, radiological findings, operative reports, and pathological examinations, along with a review of the literature.

FINDINGS

The incidence of HIECs in our series was approximately 3.02%, with female predominance. The average age was 32 years and the average duration of complaints was nine months. The most common location was the parasellar area (6 cases), followed by cerebellum (4 cases), clival region (3 cases), cerebello-pontine angle (1 case) and lateral ventricle (1 case). Gross-total excision of the tumor was achieved in ten patients (66.7%). Four (26.7%) patients underwent subtotal resection; and one (6.6%) patient underwent partial resection. Aseptic meningitis that occurred postoperatively in two cases was controlled by lumbar drainage.

CONCLUSIONS

Recurrent leakage of the irritating cyst contents and subsequent chemical inflammatory response may be responsible for the high-density on CT scans and the cystic nature. A correct histological diagnosis is important because, in contrast to typical ECs and other lesions, HIECs are more prone to spread intra-operatively and result in severe aseptic meningitis.

Remanent zero field spin splitting of self-assembled quantum dots in a paramagnetic host

We report on the observation of a finite spin splitting at zero magnetic field in resonant tunneling experiments on CdSe self-assembled quantum dots in a (Zn,Be,Mn)Se barrier. This is remarkable since bulk II-VI dilute magnetic semiconductors are paramagnets. Our experiment may be viewed as tunneling through a single magnetic polaron, where the carriers contained inside the dot act to mediate an effective ferromagnetic interaction between Mn ions in their vicinity. The effect is observable up to relatively high temperatures, which we tentatively ascribe to a feedback mechanism with the electrical current, previously predicted theoretically.

Direct Evidence of Oxidized Gold on Supported Gold Catalysts

Supported gold catalysts have drawn worldwide interest due to the novel properties and potential applications in industries. However, the origin of the catalytic activity in gold nanoparticles is still not well understood. In this study, time-of-flight secondary ion mass spectroscopy (TOF-SIMS) has been applied to investigate the nature of gold in Au (1.3 wt %)/gamma-Al2O3 and Au (2.8 wt %)/TiO2 catalysts prepared by the deposition-precipitation method. The SIMS spectrum of the supported gold catalysts presented AuO-, AuO2-, and AuOH- ion clusters. These measurements show direct evidence for oxidized gold on supported gold catalysts and may be helpful to gaining better understanding of the origin of the catalytic activity.