[Anti-myelin-associated glycoprotein antibody positive IgM monoclonal gammopathy related peripheral neuropathy: 11 cases and literature review]

目的

提高对罕见的抗髓鞘相关糖蛋白（MAG）抗体阳性的IgM相关性周围神经病（IgM-PN）的认识。

方法

总结2014年1月至2019年4月北京协和医院诊断的11例抗MAG抗体阳性的IgM-PN患者的临床特点、实验室检查、治疗方案和预后。

结果

11例患者中，男8例，女3例，中位发病年龄63（52~77）岁。其中9例患者以远端肢体麻木起病，6例伴肌力减退。神经传导速度检查示，均为周围神经脱髓鞘损害，以下肢感觉神经损害为主，6例伴慢性轴索损害。11例患者均存在血清IgM型单克隆免疫球蛋白，6例为IgM κ型，3例为IgM λ型，2例为IgM κ/IgG κ双克隆型。3例患者继发于巨球蛋白血症。11例患者的血清抗MAG抗体均为阳性。9例患者接受利妥昔单抗单药或联合化疗，治疗后7例患者的神经症状稳定或改善。

结论

抗MAG抗体阳性的IgM-PN是一种罕见的M蛋白相关性疾病。对于伴IgM型M蛋白的周围神经病患者，应常规筛查抗MAG抗体。基于利妥昔单抗的治疗可作为其一线治疗方案。

Challenges Faced with Small Molecular Modulators of Potassium Current Channel Isoform Kv1.5

The voltage-gated potassium channel Kv1.5, which mediates the cardiac ultra-rapid delayed-rectifier (IKur) current in human cells, has a crucial role in atrial fibrillation. Therefore, the design of selective Kv1.5 modulators is essential for the treatment of pathophysiological conditions involving Kv1.5 activity. This review summarizes the progress of molecular structures and the functionality of different types of Kv1.5 modulators, with a focus on clinical cardiovascular drugs and a number of active natural products, through a summarization of 96 compounds currently widely used. Furthermore, we also discuss the contributions of Kv1.5 and the regulation of the structure-activity relationship (SAR) of synthetic Kv1.5 inhibitors in human pathophysiology. SAR analysis is regarded as a useful strategy in structural elucidation, as it relates to the characteristics that improve compounds targeting Kv1.5. Herein, we present previous studies regarding the structural, pharmacological, and SAR information of the Kv1.5 modulator, through which we can assist in identifying and designing potent and specific Kv1.5 inhibitors in the treatment of diseases involving Kv1.5 activity.

Pyrazolone structural motif in medicinal chemistry: Retrospect and prospect

The pyrazolone structural motif is a critical element of drugs aimed at different biological end-points. Medicinal chemistry researches have synthesized drug-like pyrazolone candidates with several medicinal features including antimicrobial, antitumor, CNS (central nervous system) effect, anti-inflammatory activities and so on. Meanwhile, SAR (Structure-Activity Relationship) investigations have drawn attentions among medicinal chemists, along with a plenty of analogues have been derived for multiple targets. In this review, we comprehensively summarize the biological activity and SAR for pyrazolone analogues, wishing to give an overall retrospect and prospect on the pyrazolone derivatives.

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The pyrazolone structural motif is a critical element of drugs aimed at different biological end-points.

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The pyrazolone analogues have been carried out to drug-like candidates with broad range of medicinal properties.

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This review wishes to give an overall retrospect and prospect on the pyrazolone derivatives.

Serum calprotectin correlates with risk and disease severity in psoriasis patients and the decrease of calprotectin predicts better response to tumor necrosis factor inhibitors

OBJECTIVE

This study aimed to investigate the correlation of serum calprotectin expression with risk and severity of psoriasis, as well as its predictive value for clinical response to tumor necrosis factor inhibitors (TNFi) treatment in psoriasis patients.

PATIENTS AND METHODS

72 psoriasis patients and 70 health controls (HCs) were enrolled. Blood samples were collected, and serum calprotectin was determined by commercial enzyme-linked immuno sorbent assay (ELISA). All patients were treated by TNFi treatment, and followed up at 6 months, and the last follow-up date was 2016/11.

RESULTS

Calprotectin level was elevated in psoriasis patients compared to HCs (p < 0.001), and it disclosed a good diagnostic value of psoriasis with area under curve (AUC) 0.872, 95% CI: 0.810-0.935. Calprotectin expression was positively associated with Psoriasis Area and Severity Index (PASI) score (R = 0.452, p < 0.001), while it was not associated with BSA (R = 0.125, p = 0.297). 58.3% patients achieved PASI75 and 43.1% patients achieved PASI90 at M6. Calprotectin was decreased during the 6-month treatment (p < 0.001). Changes of calprotectin during the first month (∆calprotectin (M0-M1)) in PASI75 group were more than that of non-PASI75 group (p < 0.001). Also, multivariate logistic analysis revealed that ∆calprotectin (M0-M1) (p = 0.001) was an independent factor for PASI75 achievement at M6 after TNFi treatment, while pre-systemic biologic treatment (p = 0.001) was an independent factor for non-PASI75 achievement.

CONCLUSIONS

Serum calprotectin expression is correlated with risk and severity of psoriasis, and the decrease of calprotectin during the first month could predict better clinical response to TNFi treatment in psoriasis patients.

Osteoblast Responses to Titanium-Coated Subcellular Scaled Microgrooves

Statistical data have consistently shown that implant loosening is a significant causative factor for revision surgeries. Both in vivo and in vitro studies have confirmed the positive influences of microgrooved titanium implant surfaces on improving orthopedic titanium implants compared with a smooth titanium surface. Complete cell-groove adhesion is a prerequisite for rapid and robust osseointegration. For the first time, this work has quantified the influence of the titanium groove width at the subcellular scale (5-20 μm) on osteoblast responses, using titanium-coated microgrooved silicon wafer specimens (surface roughness, R_a = ∼1.5 nm), which can avoid the latent influence of variations in surface roughness from the use of normal titanium substrates. The cell-groove adhesion increased from 53.07% to 98.55% with an increasing groove width from 5 to 20 μm. In addition, both the cell spreading area and cell width were proportional to groove width. However, no statistically significant influence (p > 0.05) of groove width was identified on cell proliferation and differentiation. An exponential model was proposed to predict the groove geometries that can facilitate complete cell-groove adhesion. The underlying mechanisms were discussed. The experimental findings of this study provide a unique basis for the design of titanium implant surfaces.

[Prevalence and quality of spirometry and the impact of spirometry training in Hunan, People's Republic of China]

Objective: To explore quality of spirometry in Hunan province and the impact of education on it. Methods: Cross-sectional study and a prospective randomized cohort study. (1) A total of 460 public hospitals in Hunan province were investigated. Research assistants collected 20 consecutive reports of pulmonary ventilation test reports (PVTRs) and basal information of those hospitals which owned spirometry. (2) To measure the effect of education, 28 randomly selected 2(nd) level hospitals which owned spirometry were randomized to intervention and control group (1∶1). The intervention group received a short-time training which included face-to-face lectures and a hand-by-hand operation training course, while the control group received usual care. PVTRs were investigated 3 months after the intervention. All PVTRs were classified to grade A, B, C, D and E according to the Chinese pulmonary ventilation test (PVT) guidelines. Results: The recovery rate was 100%. The spirometry-equipped ratio was 1.6% (2/129) at 1(st) level hospitals, 39.0% (105/269) at 2(nd) level hospitals, 100% (62/62) at 3(rd) level hospitals in Hunan province. There were 100% (2/2), 91.4% (96/105) and 93.5% (58/62) utilization rate at 1(st), 2(nd) and 3(rd) level hospitals. Common reasons for not owning a spirometer were equipment cost and insufficient insurance. Lack of knowledge about spirometry and inadequate benefits were the top two reasons for low utilization rate. There were 3 120 PVTRs from 156 hospitals which used spirometry, a total of 50.4% (1 574/3 120) PVTRs got grade A, a total of 14.8% (462/3 120) PVTRs were judged as unreliable (grade D, E). There were 560 PVTRs and 28 questionnaires, respectively, before and after intervention. The technicians' knowledge improved after education compared to before (9.8±0.6 vs 8.6±1.1) (P<0.05). And 75.0% (210/280) PVTRs got A grade in the intervention group, which was significantly higher than those in the control group (75.0% vs 37.9%, P<0.05). While none of PVTRs was unreliable, which was lower than that in the control group (0 vs 14.6%, P<0.05). Conclusions: The equipment ratio and the utilization rate of spirometry are still low and imbalanced among three levels hospitals in Hunan. The short-time training is helpful to improve quality of spirometry.

Synthesis toward Bivalent Ligands for the Dopamine D2 and Metabotropic Glutamate 5 Receptors

In this study, we designed and synthesized heterobivalent ligands targeting heteromers consisting of the metabotropic glutamate 5 receptor (mGluR5) and the dopamine D₂ receptor (D₂R). Bivalent ligand 22a with a linker consisting of 20 atoms showed 4-fold increase in affinity for cells coexpressing D₂R and mGluR5 compared to cells solely expressing D₂R. Likewise, the affinity of 22a for mGluR5 increased 2-fold in the coexpressing cells. Additionally, 22a exhibited a 5-fold higher mGluR5 affinity than its monovalent precursor 21a in cells coexpressing D₂R and mGluR5. These results indicate that 22a is able to bridge binding sites on both receptors constituting the heterodimer. Likewise, cAMP assays revealed that 22a had a 4-fold higher potency in stable D₂R and mGluR5 coexpressing cell lines than 1. Furthermore, molecular modeling reveals that 22a is able to simultaneously bind both receptors by passing between the TM5-TM6 interface and establishing six protein-ligand H-bonds.

Prevalence of Cerebral Microhemorrhage following Chronic Blast-Related Mild Traumatic Brain Injury in Military Service Members Using Susceptibility-Weighted MRI

BACKGROUND AND PURPOSE

Cerebral microhemorrhages are a known marker of mild traumatic brain injury. Blast-related mild traumatic brain injury relates to a propagating pressure wave, and there is evidence that the mechanism of injury in blast-related mild traumatic brain injury may be different from that in blunt head trauma. Two recent reports in mixed cohorts of blunt and blast-related traumatic brain injury in military personnel suggest that the prevalence of cerebral microhemorrhages is lower than in civilian head injury. In this study, we aimed to characterize the prevalence of cerebral microhemorrhages in military service members specifically with chronic blast-related mild traumatic brain injury.

MATERIALS AND METHODS

Participants were prospectively recruited and underwent 3T MR imaging. Susceptibility-weighted images were assessed by 2 neuroradiologists independently for the presence of cerebral microhemorrhages.

RESULTS

Our cohort included 146 veterans (132 men) who experienced remote blast-related mild traumatic brain injury (mean, 9.4 years; median, 9 years after injury). Twenty-one (14.4%) reported loss of consciousness for <30 minutes. Seventy-seven subjects (52.7%) had 1 episode of blast-related mild traumatic brain injury; 41 (28.1%) had 2 episodes; and 28 (19.2%) had >2 episodes. No cerebral microhemorrhages were identified in any subject, as opposed to the frequency of SWI-detectable cerebral microhemorrhages following blunt-related mild traumatic brain injury in the civilian population, which has been reported to be as high as 28% in the acute and subacute stages.

CONCLUSIONS

Our results may reflect differences in pathophysiology and the mechanism of injury between blast- and blunt-related mild traumatic brain injury. Additionally, the chronicity of injury may play a role in the detection of cerebral microhemorrhages.

Design, Synthesis, and Biological Evaluation of Bivalent Ligands Targeting Dopamine D2 -Like Receptors and the μ-Opioid Receptor

Currently, there is mounting evidence that intermolecular receptor-receptor interactions may result in altered receptor recognition, pharmacology and signaling. Heterobivalent ligands have been proven useful as molecular probes for confirming and targeting heteromeric receptors. This report describes the design and synthesis of novel heterobivalent ligands for dopamine D₂ -like receptors (D₂ -likeR) and the μ-opioid receptor (μOR) and their evaluation using ligand binding and functional assays. Interestingly, we identified a potent bivalent ligand that contains a short 18-atom linker and combines good potency with high efficacy both in β-arrestin 2 recruitment for μOR and MAPK-P for D₄ R. Furthermore, this compound was characterized by a biphasic competition binding curve for the D₄ R-μOR heterodimer, indicative of a bivalent binding mode. As this compound possibly bridges the D₄ R-μOR heterodimer, it could be used as a pharmacological tool to further investigate the interactions of D₄ R and μOR.

An interpretable health behavioral intervention policy for mobile device users

An increasing number of people use mobile devices to monitor their behavior, such as exercise, and record their health status, such as psychological stress. However, these devices rarely provide ongoing support to help users understand how their behavior contributes to changes in their health status. To address this challenge, we aim to develop an interpretable policy for physical activity recommendations that reduce a user's perceived psychological stress, over a given time horizon. We formulate this problem as a sequential decision-making problem and solve it using a new method that we refer to as threshold Q-learning (TQL). The advantage of the TQL method over traditional Q-learning is that it is "doubly robust" and interpretable. This interpretability is achieved by making model assumptions and incorporating threshold selection into the learning process. Our simulation results indicate that the TQL method performs better than the Q-learning method given model misspecification. Our analyses are performed on data collected from 79 healthy adults over a 7 week period, where the data comprise physical activity patterns collected from mobile devices and self-assessed stress levels of the users. This work serves as a first step toward a computational health coaching solution for mobile device users.

The effect of ordered and partially ordered surface topography on bone cell responses: a review

Current understanding of the role of ordered and partially ordered surface topography in bone cell responses for bone implant design.

Role of ultrasonic treatment, inoculation and solute in the grain refinement of commercial purity aluminium

The present study investigates the influence of ultrasonic treatment on the grain refinement of commercial purity aluminium with a range of Al3Ti1B master alloy additions. When the aluminium contains the smallest amount of added master alloy, ultrasonics caused significant additional grain refinement compared to that provided by the master alloy alone. However, the influence of ultrasonics on grain size reduces with increasing addition of the master alloy which adds additional TiB₂ particles and Ti solute with each incremental addition. Applying the Interdependence model to analyse the experimentally measured grain sizes revealed that the results of this study and those from similar experiments on an Al-2Cu alloy were consistent when the alloy compositions are converted to their growth restriction factors (Q) and that increasing Q had a major effect on reducing grain size and increasing grain number density. Compared with the application of ultrasonic treatment where an order of magnitude increase in the grain number density is achieved, an increase in the Ti content over the range of master alloy additions, causes the grain number density to increase by approximately three times.

Study of three types of desensitizers in dentin bonding strength

One hundred and twenty human molars without decay (premolars and complete third molars) freshly extracted for orthodontic purposes were used in the study to explore the impact of application of three kinds of desensitizers on self-etching/all-etching bond strength of dentin. The roots were ground along the cementoenamel junction (CEJ), the residual crowns were divided into two parts along mesial and distal direction, and the enamel layer was removed. The dentin was ground into standard pieces of 3x3x3 mm and then polished using alumina waterproof abrasive paper. Two hundred and forty specimens were divided into two groups according to self-etching bond (OptiBond, iBond, XenoIV) and all-etching bond (OptiBond, iBond, Probond). Each of the two groups were subdivided into three groups with different brands, and then further subdivided into three experimental groups and a control group (10 samples in each final group). The surface of dentin coated with desensitizer was examined using scanning electron microscope. Results showed that only the shear strength of iBond + Ddes + Z100 resin group was lower compared to the control group (P < 0.05). The comparison of the resin shear strength in other experimental groups with the control groups demonstrated no statistically significant difference (P > 0.05). The shear strength of Optibond + Gluma, Optibond + Ddes, iBond + Ddes + Z100 resin group in all-etching bond group and the experimental groups in Probond group was lower than in the control group (P < 0.05). The resin shear strength in other groups did not differ from the controls (P > 0.05).

The effects of water on degradation of the zirconia-resin bond

OBJECTIVES

10-methacryloyloxydecyldihydrogenphosphate (MDP) containing primers improve bonding of yttria-stabilised tetragonal zirconia (Y-TZP) to methacrylate resins. The present study investigated the role played by water in the deterioration of MDP-mediated zirconia-resin bonds.

METHODS

Grit-blasted Y-TZP plates were conditioned with two MDP primers and bonded with resin for shear bond strength (SBS) testing. Additional bonded plates were aged hydrothermally and compared with unaged Y-TZP after 24h of water-storage or 6 months of water/acid/alkali-storage. The monoclinic phase (m-ZrO₂) in different groups was determined by X-ray diffraction. Hydrolytic stability of the coordinate bond between MDP and zirconia in neutral/acid/alkaline environment was analysed using thermodynamic calculations. Microleakage and release of the element phosphorus from MDP-mediated Y-TZP/resin-bonded interfaces were evaluated via methylene blue dye infiltration and inductively coupled plasma-mass spectrometry (ICP-MS).

RESULTS

Hydrothermal ageing did not significantly alter SBS. Ageing in acidic or neutral medium led to significant decline in SBS. The m-ZrO₂ phase increased after hydrothermal ageing but no m-ZrO₂ was detected in the water/acid/alkali-aged specimens. A higher equilibrium constant was identified in the MDP-t-ZrO₂ complex when compared with the MDP-m-ZrO₂ complex. MDP-conditioning failed to prevent infiltration of the methylene blue dye. Phosphorus was detected by ICP-MS from the solutions used for soaking the resin-bonded specimens.

CONCLUSIONS

Hydrolysis of the coordinate bond between MDP and ZrO₂, rather than t→m phase transformation, weakens the bond integrity between MDP-conditioned Y-TZP and methacrylate resin.

CLINICAL SIGNIFICANCE

Hydrolysis of the coordinate bond between MDP and zirconia is responsible for deterioration of the integrity of the bond between MDP-conditioned Y-TZP and methacrylate resin.

Osteogenesis-promoting activity of composites SBA-15 mesoporous particles carrying oxytocin in vitro and in vivo

This study analyzes the performance of SBA-15 mesoporous particles carrying oxytocin (OT) in promoting osteogenesis in vitro and in vivo. The SBA-15 particles synthesized in the previous studies (about 30 μm in diameter and containing 10 nm deep pores) were loaded with the drug oxytocin and cultured with human osteosarcoma MG-63 cell line in vitro. The influence of particles on cell proliferation was studied. The level of the osteogenic marker (alkaline phosphatase and type I collagen) was measured. For in vivo studies, the connectivity defects of rabbit skull were prepared, and SBA-15 suspensions were regularly injected at the defect sites. The changes in the defect site calcium salt deposition were measured, and morphological changes were observed by microscopy. The material had to promote effect on osteogenesis-related indicators such as alkaline phosphatase and collagen I in bone sarcoma cell line MG-63. In vivo, the calcium salt deposition in OT/SBA-15 group was significantly higher than in the blank group. SBA-15 carriers appeared to persist in the region of the defect after the injection and release the drugs slowly, thus playing a more distinct role in promoting bone repair of local bone defects. The results showed that SBA-15 particles with OT could slow the release drugs and could help in promoting osteogenesis.

Bronchial lavage P 16INK4A gene promoter methylation and lung cancer diagnosis: A meta-analysis

OBJECTIVE

To evaluate the diagnostic value of bronchial lavage P16INK4A promoter methylation and lung cancer.

MATERIALS AND METHODS

The databases of PubMed, Medline, China National Knowledge Infrastructure, and Wanfang were electronically searched by two reviewers to find the suitable studies related to the association between P16INK4A promoter methylation and lung cancer. The P16INK4A promoter methylation rate was extracted from each included individual study. The diagnostic sensitivity, specificity, and area under the receiver operating characteristic ROC curve of bronchial lavage P16INK4Aas a biomarker for diagnosis of lung cancer were pooled by stata 11.0 software (Stata Corporation, College Station, TX, USA).

RESULTS

At last, 10 publications were included in this meta-analysis. Of the included 10 studies, five are published in English with relatively high quality and other five papers published in Chinese have relatively low quality. The pooled sensitivity and specificity of bronchial lavage P16INK4A promoter methylation for lung cancer diagnosis were 0.61 (95% confidence interval [CI]: 0.57-0.65) and 0.81 (95% CI: 0.78-0.85), respectively, with random effect model. The ROC curve were calculated and drawn according to Bayes' theorem by stata 11.0 software. The systematic area under the ROC was 0.72 (95% CI: 0.68-0.76), which indicated that the diagnostic value of bronchial lavage P16INK4A promoter methylation for lung cancer was relatively high. Moreover, no significant publication bias was existed in this meta-analysis (t = 0.69, P > 0.05).

CONCLUSION

Bronchial lavage P16INK4A promoter methylation can be a potential biomarker for diagnosis of lung cancer.

Pediatric tuberculosis drug market: an insider perspective on challenges and solutions

Representative stakeholders were consulted on how they felt access to pediatric tuberculosis (TB) drugs could be improved. A key recommendation is the development of new child-friendly, adequately dosed formulations with a good shelf life in all climate zones. There is also an urgent need to improve the diagnosis and reporting of children with TB. Manufacturers of pediatric TB medications are to be incentivized through improved coordination among all stakeholders, with streamlined regulatory approvals and increased consumer education on drug and regimen guidelines. Finally, pooled procurement is advised to ensure sustained market supply against affordable prices.

Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: A review

One of the critical issues in orthopaedic regenerative medicine is the design of bone scaffolds and implants that replicate the biomechanical properties of the host bones. Porous metals have found themselves to be suitable candidates for repairing or replacing the damaged bones since their stiffness and porosity can be adjusted on demands. Another advantage of porous metals lies in their open space for the in-growth of bone tissue, hence accelerating the osseointegration process. The fabrication of porous metals has been extensively explored over decades, however only limited controls over the internal architecture can be achieved by the conventional processes. Recent advances in additive manufacturing have provided unprecedented opportunities for producing complex structures to meet the increasing demands for implants with customized mechanical performance. At the same time, topology optimization techniques have been developed to enable the internal architecture of porous metals to be designed to achieve specified mechanical properties at will. Thus implants designed via the topology optimization approach and produced by additive manufacturing are of great interest. This paper reviews the state-of-the-art of topological design and manufacturing processes of various types of porous metals, in particular for titanium alloys, biodegradable metals and shape memory alloys. This review also identifies the limitations of current techniques and addresses the directions for future investigations.

Development of a new benazepril hydrochloride chewable tablet and evaluation of its bioequivalence for treatment of heart failure in dogs

The aim of the study was to develop a new chewable benazepril hydrochloride(BH) tablet, investigate its physical properties, and evaluate its bioequivalence with the branded formulation (Fortekor). A corrective agent was included in the formula to improve its palatability and convenience for administration to dogs. The tablet remained stable in light, heat, and humidity tests, and its physical properties such as hardness, uniformity of content, and dissolution rate were highly consistent with the technical standards. After single and repeated administrations to eight beagles and single dose to 14 mongrel dogs (0.5 mg/kg p.o.), plasma BH and its active metabolite, benazeprilat (BZ), were detected. There was no significant difference in the major pharmacokinetic parameters (Cmax , Tmax, and AUC₀₋₂₄) between the two formulations. The 90% confidence intervals calculated for the ratios of area under the time-concentration curve (AUC₀₋₂₄) were 92.4-116.3% for BH and 89.9-102.3% for BZ, within the accepted range for bioequivalence of 80-125%. The results showed our new chewable tablet is bioequivalent to the commercial product and suitable for addition to the benazepril product family for the treatment of heart failure in dogs.