Intra-Articular Magnesium Plus Bupivacaine Is the Most Effective and Safe Postoperative Analgesic Option Following Knee Arthroscopy: A Network Meta-analysis

PURPOSE

To evaluate the comparative efficacy and safety of single-dose intra-articular injection of commonly used analgesics after knee arthroscopy.

METHODS

A systematic literature review was done to search for randomized controlled trials (RCTs) published from database inception to October 1, 2020, that compared analgesics (i.e., morphine, bupivacaine, ropivacaine, and magnesium alone or in combination) with placebo or each other after knee arthroscopy. The primary outcomes were postoperative pain intensity at 2 hours and 24 hours. Secondary outcomes included the time to first analgesic request, number of patients requiring supplementary analgesics and side effects. We estimated summary standardized mean differences (SMDs) or odds ratios with 95% credible intervals (95% CrIs) using Bayesian network meta-analysis with random effects.

RESULTS

In total, 78 randomized controlled trials comprising 4,425 participants were included. Compared with placebo, magnesium plus bupivacaine was most likely to be effective in relieving pain at both 2-hour (SMD = -3.81, 95% CrI -5.28 to -2.35) and 24-hour after surgery (SMD = -2.81, 95% CrI: -4.29 to -1.30). Following was morphine plus bupivacaine (2-hour: SMD = -2.19, 95% CrI -3.05 to -1.31; 24-hour: SMD = -1.44, 95% CrI -2.14 to -0.73) and bupivacaine alone (2-hour: SMD = -1.66, 95% CrI -2.33 to -0.98; 24-hour: SMD = -0.67, 95% CrI -1.22 to -0.07); ropivacaine alone and magnesium alone were not effective on pain relief. The interval time to first analgesic request was significantly extended compared with placebo except for ropivacaine alone and magnesium alone. The number of patients requiring supplementary analgesics was reduced in all groups except ropivacaine alone. No statistically significant difference was found between any studied analgesics or placebo with regard to side effects.

CONCLUSIONS

Of 6 common postoperative intra-articular analgesics, magnesium plus bupivacaine provides the most effective pain relief without increasing short-term side effects after knee arthroscopy.

LEVEL OF EVIDENCE

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

Aqueous construction of raspberry-like ZIF-8 hierarchical structures with enhanced superhydrophobic performance

Materials with super-wetting ability have attracted wide attention from both academia and industry due to their great potential applications. A straightforward and versatile route was proposed for the large-scale synthesis of a monodisperse raspberry-like metal-organic framework (ZIF-8) using zinc nitrate as a zinc source and dimethylimidazole as an organic ligand in aqueous solution. After hydrophobic treatment with hexadecyltrimethoxysilane, the ethanolic suspension of three-dimensional raspberry-like ZIF-8 showed excellent superhydrophobic properties. Furthermore, commercial adhesives were used to blend with the suspension to improve the bonding strength to different substrates. These surfaces retained their water resistance after 50 finger-wipe cycles, 40 sandpaper abrasions and knife scratches. Moreover, the prepared hydrophobic surface can withstand the impact of water flow for 10 minutes. The formulations developed can be used for superhydrophobic coating applications on different substrate surfaces such as aluminum foil, glass, paper and cotton.

A nationwide comparison of staggered and simultaneous bilateral knee arthroplasty during a single hospitalization: Trends, risks and benefits

Background

We aimed to: (1) perform a nationwide trend analysis of staggered and simultaneous bilateral knee arthroplasty (KA); (2) investigate patient demographics and hospital characteristics in two groups; and (3) compare the outcomes of two groups with a focus on complications, length of stay (LOS) and hospitalization costs.

Methods

Utilizing the Hospital Quality Monitoring System, we included patients who underwent bilateral KA during a single hospitalization between 2013 and 2019. Patient demographics and hospital characteristics were compared between two groups. Outcomes were compared between propensity-score matched groups using logistic and linear regression.

Results

During the study period, 6291 staggered bilateral KA and 6284 simultaneous bilateral KA were performed. From 2013 to 2019, the proportion of staggered bilateral KA increased from 32.74% to 59.08%. Patients who were older, were single, had more comorbidities and had a non-osteoarthritis indication for surgery tended to receive staggered bilateral KA. Compared with 3327 propensity-score matched patients undergoing simultaneous bilateral KA, patients undergoing staggered bilateral KA were associated with a significantly lower incidence of wound infection (odds ratio [OR] ​= ​0.22; 95% confidence interval [CI], 0.07–0.65), and readmission within 30 days (OR ​= ​0.73; 95%CI, 0.54–0.99) and 90 days (OR ​= ​0.70; 95%CI, 0.55–0.89). However, staggered bilateral KA had higher odds of blood transfusion (OR ​= ​1.20; 95%CI, 1.02–1.40) and deep venous thrombosis (DVT) (OR ​= ​2.62; 95%CI, 1.82–3.98). Moreover, staggered bilateral KA can lead to higher costs (108,316.21 Chinese yuan [CNY] vs 103,367.60 CNY) and longer LOS (17.29 days vs 12.18 days) than simultaneous bilateral KA.

Conclusion

Our study indicates that staggered bilateral KA has become more common than simultaneous bilateral KA in China. Compared to simultaneous bilateral KA, staggered bilateral KA was associated with a lower incidence of wound infection and readmission. Staggered bilateral KA may be an alternative for patients who can't tolerate simultaneous surgery.

The translational potential of this article: Our study indicates that staggered bilateral KA is a safe and economical option for elderly patients who require bilateral KA but are at high clinical risk. The rising proportion of staggered bilateral KA will be a new trend in bilateral KA.

Effect of atrial septal dilation tumor and patent foramen rotundus on cryptogenic ischemic stroke in young and middle-aged patients

Objective

To investigate the effect of atrial septal aneurysm (ASA) and patent foramen ovale (PFO) on cryptogenic ischemic stroke in young and middle-aged patients.

Methods

A case-control study was conducted to select 96 young and middle-aged patients with cryptogenic ischemic stroke in the Department of Neurology of our hospital from January 2015 to January 2020 (observation group). A total of 192 patients with non-ischemic stroke were selected as the control group. The clinicadata and transthoracic echocardiography (cTTE) results were compared between the two groups.

Results

The ASA depth and tumor wall thickness in the observation group were 15.50 (12.40, 19.80) mm and 3.90 (2.80,4.50) mm, respectively, which were significantly higher than those in the control group (P < 0.05). Logistic regression analysis showed that PFO, and PFO combined with ASA were the influencing factors of cryptogenic ischemic stroke in middle-aged and young people OR = 1.923 and 1.384, P < 0.05).

Conclusion

Atrial septal aneurysm combined with PFO and PFO are independent influencing factors factor for the occurrence of cryptogenic ischemic stroke in young and middle-aged people, which is worthy of further study.

Peptic Ulcer Disease and Risk of Hip Fracture: A General Population-based Cohort Study

AIMS

Previous studies reported proton pump inhibitor (PPI) use may increase the risk of fracture; however, the findings may be susceptible to indication bias because peptic ulcer disease (PUD), 1 major indication for PPIs, may affect skeletal health. Determining whether PUD would increase hip fracture risk may help identify high-risk populations and explore risk factors.

METHODS

We conducted a cohort study using data from The Health Improvement Network (THIN) in the United Kingdom. THIN contains patient information such as disease diagnosis and medicine prescriptions. Up to 5 non-PUD individuals (n = 138 265) were matched to each case of incident PUD (n = 27 653) by age, sex, and body mass index. We examined the association between PUD and hip fracture by a multivariable Cox proportional hazard model. We repeated the same analysis among individuals with incident PUD and gastroesophageal reflux disease (GERD) (n = 27 160), another disease with similar indication for PPIs, as a positive control exposure.

RESULTS

Over a mean of 5.6 years of follow-up, hip fracture occurred in 589 individuals with PUD and 2015 individuals without PUD (3.8 vs 2.6/1000 person-years), with a multivariable-adjusted hazard ratio (HR) being 1.44 (95% confidence interval [CI], 1.31-1.58). The association persisted among subgroups stratified by sex and age. In positive control exposure analysis, the hip fracture risk was also higher in PUD than GERD (3.8 vs 2.4/1000 person-years; multivariable-adjusted HR = 1.65; 95% CI, 1.45-1.7).

CONCLUSIONS

This general population-based cohort study suggests, after controlling for acid-lowering medication and other potential risk factors, PUD is independently associated with an increased risk of hip fracture.

Denosumab and Risk of Community-acquired Pneumonia: A Population-based Cohort Study

CONTEXT

Recent meta-analyses of randomized controlled trials have raised concerns that denosumab might increase the risk of infection. However, data of denosumab on the risk of community-acquired pneumonia are sparse.

OBJECTIVE

This work aimed to examine the risk of community-acquired pneumonia in individuals receiving denosumab compared to those receiving alendronate.

METHODS

We conducted a propensity score-matched cohort study with a UK primary care database (IQVIA Medical Research Database). We examined the relation of denosumab to community-acquired pneumonia using a Cox proportional hazard model. The study participants were osteoporotic patients older than 45 years who were initiators of denosumab or alendronate from August 1, 2010, to September 17, 2020. The outcome measure was community-acquired pneumonia.

RESULTS

Patients treated with denosumab (n = 933) were compared with those treated with alendronate (n = 4652). In the matched population, the mean (SD) age was 77 (11) years, 89% were women, and about half of the study population had a history of major osteoporotic fracture. Over 5 years of follow-up, the incidence of community-acquired pneumonia per 1000 person-years was 72.0 (95% CI, 60.1-85.7) in the denosumab group and 75.1 (95% CI, 69.4-81.2) in the alendronate group. The hazard of community-acquired pneumonia was similar between denosumab and alendronate users (hazard ratio [HR] 0.96; 95% CI, 0.79-1.16). The results remained consistent in a series of sensitivity analyses, with HR ranging from 0.82 (95% CI, 0.65-1.04) to 0.99 (95% CI, 0.81-1.21).

CONCLUSION

Denosumab does not significantly increase the susceptibility of community-acquired pneumonia and could possibly be safely used for the management of osteoporosis.

Incidence, patterns and risk factors for readmission following knee arthroplasty in China: A national retrospective cohort study

BACKGROUND

Limited data exist on readmission following knee arthroplasty (KA) in countries without well-established referral or extended care systems. This study aimed to investigate the incidence, patterns and risk factors for readmission following KA in China.

MATERIAL AND METHODS

In this national retrospective cohort study, we reviewed 167,265 primary KAs registered in the Hospital Quality Monitoring System in China between 2013 and 2018. Readmissions after KA within 30 and 90 days were evaluated. The causes for readmission were identified and classified as surgical or medical. The potential risk factors of readmission were assessed using multivariable logistic regression.

RESULTS

4017 (2.4%) patients readmitted within 30 days, and 7258 (4.3%) patients readmitted within 90 days. The readmission rate exhibited a downward trend during the period from 2013 to 2018 (2.7%-2.3% for 30-day readmission; 4.5%-4.2% for 90-day readmission). Surgical causes contributed to 54.3% readmissions within 30 days and 47.3% readmissions within 90 days. Wound infection/complication, joint pain, and thromboembolism were the most frequently reported reasons for surgical readmission. Older age, male sex, single marital status, non-osteoarthritis indication, a high comorbidity index, non-provincial hospitals, low hospital volume, and longer length of stay were associated with an increased risk of readmission. The geographic regions of hospitals contributed greatly to the variety of readmissions.

CONCLUSION

The readmission rate following KA decreased from 2013 to 2018. Surgery-related causes, especially wound infection/complication and pain, accounted for a large proportion. Both patient and hospital factors were associated with readmissions. Improved primary care and targeted measures are needed to help further prevent readmissions and optimize resource utilization.

Comparative risk-benefit profiles of weak opioids in the treatment of osteoarthritis: a network meta-analysis of randomized controlled trials

BACKGROUND

Despite their poor tolerance, weak opioids are still the most commonly-prescribed medicine for osteoarthritis (OA)-related pain. The objective of this network meta-analysis was to comparatively examine the efficacy and safety of weak opioids in OA treatment.

METHODS

Databases including PubMed, Embase, Cochrane Library and Web of Science were searched from inception to August 5, 2020 to retrieve randomized controlled trials (RCTs) comparing weak opioids with placebo or between one another in OA patients. Bayesian network meta-analysis was performed on the following outcomes of interest, namely the change-from-baseline score in pain relief, gastrointestinal (GI) adverse events (AEs), central nervous system (CNS) AEs, and total number of AEs (i.e., the number of subjects experiencing any AE for at least once) during follow-up.

RESULTS

A total of 14 RCTs involving four types of weak opioids were included in this meta-analysis. Compared to placebo, tramadol (standardized mean difference [SMD] = -0.34, 95% credible interval [CrI]: -0.53 to -0.18) and codeine (SMD = -0.39, 95% CrI: -0.79 to -0.04) were effective for pain relief, but involved a higher risk of GI AEs, CNS AEs and total number of AEs. Dextropropoxyphene demonstrated a significantly lower risk of GI AEs (OR = 0.28, 95%CrI: 0.17 to 0.51), CNS AEs (OR = 0.29, 95%CrI: 0.11 to 0.78) and total number of AEs (OR = 0.35, 95%CrI: 0.15 to 0.82) compared to codeine. Dihydrocodeine had a better safety profile in CNS AEs (SUCRA = 64.8%) and total number of AEs (SUCRA = 66.6%).

CONCLUSIONS

The results of the present study confirmed that tramadol and codeine were effective drugs for the treatment of OA, but involved considerable safety issues. Dextropropoxyphene and dihydrocodeine exhibited a relatively good safety profile but their efficacy still warrant further investigation.

Efficacy and safety of biologic agents for the treatment of osteoarthritis: a meta-analysis of randomized placebo-controlled trials

Background:

We aimed to evaluate the efficacy and safety of biologic agents targeting three main cytokines, that is, nerve growth factor (NGF), interleukin-1 (IL-1), and tumor necrosis factor-α (TNF-α), for osteoarthritis (OA) treatment.

Methods:

Databases (PubMed, Embase, and Cochrane Library) and ClinicalTrials.gov were systematically searched for randomized placebo-controlled trials (RCTs) of biologic agents from inception to November 15, 2020. The outcomes were the mean change in pain, function scores, and the risk of adverse effects (AEs).

Results:

Out of the 28 studies with 29 RCTs (8555 individuals) included, biologic agents were superior to placebo in pain relief (standardized mean difference [SMD] = 0.28, 95% confidence interval [CI] = 0.17–0.38, p < 0.001) and function improvement (SMD = 0.30, 95% CI = 0.18–0.43, p < 0.001). The incidence of any AEs (risk ratio [RR] = 1.09, 95% CI = 1.05–1.14, p < 0.001) and discontinuations due to AEs (RR = 1.39, 95% CI = 1.05–1.83, p = 0.021) were higher following treatment with biologic agents while no significant difference was found in serious AEs. Subgroup analyses showed that NGF inhibitors provided superior pain relief (SMD = 0.36, 95% CI = 0.26–0.47, p < 0.001) and function improvement (SMD = 0.41, 95% CI = 0.30–0.51, p < 0.001), whereas IL-1 inhibitors and TNF-α inhibitors did not. Meanwhile, NGF inhibitors increased the incidence of any AEs (RR = 1.12, 95% CI = 1.07–1.17, p < 0.001) and discontinuations due to AEs (RR = 1.48, 95% CI = 1.07–2.06, p = 0.018). IL-1 inhibitors and TNF-α inhibitors showed no difference in safety compared with placebo.

Conclusions:

The efficacy and safety of biologic agents vary by mechanism of action. NGF inhibitors can relieve OA-related pain and improve function but involve safety concerns. IL-1 inhibitors and TNF-α inhibitors are relatively safe options but with limited efficacy.

Associations between adipokines gene polymorphisms and knee osteoarthritis: a meta-analysis

Background

Adipokines gene polymorphisms are speculated to be associated with the risk of knee osteoarthritis (OA), but evidence remains conflicting. This study therefore aimed to examine whether associations exist between adipokines gene polymorphisms and knee OA by considering the evidence collected from eligible studies through a meta-analysis.

Methods

A systematic search was performed on PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang up to March 31, 2020. Meta-analysis was carried out by focusing on the associations between adipokines gene polymorphisms and knee OA with the allele model, dominant model, and recessive model.

Results

The present meta-analysis included 5 eligible studies for ADIPOQ rs1501299 with 1,021 cases and 1,097 controls, 3 eligible studies for ADIPOQ rs2241766 with 549 cases and 544 controls, 3 eligible studies for LEPR rs1137101 with 808 cases and 856 controls, 2 eligible studies for VISFATIN rs4730153 with 339 cases and 680 controls and 2 eligible studies for VISFATIN rs16872158 with 339 cases and 680 controls. Significant association was observed between LEPR rs1137101 and knee OA in the overall population (recessive: OR = 0.40, 95% CI 0.21–0.79). Limited data revealed that associations may exist between ADIPOQ rs2241766 and knee OA in Asians (dominant: OR = 1.35, 95% CI 1.03–1.78), between VISFATIN rs4730153 and knee OA in Asians (allele: OR = 0.58, 95% CI 0.41–0.83; dominant: OR = 0.57, 95% CI 0.39–0.83), and between VISFATIN rs16872158 and knee OA in Asians (allele: OR = 1.84, 95% CI 1.26–2.68; dominant: OR = 1.94, 95% CI 1.31–2.89).

Conclusions

Adipokines gene polymorphisms may be associated with knee OA. The association was observed in LEPR rs1137101 in the present study. In addition, limited data revealed that associations may also exist in ADIPOQ rs2241766, VISFATIN rs4730153 and VISFATIN rs16872158.

Prospero registration

CRD42020187664.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05111-4.

Morphological classification and measurement of the glenoid cavity using three-dimensional reconstruction in a Chinese population

BACKGROUND

The purpose of this study was to examine the various shapes and record the morphometric data of the glenoid cavity in a Chinese population.

MATERIALS AND METHODS

A total of 501 scapulae, 247 left and 254 right, were analyzed. We classified the shape of the glenoid cavity as type Ⅰ (pear-shaped), type Ⅱ (oval-shaped), type Ⅲ (teardrop-shaped), type Ⅳ (calabash-shaped) or type Ⅴ (inverted comma-shaped). Four defined parameters, the superior-inferior glenoid diameter (AB), upper anterior-posterior glenoid diameter (CD), lower anterior-posterior glenoid diameter (EF) and glenoid index (GI), were measured, and five shapes were classified via three-dimensional reconstruction.

RESULTS

The mean AB, CD, EF and GI values of the glenoid were 3.51±0.41 cm, 1.95±0.28 cm, 2.60±0.34 cm, and 1.35±0.12 cm, respectively. The AB value of type Ⅱ glenoid cavities was significantly smaller than that of type Ⅰ and Ⅲ glenoid cavities (P<0.05), but the GI value of type Ⅱ glenoid cavities was larger than that of type Ⅲ cavities (P<0.05). The CD value showed a difference between type Ⅰ and type Ⅲ glenoid cavities (P<0.05). For the EF parameter, the values of type Ⅲ glenoid cavities were significantly larger than those of type Ⅰ and Ⅱ glenoid cavities (P<0.05).

CONCLUSIONS

Measuring and observing the variety of shapes and sizes of the glenoid cavity in Chinese people is conducive to for better understand its morphological features. This information can also guide surgeons in the design and selection of suitable prostheses for total shoulder arthroplasty in the Chinese population in order to reduce postoperative complications.

Association between egg consumption and metabolic syndrome in Chinese population: a cross-sectional study

OBJECTIVES

Metabolic syndrome (MS) comprises a constellation of symptoms that include abdominal obesity, hypertension, hyperglycaemia and dyslipidaemia. Dietary intake is a crucial environmental risk factor for MS, but the exact association between MS and egg consumption, which accounts for more than half of the daily total cholesterol intake in Chinese population, has not been previously studied. The aim of this study was to examine the correlation between dietary egg consumption and the prevalence of MS in the context of a large population.

DESIGN

A cross-sectional study.

SETTINGS

Our study was conducted in a health examination centre in China.

PARTICIPANTS

Participants who aged ≥40 years and received routine physical examinations were included for analyses.

MAIN OUTCOME MEASURES

MS was diagnosed in accordance with the clinical diagnosis criteria specified in the American Heart Association Guidelines. Egg consumption was assessed by a validated semi-quantitative food frequency questionnaire.

RESULTS

A total of 11 529 participants (46.2% women) were included in the present study. On the basis of multivariable logistic regression analysis, egg consumption was negatively associated with the prevalence of MS after adjusting for dietary energy intake (OR=0.84, 95% CI 0.76 to 0.93, p value for trend=0.001). The above findings did not change with further adjustment for other potential confounders: model 2 was further adjusted for age, body mass index and sex (based on model 1) and model 3 was further adjusted for education level, physical activity level, smoking status, alcohol use status, dietary fat intake, dietary fibre intake and nutritional supplementation (based on model 2). Consistent results were obtained from the analysis in the female subgroup but not in male subjects.

CONCLUSIONS

A higher level of egg consumption was associated with a lower prevalence of MS in our study participants, and particularly in female subjects.

A siamese network with adaptive gated feature fusion for individual knee OA features grades prediction

Grading individual knee osteoarthritis (OA) features is a fine-grained knee OA severity assessment. Existing methods ignore following problems: (1) more accurately located knee joints benefit subsequent grades prediction; (2) they do not consider knee joints' symmetry and semantic information, which help to improve grades prediction performance. To this end, we propose a SE-ResNext50-32x4d-based Siamese network with adaptive gated feature fusion method to simultaneously assess eight tasks. In our method, two cascaded small convolution neural networks are designed to locate more accurate knee joints. Detected knee joints are further cropped and split into left and right patches via their symmetry, which are fed into SE-ResNext50-32x4d-based Siamese network with shared weights, extracting more detailed knee features. The adaptive gated feature fusion method is used to capture richer semantic information for better feature representation here. Meanwhile, knee OA/non-knee OA classification task is added, helping extract richer features. We specially introduce a new evaluation metric (top±1 accuracy) aiming to measure model performance with ambiguous data labels. Our model is evaluated on two public datasets: OAI and MOST datasets, achieving the state-of-the-art results comparing to competing approaches. It has the potential to be a tool to assist clinical decision making.

Helix B surface peptide protects against acute lung injury through reducing oxidative stress and endoplasmic reticulum stress via activation of Nrf2/HO-1 signaling pathway

OBJECTIVE

Acute lung injury (ALI) is a clinical problem with poor prognosis and high mortality. The purpose of this study was to explore the effects of helix B position peptide (HBSP) on ALI and its mechanism.

MATERIALS AND METHODS

C57/BL6 male mice were used to construct ALI models by LPS tracheal injection and detect the effect of HBSP on mouse ALI by subcutaneously injecting HBSP. In addition, normal human lung epithelial cell line (BEAS-2B) were cultured and stimulated with HBSP. Then, the effects of HBSP on oxidative stress and endoplasmic reticulum stress (ERS) in BEAS-2B cells were examined. Finally, the effect of HBSP on the Nrf2/HO-1 signaling pathway was examined, and the mechanism of action of HBSP was verified using the Nrf2/HO-1 signaling pathway inhibitor ML385.

RESULTS

In vitro, HBSP increased the expression of SOD1/2 and decreased the expression of ERS-related molecules such as CHOP, GRP-78, and caspase-12, indicating that HBSP effectively reduces the level of oxidative stress and ERS in BEAS-2B cells. In addition, HBSP also increased the activity of the Nrf2/HO-1 signaling pathway and ML385 reduced the protective effect of HBSP on BEAS-2B cells. In vivo, HBSP significantly reduced LPS-induced mouse ALI. W/D and inflammatory factors in the BALF of the mouse lung were significantly reduced and the level of oxidative stress was also reduced.

CONCLUSIONS

HBSP plays an important role in relieving ALI by activating Nrf2/HO-1 signaling pathway, which reduces the level of inflammation in lung tissue and oxidative stress and ERS in lung epithelial cells.

Liquid biopsy by combining 5-hydroxymethylcytosine signatures of plasma cell-free DNA and protein biomarkers for diagnosis and prognosis of hepatocellular carcinoma

BACKGROUND

Liquid biopsy based on 5-hydroxymethylcytosine (5hmC) signatures of plasma cell-free DNA (cfDNA) originating from tumor cells provides a novel approach for early diagnosis in hepatocellular carcinoma (HCC). Here, we sought to develop a reliable model using cfDNA 5hmC signatures and protein biomarkers for diagnosis and prognosis of HCC.

PATIENTS AND METHODS

We carried out genome-wide 5hmC sequencing of cfDNA samples collected from 165 healthy volunteers, 62 liver cirrhosis (LC) patients and 135 HCC patients. A sensitive 5hmC diagnostic model was developed based on 5hmC signatures selected by sparse Partial Least Squares Discriminant Analysis and cross-validation to define the weighted diagnostic score (wd-score). Then, we combined protein biomarkers with the wd-score to build a more robust score (HCC score) by logistic regression.

RESULTS

The distribution pattern of differential 5hmC regions could clearly distinguish HCC patients, LC patients and healthy volunteers. The wd-score based on 64 5hmC signatures in cfDNA achieves 93.24% of area under the curve (AUC) to distinguish HCC patients from non-HCC patients, and the HCC score by combing protein biomarkers achieves 92.75% of AUC to distinguish HCC patients from LC patients. Meanwhile, the HCC score showed high capacity for screening high recurrence risk patients after receiving surgical resection, and appeared to be an independent indicator for both relapse-free survival (P = 0.00865) and overall survival (P = 0.000739). Furthermore, the values of the HCC score in patients' longitudinal plasma samples were positively associated with tumor burden dynamics during follow-up.

CONCLUSION

We have developed and validated a novel non-invasive liquid biopsy strategy for HCC diagnosis, prognosis and surveillance during HCC progression.

Horizontal orientation of zygomorphic flowers: significance for rain protection and pollen transfer

Floral traits are recognized to have evolved under selection for abiotic and biotic factors. Complex zygomorphic flowers usually face horizontally. It has been proved that a horizontal orientation facilitates pollinator recognition and pollination efficiency, but its significance in adaptation to abiotic factors remains unknown. The floral orientation of Abelia × grandiflora naturally varies around horizontal (with an angle of -30 to +33° between the floral main axis and the horizontal). We examined whether three different floral orientations affected flower thermal conditions, response to rain and pollination. Results showed that floral orientation had no effect on diurnal variations in flower temperature. The anthers of all three flower orientations were wetted by rainfall, but the inclined upward-facing flowers contained significantly more rainwater. The horizontal flowers received significantly higher visitation by hawkmoths and had a higher stigmatic pollen load. In contrast, the upward flower orientation reduced pollination precision, while downward-facing flowers had decreased pollinator attraction. This study indicates that horizontal flowers may have evolved as a trade-off between rain protection and pollination. Zygomorphic flowers that deviate from a horizontal orientation may have lower fitness because of flower flooding by rainwater and decreased pollen transfer.

Selenium and bone health: a protocol for a systematic review and meta-analysis

INTRODUCTION

Bone health affects the ability of human body to stay active, and its degradation can cause considerable morbidity and mortality. The factors related to bone health play an important role in preventing osteoporosis and its adverse consequences. However, the risk factors for osteoporosis have not been fully elucidated. Deficiency in the trace element selenium may be one of the risk factors for the development of osteoporosis. Previous studies have investigated the effects of selenium on osteoporosis; however, the results are inconclusive. Therefore, the present study aimed to systematically examine the existing literature on the associations between dietary or serum selenium and bone mineral density (BMD), osteoporosis or osteoporotic fractures, and to quantify such associations through meta-analysis.

METHODS AND ANALYSIS

PubMed, Embase and Cochrane Library will be searched using a specified search strategy to identify relevant studies up to October 2019. Both interventional and observational studies in humans will be included. The outcomes will include BMD and the prevalence or incidence of osteoporosis and osteoporotic fractures. For dietary or serum selenium and BMD, osteoporosis or osteoporotic fractures pooled analyses, estimates will be expressed as the mean difference, and the pooled OR, relative risk, HR or beta coefficient, and corresponding 95% CIs. Heterogeneity of the studies and publication bias will be investigated accordingly. To assess the quality and the risk of bias of the included studies, the Newcastle-Ottawa Quality Scale or the Cochrane risk of bias assessment tool will be used where appropriate.

ETHICS AND DISSEMINATION

Since no private and confidential patient data will be included in the reporting, approval from an ethics committee is not required. The results will be published in a peer-reviewed journal. The study raises no ethical issues.

PROSPERO REGISTRATION NUMBER

CRD42019147188.