Knee symptom but not radiographic knee osteoarthritis increases the risk of falls and fractures: results from the Osteoarthritis Initiative

OBJECTIVE

To describe the effect of knee symptoms and radiographic osteoarthritis (ROA) on the risk of falls, recurrent falls, and fractures.

DESIGN

Participants from the Osteoarthritis Initiative were classified as having 'no', 'unilateral' or 'bilateral' knee symptoms (≥19 on a 0-96 Western Ontario and McMaster Universities Osteoarthritis Index) and ROA (Kellgren-Lawrence grade ≥2) for each visit. Self-reported falls and fractures in the past 12 months were extracted at baseline and follow-up visits until month 96. Recurrent falls were defined as having ≥2 falls in the past 12 months. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using mixed-effects complementary log-log regression.

RESULTS

Of 4465 participants, 3145 (70%), 1681 (38%), and 806 (18%) experienced at least one fall, recurrent fall, and fracture, respectively, over 96 months. Compared to participants without symptomatic knee, unilateral and bilateral knee symptoms were associated with a 17% increased risk of falls and a 36-46% increased risk of recurrent falls, and bilateral knee symptoms increased the risk of fractures (HR 1.45, 95%CI 1.17 to 1.81). Compared to participants with no ROA in either knee, bilateral ROA was associated with a reduced risk of falls (HR 0.87, 95%CI 0.77 to 0.99) and fractures (HR 0.78, 95%CI 0.64 to 0.96). No statistically significant interactions between knee symptoms and ROA were observed.

CONCLUSIONS

This large population-based study showed that knee symptoms but not ROA increased the risk of falls, recurrent falls, and fractures, and that adults with bilateral ROA may have a lower risk of falls and fractures.

Effects of hot balloon versus cryoballoon ablation for atrial fibrillation: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

Catheter ablation has developed as the most effective therapeutic approach and won the highest-level guideline recommendation in treating atrial fibrillation (AF) in the decades. Several balloon-based catheter ablations, including hot balloon ablation (HBA) and cryoballoon ablation (CBA), have rapidly emerged as alternative modalities to conventional radiofrequency catheter-based AF ablation. However, the differences in characteristics, effectiveness, clinical outcomes, safety, and efficacy between HBA and CBA remain undetermined. 

Purpose

To compare the differences in the prognosis and characteristics between HBA and CBA. 

Methods

Our electronic search was conducted in six databases, including PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov, and medRxiv, with specific search strategies. Eligible studies were selected according to specific criteria. All records were identified up to June 1, 2021. The mean difference, odds ratios (ORs), and 95% confidence interval (95% CI) were calculated to evaluate the clinical outcomes. Heterogeneity and risk of bias were also assessed with predefined criteria.

Results

A total of 7 studies were included in our final meta-analysis. Comparing with CBA, more patients in the HBA group required touch-up ablation (OR 2.76, 95% CI, 2.02, 3.77, P = 0.000). More residual conduction was seen in the HBA group. HBA group had a longer procedure duration than the CBA group (WMD 14.24, 95%CI 4.39, 24.09, P = 0.005). More patients in the CBA group were likely to have AF occurrence (OR 0.75, 95% CI, 0.44, 1.27, P = 0.281) and accepted more antiarrhythmic drug therapy (OR 0.70, 95% CI, 0.45, 1.09, P = 0.114), although the result was insignificant. 

Conclusions

Both HBA and CBA are effective ablation approaches to treat atrial fibrillation. Patients who received HBA were more likely to receive touch-up ablation and undergo longer procedure time. Patients in the CBA group were more likely to have AF occurrence and accepted more antiarrhythmic therapies. However, the long-term safety is still unknown. Further studies of multicenter, randomized clinical trials are warranted to verify this fundamental question.

The diagnostic value of different criteria in predicting the response of LBBB patients: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

 

The left bundle branch has emerged as an essential part of the cardiac conduction system. However, many patients with conventional left bundle branch block (LBBB) QRS morphology appeared to have a poor response to cardiac resynchronization therapy (CRT) therapy; these might be due to they were non-LBBB patients who met the conventional diagnostic criteria but failed to meet the strict LBBB standard. There are different criteria to select appropriate CRT patients currently. Several studies have reported that patients with complete LBBB had worse ventricular synchronization and worse prognosis. Thus, it is of great clinical significance to distinguish between complete LBBB and non-LBBB. 

Purpose

 

To compare the difference in mortality and CRT response between complete LBBB and non-LBBB patients. 

Methods

 

This meta-analysis has been registered on the International Prospective Register of Systematic Reviews (ID: CRD42021242318). A systematic search on PubMed, Cochrane library, Embase databases was conducted before July 2021. All the included studies were screened and identified based on the specific inclusion and exclusion criteria. Relevant data, including time to event data for different outcomes (e.g., hazard ratio, HR), responders, electrocardiogram parameters, and echocardiographic changes, were extracted for meta-analysis.

Results

 

A total of 15 studies were ultimately involved in this meta-analysis. A random-effect model was conducted due to the substantial heterogeneity. The results showed that patients who received CRT treatment in the complete LBBB group had a 35% reduction in mortality than in the non-LBBB group (HR 0.65, 95% CI 0.56 to 0.77, P =0.000). The subgroup analysis showed that when stratified by the Strauss criteria, the survival was much higher in complete LBBB patients (HR 0.58, 95% CI 0.43 to 0.77, P =0.000), compared with other criteria, including ESC, AHA, Marriot, and conventional (HR 0.72, 95% CI 0.63 to 0.82, P =0.000). The pooled results suggested that the patient survival rate was significantly better under the Strauss criteria than other standards.

Conclusions

 

Present criteria differentiating complete LBBB and non-LBBB have good predictive value for survival. Among those, Strauss criteria may provide the most valuable information on the predictive effects of mortality and survival rate. This meta-analysis indicates that the use of Strauss criteria correlated independently with the response and prognosis of CRT patients with LBBB.

Treponema denticola Promotes OSCC Development via the TGF-β Signaling Pathway

Numerous studies have demonstrated an association between periodontitis and oral squamous cell carcinoma (OSCC), and periodontal pathogens such as Treponema denticola are implicated in the pathogenesis of OSCC. Previous studies have mainly focused on T. denticola surface proteins—for example, chymotrypsin-like proteinase, which was detected in the majority of orodigestive tumor tissues. T. denticola may influence the development of OSCC. Nevertheless, the potential direct regulatory mechanism of T. denticola in OSCC is still unclear. Therefore, this study aimed to explore the direct effect of T. denticola on OSCC cell proliferation and elucidate potential mechanisms of T. denticola in contributing to cell proliferation. A series of in vitro experiments (e.g., CCK-8, EdU, flow cytometry) were performed to explore the effect of T. denticola on cell proliferation, cell cycle, and apoptosis. Mice experiments were performed to explore the effect of T. denticola on tumor growth. Whole mRNA transcriptome sequencing and quantitative real-time polymerase chain reaction were performed to explore the intracellular signaling pathway. Our study found that T. denticola could invade Cal-27 cells and directly promote cell proliferation, regulate the cell cycle, and inhibit apoptosis. T. denticola could also promote the growth of OSCC tumors in mice, and it upregulated Ki67 expression. Regarding the mechanism, T. denticola could promote the development of OSCC by activating the TGF-β pathway. In conclusion, T. denticola could promote OSCC cell proliferation directly, and the mechanism was associated with intracellular TGF-β pathway activation.

Measurement of Prompt D^{0}, Λ_{c}^{+}, and Σ_{c}^{0,++}(2455) Production in Proton-Proton Collisions at sqrt[s]=13 TeV

The p_{T}-differential production cross sections of prompt D^{0}, Λ_{c}^{+}, and Σ_{c}^{0,++}(2455) charmed hadrons are measured at midrapidity (|y|<0.5) in pp collisions at sqrt[s]=13  TeV. This is the first measurement of Σ_{c}^{0,++} production in hadronic collisions. Assuming the same production yield for the three Σ_{c}^{0,+,++} isospin states, the baryon-to-meson cross section ratios Σ_{c}^{0,+,++}/D^{0} and Λ_{c}^{+}/D^{0} are calculated in the transverse momentum (p_{T}) intervals 2<p_{T}<12 and 1<p_{T}<24  GeV/c. Values significantly larger than in e^{+}e^{-} collisions are observed, indicating for the first time that baryon enhancement in hadronic collisions also extends to the Σ_{c}. The feed-down contribution to Λ_{c}^{+} production from Σ_{c}^{0,+,++} is also reported and is found to be larger than in e^{+}e^{-} collisions. The data are compared with predictions from event generators and other phenomenological models, providing a sensitive test of the different charm-hadronization mechanisms implemented in the models.

Measurement of the Cross Sections of Ξ_{c}^{0} and Ξ_{c}^{+} Baryons and of the Branching-Fraction Ratio BR(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/BR(Ξ_{c}^{0}→Ξ^{-}π^{+}) in pp Collisions at sqrt[s]=13 TeV

The p_{T}-differential cross sections of prompt charm-strange baryons Ξ_{c}^{0} and Ξ_{c}^{+} were measured at midrapidity (|y|<0.5) in proton-proton (pp) collisions at a center-of-mass energy sqrt[s]=13  TeV with the ALICE detector at the LHC. The Ξ_{c}^{0} baryon was reconstructed via both the semileptonic decay (Ξ^{-}e^{+}ν_{e}) and the hadronic decay (Ξ^{-}π^{+}) channels. The Ξ_{c}^{+} baryon was reconstructed via the hadronic decay (Ξ^{-}π^{+}π^{+}) channel. The branching-fraction ratio BR(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/BR(Ξ_{c}^{0}→Ξ^{-}π^{+})=1.38±0.14(stat)±0.22(syst) was measured with a total uncertainty reduced by a factor of about 3 with respect to the current world average reported by the Particle Data Group. The transverse momentum (p_{T}) dependence of the Ξ_{c}^{0}- and Ξ_{c}^{+}-baryon production relative to the D^{0} meson and to the Σ_{c}^{0,+,++}- and Λ_{c}^{+}-baryon production are reported. The baryon-to-meson ratio increases toward low p_{T} up to a value of approximately 0.3. The measurements are compared with various models that take different hadronization mechanisms into consideration. The results provide stringent constraints to these theoretical calculations and additional evidence that different processes are involved in charm hadronization in electron-positron (e^{+}e^{-}) and hadronic collisions.

Spastic paraplegia as the only manifestation in neuropsychiatric lupus: a case report

Demyelination syndrome is one manifestation of neuropsychiatric lupus erythematosus (NPLE) and is rare in systemic lupus erythematosus (SLE). When SLE presents only neuropsychiatric symptoms without damage to other systems, its diagnosis becomes difficult. Herein, we report a 29-year-old male who suffered from lower limb stiffness with recessive onset and progressive aggravation in one year. He had paraplegia, spastic hypertonia, abnormal gait, and bilateral positive Babinski signs. His symptoms indicated spastic paraplegia. Brain MRI showed multiple small demyelinating lesions in the lateral ventricle, brainstem, and cerebellum. Anti-ds DNA, anti-Sm and anti-RNP antibodies were positive. He was diagnosed with NPLE and had a good treatment response to steroids. To the best of our knowledge, this is the first case of spastic paraplegia as the only manifestation in SLE.

Introduction to DOK2 and its potential role in cancer

Cancer is a complex, multifactorial disease that modern medicine ultimately aims to overcome. Downstream of tyrosine kinase 2 (DOK2) is a well-known tumor suppressor gene, and a member of the downstream protein DOK family of tyrosine kinases. Through a search of original literature indexed in PubMed and other databases, the present review aims to extricate the mechanisms by which DOK2 acts on cancer, thereby identifying more reliable and effective therapeutic targets to promote enhanced methods of cancer prevention and treatment. The review focuses on the role of DOK2 in multiple tumor types in the lungs, intestines, liver, and breast. Additionally, we discuss the potential mechanisms of action of DOK2 and the downstream consequences via the Ras/MPAK/ERK or PI3K/AKT/mTOR signaling pathways.

Λ_{c}^{+} Production and Baryon-to-Meson Ratios in pp and p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV at the LHC

The prompt production of the charm baryon Λ_{c}^{+} and the Λ_{c}^{+}/D^{0} production ratios were measured at midrapidity with the ALICE detector in pp and p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. These new measurements show a clear decrease of the Λ_{c}^{+}/D^{0} ratio with increasing transverse momentum (p_{T}) in both collision systems in the range 2<p_{T}<12  GeV/c, exhibiting similarities with the light-flavor baryon-to-meson ratios p/π and Λ/K_{S}^{0}. At low p_{T}, predictions that include additional color-reconnection mechanisms beyond the leading-color approximation, assume the existence of additional higher-mass charm-baryon states, or include hadronization via coalescence can describe the data, while predictions driven by charm-quark fragmentation processes measured in e^{+}e^{-} and e^{-}p collisions significantly underestimate the data. The results presented in this Letter provide significant evidence that the established assumption of universality (colliding-system independence) of parton-to-hadron fragmentation is not sufficient to describe charm-baryon production in hadronic collisions at LHC energies.

Experimental Evidence for an Attractive p-ϕ Interaction

This Letter presents the first experimental evidence of the attractive strong interaction between a proton and a ϕ meson. The result is obtained from two-particle correlations of combined p-ϕ⊕ p[over ¯]-ϕ pairs measured in high-multiplicity pp collisions at sqrt[s]=13  TeV by the ALICE Collaboration. The spin-averaged scattering length and effective range of the p-ϕ interaction are extracted from the fully corrected correlation function employing the Lednický-Lyuboshits approach. In particular, the imaginary part of the scattering length vanishes within uncertainties, indicating that inelastic processes do not play a prominent role for the p-ϕ interaction. These data demonstrate that the interaction is dominated by elastic p-ϕ scattering. Furthermore, an analysis employing phenomenological Gaussian- and Yukawa-type potentials is conducted. Under the assumption of the latter, the N-ϕ coupling constant is found to be g_{N-ϕ}=0.14±0.03(stat)±0.02(syst). This work provides valuable experimental input to accomplish a self-consistent description of the N-ϕ interaction, which is particularly relevant for the more fundamental studies on partial restoration of chiral symmetry in nuclear medium.

Mechanical properties of three-dimensionally printed titanium plates used in jaw reconstruction: preliminary study

The aim of this study was to compare the mechanical properties of three-dimensionally (3D)-printed and conventional surgical plates used for the repair of maxillary or mandibular defects under the same experimental conditions, and to provide experimental evidence for the future application and clinical trial of 3D-printed individualized surgical plates. For the experimental group, two groups of surgical plates with thicknesses of 2.0 mm and 2.5 mm were designed and 3D-printed by electron beam melting, using Ti-6Al-4V as raw material. Conventional commercially available surgical plates with the same thickness were adopted as the control group. A Vickers hardness tester and universal testing machine were used to measure the mechanical properties of the plates (hardness, bending strength, tensile strength, and yield strength). The mechanical properties of 3D-printed surgical plates were significantly better than those of conventional surgical plates of the same thickness (P < 0.001). Comparing the surgical plates of different thickness, the 2.5 mm-thick plates had the highest bending strength in the experimental group (P < 0.001) and the best hardness (P < 0.001), bending strength (P = 0.001), tensile strength (P = 0.001), and yield strength (P = 0.001) in the control group. No statistical difference was found between the two kinds of plates in the experimental group in terms of hardness (P = 0.060), tensile strength (P = 0.096), and yield strength (P = 0.496). The 3D-printed surgical plates have better mechanical properties than the conventional ones.

[Metabolic staging and nutritional treatment strategies of severely burned patients]

The complexity of burn metabolism and limitations of its cognition are the core factors leading to dissatisfactory efficacy of nutritional therapy in severe burn patients. Precise understanding of burn metabolic rules is a prerequisite for improving the pertinence and effectiveness of nutritional therapy. The previous division of burn metabolic stages based on energy consumption did not pay enough attention to substance metabolism, so it is difficult to fully comprehend the overall change pattern and stage characteristics of burn metabolism. Through the effective integration of the metabonomics, physiomics, and clinical data, combining the pathophysiological characteristics of burns at different clinical phases, this paper suggested that the metabolism of severe burns should be divided into four stages and proposed the corresponding nutritional strategies and measures according to different metabolic characteristics, in order to provide a basis for further enhancing the nutritional efficacy in burn patients.

Multiharmonic Correlations of Different Flow Amplitudes in Pb-Pb Collisions at sqrt[s_{NN}]=2.76 TeV

The event-by-event correlations between three flow amplitudes are measured for the first time in Pb-Pb collisions, using higher-order symmetric cumulants. We find that different three-harmonic correlations develop during the collective evolution of the medium when compared to correlations that exist in the initial state. These new results cannot be interpreted in terms of previous lower-order flow measurements since contributions from two-harmonic correlations are explicitly removed in the new observables. A comparison to Monte Carlo simulations provides new and independent constraints for the initial conditions and system properties of nuclear matter created in heavy-ion collisions.

[Treatment efficacy of dietary supplement Licofor for dry eye associated with meibomian gland dysfunction]

Objective: To evaluate the clinical efficacy of dietary supplement Licofor in the treatment of dry eye associated with meibomian gland dysfunction (MGD). Methods: This was a prospective, randomized controlled clinical trial. Sixty patients [25 males, 35 females, aged (42±13) years] who had dry eye associated with MGD were recruited in Xiangya Hospital of Central South University from December 2018 to October 2019. The patients were equally divided into two groups: 30 cases (60 eyes) in the experimental group and 30 cases (60 eyes) in the control group. All subjects were treated with eye hot compress, artificial tears and antibiotic ointment. After that, the experimental group and control group were received dietary supplementary Licofor or placebo daily for 12 weeks. The symptoms and signs of dry eye, morphology and function of meibomian gland, and inflammatory response were assessed at the beginning, 4^th, 8^th and 12^th week of treatment. Results: After 12 weeks of treatment, statistically significant improvements in ocular surface disease index (OSDI) scores, tear break-up time (TBUT), corneal fluorescein staining (CFS), the morphology of eyelid margin, meibomian gland orifice, meibomian gland expressibility, meibum quality, and periglandular inflammatory cell density were determined in both groups (all P<0.05). In the Licofor group, the improvement of OSDI scores [16.7 (12.5, 20.8) vs 20.8 (18.8, 22.9), P<0.001], the morphology of eyelid margin, meibomian gland orifice and periglandular inflammatory cell density [443 (318, 513) vs 553 (415, 676)/mm², P=0.002] were more significant (all P<0.05). Conclusion: The combined treatment of licofor and conventional treatment can significantly improve symptoms of dry eye, the morphology of eyelid margin, meibomian gland orifice, meibum quality, and eyelid inflammation response of dry eye associated with MGD.

Effect of diltiazem on exercise tolerance in patients with stable coronary artery disease and hypertension

The present study aimed to investigate the effect of diltiazem on cardiovascular risk and exercise tolerance in patients with stable coronary artery disease and hypertension. From 2016 to 2018, 80 patients with stable coronary artery disease (5 < Gensini score < 20) and hypertension were enrolled into the present study. These patients were randomly divided into two groups: diltiazem group (Dil, 90 mg, bid), and control group (angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) for reducing blood pressure and β-receptor blockers for controlling heart rate). Liver and kidney function, heart rate variability (HRV), blood pressure variability (BPV) and bicycle exercise were measured at baseline and after six months. The incidence of cardiovascular events (re-hospitalization due to angina pectoris, acute myocardial infarction, and cardiogenic death) was also assessed. The differences in all indexes at baseline between these two groups were not statistically significant (P > 0.05, respectively). After six months of treatment, both groups of patients had significant improvements in HRV, BPV and exercise tolerance compared that before treatment (p < 0.05). The difference in the decrease in systolic blood pressure, improvement of HRV and BPV, and cardiovascular events between these two groups was not statistically significant (P = 0.588, 0.431, 0.152, 1.000, respectively). But the Dil group was significantly better than the control group in degree of heart rate decline, diastolic blood pressure decline, and improvement of ST segment depression (P < 0.001), and the improvement in exercise tolerance was also better than that of the control group. We found that diltiazem compared with ACEI/ARB and β-receptor blockers can further improve the exercise tolerance of patients with stable coronary artery disease and hypertension.

Soft-Dielectron Excess in Proton-Proton Collisions at sqrt[s]=13 TeV

A measurement of dielectron production in proton-proton (pp) collisions at sqrt[s]=13  TeV, recorded with the ALICE detector at the CERN LHC, is presented in this Letter. The data set was recorded with a reduced magnetic solenoid field. This enables the investigation of a kinematic domain at low dielectron (ee) invariant mass m_{ee} and pair transverse momentum p_{T,ee} that was previously inaccessible at the LHC. The cross section for dielectron production is studied as a function of m_{ee}, p_{T,ee}, and event multiplicity dN_{ch}/dη. The expected dielectron rate from hadron decays, called hadronic cocktail, utilizes a parametrization of the measured η/π^{0} ratio in pp and proton-nucleus collisions, assuming that this ratio shows no strong dependence on collision energy at low transverse momentum. Comparison of the measured dielectron yield to the hadronic cocktail at 0.15<m_{ee}<0.6  GeV/c^{2} and for p_{T,ee}<0.4  GeV/c indicates an enhancement of soft dielectrons, reminiscent of the "anomalous" soft-photon and soft-dilepton excess in hadron-hadron collisions reported by several experiments under different experimental conditions. The enhancement factor over the hadronic cocktail amounts to 1.61±0.13(stat)±0.17(syst,data)±0.34(syst,cocktail) in the ALICE acceptance. Acceptance-corrected excess spectra in m_{ee} and p_{T,ee} are extracted and compared with calculations of dielectron production from hadronic bremsstrahlung and thermal radiation within a hadronic many-body approach.

DNA polymerase β may be involved in protecting human bronchial epithelial cells from the toxic effects induced by methyl tert-butyl ether exposure

Methyl tert-butyl ether (MTBE), a widely used gasoline additive and a ubiquitous environmental pollutant in many countries and regions, can cause various kinds of toxic effects on human health. However, the molecular mechanism underlying its toxic effects remains elusive. The present study aimed to explore the cytotoxicity, DNA damage and oxidative damage effects of MTBE on human bronchial epithelial cells (16HBE) and the possible role of DNA polymerase β (pol-β) in this process. RNA interference (RNAi) was used to obtain pol-β gene knocked-down cells (pol-β^-). CCK-8 assay was adopted to analyze the cell viability. Alkaline single-cell gel electrophoresis (SCGE) was performed to detect the DNA damage effects of MTBE. The enzyme activity of GSH-Px, SOD, CAT and the level of MDA were assessed. The data indicated that when treated with MTBE at the concentration exceeding 50 μmol/L and for the time exceeding 24 h, the pol-β^- exhibited significantly decreased cell viability and increased DNA damage effects, as compared to the control (P < 0.05). Furthermore, there was significant difference in the levels of GSH-pX, SOD, CAT and MDA between the pol-β^- and the control (P < 0.05). Our investigation suggests that MTBE can cause obvious cytotoxicity, DNA damage and oxidative damage effects on 16HBE cells. DNA polymerase β may be involved in protecting 16HBE cells from the toxic effects induced by MTBE exposure. These findings provide a novel insight into the molecular mechanism underlying the toxic effects of MTBE on human cells.