Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery

AIMS

The aims of the study were to determine the relationship between preoperative geriatric nutritional risk index (GNRI) and the occurrence of postoperative delirium (POD) in elderly patients after cardiac surgery and to evaluate the additive value of GNRI for predicting POD.

METHODS

The data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database. Patients who underwent cardiac surgery and were aged 65 or older were included. The relationship between preoperative GNRI and POD was investigated using logistic regression. We determined the added predictive value of preoperative GNRI for POD by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

RESULTS

A total of 4286 patients were included in the study, and 659 (16.1%) developed POD. Patients with POD had significantly lower GNRI scores than patients without POD (median 111.1 vs. 113.4, p < 0.001). Malnourished patients (GNRI ≤ 98) had a significantly higher risk of POD (odds ratio, 1.83, 90% CI, 1.42-2.34, p < 0.001) than those without malnutrition (GNRI > 98). This correlation remains after adjusting for confounding variables. The addition of GNRI to the multivariable models slightly but not significantly increases the AUCs (all p > 0.05). Incorporating GNRI increases NRIs in some models and IDIs in all models (all p < 0.05).

CONCLUSIONS

Our results showed a negative association between preoperative GNRI and POD in elderly patients undergoing cardiac surgery. The addition of GNRI to POD prediction models may improve their predictive accuracy. However, these findings were based on a single-center cohort and will need to be validated in future studies involving multiple centers.

[Progress in research of epidemiology of relapsing fever and prevention and control measures]

Relapsing fever, caused by Borreliae of the relapsing fever groups, is an infectious disease, which would cause spirochaetaemia and repeated fever in human. To comprehensively understand the classification and distribution of relapsing fever, as well as correlated factors, this paper summarizes the progress in research of epidemiology of relapsing fever in the world, and suggests prevention and control measures. The disease is heterogenous and can be divided into three groups according to vectors, i.e. tick-borne relapsing fever, louse-borne relapsing fever and the avian relapsing fever. Tick borne relapsing fever can be further divided into two types: soft tick transmission and hard tick transmission. Soft tick-borne relapsing fever generally has obvious geographical distribution characteristics, while hard tick-borne relapsing fever is widely distributed all over the world. Louse-borne relapsing fever, also known as epidemic forms of relapsing fever, is caused by body lice, and the incidence is usually associated with war, famine, refugees and poor sanitation. The prevention and control of relapsing fever should be based on local conditions.

Risk prediction of second primary malignancies in primary colorectal neuroendocrine neoplasms patients: a population-based study

PURPOSE

In this study, we aimed to identify risk factors for developing second primary malignancies (SPMs) in colorectal neuroendocrine neoplasms (NENs) patients and develop a competing-risk nomogram to predict SPMs' probabilities quantitatively.

METHODS

Patients with colorectal NENs were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database during 2000-2013. Potential risk factors for SPMs' occurrence in colorectal NENs' patients were identified by the Fine and Gray's proportional sub-distribution hazards model. Then, a competing-risk nomogram was constructed to quantify SPMs' probabilities. The discriminative abilities and calibrations of this competing-risk nomogram were assessed by the area under the receiver-operating characteristic (ROC) curves (AUC) and calibration curves.

RESULTS

We identified 11,017 colorectal NENs' patients, and randomly divided them into training (n = 7711 patients) and validation (n = 3306 patients) cohorts. In the whole cohort, 12.4% patients (n = 1369) had developed SPMs during the maximum follow-up of approximately 19 years (median 8.9 years). Sex, age, race, primary tumor location, and chemotherapy were identified as risk factors for SPMs' occurrence in colorectal NENs' patients. Such factors were selected to develop a competing-risk nomogram and showed excellent predictive ability for SPMs' occurrence (the 3-, 5-, and 10-year AUC values were 0.631, 0.632, and 0.629 in the training cohort and 0.665, 0.639, 0.624 in the validation cohort, respectively).

CONCLUSIONS

This research identified risk factors for SPMs' occurrence in colorectal NENs' patients. Competing-risk nomogram was constructed and proved to have good performance.

Pharmacological inhibition of the cGAS-STING signaling pathway suppresses microglial M1-polarization in the spinal cord and attenuates neuropathic pain

Neuroinflammation plays a vital role in the development of neuropathic pain and is mediated mainly by microglia. Suppressing microglial M1-polarization attenuates neuropathic pain. Recently, the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway has emerged as a key mediator of inflammation and shows potential in modulating microglial polarization. In this study, we evaluated whether cGAS-STING is a potential therapeutic target. Spared nerve injury (SNI) surgery was conducted in adult male rats to establish a neuropathic pain model. We showed that SNI promoted microglial M1-polarization and induced cGAS-STING pathway activation in the spinal cord. Double-label immunofluorescence assays showed that cGAS-STING activation mainly occurred in neurons and microglia but not astrocytes. We further conducted in vitro experiments using BV-2 microglial cells. The results showed that LPS-induced microglial M1-polarization was accompanied by cGAS-STING pathway activation, but cGAS-STING inhibition by antagonists suppressed LPS-induced microglial M1-polarization. In vivo, we also showed that a cGAS antagonist and a STING antagonist suppressed the microglial M1-polarization and ameliorated the mechanical allodynia induced by SNI. These findings suggested that the cGAS-STING pathway might be a potential therapeutic target for treating neuropathic pain. However, further research is warranted to verify our findings in female rodents.

Esophageal cancer-related gene 4 and solid tumors: a brief literature review

Esophageal cancer-related gene 4 (ECRG4) plays key roles in various malignancies, including lung cancer, prostate cancer, esophageal cancer, and breast cancer, and has potential applications in the early diagnosis, prevention, treatment, and prognosis of cancer. However, the mechanisms underlying the role of ECRG4 in cancer remain elusive. An association between ECRG4 and proliferation, migration, cell cycle, apoptosis, methylation, and ubiquitination in cancer has been found. Additionally, some studies have investigated the regulatory mechanism of the relationship between ECRG4 and long non-coding RNAs, co-factors, and resistance to chemotherapy. Drugs that demethylate ECRG4 are in clinical use. Thus, further investigation of the mechanisms by which ECRG4 influences tumorigenesis, and its clinical significance, are needed. The present study outlines the current understanding of the functions of ECRG4 in cancer and discusses its potential value in cancer therapy.

Preoperative screening of patients at high risk of obstructive sleep apnea and postoperative complications: A systematic review and meta-analysis

STUDY OBJECTIVE

To determine the association between postoperative complications and a high versus low risk of obstructive sleep apnea (OSA) as determined via screening tools.

DESIGN

Systematic review and meta-analysis of cohort studies. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched from their inception to January 5, 2021.

SETTING

Operating room, postoperative recovery area, and ward.

PATIENTS

Adult patients scheduled for surgery.

INTERVENTIONS

We used Review Manager 5.4 to pool the data. The quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation system.

MEASUREMENTS

The primary outcome was the composite endpoint of postoperative respiratory complications. The secondary outcomes were postoperative cardiac and neurological complications, intensive care unit (ICU) admission, and mortality.

MAIN RESULTS

Twenty-six studies with 50,592 patients were included. A STOP-Bang score ≥ 3 (versus <3) was associated with higher incidences of postoperative respiratory (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.66-2.68) and neurological complications (OR, 3.60; 95% CI, 1.56-8.31). A STOP-Bang score ≥ 5 (versus <5) was associated with higher incidences of postoperative respiratory (OR, 2.37; 95% CI, 1.11-5.04) and cardiac complications (OR, 4.95; 95% CI, 1.22-20.00) and higher in-hospital mortality (OR, 26.39; 95% CI, 2.89-241.30). A Berlin score ≥ 2 (versus <2) was not associated with the incidence of postoperative complications, ICU admission, or mortality. The quality of evidence for all outcomes was very low.

CONCLUSIONS

Very low-quality evidence suggested that a high risk of OSA, as assessed using the STOP-Bang questionnaire, was associated with a higher incidence of postoperative respiratory complications, and may also be associated with higher incidences of postoperative cardiac and neurological complications than a low risk of OSA. Since most of the included studies did not adjust for confounding factors, our findings need to be interpreted with caution. PROSPERO registration number: CRD42021220236.

[Immediate rehabilitation of edentulous mandibles with implant-supported full-arch prostheses by intra-oral welding technique: a two-year follow-up]

Objective: To evaluate the 2-year clinical outcome of immediate loading implant-supported fixed full-arch prostheses in mandibles using intra-oral welding technique and to discuss the characteristics of the technique. Methods: Totally 15 patients (4 males and 11 females) who treated with immediate rehabilitation of edentulous mandibles with implant-supported full-arch prostheses from July 2015 to February 2019 in Department of Implantology, Peking University School and Hospital of Stomatology were included in the present study. The patients' average age was 64.2±9.3 years. In each case, 4 implants were placed in the mandible area, a titanium bar was connected with each of the implants by using intra-oral welding technique as the Ti-metal framework of the prostheses. Pre-fabricated abutment-level fixed prostheses were delivered immediately after the surgery. A total of 60 implants, 15 mandibles were treated. Biological and mechanical complications, hygiene of the tissue-contacted surface of the restoration and patients' satisfactory grade were recorded. The radiological fitness of welded frameworks to abutments, survival rate of implants and marginal bone loss were calculated and analyzed. The observation period of the study was 24-55 months, with an average of 34.9 months. Results: All of the 15 cases of welded bar-abutment frameworks were fixed on implants with well passive fitness in clinical and radiological level. However, 2 of the 60 implants were failed by loss of osseointegration, and the result of implant survival rate of 96.7% in 2 years. The average marginal bone loss was (0.7±0.2) mm. The average bleeding index of the 58 implants remained was under 3 without clinical signs of gingival swelling, tenderness or fistula. No mechanical complications, such as break or distortion of the implants, occurred. Fracture of artificial teeth and complex resin area happened in 6 of the 15 prostheses. The average debris index was 3.4±0.4 and the hygiene of the tissue-contact areas was under satisfactory condition. Conclusions: Using the intra-oral welding technique to achieve a rigid splint of implants, the clinical outcome of the newly performed technique was predictable in early stage. The frame structure remained stable to avoiding the occurrence of mechanical complications. The provisional restoration could be expected to provide long functional period. Long term result of the treatment were needed for further observation.

The analysis of osteosarcopenia as a risk factor for fractures, mortality, and falls

Osteosarcopenia is defined as the concomitant occurrence of sarcopenia and osteoporosis/osteopenia. This study aimed to clarify whether osteosarcopenia implies a greater risk of fractures, mortality, and falls and to draw attention to osteosarcopenia.

INTRODUCTION

Osteosarcopenia, which is characterized by the co-existence of osteoporosis/osteopenia and sarcopenia, is one of the most challenging geriatric syndromes. However, the association between osteosarcopenia and the risk of falls, fractures, disability, and mortality is controversial.

METHODS

We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, from their inception to March 18, 2021, for cohort studies on the relationship between osteosarcopenia and fractures, falls, and mortality. Two reviewers independently extracted data and assessed study quality. A pooled analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) using fixed or random-effects models.

RESULTS

Eight cohort studies including 19,836 participants showed that osteosarcopenia significantly increased the risk of fracture (OR 2.46, 95% CI 1.83-3.30, P_{heterogeneity} = 0.006, I² = 63.0%), three cohort studies involving 2601 participants indicated that osteosarcopenia significantly increased the risk of mortality (OR 1.66, 95% CI 1.23-2.26, P_{heterogeneity} = 0.214, I² = 35.2%), and three cohort studies involving 3144 participants indicated that osteosarcopenia significantly increased the risk of falls (OR 1.62, 95% CI 1.28-2.04, P_{heterogeneity} = 0.219, I² = 34.1%). No publication bias existed among the studies regarding the association between osteosarcopenia and fractures. The findings were robust according to the subgroup and sensitivity analyses.

CONCLUSIONS

This pooled analysis demonstrated that osteosarcopenia significantly increased the risk of fractures, falls, and mortality, thus highlighting its relevance in daily life. Therefore, we suggest that elderly persons should be aware of the risks associated with osteosarcopenia.

Down-regulation of betatrophin enhances insulin sensitivity in type 2 diabetes mellitus through activation of the GSK-3β/PGC-1α signaling pathway

OBJECTIVE

The incidence of type 2 diabetes mellitus (T2DM) among children and adolescents has been rising. Accumulating evidences have noted the significant role of betatrophin in the regulation of lipid metabolism and glucose homeostasis. In our study, we tried to figure out the underlying mechanism of betatrophin in insulin resistance (IR) in type 2 diabetes mellitus (T2DM).

METHODS

First, fasting serum betatrophin, fasting blood glucose (FBG), insulin, total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) were detected in T2DM children. The homeostasis model assessment of insulin resistance (HOMA-IR), Gutt insulin sensitivity index (ISI_G) and Matsuda insulin sensitivity index (ISI_M) were calculated. A T2DM-IR mouse model was induced by high-fat diet, with the expression of GSK-3β and PGC-1α detected. Besides, HepG2 cells were induced by a high concentration of insulin to establish an IR cell model (HepG2-IR). The cell viability, glucose consumption, liver glycogen content, inflammation, and fluorescence level of GSK-3β and PGC-1α were analyzed.

RESULTS

Betatrophin was highly expressed in serum of T2DM children and was positively correlated with FBG, insulin, TC, TG, LDL-C and HOMA-IR, while negatively correlated with ISI_G and ISI_M. Betatrophin and GSK-3β in the liver tissues of T2DM-IR mice were increased, while the PGC-1α expression was decreased. Betatrophin expression was negatively correlated with PGC-1α and positively correlated with GSK-3β. Silencing of betatrophin enhanced insulin sensitivity through the activation of GSK-3β/PGC-1α signaling pathway. In vitro experiments also found that silencing of betatrophin promoted glucose consumption and glycogen synthesis while inhibited inflammation.

CONCLUSION

Our findings concluded that silencing of betatrophin could enhance insulin sensitivity and improve histopathological morphology through the activation of GSK-3β/PGC-1α signaling pathway.

Angiotensin II type 1 receptor blockade attenuates posttraumatic stress disorder-related chronic pain by inhibiting glial activation in the spinal cord

Clinically, posttraumatic stress disorder (PTSD) and chronic pain are highly comorbid conditions, but the underlying mechanisms of and therapeutic strategies against PTSD-related pain remain unclear. Our previous studies suggested that dysregulation of neuroinflammation contributes to the development of stress-induced hyperalgesia. Recent studies reported that angiotensin II was a 'stress-related hormone', and could induce glial activation by stimulating the type 1 receptor (AT1R). In the present study, we aimed to investigate whether AT1R blockade could attenuate mechanical allodynia induced by PTSD-like stress. Adult male rats were exposed to single prolonged stress (SPS) to establish a model of PTSD-pain comorbidity. Our results showed that SPS exposure increased the levels of angiotensin II in the hippocampus, prefrontal cortex (PFC) and spinal cord; intraperitoneal injection of losartan attenuated SPS-induced mechanical allodynia, and suppressed SPS-induced glial activation (both microglia and astrocytes) and proinflammatory cytokine expression in the PFC and spinal cord, but not in the hippocampus. We further showed that intrathecal injection of losartan also exerted anti-hyperalgesic effect and suppressed SPS-induced glial activation and proinflammatory cytokine expression in the spinal cord. These results indicated that AT1R blockade by losartan attenuated mechanical allodynia induced by PTSD-like stress, and this may be attributed to the suppression of glial activation and proinflammatory cytokine expression in the spinal cord. Although further research is warranted to verify our findings in female rodents and to assess pharmacological effects of AT1R blockade in PFC and hippocampus, our study suggested the therapeutic potential of targeting AT1R in the treatment of PTSD-related chronic pain.

[Serological study of Lyme disease antibody in 2 311 patients with arthritis symptoms in Hainan Province]

Objective: To understand the infectious status of Lyme disease among patients with arthritis symptoms in Hainan Province, and to provide a theoretical basis for prevention and control of Lyme disease. Methods: From 2013 to 2018, sampling surveys had been conducted in medical institutions in 8 cities in Hainan Province(Haikou, Sanya, Danzhou, Dongfang, Wenchang, Qionghai, Qiongzhong, Wuzhishan), 2 311 patients serum samples were collected with arthritis symptoms, and descriptive research were conducted base on the collected clinical data. The Indirect Fluorescent-Antibody Test (IFA) method was used for preliminary screening of Lyme disease antibody, the Western Blot (WB) method was used for IFA positive samples confirmation. Statistical analysis using χ² test. Results: 2 311 serum samples were tested by IFA, and 166 were positive with the positive rate of 7.18%. Further confirmed by WB method, 62 samples were positive, the positive rate of Lyme disease antibody was 2.68%(62/2 311). The positive rate of Lyme disease antibody among patients with arthritis in different regions of Hainan was statistically significant (χ²=40.636,P<0.001), and the positive rate in Qiongzhong city was the highest (8.81%, 14/159). Danzhou's positive rate was the second highest, 5.62%(5/89). Dongfang city had the lowest positive rate (0.51%, 2/394). The positive rates of Lyme disease serum antibody in men and women were 2.79% (33/1 182) and 2.57% (29/1 129), respectively; the positive rates of antibodies between each age groups were in the range of 1.74% to 3.64%. The antibody positive rate of Lyme disease showed no significant difference between gender and age (χ²=0.110,P=0.740 ;χ²=1.938,P=0.747). Conclusion: Patients with arthritis symptoms caused by Borrelia burgdorferi infection were found in 8 cities in Hainan province, but the Lyme disease antibody positive rate was different among cities, with Qiongzhong County being the highest.

The Role of Baseline Sarcopenia Index in Predicting Chemotherapy-Induced Undesirable Effects and Mortality in Older People with Stage III or IV Non-Small Cell Lung Cancer

OBJECTIVES

To assess the predictability value of Sarcopenia index( (SI, serum creatinine value/cystatin C value×100) in determining potential chemotherapy-induced undesirable reactions and eventual death of older patients diagnosed with stage III or IV of non-small cell lung cancer (NSCLC).

METHODS

General information was retrieved from health records and mortality data was obtained by phone interview. Serum Cr and CysC levels were measured before chemotherapy. The endpoints recorded were chemotherapy-induced undesirable reactions and mortality from any causes. Logit regression analysis was employed for the analysis of correlation between the SI and short-term adverse reactions to chemotherapy. Cox regression analysis was employed to analyze correlation between the SI and mortality.

RESULTS

In this study, 664 NSCLC patients were enrolled. Among them, 83.13% were diagnosed with adenocarcinoma lung cancer and 16.87% with squamous cell carcinoma lung cancer. As of March 1, 2019, 486 patients died, including 361(74.28%) males and 125 (25.72%) females. After the first course of chemotherapy, the proportion of short-term adverse reactions, including bone marrow suppression, digestive reactions, all infection, liver function impairment, and other adverse reactions (non-infectious fever or rashes) was 16%, 4.7%, 7.4, %, 6.6%, and 2.11%, respectively. After adjusting for confounding factors, there was no association between the SI and adverse reactions. We found that high SI was independently associated with a lower risk of mortality after adjusting for confounding factors in females (HR=0.593,95% CI: 0.382-0.92; p=0.02). There was no marked association existed between the SI and mortality in males.

CONCLUSION

Among patients with stage III or IV non-small cell lung cancer, the SI is associated with mortality in females, but not in males.

The Relationship between Pre-Admission Waiting Time and the Surgical Outcomes after Hip Fracture Operation in the Elderly

OBJECTIVES

To investigate the association between pre-admission waiting time and postoperative complications, length of stay (LOS), and costs during hospitalization.

METHOD

This was a single-center, observational study. The subjects of this study were elderly hip fracture patients who were admitted to the Department of Orthopedics, West China Hospital, Sichuan University, from December 2010 to June 14, 2017, and that underwent internal fixation or joint replacement surgery. The pre-admission waiting time was treated as a categorical variable according to median and first quartile values. Outcomes included postoperative complications (pneumonia and other complications [urinary tract infection, heart failure, non-A-grade healing]), LOS, and costs during hospitalization. LOS and costs during hospitalization were converted into binary outcomes based upon median values. Binary logistic regression analyses were used to analyze correlations between pre-admission waiting time and patient outcomes.

RESULTS

A total of 889 patients 60 years of age and older were enrolled in this study, of whom 65.47% were females and 34.53% were males. The proportion of patients with pre-admission waiting times less than 8 h, 8 - 24 h, and ≥ 24 h were 24.3%, 17.32%, and 58.38%, respectively. Postoperative pneumonia and other complications affected 12.04% and 6.30% of patients, respectively. Relative to patients with the pre-admission waiting times of less than 8 h, those with longer pre-admission waiting times exhibited a higher risk of postoperative pneumonia (8 - 24 h: OR = 2.72,95% CI: 1.29-5.74, p = 0.009; ≥ 24 h: OR = 2.76,95% CI: 1.48-5.14, p = 0.001). Patients with the pre-admission waiting time ≥ 24 h also exhibited a higher risk of the other complications (OR = 2.55, 95% CI: 1.53-4.26, p <0.001), a longer LOS (OR = 1.43, 95% CI:1.02-2.01, p = 0.036), and higher costs during hospitalization (OR = 1.51, 95% CI:1.05 - 2.17, p = 0.026) relative to patients with a waiting time less than 8 hours.

CONCLUSION

Pre-admission waiting time was associated with postoperative complications, LOS, and hospitalization costs among older Chinese patients undergoing surgery to treat hip fractures.

Vessel Wall MRI Enhancement in Noninflammatory Cerebral Amyloid Angiopathy

Cerebral amyloid angiopathy is characterized by deposition of amyloid-β fibrils in the walls of small-to-medium-sized blood vessels. In this retrospective review of 5 patients with histologically confirmed noninflammatory cerebral amyloid angiopathy, high-resolution vessel wall MRI showed arterial wall enhancement in 2 patients (40%). Despite common consensus of equating vessel wall enhancement with inflammation, this report demonstrates that β-amyloid accumulation alone without inflammation can be associated with arterial wall enhancement in a subset of patients.

Ethnic Groups Differences in the Prevalence of Sarcopenia Using the AWGS Criteria

OBJECTIVES

To estimate the prevalence of sarcopenia in different ethnic groups and the association with cultural life styles in west China.

DESIGN

A cross-sectional study.

SETTINGS

The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

4500 participants aged 50 years or older in west China were enrolled in this study. Sarcopenia was defined according to the diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS).

MEASUREMENTS

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all eligible participants. Life-style information were collected by reviewers. Relationships between sarcopenia and ethnic groups were analyzed using univariate and multivariate analyses.

RESULTS

We found 869 (19.31%) adults aged 50 years old or older were sarcopenia. The mean age is 62.4±8.3 years. The main ethnic groups enrolled in this study is Han, Tibetan, Qiang, Yi and Hui. The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Compared to Han, after adjusting sex and age, Qiang has a lower prevalence of sarcopenia (odds ratio [OR]: 0.44, 95% CI 0.35-0.55), Yi has a higher prevalence of sarcopenia (OR: 1.78, 95% CI 1.29-2.43). While adding adjusting other potential cofounders, sarcopenia is still less prevalent in Qiang (OR: 0.44, 95% CI 0.34-0.57).

CONCLUSIONS

The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Sarcopenia was less prevalent in Qiang compared with Han. Further studies to determine related factors of sarcopenia among different ethnic groups are recommended.

Sarcopenia, Obesity and Sarcopenia Obesity in Comparison: Prevalence, Metabolic Profile, and Key Differences: Results from WCHAT Study

OBJECTIVE

To identify the prevalence, lifestyle factors, chronic disease status, and assessing the metabolic profile, comparing key differences in a cohort of subjects with non-sarcopenia/non-obesity (H), sarcopenia/non-obesity (S), non-sarcopenia/obesity (O) and sarcopenia obesity (SO) in a multi-ethnic population in west China.

DESIGN

A cross-sectional study.

SETTING

The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

We included 4,500 participants aged 50 years or older who did bioelectrical impedance in our analysis from West China Health and Aging Trend (WCHAT) study.

MEASUREMENTS

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all participants. We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia (AWGS). Obesity was defined as the highest sex-specific quintile of the percentage body fat. Different variables like anthropometry measures, life styles, chronic disease and blood test were collected. Analysis of variance and a multinomial logistic regression analysis adjusting for covariates were used to assess the differences of metabolic profiles among different groups.

RESULTS

Of 4500 participants aged 50 years old or older, the proportions of H, O, S, SO were 63.0%, 17.7%, 16.7% and 2.6%, respectively. And the prevalence of S subjects in men was 18.3% and 15.7% in women, while the prevalence of SO was 3.7% in men and 2.0% in women. Data showed that the prevalence of S and SO has an aging increase pattern which was opposite with O. Both S and SO tends to be older, lower educational level, without spouse, smoking, comorbidity of chronic disease, poor nutrition status, depression and cognitive decline compared to H and S seems to be worse than SO. Compared to H, S cohort showed a decrease in Vitamin D, triglyceride, albumin, fasting glucose, insulin, creatinine, ALT, nutrition scores and increase in HDL. SO cohort were observed for an increase in cholesterol, LDL, total protein and decrease in vitamin D. While O cohort showed an increase in triglyceride, cholesterol, LDL, total protein, glucose, insulin, WBC, uric acid, ALT and nutrition scores, but a decrease in HDL and vitamin D level.

CONCLUSIONS

Among individuals aged 50 years old or older in West China. S, O and SO participants demonstrate distinct differences in the life-styles, chronic disease profile, and metabolic profiles. The prevalence of S and SO has an aging increase pattern contrary to O. Both S and SO tend to be older, lower educational level, without spouse, smoking, comorbidity of chronic disease, poor nutrition status, depression and cognitive decline compared to H and S looks like to be worse than SO. Besides, the S subjects seem to have more metabolic index changes than SO compared to H. While O subjects have some contrary metabolic index to S subjects.

[Regulatory effect of exosomes secreted by vaginal wall fibroblasts on angiogenesis in patients with stress urinary incontinence]

Objective: Exosomes are considered to mediate intercellular communication by delivering biomolecules like mRNA, miRNA into recipient cells. The purpose of this study was to evaluate the effects of exosomes secreted by fibroblasts from women with stress urinary incontinence (SUI-EXO) on endothelial cells angiogenesis. Methods: Primary fibroblasts were acquired from periurethral vaginal wall tissues and exosomes were prepared by ultracentrifugation of fibroblasts cells conditioned medium. The expression levels of pro-angiogenic and anti-angiogenic genes were assessed using qRT-PCR analysis. Migration of endothelial cells was measured by transwell assay, and the effects of SUI-EXO on angiogenesis were evaluated by performing a tube formation assay in vitro. Results: SUI-EXO was successfully isolated from fibroblasts cells conditional medium and transferred to endothelial cells efficiently. When the endothelial cells were treated with SUI-EXO, the expression levels of pro-angiogenic genes in fibroblasts were downregulated, and the expression levels of anti-angiogenic genes were upregulated significantly (P<0.01). Endothelial cells exhibited a decreased migratory capacity after treatment with SUI-EXO compared to exosomes from health women (64.6±8.7 vs 114.5±14.2,P<0.01), and tube formation of endothelial cells was also significantly inhibited in the SUI-EXO treated group as determined by the increase of the tube length (87.6±13.3 vs 168.5±28.3,P<0.01). Conclusion: This study suggests that SUI-EXO plays related roles in regulating endothelial cells angiogenesis and SUI-EXO maybe involve in the pathogenesis of SUI.

The Association between Sarcopenia and Prealbumin Levels among Elderly Chinese Inpatients

OBJECTIVES

The goal of the present study was to assess the relationship between sarcopenia and prealbumin levels among hospitalized patients ages 60 and older.

DESIGN

Cross-sectional study.

SETTING

The geriatric wards in Guizhou Provincial People's Hospital, Guiyang. Guizhou, China.

MEASUREMENTS

Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria, which consist of three components: low muscle mass, assessed based on an index of appendicular skeletal mass/height2 <7.0kg/m2 for men and <5.4kg/m2 for women; low muscle strength, defined as handgrip strength <26kg for men and <18kg for women; and low physical performance, defined as gait speed <0.8m/s. Using these criteria, sarcopenia was defined as presence of low muscle mass in addition to low muscle strength and/or low physical performance. Prealbumin levels and other variables were considered as being independent variables in an effort to evaluate any potential associations between these factors and sarcopenia status using non-adjusted and multivariate-adjusted regression models.

RESULTS

The overall prevalence of sarcopenia was 60.17%, affecting 65 (70.65%) men and 6 (23.08%) women in the present study. Age, body mass index (BMI), and prealbumin levels were each independently associated with sarcopenia (p<0.05). In a multivariate model, after adjusting for all potential covariates, prealbumin levels remained significantly associated with sarcopenia incidence, with an inflection point of 265.9mg/L. The effect sizes and the confidence intervals on the left and right sides of this inflection point were 0.94 (0.90 to 0.99) and 1.07 (0.93 to 1.23), respectively.

CONCLUSION

Among older Chinese inpatients in the present study, prealbumin levels were negatively correlated with sarcopenia incidence, when prealbumin levels were below 265.9mg/L.

IL-27 regulates HIF-1α-mediated VEGFA response in macrophages of diabetic retinopathy patients and healthy individuals

Human macrophages produce vascular endothelial growth factor A (VEGFA) for angiogenesis in diabetic retinopathy (DR). The regulatory function of IL-27 on human macrophages is not well understood. In particular, the effect of IL-27 on VEGFA response in human macrophages has not been investigated. We find that IL-27 suppresses VEGFA mRNA expression as well as protein secretion by human macrophages. The synergistic action of purinergic signaling and activation of hypoxia-inducible factor 1 alpha (HIF-1α) induces VEGFA production in a positive feedback loop. IL-27 signaling in human macrophages disrupts this positive feedback loop thus suppresses VEGFA production. Blockade of IL-27 signaling with a JAK2 antagonist reverses this downregulatory effect on HIF-1α and partially blocks the inhibitory effect on VEGFA production. Lastly, DR patient macrophages have a higher propensity to produce VEGFA and this is amplified by an in vitro challenge with the pro-inflammatory cytokine IL-1β. IL-27 suppresses VEGFA production by DR patient macrophages even in the presence of IL-1β challenge indicating a potential therapeutic use of IL-27 in the clinic.

Association of sarcopenia and fractures in community-dwelling older adults: a systematic review and meta-analysis of cohort studies

To our knowledge, no comprehensive meta-analysis has examined the association between sarcopenia and the risk of fractures. This systematic review and meta-analysis of prospective cohort studies aims to summarize whether sarcopenia is a risk factor for fractures among community-dwelling older adults. We searched four electronic literature databases (Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PubMed) for relevant publications from inception to December 2017, using relevant keywords. We conducted a pooled analysis of the association between sarcopenia and the risk of fractures by employing a random-effects model. Subgroup analyses were conducted based on definitions of sarcopenia and gender. In total, nine studies were included in our systematic review and meta-analysis. The prevalence of sarcopenia ranged from 4.3 to 33.1%. The pooled RR of fractures for the sarcopenic versus the nonsarcopenic was 1.34 (95% CI = 1.13-1.58, P = 0.001, I² = 5.5%, P-heterogeneity = 0.391). Subgroup analyses showed that associations between sarcopenia and fractures were significant when using the AWGS definition (combined effect size = 1.78, 95% CI = 1.25-2.54, P = 0.001), and studies in males (combined effect size = 1.39, 95% CI = 1.13-1.71, P = 0.002). In conclusion, we found that compared to nonsarcopenic, the association between sarcopenia and fractures among community-dwelling older people was significant when using the AWGS definition, and only for males. Future studies are needed to establish a possible association between sarcopenia definitions and risk of fractures of different sites.

[Antimicrobial susceptibility and drug-resistance genes of Yersinia spp. of retailed poultry in 4 provinces of China]

Objective: To monitor the antimicrobial resistance and drug-resistance genes of Yersinia enterocolitis, Y. intermedia and Y. frederiksenii recovered from retailed fresh poultry of 4 provinces of China. Methods: The susceptibility of 25 isolated Yersinia spp. to 14 classes and 25 kinds of antibiotics was determined by broth microdilution method according to CLSI (Clinical and Laboratory Standards Institute). The antibiotic resistance genes were predicted with antibiotic resistance genes database (ARDB) using whole genome sequences of Yersinia spp. Results: In all 22 Y. enterocolitis tested, 63.7% (14 isolates), 22.8% (5 isolates), 4.6% and 4.6% of 1 isolates exhibited the resistance to cefoxitin, ampicillin-sulbactam, nitrofurantoin and trimethoprim-sulfamethoxazole, respectively. All the 25 isolates were multi-drug resistant to more than 3 antibiotics, while 64.0% of isolates were resistant to more than 4 antibiotics. A few Y. enterocolitis isolates of this study were intermediate to ceftriaxone and ciprofloxacin. Most Yersinia spp. isolates contained antibiotic resistance genes mdtG, ksgA, bacA, blaA, rosAB and acrB, and 5 isolates recovered from fresh chicken also contained dfrA1, catB2 and ant3ia. Conclusion: The multi-drug resistant Yersinia spp. isolated from retailed fresh poultry is very serious in the 4 provinces of China, and their contained many kinds of drug-resistance genes.

Adherence to the Mediterranean Diet and the Risk of Frailty in Old People: A Systematic Review and Meta-Analysis

BACKGROUND

Frailty is a common geriatric syndrome in old people. It remains controversial whether Mediterranean diet could prevent old people from developing into frailty. The aim of this study is to summarize the relevant studies and assess the effectiveness of adherence to Mediterranean diet on frailty in old people.

METHOD

A systematic search of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials was conducted to identify all relevant studies up to Oct 2017. We included studies regarding the associations between adherence to Mediterranean diet and risk of frailty among elders. A meta-analysis was performed to explore the effects of Mediterranean diet on frailty.

RESULTS

Six studies matched the inclusion criteria, of which five were prospective and one was cross-sectional. A total of 10,210 participants from the five prospective cohort studies were included to perform the meta-analyses. In comparison with lowest adherence to Mediterranean diet, elders with highest adherence to Mediterranean diet were significantly associated with lower risk of frailty in the future (RR= 0.56, 95% CI=0.36-0.89, p=0.015). Furthermore, the pooled estimates from four studies performed among participants in western countries (European and North American) showed that higher adherence to Mediterranean diet was associated with a 52% reduced risk of frailty (RR= 0.48, 95% CI=0.32-0.72, p<0.001). However, one study showed no association between Mediterranean diet and frailty among Asian elders (RR=1.06, 95% CI=0.83-1.36, p=0.638).

CONCLUSION

A higher adherence to Mediterranean diet is associated with a lower risk of frailty in old people. Meanwhile, the benefits may be more obvious among elders from western countries.

A circular white-light flare with impulsive and gradual white-light kernels

White-light flares are the flares with emissions visible in the optical continuum. They are thought to be rare and pose the most stringent requirements in energy transport and heating in the lower atmosphere. Here we present a nearly circular white-light flare on 10 March 2015 that was well observed by the Optical and Near-infrared Solar Eruption Tracer and Solar Dynamics Observatory. In this flare, there appear simultaneously both impulsive and gradual white-light kernels. The generally accepted thick-target model would be responsible for the impulsive kernels but not sufficient to interpret the gradual kernels. Some other mechanisms including soft X-ray backwarming or downward-propagating Alfvén waves, acting jointly with electron beam bombardment, provide a possible interpretation. However, the origin of this kind of white-light kernel is still an open question that induces more observations and researches in the future to decipher it.

Understanding Risk in the Oldest Old: Frailty and the Metabolic Syndrome in a Chinese Community Sample Aged 90+ Years

OBJECTIVES

To investigate the relationship between frailty and the metabolic syndrome and to evaluate how these contribute to mortality in very old people.

DESIGN

Secondary analysis of data from the Project of Longevity and Aging in Dujiangyan.

SETTING

Community sample from Sichuan Province, China.

PARTICIPANTS

People aged 90+ years (n=767; baseline age=93.7±3.4 years; 68.0% women.

MEASUREMENTS

After a baseline health assessment, participants were followed for four years (54.0% died). A frailty index (FI) was calculated as the sum of deficits present, divided by the 35 health-related deficits considered. Relationships between the FI and the metabolic syndrome were tested; their effect on death was examined.

RESULTS

The mean FI was 0.26 ±0.11. Higher FI scores were associated with a greater risk of death, adjusted for age, sex, education, and metabolic syndrome items. The hazard ratio was 1.03 (95% confidence interval 1.02, 1.04) for each 1% percent increase of the FI. The mortality risk did not change with the metabolic syndrome (odds ratio=0.99; 0.71-1.36).

CONCLUSIONS

In the oldest old, frailty was a significant risk for near-term death, regardless of the metabolic syndrome. Even using age-adjusted models, the epidemiology of late life illness may need to account for frailty routinely.

Cell-based therapy for traumatic brain injury

Traumatic brain injury is a major economic burden to hospitals in terms of emergency department visits, hospitalizations, and utilization of intensive care units. Current guidelines for the management of severe traumatic brain injuries are primarily supportive, with an emphasis on surveillance (i.e. intracranial pressure) and preventive measures to reduce morbidity and mortality. There are no direct effective therapies available. Over the last fifteen years, pre-clinical studies in regenerative medicine utilizing cell-based therapy have generated enthusiasm as a possible treatment option for traumatic brain injury. In these studies, stem cells and progenitor cells were shown to migrate into the injured brain and proliferate, exerting protective effects through possible cell replacement, gene and protein transfer, and release of anti-inflammatory and growth factors. In this work, we reviewed the pathophysiological mechanisms of traumatic brain injury, the biological rationale for using stem cells and progenitor cells, and the results of clinical trials using cell-based therapy for traumatic brain injury. Although the benefits of cell-based therapy have been clearly demonstrated in pre-clinical studies, some questions remain regarding the biological mechanisms of repair and safety, dose, route and timing of cell delivery, which ultimately will determine its optimal clinical use.

USP4 inhibits p53 and NF-κB through deubiquitinating and stabilizing HDAC2

Histone deacetylases (HDACs) are major epigenetic modulators involved in a broad spectrum of human diseases including cancers. As HDACs are promising targets of cancer therapy, it is important to understand the mechanisms of HDAC regulation. In this study, we show that ubiquitin-specific peptidase 4 (USP4) interacts directly with and deubiquitinates HDAC2, leading to the stabilization of HDAC2. Accumulation of HDAC2 in USP4-overexpression cells leads to compromised p53 acetylation as well as crippled p53 transcriptional activation, accumulation and apoptotic response upon DNA damage. Moreover, USP4 targets HDAC2 to downregulate tumor necrosis factor TNFα-induced nuclear factor (NF)-κB activation. Taken together, our study provides a novel insight into the ubiquitination and stability of HDAC2 and uncovers a previously unknown function of USP4 in cancers.

Polypharmacy among nonagenarians/centenarians in rural China

BACKGROUND

Little is known about the prevalence and relevant factors of polypharmacy in nonagenarian and centenarians.

AIM

The aim of this study is to examine the prevalence and associated factors of polypharmacy in a sample of nonagenarians and centenarians living in a rural area of China.

METHODS

The data were from the 'Project of Longevity and Aging in Dujiangyan' study. Medication use and relevant covariates were obtained by face-to-face interviews. Minor polypharmacy was defined as the concomitant use of two to four medications, whereas major polypharmacy referred to the concomitant use of five or more medications.

RESULTS

We included 859 participants with mean age of 93.7 ± 3.3 years. The number of chronic diseases was 1.4 ± 1.2 per subject, whereas the number of drugs was 0.8 ± 1.4 per subject. The prevalence of minor polypharmacy and major polypharmacy was 16.5% and 3.7% respectively. Illiteracy (odds ratio (OR) 2.93, 95% confidence interval (CI) 1.52 to 5.66), cognitive impairment (OR 3.15, 95% CI 1.44 to 6.88), hypertension (OR 2.88, 95% CI 1.46 to 5.67), respiratory disease (OR 2.22, 95% CI 1.08 to 4.58), osteoarthritis (OR 1.24, 95% CI 1.01 to 1.51), and cancer (OR 10.70, 95% CI 1.90 to 126.80) were positively associated with minor polypharmacy. Illiteracy (OR 4.24, 95% CI 1.53 to 11.81), hypertension (OR 3.40, 95% CI 1.22 to 9.49) and cancer (OR 3.40, 95% CI 1.14 to 10.12) were also positively associated with major polypharmacy.

CONCLUSIONS

Although most subjects suffer from some chronic diseases, minor polypharmacy and major polypharmacy are not common among nonagenarians/centenarians in rural China.

Microvesicles Derived From Human Mesenchymal Stem Cells Restore Alveolar Fluid Clearance in Human Lungs Rejected for Transplantation

The need to increase the donor pool for lung transplantation is a major public health issue. We previously found that administration of mesenchymal stem cells "rehabilitated" marginal donor lungs rejected for transplantation using ex vivo lung perfusion. However, the use of stem cells has some inherent limitation such as the potential for tumor formation. In the current study, we hypothesized that microvesicles, small anuclear membrane fragments constitutively released from mesenchymal stem cells, may be a good alternative to using stem cells. Using our well established ex vivo lung perfusion model, microvesicles derived from human mesenchymal stem cells increased alveolar fluid clearance (i.e. ability to absorb pulmonary edema fluid) in a dose-dependent manner, decreased lung weight gain following perfusion and ventilation, and improved airway and hemodynamic parameters compared to perfusion alone. Microvesicles derived from normal human lung fibroblasts as a control had no effect. Co-administration of microvesicles with anti-CD44 antibody attenuated these effects, suggesting a key role of the CD44 receptor in the internalization of the microvesicles into the injured host cell and its effect. In summary, microvesicles derived from human mesenchymal stem cells were as effective as the parent mesenchymal stem cells in rehabilitating marginal donor human lungs.

Recombinant adenovirus-mediated overexpression of PTEN and KRT10 improves cisplatin resistance of ovarian cancer in vitro and in vivo

Drug resistance is a major cause of treatment failure in ovarian cancer patients, and novel therapeutic strategies are urgently needed. Overexpression of phosphatase and tensin homolog (PTEN) has been shown to preserve the cisplatin-resistance of ovarian cancer cells, while cisplatin-induced keratin 10 (KRT10) overexpression mediates the resistance-reversing effect of PTEN. However, whether overexpression of PTEN or KRT10 can improve the cisplatin resistance of ovarian cancer in vivo has not been investigated. Therefore, we investigated the effects of adenovirus-mediated PTEN or KRT10 overexpression on the cisplatin resistance of ovarian cancer in vivo. Recombinant adenoviruses carrying the gene for PTEN or KRT10 were constructed. The effects of overexpression of PTEN and KRT10 on cisplatin resistance of ovarian cancer cells were examined using the 3(4,5-dimethylthiazol-2-yl)2,5-diphenyltetrazolium bromide (MTT) and TdT-mediated dUTP nick-end labeling (TUNEL) assays in vitro. Subcutaneously transplanted nude mice, as a model of human ovarian cancer, were used to test the effects of PTEN and KRT10 on cisplatin resistance of ovarian cancer in vivo. The MTT assay showed that recombinant adenovirus-mediated overexpression of KRT10 and PTEN enhanced the proliferation inhibition effect of cisplatin on C13K cells. Recombinant adenovirus-mediated overexpression of KRT10 and PTEN also increased the cisplatin-induced apoptosis rate of C13K cells. Furthermore, recombinant adenovirus-mediated overexpression of KRT10 and PTEN enhanced the inhibitory effect of cisplatin on C13K xenograft tumor growth. Thus, recombinant adenovirus-mediated overexpression of KRT10 and PTEN may improve the cisplatin resistance of ovarian cancer in vitro and in vivo.

Serum high mobility group box protein 1 as a clinical marker for ovarian cancer

The aim of the study was to evaluate the clinical value of serum high mobility group box chromosomal protein 1 (HMGB1) in ovarian cancer and analyze the correlation between HMGB1 and ovarian cancer clinicopathologic outcomes.A total of 105 patients with diagnosed epithelial ovarian cancer, 46 patients with ovarian benign disease and 33 healthy volunteers were enrolled from January 2011 through January 2013. Serum HMGB1 levels were analyzed by enzyme-linked immunosorbent assay.The mean value of serum HMGB1 levels in ovarian cancer patients (78.18±54.87ng/ml) was significantly higher than those in benign patients (33.98±9.97ng/ml) and healthy control (26.71±7.99ng/ml, p < 0.0001), respectively. The serum HMGB1 levels were 40.33±6.50ng/ml, 61.16±20.15ng/ml, 81.81±51.15ng/ml and 119.48±84.28ng/ml in patients with TNM stage I, II, III, and IV, respectively (p < 0.0001). There were 81 of the 105 ovarian cancer patients obtained complete remission, the serum HMGB1 levels before treatment(71.99±42.49ng/ml) were much higher than that at remission stage(42.10±15.48ng/ml) (p < 0.0001). During our investigating period, 28 ovarian cancer patients underwent recurrence, the serum HMGB1 levels were 75.54±39.50ng/ml in these recurrent ovarian cancer patients compared to 42.04±10.68ng/ml in non-recurrent ovarian cancer (p < 0.0001). None of the remission or recurrent patients came from benign ovarian tumor group.Our study suggests that HMGB1 may be a useful clinical marker for evaluating progression and predicting prognosis of ovarian carcinoma. Targeting HMGB1 production or release might have potential approaches for ovarian carcinoma treatment.

Ribosomal proteins L11 and L5 activate TAp73 by overcoming MDM2 inhibition

Over the past decade, a number of ribosomal proteins (RPs) have been found to have a role in activating the tumor suppressor p53 by directly binding to MDM2 and impeding its activity toward p53. Herein, we report that RPL5 and RPL11 can also enhance the transcriptional activity of a p53 homolog TAp73, but through a distinct mechanism. Interestingly, even though RPL5 and RPL11 were not shown to bind to p53, they were able to directly associate with the transactivation domain of TAp73 independently of MDM2 in response to RS. This association led to perturbation of the MDM2-TAp73 interaction, consequently preventing MDM2 from its association with TAp73 target gene promoters. Furthermore, ectopic expression of RPL5 or RPL11 markedly induced TAp73 transcriptional activity by antagonizing MDM2 suppression. Conversely, ablation of either of the RPs compromised TAp73 transcriptional activity, as evident by the reduction of p21 and Puma expression, in response to 5-fluorouracil (5-FU). Consistently, overexpression of RPL5 or RPL11 enhanced, but knockdown of either of them hampered, TAp73-mediated apoptosis. Intriguingly, simultaneous knockdown of TAp73 and either of the RPs was required for rescuing the 5-FU-triggered S-phase arrest of p53-null tumor cells. These results demonstrate a novel mechanism underlying the inhibition of tumor cell proliferation and growth by these two RPs via TAp73 activation.

Intra-articular clonidine for post-operative analgesia following arthroscopic knee surgery: a systematic review and meta-analysis

PURPOSE

To assess the efficacy and safety of a single dose of intra-articular clonidine for post-operative pain following arthroscopic knee surgery by analyzing relevant randomized controlled trials (RCTs).

METHODS

PubMed, EMBASE, Cochrane Library, ISI Web of knowledge, Chinese Biomedical Literature Database, Google Scholar and other databases were searched for RCTs comparing a single dose of intra-articular clonidine with placebo for post-operative pain following arthroscopic knee surgery. Risk of bias of included studies was assessed by Cochrane Collaboration's tool, and data were analyzed by RevMan 5.1 software. Pain intensity, supplementary analgesic use and side effects were evaluated as the outcomes.

RESULTS

Seven RCTs were included, and the results of the meta-analysis showed that intra-articular clonidine reduced the pain intensity for the first 4 h after surgery, reduced the risk of using rescue analgesics and the incidence of post-operative nausea, but increased the risk of hypotension after surgery.

CONCLUSIONS

A single dose of intra-articular clonidine has a definite analgesic effect, but the analgesic effect is mild and short lasting, which is just for 4 h after injection, and intra-articular clonidine alone could not provide sufficient post-operative analgesia following arthroscopic knee surgery. Post-operative hypotension may be the side effect that should be paid the most attention in the ambulatory setting.

LEVEL OF EVIDENCE

II.

Developments in selective small molecule ATP-targeting the serine/threonine kinase Akt/PKB

The serine/threonine kinase Akt, also known as protein kinase B (PKB), plays a key role in cell survival and proliferation through a number of downstream effectors. Recent studies indicate that unregulated activation of the Phosphatidylinositol 3-kinase (PI3K)/Akt pathway is a prominent feature of many human cancers and Akt is overexpressed or activated in all major cancers. For these reasons, Akt is considered as an attractive target for cancer therapy. In the past few years, several series of compounds with diverse structural features have been reported as Akt inhibitors, such as, ATP-competitive inhibitors, Phosphatidylinositol (PI) analogs, and allosteric inhibitors. Although most of the inhibitors exhibited potent inhibitory activities at nanomolar concentrations against Akt, some of them have shown unfavorable selectivity against other protein kinases especially PKA and PKC. This review will focus on the recent advances in the development and biological evaluation of selective ATP-competitive inhibitors for Akt. We will summarize the novel approaches toward the developments of selective ATP-competitive inhibitors, expecting to give information to design new ATP-competitive inhibitors with high selectivity, bioavailability, and potency.

NAT2 polymorphisms and susceptibility to anti-tuberculosis drug-induced liver injury: a meta-analysis

BACKGROUND AND OBJECTIVE

Although a series of studies have evaluated the potential association between N-acetyltransferase 2 (NAT2) polymorphisms and the risk of anti-tuberculosis drug-induced liver injury (ATLI), the results have generally been controversial and inadequate, mainly due to limited power. The present meta-analysis sought to resolve this problem.

DESIGN

PubMed, Embase and Web of Science were searched using the following key words: 'N-acetyltransferase 2' or 'NAT2' and 'polymorphism' and 'tuberculosis' or 'TB' and 'hepatotoxicity' or 'liver injury'. Crude odds ratios (ORs) with 95% confidence intervals (CIs) were summarised in forest plots and set out in a table.

RESULTS

A total of 14 studies, comprising 474 cases and 1446 controls, were included in the meta-analysis. A significant association was observed between NAT2 slow acetylators and the risk of ATLI. The OR for NAT2 slow acetylators compared with rapid acetylators was 4.697 (95%CI 3.291-6.705, P < 0.001). Subgroup analyses indicate that both Asian and non-Asian cases with slow acetylators develop ATLI more frequently, which is similar to patients with slow acetylators receiving first-line combination treatment. On comparing NAT2 intermediate acetylators with rapid acetylators, the OR for ATLI was 1.261 (95%CI 0.928-1.712, P = 0.138).

CONCLUSIONS

This meta-analysis showed that tuberculosis patients with slow acetylators had a higher risk of ATLI than other acetylators. Screening of patients for the NAT2 genetic polymorphisms will be useful for the clinical prediction and prevention of ATLI.

Ribosomal protein S14 unties the MDM2-p53 loop upon ribosomal stress

The MDM2-p53 feedback loop is crucially important for restricting p53 level and activity during normal cell growth and proliferation, and is thus subjected to dynamic regulation in order for cells to activate p53 upon various stress signals. Several ribosomal proteins, such as RPL11, RPL5, RPL23, RPL26 or RPS7, have been shown to have a role in regulation of this feedback loop in response to ribosomal stress. Here, we identify another ribosomal protein S14, which is highly associated with 5q-syndrome, as a novel activator of p53 by inhibiting MDM2 activity. We found that RPS14, but not RPS19, binds to the central acidic domain of MDM2, similar to RPL5 and RPL23, and inhibits its E3 ubiquitin ligase activity toward p53. This RPS14-MDM2 binding was induced upon ribosomal stress caused by actinomycin D or mycophenolic acid. Overexpression of RPS14, but not RPS19, elevated p53 level and activity, leading to G1 or G2 arrest. Conversely, knockdown of RPS14 alleviated p53 induction by these two reagents. Interestingly, knockdown of either RPS14 or RPS19 caused a ribosomal stress that led to p53 activation, which was impaired by further knocking down the level of RPL11 or RPL5. Together, our results demonstrate that RPS14 and RPS19 have distinct roles in regulating the MDM2-p53 feedback loop in response to ribosomal stress.

A randomized, controlled trial of fingolimod (FTY720) in Japanese patients with multiple sclerosis

BACKGROUND

Fingolimod (FTY720) has previously shown clinical efficacy in phase II/III studies of predominantly Caucasian populations with multiple sclerosis (MS).

OBJECTIVES

To report six-month efficacy and safety outcomes in Japanese patients with relapsing MS treated with fingolimod.

METHODS

In this double-blind, parallel-group, phase II study, 171 Japanese patients with relapsing MS were randomized to receive once-daily fingolimod 0.5 mg or 1.25 mg, or matching placebo for six months. The primary and secondary endpoints were the percentages of patients free from gadolinium (Gd)-enhanced lesions at months 3 and 6, and relapses over six months, respectively; safety outcomes were also assessed.

RESULTS

147 patients completed the study. Higher proportions of patients were free from Gd-enhanced lesions at months 3 and 6 with fingolimod (0.5 mg: 70%, p = 0.004; 1.25 mg: 86%, p < 0.001) than with placebo (40%). Odds ratios for the proportions of relapse-free patients over six months favoured fingolimod versus placebo but were not significant. Adverse events related to fingolimod included transient bradycardia and atrioventricular block at treatment initiation, and elevated liver enzyme levels.

CONCLUSIONS

This study demonstrated the clinical efficacy of fingolimod for the first time in Japanese patients with MS, consistent with the established effects of fingolimod in Caucasian patients.

Presence of baseline prehypertension and risk of incident stroke: a meta-analysis

OBJECTIVE

To qualitatively and quantitatively assess the association of prehypertension with incident stroke through a meta-analysis of prospective cohort studies.

METHODS

We searched Medline, Embase, the Cochrane Library, and bibliographies of retrieved articles. Prospective cohort studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95%confidence intervals (CI) of stroke with respect to baseline prehypertension.

RESULTS

Twelve studies with 518,520 participants were included. Prehypertension was associated with risk of stroke (RR 1.55, 95% CI 1.35-1.79; p < 0.001). Seven studies further distinguished a low prehypertensive population (systolic blood pressure [SBP] 120-129 mm Hg or diastolic blood pressure [DBP] 80-84 mm Hg) and a high prehypertensive population (SBP 130-139 mm Hg or DBP 85-89 mm Hg). Among persons with lower-range prehypertension, stroke risk was not significantly increased (RR 1.22, 0.95-1.57). However, for persons with higher values within the prehypertensive range, stroke risk was substantially increased (RR 1.79, 95% CI 1.49-2.16).

CONCLUSIONS

Prehypertension is associated with a higher risk of incident stroke. This risk is largely driven by higher values within the prehypertensive range and is especially relevant in nonelderly persons. Randomized trials to evaluate the efficacy of blood pressure reduction in persons with this designation are warranted.