Evaluation of the Size-Dependent Cytotoxicity of DLC (Diamondlike Carbon) Wear Debris in Arthroplasty Applications

Patients with DLC (diamond like carbon)-coated artificial joints may be exposed to a wide size range of DLC wear debris (DW). In this study, the cytotoxicity of DW of different size ranges (0-0.22, 0.22-0.65, 0.65-1.0, and 1.0-5.0 μm) was evaluated. The microstructure and physical characteristics of DW were investigated by Raman spectroscopy, transmission electron microscopy (TEM), scanning electron microscope (SEM), and dynamic light scattering (DLS). Macrophages, osteoblasts, and fibroblasts were incubated with DW of different size ranges respectively followed by cytotoxicity evaluations of inflammatory cytokines, alkaline phosphatase (ALP) assays, and related signal protein expression analysis. The results showed that, except for the size range of 0-0.22 μm, DW cytotoxicity showed a size-dependent (0.22-5.0 μm) decrease with increasing size. Within the range of 0.22-5.0 μm, DW of larger size resulted in lessened inflammatory response and enhanced osteoblastogenesis and fibrogenesis, with increased viability of cells (macrophages, osteoblasts, and fibroblasts), better morphology, less release of pro-inflammatory factors and more release of anti-inflammatory factors. The results demonstrated that DW sizes below 0.22 μm had less negative effects on cell adhesion and growth because of the BSA (bovine serum albumin) encapsulation effect. These findings provide valuable knowledge about the comprehensive mechanism of promotion of inflammatory response and inhibition of osteoblastogenesis and fibrogenesis induced by DW. In conclusion, an effective system of biocompatibility evaluation for different sizes of DW was derived.

P2X3 receptor-mediated visceral hyperalgesia and neuronal sensitization following exposure to PTSD-like stress in the dorsal root ganglia of rats

BACKGROUND

Patients with posttraumatic stress disorder (PTSD) often share co-morbidity with chronic pain conditions. Recent studies suggest a role of P2X3 receptors and ATP signaling in pain conditions. However, the underlying mechanisms of visceral hyperalgesia following exposure to PTSD-like stress conditions remain unclarified.

METHODS

The behavior and hormones relevant for PTSD were studied. Visceromotor responses (VMR) and the abdominal withdrawal reflexes (AWR) to colorectal distention (CRD) were recorded to determine P2X3-receptor-mediated alteration of hyperalgesia following single-prolonged stress (SPS) exposure. Immunofluorescence, Western blotting, and patch-clamp were used.

KEY RESULTS

The escape latency, adrenocorticotropic hormone and cortisol were increased on days 7-14. Visceromotor responses and AWR was reduced at day 1 in SPS rats but increased to higher levels than in controls after exposure to day 7. Intrathecal administration of the P2X3-receptor antagonist TNP-ATP abolished the CRD response. Based on immunofluorescence and Western blotting analysis, SPS-treated rats exhibited reduced P2X3 expression in dorsal root ganglia (DRG) after day 1 compared with controls. P2X3 expression in DRG was enhanced on day 7 after SPS and the increase of the P2X3 expression was maintained on day 14 and 21 compared with controls. The P2X3-receptor agonist α,β-me ATP (10 μM) induced a fast desensitizing inward current in DRG neurons of both control and SPS-treated rats. The average peak current densities in SPS-treated group were increased 3.6-fold. TNP-ATP (100 nM) markedly blocked all fast α,β-me ATP-induced inward currents in the DRG neurons both in control and SPS-treated rats.

CONCLUSIONS & INFERENCES

The data indicate an important role of P2X3 signaling in visceral hyperalgesia following PTSD-like stress.

[Clinical experience on the employment of the staged step-up approach in the treatment of local complications secondary to severe acute pancreatitis]

Objective: To explore the experience and prognostic factors associated with the employment of the step-up approach in the treatment of local complications secondary to severe acute pancreatitis (SAP). Methods: The clinical data of 279 patients admitted to the Department of Pancreatic and Biliary Surgery, First Affiliated Hospital of Harbin Medical University from January 2011 to December 2015, whose local complications secondary to SAP were treated in a staged step-up framework, were retrospectively analyzed.For patients with documented or suspected infected pancreatic necrosis or gastrointestinal tract obstruction, some non-surgical interventions were initialed with the aim of postponing the timing of surgery to the forth week from the onset of SAP.The first-step intervention was a percutaneous catheter drainage (PCD) under the guidance of ultrasound. A minimal access retroperitoneal pancreatic necrosectomy, representing the second-step intervention, was conducted when PCD had failed. Finally, an open necrosectomy (the third-step intervention) was immediately resorted to when all of previous minimal invasive interventions had failed.Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ² test or Fisher's exact test.A multivariable Logistic regression analytic model was established to figure out the prognostic factors that were independently associated with the requirement of debridement in addition to drainage procedure during the staged step-up framework of patients with local complications secondary to SAP. Results: The initial interventions in this series were performed at 12 d (9-22 d) from the on-set of SAP and 104 cases (37.3%) were cured with ultrasound guided PCD alone.There were 152 cases (54.5%) cured by debridement in addition to PCD with the time interval of 30 d (25 to 44 d) since the on-set of the disease.The overall incidence of postoperative complications was 22.6% (63 cases) and in-hospital mortality was 8.2% (23 cases) in the present series.Multiple organ failures(MOF)(P<0.01, OR=3.15), heterogeneous collections (P<0.01, OR=2.40) and tertiary transfer (P=0.03, OR=1.80) were verified as the prognostic factors that were independently associated with the requirement of debridement in addition to PCD during the staged step-up framework of patients with local complications secondary to SAP. Conclusions: The staged step-up framework is a promising innovation that complies well with the era of minimal invasive surgery and is optimally suitable for the surgical interventions against SAP.MOF, heterogeneous collections and tertiary transfer are the prognostic factors that are independently associated with the requirement of debridement in addition to PCD during the staged step-up framework of patients with local complications secondary to SAP.

Glycemic control and self-monitoring of blood glucose in Chinese patients with type 2 diabetes on insulin: Baseline results from the COMPASS study

AIMS

Self monitoring of blood glucose (SMBG) is not widely utilized in insulin-treated patients with type 2 diabetes. In this analysis, we evaluated the current state of SMBG in Chinese adults with type 2 diabetes treated with insulin.

METHODS

The 2-phase COMPASS study involved 24 centers across 10 provinces and cities in China. In the first phase, a cross sectional survey was carried out in type 2 diabetes patients receiving insulin treatment. The inclusion criteria for the study subjects in the first phase were: type 2 diabetes, insulin treatment for ≥ 3 months, and age ≥ 18 years. Evaluation was made on the status of SMBG and insulin therapy in these patients by a questionnaire.

RESULTS

A total of 2819 patients (age 58.2 ± 10.8 years; 49.6% females; BMI 24.6 ± 3.4 kg/m(2)) with insulin-treated type 2 diabetes were recruited in phase I of this study. The majority of patients (80.4%) were receiving insulin treatment for at least 6 months. At baseline, the mean HbA1c was 8.5 ± 1.9% and 54.6% of patients had an HbA1c above 8%. 50.4% of the cohort had diabetes for at least 10 years, and fewer of these patients achieved HbA1c <7.0% (53 mmol/mol). At baseline, 65.8% of patients reported that daily SMBG frequency was performed on a random basis. 59.2% of patients reported that they occasionally, rarely or never follow their physician's instructions regarding SMBG. Hypoglycemia occurred in over 50% of patients, although in 71.8% of patients this was a rare occurrence.

CONCLUSIONS

There is low utilization of SMBG in Chinese adults with insulin-treated type 2 diabetes, with approximately two-thirds of patients reporting irregular use of SMBG. This is in line with an overall poor level of glycemic control.

Impact of structured self-monitoring of blood glucose on the quality of life of insulin-treated Chinese patients with type 2 diabetes mellitus: Results from the COMPASS study

AIMS

To evaluate the effect of structured self-monitoring of blood glucose (SMBG) regimen on quality of life (QoL) in poorly controlled insulin-treated patients with type 2 diabetes.

METHODS

Phase II of the COMPASS trial was a 6-month, multicenter, prospective, single-arm, interventional study. This study recruited 820 outpatients from 19 clinical sites in China who met the following inclusion criteria: type 2 diabetes, insulin treatment for ≥ 3 months, and age 18-65 years, an HbA1c >8.0% (64 mmol/mol), and willingness to perform SMBG. Subjects were advised to follow a structured SMBG regimen specific to their insulin regimen, and were trained to respond to SMBG readings via lifestyle changes and insulin dose self-adjustment. QoL assessments (SF-36) were performed at baseline and 6 months.

RESULTS

Patients with a mean age of 55.13 ± 9.77 years had an average diabetes duration of 9.83 ± 7.05 years and had been receiving insulin therapy for a mean of 45.4 ± 46.79 months. All QoL parameters were significantly improved following structured SMBG after 6 months, most notably the physical role functioning (p<0.0001) and emotional role functioning (p<0.0001) component scores. Overall, 40.6% of patients rated their overall QoL as 'a bit' or a lot better' after structured SMBG compared with 16.5% prior to the intervention (p<0.0001). SMBG also improved overall feelings of wellbeing, with 39.13% of patients believing that their health was deteriorating prior to SMBG compared with only 14.4% of patients after the intervention (p<0.0001).

CONCLUSIONS

The structured SMBG program in insulin-treated Chinese outpatients with type 2 diabetes significantly improved QoL outcomes. Physical and emotional role functioning are the 2 QoL scales that demonstrate the largest improvement with SMBG.

The effect of treadmill training and N-acetyl-l-cysteine intervention on biogenesis of cytochrome c oxidase (COX)

Mitochondrial biogenesis refers to increased content of mitochondria, which has been shown to be promoted by aerobic exercise. During this process, oxidative stress is considered the essential initiator. Even though some studies have addressed the issue as to whether antioxidants would hamper the effects of exercise on mitochondrial biogenesis, no consensus has been achieved. Therefore, the purpose of the present study was to investigate the effects of exercise and antioxidant intervention on mitochondrial biogenesis, as well as COX biogenesis. Thirty-two clean-grade male ICR mice were randomly assigned to a control group (Con), exercise group (Ex), N-acetyl-l-cysteine group (NAC), or NAC plus exercise group (NEx). The NAC and NEx groups were injected with NAC (0.1 mg/g/2 days) intraperitoneally for 3 weeks, whereas the Con and Ex groups were administered saline for the same period of time. Mice assigned to Ex and NEx groups started exercise training 1 week before drug intervention was initiated. After 1 week of acclimatization, the mice were allowed to run at a speed of 28 m/min for 60 min, 6 days a week. The results showed that exercise training caused an increase in mRNA and protein levels of COXIV, whereas NAC intervention lowered the two so significantly that even exercise training could not reverse the effect of NAC intervention. Our data suggest that even though antioxidant intervention could alleviate oxidative damage caused by exercise, it was not necessarily beneficial for mitochondrial biogenesis.

In Vivo Antioxidant Properties of Lotus Root and Cucumber: A Pilot Comparative Study in Aged Subjects

OBJECTIVES

To compare the effects of lotus root and cucumber on antioxidant function in aged subjects.

DESIGN

Pilot comparative study.

SETTING

Research setting with vegetable intervention.

PARTICIPANTS

Healthy aged subjects over the age of sixty.

INTERVENTION

30-day supplementation of lotus root or cucumber powder.

MEASUREMENTS

Plasma value of ferric reducing antioxidant power assay, activity of antioxidant enzymes, contents of some antioxidants, oxidation products, hemolysis, blood mononuclear cell DNA damage and urinary excretion of 8-hydroxy-2'-deoxyguanosine were measured before and after the intervention.

RESULTS

Plasma glutathione peroxidase activity, contents of vitamin C, total phenolics were significantly increased, while plasma uric acid content significantly decreased in both groups at the end of the intervention. Meanwhile, hemolysis was significantly reduced in both groups and DNA injury rate of blood mononuclear cells in lotus root group and the ratio of comet tail length to total length in cucumber group were also declined significantly post-intervention. However, plasma value of ferric reducing antioxidant power assay, contents of reduced glutathione, vitamin E, malondialdehyde, oxidized low density lipoprotein, carbonyls and activity of superoxide dismutase and catalase were not changed significantly in both group after the intervention.

CONCLUSION

These results suggest that lotus root and cucumber are not remarkably different in improving antioxidant function in aged subjects, though they are significantly different in antioxidant capacity in vitro. The benefits observed in this study may come from the additive or synergistic combinations of antioxidants contained in vegetables.

The INTERPRET-DD study of diabetes and depression: a protocol

AIM

People with diabetes are at an increased risk of developing depression and other psychological disorders. However, little is known about the prevalence, correlates or care pathways in countries other than the UK and the USA. A new study, the International Prevalence and Treatment of Diabetes and Depression Study (INTERPRET-DD) aims to address this dearth of knowledge and identify optimal pathways to care across the globe.

METHOD

INTERPRET-DD is a 2-year longitudinal study, taking place in 16 countries' diabetes outpatients' facilities, investigating the recognition and management of depressive disorders in people with Type 2 diabetes. Clinical interviews are used to diagnose depression, with clinical and other data obtained from medical records and through patient interviews. Pathways to care and the impact of treatment for previously unrecognized (undocumented) depression on clinical outcomes and emotional well-being are being investigated.

RESULTS

Initial evidence indicates that a range of pathways to care exist, with few of them based on available recommendations for treatment. Pilot data indicates that the instruments we are using to measure both the symptoms and clinical diagnosis of depression are acceptable in our study population and easy to use.

CONCLUSIONS

Our study will increase the understanding of the impact of comorbid diabetes and depression and identify the most appropriate (country-specific) pathways via which patients receive their care. It addresses an important public health problem and leads to recommendations for best practice relevant to the different participating centres with regard to the identification and treatment of people with comorbid diabetes and depression.

Diabetes nutrition therapy and dietary intake among individuals with Type 1 diabetes in China

AIMS

To describe the contribution of diabetes nutrition therapy to disease self-management among individuals with Type 1 diabetes in China and to estimate the association of diabetes nutrition therapy with dietary intake.

METHODS

The 3C Study was an epidemiological study of the coverage, cost and care of Type 1 diabetes in China. The data reported in the present study are from the 3C Nutrition Ancillary Study, a follow-up study conducted a mean ± sd of 1.6 ± 0.2 years later. Diabetes nutrition therapy was assessed by an interviewer-administered questionnaire. Dietary intake was assessed using three 24-h recalls. The association of diabetes nutrition therapy with dietary intake was estimated using ancova.

RESULTS

Participants (n = 100; 54% male) had a mean ± sd age of 41.7 ± 16.3 years and a mean ± sd diabetes duration of 11.8 ± 9.7 years. Fewer than half of the participants reported that they had 'ever' met with a dietitian. While 64% of participants were taught carbohydrate counting, only 12% 'ever' use this tool. Participants on insulin pumps and those testing ≥ 1 time/day reported greater dietary flexibility and higher fruit intakes compared with participants on other insulin regimens and testing less frequently. After adjustment for confounding by age and occupation, there were no consistent differences in dietary intake across subgroups of diabetes nutrition therapy.

CONCLUSIONS

In this sample of individuals with Type 1 diabetes in China there is little dietitian involvement or carbohydrate counting. Increased frequency of nutrition education in conjunction with intensified self-monitoring of blood glucose is needed to improve care.

Comparison of the effects on glycaemic control and β-cell function in newly diagnosed type 2 diabetes patients of treatment with exenatide, insulin or pioglitazone: a multicentre randomized parallel-group trial (the CONFIDENCE study)

OBJECTIVE

Progressive β-cell dysfunction hinders the maintenance of glycaemic control in type 2 diabetes, but comparative data on β-cell-protective therapies are lacking in the early stage of type 2 diabetes. Here we evaluated the comparative glycaemic efficacy and impact on β-cell function of three antihyperglycaemic agents that have a β-cell-protective effect, exenatide, insulin and pioglitazone, in newly diagnosed patients with type 2 diabetes.

DESIGN AND METHODS

In this 48-week, multicentre, parallel-group study, 416 patients newly diagnosed with type 2 diabetes were randomly assigned 1 : 1 : 1 to receive exenatide, insulin or pioglitazone. The primary end-point was the change in glycosylated haemoglobin (HbA1c) from baseline. Secondary end-points included effects on weight, blood pressure, lipid profiles and β-cell function assessed by homeostasis model assessment, fasting proinsulin:insulin (PI/I), disposition index (DI) and acute insulin response (AIR).

RESULTS

At week 48, mean [95% confidence interval (CI)] HbA1c changes from baseline were -1.8% (-1.55% to -2.05%) with exenatide, -1.7% (-1.52% to -1.96%) with insulin and -1.5% (-1.23% to -1.71%) with pioglitazone. Treatment differences were -0.20% (95% CI -0.46% to 0.06%) for exenatide versus insulin (P = 0.185), and -0.37% (95% CI -0.63% to -0.12%) for exenatide versus pioglitazone (P = 0.002). Significant improvements from baseline in AIR, PI/I and DI were observed with all treatments, with the greatest improvements in DI, as well as weight, blood pressure and lipid profile, observed with exenatide.

CONCLUSIONS

All three agents showed efficacy regarding glycaemic control and metabolic benefits; however, exenatide showed the greatest efficacy. β-cell function improved in all treatment groups; hence, early initiation of β-cell-protective therapy may halt the decline in β-cell function in type 2 diabetes.

Canagliflozin in Asian patients with type 2 diabetes on metformin alone or metformin in combination with sulphonylurea

AIMS

To evaluate the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in Asian patients with type 2 diabetes mellitus (T2DM) inadequately controlled by metformin or metformin in combination with sulphonylurea.

METHODS

In this 18-week, randomized, double-blind, placebo-controlled phase III study, patients (N = 676) received canagliflozin 100 or 300 mg or placebo once daily. The primary efficacy endpoint was change in glycated haemoglobin (HbA1c) level from baseline at week 18. Additional endpoints included change in fasting plasma glucose (FPG) and percent change in body weight. Adverse events (AEs) were recorded throughout the study. Efficacy and safety were assessed in the overall population and in two strata based on background therapy.

RESULTS

At week 18, canagliflozin 100 and 300 mg provided significant reductions from baseline in HbA1c compared with placebo (-0.97, -1.06 and -0.47%, respectively; p < 0.001). Relative to placebo, canagliflozin 100 and 300 mg also significantly reduced FPG (-1.0 and -1.4 mmol/l) and body weight [-2.2% (-1.5 kg) and -2.3% (-1.6 kg)]. Both canagliflozin doses lowered systolic blood pressure (BP) compared with placebo. The overall incidence of AEs was 38.6, 43.2 and 42.0% with canagliflozin 100 and 300 mg and placebo, respectively. The incidence of genital mycotic infections and urinary tract infections was low and similar across groups. Efficacy and safety findings in the two strata were generally consistent with the overall population.

CONCLUSIONS

Canagliflozin provided glycaemic improvements and reductions in body weight and systolic BP, and was generally well tolerated in Asian patients with T2DM on metformin or metformin in combination with sulphonylurea.

Absence of static loop-current magnetism at the apical oxygen site in HgBa2CuO4+δ from NMR

The simple structure of HgBa(2)CuO(4+δ) (Hg1201) is ideal among cuprates for study of the pseudogap phase as a broken symmetry state. We have performed (17)O nuclear magnetic resonance on an underdoped Hg1201 crystal with a transition temperature of 74 K to look for circulating loop currents proposed theoretically and inferred from neutron scattering. The narrow spectra preclude static local fields in the pseudogap phase at the apical site, suggesting that the moments observed with neutrons are fluctuating. The nuclear magnetic resonance frequency shifts are consistent with a dipolar field from the Cu(2+) site.

A novel germline mutation of the MEN1 gene caused multiple endocrine neoplasia type 1 in a Chinese young man and 1 year follow-up

BACKGROUND

Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant cancer predisposition syndrome which manifests a variety of endocrine and non-endocrine neoplasms and lesions. Because of its complexity in clinical manifestations, it is always difficult to set up the diagnosis in the early stage of the disease.

AIM

Using genetic diagnosis to identify and describe the process of the disease from the very beginning and followed the treatment result in 1 year.

MATERIALS AND METHODS

In this assay, a Chinese young man aged 31 with parathyroid hyperplasia, suspected gastrinoma and an enlarged pituitary with elevated level of prolactin (PRL) and growth hormone (GH) was admitted to our Department ward. We performed genetic analysis in his family and described a new nonsense mutation at codon 308 in exon 6 of the MEN1 gene, where a cytosine residue was exchanged for guanine residue (TCA > TGA), and a termination condon (S308X) occurred. During the 1 year follow up, typical manifestations emerged in this kindred and further confirmed the diagnosis of familial MEN 1.

CONCLUSIONS

We presented a case of MEN 1 from its early stage and followed the progression. Meanwhile, the mutation in this kindred has not been reported and our finding can contribute to better understanding about this disease.

Doping-dependent photon scattering resonance in the model high-temperature superconductor HgBa2CuO4+δ revealed by Raman scattering and optical ellipsometry

We study the model high-temperature superconductor HgBa(2)CuO(4+δ) with electronic Raman scattering and optical ellipsometry over a wide doping range. The dependence of the resonant Raman cross section on the incident photon energy changes drastically as a function of doping, in a manner that corresponds to a rearrangement of the interband optical transitions seen with ellipsometry. This doping-dependent Raman resonance allows us to reconcile the apparent discrepancy between Raman and x-ray detection of magnetic fluctuations in superconducting cuprates. Intriguingly, the strongest variation occurs across the doping level where the antinodal superconducting gap appears to reach its maximum.