A prospective one-year natural history study of mucopolysaccharidosis types IIIA and IIIB: Implications for clinical trial design

Mucopolysaccharidosis type III is a group of four autosomal recessive enzyme deficiencies leading to tissue accumulation of heparan sulfate. Central nervous system disease is prominent, with initial normal development followed by neurocognitive decline leading to death. In order to define outcome measures suitable for gene transfer trials, we prospectively assessed disease progression in MPS IIIA and IIIB subjects >2years old at three time points over one year (baseline, 6 and 12months). Fifteen IIIA (9 male, 6 female; age 5.0±1.9years) and ten IIIB subjects (8 male, 2 female; age 8.6±3years) were enrolled, and twenty subjects completed assessments at all time points. Cognitive function as assessed by Mullen Scales maximized at the 2.5 to 3year old developmental level, and showed a significant age-related decline over a 6month interval in three of five subdomains. Leiter nonverbal IQ (NVIQ) standard scores declined toward the test floor in the cohort by 6 to 8years of age, but showed significant mean declines over a 6month interval in those <7years old (p=0.0029) and in those with NVIQ score≥45 (p=0.0313). Parental report of adaptive behavior as assessed by the Vineland-II composite score inversely correlated with age and showed a significant mean decline over 6month intervals (p=0.0004). Abdominal MRI demonstrated increased volumes in liver (mean 2.2 times normal) and spleen (mean 1.9 times normal) without significant change over one year; brain MRI showed ventriculomegaly and loss of cortical volume in all subjects. Biochemical measures included urine glycosaminoglycan (GAG) levels, which although elevated showed a decline correlating with age (p<0.0001) and approached normal values in older subjects. CSF protein levels were elevated in 32% at enrollment, and elevations of AST and ALT were frequent. CSF enzyme activity levels for either SGSH (in MPS IIIA subjects) or NAGLU (in MPS IIIB) significantly differed from normal controls. Several other behavioral or functional measures were found to be uninformative in this population, including timed functional motor tests. Our results suggest that cognitive development as assessed by the Mullen and Leiter-R and adaptive behavior assessment by the Vineland parent interview are suitable functional outcomes for interventional trials in MPS IIIA or IIIB, and that CSF enzyme assay may be a useful biomarker to assess central nervous system transgene expression in gene transfer trials.

A review of the clinical approach to persistent pain following total hip replacement

Total hip arthroplasty is effective in reducing pain and improving functional outcome for a variety of hip pathologies. Approximately 27% patients, however, complain of pain at 6 months' follow-up following surgery. The pain may worsen over time and can become severe and chronic in around 4% of patients who ultimately require revision surgery. Therefore, it is important for clinicians to comprehensively assess patients undergoing total hip arthroplasty in order to identify the underlying pathology of a painful hip and then offer prompt treatment. Causes of hip pain after total hip arthroplasty are analysed in this article, as well as the systematic approach to evaluation and appropriate diagnostic investigations.

[Association between sense of coherence and occupational stress of workers in modern service industry in Shanghai, China]

Objective: To investigate understand the current status of the sense of coherence and occupational stress in modern service workers, and to analyze the association between occupational stress and the sense of coherence. Methods: From March to April, 2016, 834 modern service workers from 3 companies in Shanghai, China (in air transportation industry, marketing industry, and travel industry) were surveyed by non-ran-dom sampling. The self-completion questionnaires were filled out anonymously given the informed consent of the workers. The occupational stress questionnaire was used to evaluate occupational stress, and the Chinese version of the Sense of Coherence Scale (SOC-13) was used to assess the mental health. Results: The mean score for the sense of coherence of the respondents was 61.54±10.46, and 50.1% of them were self-rated as having occupational stress. There were significant differences in SOC score between groups with different ages, marital status, positions, lengths of service, family per capita monthly income, and weekly work hours (P<0.05). The occupational stress score differed significantly across groups with different marital status, lengths of service, and weekly work hours (P<0.05). The scores for working autonomy, social support, and occupational stress differed significantly between groups with different SOC levels (P<0.05). There were significant differences in SOC score and the distribution of low-SOC respondents between groups with different levels of working autonomy, social support, and occupational stress. High SOC is a protective factor for occupational stress (OR=0.39, 95%CI 0.26~ 0.59). Conclusion: Modern service workers in Shanghai have high SOC and moderate occupational stress. Therefore, improving SOC may reduce occupational stress.

Molecular cloning and expression analysis of Fem1b from oriental river prawn Macrobrachium nipponense

Feminization-1 homolog b (Fem1b) is one of the genes essential for male development and play central roles in sex determination of Caenorhabditis elegans. In this study, we cloned and characterized the full-length Fem1b cDNA from the freshwater prawn Macrobrachium nipponense (MnFem1b) in different tissues and at different developmental stages. Real-time quantitative reverse polymerase chain reaction (RT-qPCR) showed that the MnFem1b gene was expressed in all investigated tissues, with the highest expression level found in the testes. The results revealed that the MnFem1b gene might play roles in aspects of development of the male prawn phenotype. The RT-qPCR also revealed that MnFem1b mRNA expression was significantly increased at 10 days after metamorphosis. The expression levels in all investigated tissues showed a certain degree of sexually dimorphism, the expression levels in males were significantly higher than those in females (P < 0.05). Notably, the highest expression of MnFem1b was found in the testes. The expression of MnFem1b in different tissues indicates that it plays multiple biological functions in M. nipponense.

Methods Comparison and Bias Estimation of Three Distinct Biochemistry Analytical Systems in One Clinical Laboratory Using Patient Samples

BACKGROUND

In China, one laboratory usually owns more than one diagnostic device or reagent kit measuring the same analyte and this situation causes great troubles for quality control and traceability. To determine if the different devices yield equivalent results, the correlation coefficients and predicted bias between three distinct bio-chemistry analyzers in our lab were evaluated.

METHODS

40 analytes were detected and used to evaluate method performance and comparability of results between different analyzers. The Vitros5600 and Hitachi7170 analyzers were separately compared with the Cobas 8000 analyzer according to Clinical and Laboratory Standards Institute (CLSI) guideline (EP9-A2). Within-day and between-day imprecision of the three analytical systems were calculated in accordance with CLSI guidelines EP15-A2.

RESULTS

Comparing the Hitachi7170 with Cobas8000 analyzer, except for calcium, magnesium, chloride ion (CL-), and carbon dioxide, the other 36 analytes were closely correlated (R2 > 0.95), while 4 of the 36 analytes' predicted bias exceeded the acceptable criteria. As for the Vitros5600 and Cobas8000, except for albumin, sodium ion (NA+), magnesium, and chloride (CL), the other 13 analytes were closely correlated (R2 > 0.95), while 5 of the 13 analytes' predicted bias exceeded the acceptable criteria.

CONCLUSIONS

Significant differences for several analytes between distinct analyzers were found; for some analytes the predicted bias between dry chemical analyzer and conventional wet chemical analyzer can reach 30%, which is worthy of our concern. When one analyte was detected on more than one device, a strict method comparison study should be performed regularly. Reference intervals should be validated and transferred from the Cobas 8000 to Vitros5600 when the bias cannot be adjusted.

Network meta-analysis accurately predicted the outcome of a subsequent randomised trial comparing once weekly dulaglutide 1.5 mg and once daily liraglutide 1.8 mg

BACKGROUND

Glucagon-like peptide-1 (GLP-1) receptor agonists are an established treatment for people with type 2 diabetes (T2D). We aimed to indirectly compare two GLP-1 receptor agonists, once weekly dulaglutide 1.5 mg and once daily liraglutide 1.8 mg, as a part of clinical trial planning.

METHODS

Studies for inclusion in the network meta-analysis (NMA) included all available dulaglutide and liraglutide data as of November 2011 as well as results from the exenatide once weekly registration programme. Change from baseline in haemoglobin A1c (A1c) was the primary endpoint, and a 26-week treatment effect was estimated.

RESULTS

Data for 7135 people with T2D from 15 randomised controlled trials (RCTs) followed for 12-52 weeks were included in the quantitative analysis. Observed results from the NMA predicted an A1c change from baseline of -15.1 mmol/mol (-1.38%) in the dulaglutide 1.5 mg group and -14.7 mmol/mol (-1.34%) in the liraglutide 1.8 mg group, with a predicted treatment difference (dulaglutide-liraglutide) of -0.4 mmol/mol (-0.04%) [95% credible interval: -2.4 to 1.5 mmol/mol (-0.22% to 0.14%)].

CONCLUSIONS

The subsequent RCT primary result of a -0.7 mmol/mol (-0.06%) treatment difference (dulaglutide-liraglutide) in A1c demonstrated that once weekly dulaglutide 1.5 mg and once daily liraglutide 1.8 mg resulted in similar glycaemic control, which was consistent with the NMA-predicted treatment difference. NMA is a useful tool and should be considered during clinical trial planning.

REPAIR EFFECTS OF UMBILICAL CORD MESENCHYMAL STEM CELLS ON PODOCYTE DAMAGE OF IgA NEPHROPATHY

This study aimed to explore the influence of umbilical cord mesenchymal stem cells (UMSC) on stem cell homing and glomerular mesangial cell (GMC) after intravenous injection performed on mice tails with IgA nephropathy (IgAN) and its possible mechanism, which provide a new way and theoretical basis for the application of stem cell transplantation (SCT) in kidney disease treatment. Specific pathogen free (SPF) male Kunming mice were randomly divided into groups. A complex method applying bovine serum albumin (BSA) gavage, hypodermic injection of CCl4 and lipopolysaccharide (LPS) was used for building IgAN mice model. In addition, vascular endothelial growth factor (VEGF), connective tissue growth factor (CTGF) and cluster of differentiation (CD) 44 were observed by Masson staining and detected with immunohistochemistry (IHC) to confirm homing and location of mesenchymal stem cells (MSCs). Moreover, Western Blot was used for detecting VEGF and CTGF so as to explore the possible mechanism of applying UMSC in treating IgAN. Masson staining indicated that fibrosis degree of MSCs in treatment group was significantly lower than in negative control group after stem cell treatment. Routine urine test explained that proteinuria in treatment group were (7.15±0.31), (4.87±0.22), (2.95±0.16) g/24 h and (12.00±1.38) g/24 h in model group (P less than 0.05). MSCs were observed to be located in glomerulus and renal interstitium by IHC detection of CD44 and IHC qualitative observation of VEGF and CTGF had different positive expressions in three groups. Furthermore, different expressions of VEGF and CTGF were observed quantitatively by Western Blot. Fibrosis degree of renal tissue relieves, hematuresis and proteinuria eases and IgAN symptoms obviously improve after UMSC treatment, which hints that the treatment of HUMSC has protective effect on IgAN mice model.

Diet-related determinants of childhood obesity in urban settings: a comparison between Shanghai and New York

Over the past three decades, both Shanghai and New York City (NYC), have experienced dramatic rises in childhood obesity rates. Given the role that obesity plays in the aetiology of chronic diseases such as diabetes and heart disease, the elevated rates are a major concern. Despite differences in governance systems and cultures, Shanghai and NYC have experienced rapid industrialization, a growing population and a rise in income inequality. The prevalence of childhood obesity in Shanghai and NYC is greater than their respective national rate. However, the trajectory and development of this epidemic has differed between the cities. The distribution of obesity by race and ethnicity, socio-economic status, sex, and age differs markedly between the two cities. To reduce prevalence and inequities within this complex epidemic requires an understanding of the dynamic changes in living conditions among social groups in each city and the behaviours that are influenced by such changes. By comparing changes in the influences on dietary behaviours, such as food distribution, pricing, gender values, and media and marketing, this highlights opportunities for Shanghai, NYC, and other world cities with high or rising rates of childhood obesity to inform future program and policy initiatives. It reiterates the importance of a comprehensive and multilevel approach that includes action at the individual, family, community, municipal, national, and global levels.

Short-term administration of the glucagon receptor antagonist LY2409021 lowers blood glucose in healthy people and in those with type 2 diabetes

AIM

To describe the clinical effects of single and multiple doses of a potent, selective, orally administered, small-molecule antagonist of the human glucagon receptor, LY2409021, in healthy subjects and in patients with type 2 diabetes.

METHODS

LY2409021 was administered in dose-escalation studies to healthy subjects (n = 23) and patients with type 2 diabetes (n = 9) as single doses (Study 1) and daily to patients with type 2 diabetes (n = 47) for 28 days (Study 2). Safety, tolerability, pharmacokinetic (PK) and pharmacodynamic (PD) assessments were made after single doses and in patients receiving once-daily doses of LY2409021 (5, 30, 60 or 90 mg) for 28 days.

RESULTS

LY2409021 was well tolerated at all dose levels in both studies. Fasting and postprandial glucose were reduced and glucagon levels increased after single and multiple dosing, with reductions in fasting serum glucose of up to ∼1.25 mmol/l on day 28. Serum aminotransferases increased in a dose-dependent manner with multiple dosing and reversed after cessation of dosing. Significant glucose-lowering was observed with LY2409021 at dose levels associated with only minor aminotransferase increases.

CONCLUSION

Blockade of glucagon signalling in patients with type 2 diabetes is well tolerated and results in substantial reduction of fasting and postprandial glucose with minimal hypoglycaemia, but with reversible increases in aminotransferases. Inhibition of glucagon signalling by LY2409021 is a promising potential treatment for patients with type 2 diabetes and should be evaluated in longer clinical trials to better evaluate benefits and risks.

Boronic acid-based enzyme inhibitors: a review of recent progress

Since Bortezomib was approved by US FDA as the first drug to treat multiple myeloma, various boronic acid compounds have been developed as enzyme inhibitors. This paper reviewed the progress of boronic acid-based inhibitors against enzymes including proteasome, serine protease, HDACs and other enzymes in the past decade.

Recombinant human thyrotropin versus thyroid hormone withdrawal in radioiodine remnant ablation for differentiated thyroid cancer: a meta-analysis

AIM

We aim to assess the effects of recombinant human thyrotropin (rhTSH) versus thyroid hormone withdrawal (THW), and rhTSH-aided low doses (1.11 GBq and 1.85 GBq) versus high dose (3.7 GBq) of radioiodine in the residual ablation for differentiated thyroid cancer (DTC).

METHODS

Studies were obtained from computerized searches of MEDLINE, EMBASE, the Cochrane Library (all until September 2012). Randomized controlled trials were included.

RESULTS

Altogether 1325 patients with DTC participated in seven trials for residual ablation. Overall, studies had a low risk of bias. We found no statistically significant differences between rhTSH and THW treatment in terms of successful ablation rate (OR 0.87, 95% CI 0.56 to 1.37, P=0.56) but significant benefits in health-related quality of life (mean difference 3.59, 95% CI 2.81 to 4.37, P<0.00001), adverse events during and after ablation (OR 0.57, 95% CI 0.44 to 0.73, P<0.00001), radiation exposure to blood and bone marrow (mean difference -0.01, 95% CI -0.02 to -0.01, P<0.00001). In addition, no significant difference was found in the successful ablation rate between the low dose (1.11 GBq and 1.85 GBq) and high dose (3.7 GBq) of radioiodine aided by rhTSH (OR 0.85, 95% CI 0.49 to 1.47, P=0.56). There were no deaths and no serious adverse effects in DTC patients treated with either rhTSH or THW, maximum follow-up was 12 months. None of the included trials investigated secondary malignancies or economic outcomes.

CONCLUSION

rhTSH is as effective as THW on radioiodine thyroid remnant ablation with significant benefits on health-related quality of life, adverse effects during and after ablation, decreased whole body radiation exposure. The lower radioiodine doses are as effective as high doses for remnant ablation under rhTSH stimulation.

Acupuncture Therapy for the Treatment of Myelosuppression after Chemotherapy: A Literature Review over the Past 10 Years

The aim of this study is to review current studies on the effect of acupuncture therapy on bone marrow suppression after chemotherapy. The authors of the present paper have searched related literature over the past 10 years at home and abroad, analyzing the features and the effects of acupuncture therapy (including acupuncture, moxibustion, point injection, point application, etc.) for treating myelosuppression after tumor chemotherapy. We also discuss the year of publication, document type, acupuncture therapy, acupoint selection, and adverse effects with figures. We analyzed 159 articles related to acupuncture therapy from 2004 to 2013, and the analysis revealed that point injection was the most frequently used therapy for clinical applications, and that Zusanli (ST36) was the most frequently used acupoint. The results showed that some problems regarding the design method, acupoint selection, and acupuncture intervention measure existed in those research studies. We hope to provide readers with an overall and objective understanding of acupuncture and moxibustion therapy for treating myelosuppression after tumor chemotherapy.

Nuclear PRAS40 couples the Akt/mTORC1 signaling axis to the RPL11-HDM2-p53 nucleolar stress response pathway

The Ribosomal Protein (RP)-HDM2-p53 pathway has been shown to play key roles in oncogene-induced apoptosis and senescence, but the mechanism regulating this pathway remains elusive. The Proline-Rich Akt Substrate of 40 kDA (PRAS40) has recently been identified as a binding partner and inhibitor of the mechanistic Target of Rapamycin Complex 1 (mTORC1). Although other inhibitors of mTORC1 are known tumor suppressors, PRAS40 promotes cell survival and tumorigenesis. Here we demonstrate that Akt- and mTORC1-mediated phosphorylation of PRAS40 at T246 and S221, respectively, promotes nuclear-specific association of PRAS40 with Ribosomal Protein L11 (RPL11). Importantly, silencing of PRAS40 induces upregulation of p53 in a manner dependent upon RPL11. This effect is rescued by wild type PRAS40, but not by the RPL11 binding-null PRAS40 T246A mutant. We find that PRAS40 negatively regulates the RPL11-HDM2-p53 nucleolar stress response pathway and suppresses induction of p53-mediated cellular senescence. This work identifies nuclear PRAS40 as a dual-input signaling checkpoint that links cell growth and proliferation to inhibition of cellular senescence. These findings may help to explain the pro-tumorigenic effect of PRAS40 and identify the PRAS40-RPL11 complex as a promising target for p53-restorative anti-cancer drug discovery.

An experimental technique of split Hopkinson pressure bar using fiber micro-displacement interferometer system for any reflector

A novel non-contact measurement technique had been developed for the mechanical properties of materials in Split Hopkinson Pressure Bars (SHPB). Instead of the traditional strain gages mounted on the surfaces of bars, two shutters were mounted on the end of bars to directly measure interfacial velocity using Fiber Micro-Displacement Interferometer System for Any Reflector. Using the new technique, the integrated stress-strain responses could be determined. The experimental technique was validated by SHPB test simulation. The technique had been used to investigate the dynamic response of a brittle explosive material. The results showed that the new experimental technique could be applied to the dynamic behavior in SHPB test.