Challenges in a population-based registry of cardiovascular disease in Shiga, Japan

Background

Stroke and cardiovascular disease are one of the leading causes of death and disability in Japan. In order to investigate current burden, we conduct a population-based registry of cardiovascular disease in Shiga Prefecture, Japan since 2012. We will demonstrate challenges in conduct of the registry study.

Methods

In 2012, we established the Shiga Stroke Registry (SSR), a multicenter population-based registry study designed to build a complete information system for the management of stroke in Shiga Prefecture, Japan. The registry uses local monitoring, combined with remote data collection and quality control systems, to create an integrated surveillance system among a network of all acute care hospitals with neurology/neurosurgery facilities and smaller hospitals with rehabilitation facilities in the region. In 2019, study name has changed to Shiga Stroke and Heart Attack Registry (SSHR) and additional registration of coronary heart disease and aortic disease have started. Each case is reviewed and adjudicated by 2 or more specialists.

Results

In the financial year of 2018 (from April to March), a total of 4809 stroke cases were identified. From December 2018 to April 2019, a total of 515 coronary heart and aortic diseases were identified. A total 10 nurses work full-time for the registry and it takes average of 1 hour to collect information for each patient. Challenges in conduct of the cardiovascular registry involve regulatory and ethical approval, funding, associations with local hospitals, non-standardized hospital diagnosis, staff training for comprehensive data collection including pathophysiology, examination and treatment, and quality control of data collection.

Conclusions

SSHR is a population-based registry of wide range of stroke and cardiovascular disease in Shiga Prefecture, Japan. In order to keep quality of the data, we put a lot of efforts on staff training and quality control.

Key messages

Population-based registry of wide range of stroke and cardiovascular disease in Shiga, Japan. In order to keep quality of the data, we put a lot of efforts on staff training and quality control.

A population-based study identifies an association of THBS2 with intervertebral disc degeneration

OBJECTIVE

To clarify the genetic mechanisms underlying intervertebral disc degeneration (IDD), we examined the associations between single-nucleotide polymorphisms (SNPs) and indicated as coefficient of interaction term (IDD) in a general population in Japan.

METHODS

This was a cross-sectional study. In 1,605 participants, C2-3 to L5/S1 in the total spine magnetic resonance imaging (MRI) were evaluated using the Pfirrmann's scoring system. Disc scores of 4 and 5 were defined as IDD. Eight SNPs in eight genes associated with IDD were examined at each disc level, considering the non-genetic risk factors of age, sex, and body mass index (BMI).

RESULTS

The highest odds ratio was found for rs9406328 in the THBS2 gene at disc level T12-L1 (OR 1.27, 95%CI 1.05 to 1.53), and this association was strengthened after adjustment for age using logistic regression (OR 1.37, 95%CI 1.12 to 1.67). Among participants aged <50 years and 50-59, the average IDD score in those with 2 risk alleles of rs9406328 was markedly higher than in those with 0 or 1 risk allele, and the difference is much wider than the elderly participants. It indicates the genetic effect of rs9406328 is stronger in the younger age groups. Finally, multiple linear regression analyses of the association between rs9406328 and IDD, adjusted for age, sex, and BMI at each disc level, showed a statistical interaction between age and the number of risk alleles at C7-T1, T3-4 and T4-T5 as well as T12-L1.

CONCLUSION

CONCLUSION: The association between rs9406328 in THBS2 and IDD was replicated. The contributions of genetic and environmental factors to IDD differed by disc level.

P6234The relationship of alcohol consumption with risk factors of coronary heart disease and the intake of macro- and micro-nutrients in Japanese: the INTERLIPID study

Background

Many studies have reported the J-shaped relationship between alcohol consumption and coronary heart disease (CHD) risk; therefore, light-drinkers is generally recognized to be associated with the lower risk of CHD. However, the mechanisms of lower risk for CHD in light-drinkers are still unclear. Alcohol drinking status is likely to be associated with not only CHD risk factors but also dietary intake. Nevertheless, few studies report these relationships in detail.

Purpose

The purpose of this study is to evaluate the relationships of alcohol drinking status with CHD classical risk factors and the intake of macro- and micro- nutrients in Japanese.

Methods

Study participants were 1,090 Japanese men and women aged 40–59 years from The INTERLIPID study excepted for 55 individuals who had missing data (n=26) and were past-drinkers (n=29). Alcohol consumption was assessed with two 7-day alcohol records, and average ethanol intake (per week) was calculated. Participants were classified into following 4 groups: non-drinkers (0g/week), light-drinkers (<100 g/week), moderate-drinkers (100–299 g/week), and heavy-drinkers (≥300 g/week). Serum LDL and HDL cholesterol, blood pressure (BP), the prevalence of hypertension and dyslipidemia, and smoking status were assessed as CHD risk factors. The intake of energy and macro- and micro-nutrients were evaluated from the four-timed in-depth 24-hr dietary recalls. Nutrient intake densities were calculated per total energy intake without alcohol. The analysis of variance and chi-squared test were used to evaluate the relations of alcohol status with CHD risk factors and nutrient intake.

Results

Serum HDL cholesterol levels increased and LDL cholesterol levels decreased with increasing alcohol consumption. Systolic and diastolic BP increased with increasing alcohol consumption. J-shaped relationships with alcohol consumption were observed for the proportion of current smoker, number of cigarettes, and the prevalence of hypertension; that is, light-drinkers was lowest among all groups. The prevalence of dyslipidemia was the highest in non-drinkers, and decreased with increasing alcohol consumption. In heavy-drinkers, total energy (kcal/day) was the highest, but energy intake without alcohol (kcal/day) was the lowest. For macronutrients, the intake of carbohydrate (%kcal) decreased, and the intakes of total and animal protein (%kcal) increased with increasing alcohol consumption. The intakes of total cholesterol (mg/1000kcal) and sodium (mg/1000kcal) increased, and total fiber (g/1000kcal) decreased with increasing alcohol consumption. These associations were similar in men and women.

Conclusions

Alcohol consumption was related with not only CHD classical risk factors but also the intake of macro- and micro-nutrients. Non-drinkers had a higher proportion of some CHD risk factors than light-drinkers. These results might influence on J-shaped relationship between alcohol consumption and CHD risk.

Acknowledgement/Funding

1: Ministry of Education, Science, Sports, and Culture of Japan, 2: National Institutes of Health, Bethesda, MD, USA

Mechanical regulation of bone homeostasis through p130Cas-mediated alleviation of NF-κB activity

Mechanical loading plays an important role in bone homeostasis. However, molecular mechanisms behind the mechanical regulation of bone homeostasis are poorly understood. We previously reported p130Cas (Cas) as a key molecule in cellular mechanosensing at focal adhesions. Here, we demonstrate that Cas is distributed in the nucleus and supports mechanical loading-mediated bone homeostasis by alleviating NF-κB activity, which would otherwise prompt inflammatory processes. Mechanical unloading modulates Cas distribution and NF-κB activity in osteocytes, the mechanosensory cells in bones. Cas deficiency in osteocytes increases osteoclastic bone resorption associated with NF-κB-mediated RANKL expression, leading to osteopenia. Upon shear stress application on cultured osteocytes, Cas translocates into the nucleus and down-regulates NF-κB activity. Collectively, fluid shear stress-dependent Cas-mediated alleviation of NF-κB activity supports bone homeostasis. Given the ubiquitous expression of Cas and NF-κB together with systemic distribution of interstitial fluid, the Cas-NF-κB interplay may also underpin regulatory mechanisms in other tissues and organs.

Bovine Endocarditis Associated with Mycoplasma bovis

Mycoplasma bovis is a microorganism associated with pneumonia, mastitis, arthritis and otitis media of cattle; however, there are no reports of this organism causing bovine endocarditis. Five adult cattle with endocarditis characterized by caseated lesions (diameter 5-12 cm) of the endocardial surface of the left atrium, but without lesions in heart valves or affecting the right side of the heart, were identified in slaughterhouses in Japan. M. bovis was successfully isolated from the lesions and M. bovis antigen was detected immunohistochemically within the lesions. The results suggest that the lesions may have been associated with M. bovis alone. To our knowledge, this is the first demonstration of bovine endocarditis associated with M. bovis.

Impact of neointimal tissue characterization and heterogeneity of bare-metal stents and drug-eluting stents on the time course after stent implantation evaluated by integrated backscatter intravascular ultrasound

Pathological studies have suggested the different process of in-stent restenosis (ISR) of bare-metal stents (BMS) and drug-eluting stents (DES). Here, we evaluated the components of neointimal tissue using integrated backscatter intravascular ultrasound (IB-IVUS) and focused on the time course after stent implantation and tissue signal distribution. We evaluated 125 lesions of 125 patients who underwent target lesion revascularization for ISR (BMS: n = 73, DES: n = 52). Volume analysis of a 4-mm length centered on a minimum lumen area in every 1-mm cross-sectional area was performed. For IB-IVUS analysis, color-coded maps were constructed from the default setting based on the integrated backscatter (IB) values (middle-IB value, green: fibrous and low-IB value, blue: lipid pool). For the neointimal tissue volume, we evaluated the ratios of the green (%G) and blue (%B) areas. Tissue signal distribution (TD) was also obtained from the default setting based on IB values in each pixel of IB-IVUS imaging. We compared values of neointimal tissues measured by IB-IVUS between the DES and BMS and time course. The observed period was longer after BMS implantation than after DES implantation (BMS: 2545 days, DES: 1233 days, p < 0.001). Overall, %G and %B were similar between the BMS and DES groups (%G: 55% and 51%, respectively, p = 0.10; %B: 36% and 38%, respectively, p = 0.51); however, TD was significantly higher in the DES group than in the BMS group (1091 vs. 1367, p < 0.001). TD in the DES group remained high during the follow-up periods. However, TD in the BMS group was low in the early phase and significantly increased over time (r = 0.56, p < 0.001). When analyzing the ISR within 2 years after stent implantation, the BMS was distinguished with a sensitivity of 66% and a specificity of 90% (cut-off value: TD = 1135, area under the curve 0.83, 95% confidence interval 0.74-0.92). TD could differentiate neointimal tissue after BMS implantation in the early phase. TD can be a useful index in the observation of neoatherosclerosis.

Hayabusa2 arrives at the carbonaceous asteroid 162173 Ryugu-A spinning top-shaped rubble pile

The Hayabusa2 spacecraft arrived at the near-Earth carbonaceous asteroid 162173 Ryugu in 2018. We present Hayabusa2 observations of Ryugu's shape, mass, and geomorphology. Ryugu has an oblate "spinning top" shape, with a prominent circular equatorial ridge. Its bulk density, 1.19 ± 0.02 grams per cubic centimeter, indicates a high-porosity (>50%) interior. Large surface boulders suggest a rubble-pile structure. Surface slope analysis shows Ryugu's shape may have been produced from having once spun at twice the current rate. Coupled with the observed global material homogeneity, this suggests that Ryugu was reshaped by centrifugally induced deformation during a period of rapid rotation. From these remote-sensing investigations, we identified a suitable sample collection site on the equatorial ridge.

The surface composition of asteroid 162173 Ryugu from Hayabusa2 near-infrared spectroscopy

The near-Earth asteroid 162173 Ryugu, the target of the Hayabusa2 sample-return mission, is thought to be a primitive carbonaceous object. We report reflectance spectra of Ryugu's surface acquired with the Near-Infrared Spectrometer (NIRS3) on Hayabusa2, to provide direct measurements of the surface composition and geological context for the returned samples. A weak, narrow absorption feature centered at 2.72 micrometers was detected across the entire observed surface, indicating that hydroxyl (OH)-bearing minerals are ubiquitous there. The intensity of the OH feature and low albedo are similar to thermally and/or shock-metamorphosed carbonaceous chondrite meteorites. There are few variations in the OH-band position, which is consistent with Ryugu being a compositionally homogeneous rubble-pile object generated from impact fragments of an undifferentiated aqueously altered parent body.

The geomorphology, color, and thermal properties of Ryugu: Implications for parent-body processes

The near-Earth carbonaceous asteroid 162173 Ryugu is thought to have been produced from a parent body that contained water ice and organic molecules. The Hayabusa2 spacecraft has obtained global multicolor images of Ryugu. Geomorphological features present include a circum-equatorial ridge, east-west dichotomy, high boulder abundances across the entire surface, and impact craters. Age estimates from the craters indicate a resurfacing age of [Formula: see text] years for the top 1-meter layer. Ryugu is among the darkest known bodies in the Solar System. The high abundance and spectral properties of boulders are consistent with moderately dehydrated materials, analogous to thermally metamorphosed meteorites found on Earth. The general uniformity in color across Ryugu's surface supports partial dehydration due to internal heating of the asteroid's parent body.

Frequency and risk factors of thoracic metastases and optimisation of the use of cross-sectional chest imaging in follow-up patients with cervical cancer

AIM

To optimise cross-sectional chest imaging usage by identifying frequency and risk factors associated with thoracic metastases in cervical cancer patients after initial definitive treatment.

MATERIALS AND METHODS

This study, conducted during 2004-2015, examined 361 consecutive patients with histopathologically proven cervical carcinoma with at least 1 year of follow-up. Electronic medical records and all available imaging modes were used to record and assess patient and tumour characteristics and timing of thoracic metastases. Associations with these characteristics and thoracic metastases were assessed using univariate and multivariable Cox proportional hazards modelling.

RESULTS

Of the 361 patients, 31 developed thoracic metastases. Multivariate regression results showed that adeno/adenosquamous carcinomas (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.06 to 5.72), other histology (HR, 5.61; 95% CI, 1.81 to 17.42), high International Federation of Gynaecology and Obstetrics (FIGO) stage (HR, 2.84; 95% CI, 1.09 to 7.37), and presence of initial intra-abdominal lymph node metastases (HR, 2.46; 95% CI, 1.02 to 5.90) were associated significantly and independently with thoracic metastases. The second analysis among the subgroup of surgical treatment identified intermediate-high risk classification of recurrence (HR, 5.12; 95% CI, 1.14 to 22.94), high FIGO stage (HR, 2.73; 95% CI, 1.05 to 7.13), and other histology (HR, 11.51; 95% CI, 3.66 to 36.19) as independent predictors of thoracic metastases. Two of the 361 and 2/313 patients with thoracic metastases who did not correspond to the conditions above were in the respective evaluation groups.

CONCLUSION

Assessment of negative prognostic factors for thoracic metastases might contribute to reduced need for chest cross-sectional chest computed tomography examinations.

Abstract P5-03-08: Eribulin-induced EpCAM expression provides drug resistance in triple-negative breast cancer cells

Breast cancer is the most common cancer in women in the world. Among breast cancer subtypes, triple-negative breast cancer is aggressive. Because there is no effective therapy for triple-negative breast cancer, development of a novel therapeutic strategy is required.

Eribulin, a derivative of halicondrin B, is an anticancer chemical. Eribulin treatment has been approved in many countries for patients with metastatic or inoperable breast cancer, including triple-negative breast cancer. The known functions of Eribulin are inhibition of microtubule polymerization and induction of the expression of epithelial genes in breast cancer cells. However, the function of Eribulin-induced genes on the therapy for patients with triple-negative breast cancer remains unclear.

EpCAM (Epithelial cell adhesion molecule) is one of epithelial markers and known as a cell-cell adhesion molecule. In addition, EpCAM expression is involved in drug resistance in cancer. We therefore focused on EpCAM expression in Eribulin-treated breast cancer cells.

We used MDA-MB-231 cells that is a commonly used triple-negative breast cancer cell line. We treated cells with 10 nM Eribulin and observed inhibition of cell growth. In the same condition, we found up-regulation of EpCAM expression in both mRNA and protein levels. In mouse xenograft model with MDA-MB-231 cells, EpCAM expression was detected in whole tumor at 96 h after Eribulin administration. We analyzed the effect of other microtubule polymerization inhibitors, nocodazole and colchicine, on EpCAM induction. In the results, there was no up-regulation of EpCAM expression in cells treated with these chemicals, suggesting that EpCAM expression is not induced by inhibition of microtubule polymerization and growth inhibition.

To analyze EpCAM function on Eribulin treatment, we constructed shRNA-mediated EpCAM knockdown system. We introduced EpCAM knockdown in MDA-MB-231 cells and treated with Eribulin. In the results of cell growth assays, the cell number of Eribulin-treated EpCAM-knockdown cells was significantly smaller than that of Eribulin-treated control-shRNA cells, whereas no change was observed between solvent-treated control-shRNA and EpCAM-knockdown groups. In mouse xenograft experiments, EpCAM-knockdown cells showed smaller tumor weights than control-shRNA cells after administration of Eribulin. These results indicate that EpCAM expression provides Eribulin resistance in breast cancer cells.

In conclusion, we found Eribulin-induced EpCAM expression in triple-negative breast cancer cells. The EpCAM expression provides Eribulin resistance both in vitro and in vivo. These suggest that a combination of Eribulin treatment and EpCAM inhibition may improve therapy for breast cancer.

Citation Format: Tanaka S, Itou J, Sato F, Toi M. Eribulin-induced EpCAM expression provides drug resistance in triple-negative breast cancer cells [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-03-08.

Abstract P2-01-11: A peptide with the conserved amino acid residue of integrin α6 inhibits metastasis through disruption of complex formation in breast cancer cells

Metastasis inhibition may improve survival of breast cancer patients. Our previous study revealed that a transcription factor SALL4 promotes cell migration for metastasis through up-regulation of integrin α6β1 in metastatic basal-like breast cancer cells. In these cells, integrin α6β1 modulates Rho GTPase activity, which enhances focal adhesion dynamics for cell migration. We therefore focused on integrin α6 as a therapeutic target for metastasis.

We investigated the expression level of integrin α6 in breast cancer cell lines and a tissue microarray of breast cancer patients. In both experiments, we observed higher integrin α6 expression in basal-like breast cancer cells than in luminal ones. We performed shRNA-mediated integrin α6 knockdown in basal-like breast cancer cells and conducted Boyden chamber assays. In the results, reduced cell migration was observed in integrin α6 knocked-down cells. Reciprocally, we introduced integrin α6 overexpression in low-migratory luminal breast cancer cell lines and observed increased cell migration. These results indicate that integrin α6 promotes cell migration in breast cancer cells.

To identify the functional residue of integrin α6, we analyzed its amino acid sequence by in silico analyses. First, we extracted integrin α6 specific residues in integrin α family in the human genome. Then, we compared integrin α6 sequences among vertebrates. In the result, we obtained an integrin α6-specific and vertebrate-conserved sequence, Asp-358, as a candidate for the functional residue.

To inhibit integrin α6 function, we designed an 8-amino acid peptide with the sequence around Asp-358. Basal-like breast cancer cells treated with the peptide showed reduced cell migration in a dose-dependent manner. The peptide did not reduce cell migration in integrin α6 knocked-down cells, suggesting that the peptide inhibits integrin α6 function. To determine whether the peptide inhibits metastasis, we performed zebrafish metastasis assays, and observed reduced metastasis rate in the peptide-treated group. These results indicate that the peptide inhibits metastasis through reduction in cell migration.

To understand the effect of the peptide, we performed chemical cross-liking assay in a basal-like breast cancer cell line. Protein samples from the cells treated with a cross-linker showed bands of integrin α6 complexes, and the intensities of these bands were reduced in the peptide-treated group. Moreover, we immunostained cells with an antibody for focal adhesion marker, phospho-paxillin, because integrins regulates focal adhesion formation for cell migration. In the results, the peptide reduced the number of focal adhesions. These observations indicate that the peptide inhibits integrin α6 function. In the future, our findings may contribute to development of a metastasis inhibition therapy.

Citation Format: Itou J, Tanaka S, Senda N, Iida A, Sehara-Fujisawa A, Sato F, Toi M. A peptide with the conserved amino acid residue of integrin α6 inhibits metastasis through disruption of complex formation in breast cancer cells [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-01-11.

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M, Tashiro T, Tassi E, Tavares Delgado A, Tayalati Y, Taylor AC, Taylor GN, Taylor PTE, Taylor W, Teischinger FA, Teixeira-Dias P, Temming KK, Temple D, Ten Kate H, Teng PK, Teoh JJ, Tepel F, Terada S, Terashi K, Terron J, Terzo S, Testa M, Teuscher RJ, Theveneaux-Pelzer T, Thomas JP, Thomas-Wilsker J, Thompson PD, Thompson AS, Thomsen LA, Thomson E, Tibbetts MJ, Ticse Torres RE, Tikhomirov VO, Tikhonov YA, Timoshenko S, Tipton P, Tisserant S, Todome K, Todorov T, Todorova-Nova S, Tojo J, Tokár S, Tokushuku K, Tolley E, Tomlinson L, Tomoto M, Tompkins L, Toms K, Tong B, Tornambe P, Torrence E, Torres H, Torró Pastor E, Toth J, Touchard F, Tovey DR, Trefzger T, Tricoli A, Trigger IM, Trincaz-Duvoid S, Tripiana MF, Trischuk W, Trocmé B, Trofymov A, Troncon C, Trottier-McDonald M, Trovatelli M, Truong L, Trzebinski M, Trzupek A, Tseng JCL, Tsiareshka PV, Tsipolitis G, Tsirintanis N, Tsiskaridze S, Tsiskaridze V, Tskhadadze EG, Tsui KM, Tsukerman II, Tsulaia V, Tsuno S, Tsybychev D, Tu Y, Tudorache A, Tudorache V, Tulbure TT, Tuna AN, Tupputi SA, Turchikhin S, Turgeman D, Turk Cakir I, Turra R, Tuts PM, Ucchielli G, Ueda I, Ughetto M, Ukegawa F, Unal G, Undrus A, Unel G, Ungaro FC, Unno Y, Unverdorben C, Urban J, Urquijo P, Urrejola P, Usai G, Usui J, Vacavant L, Vacek V, Vachon B, Valderanis C, Valdes Santurio E, Valencic N, Valentinetti S, Valero A, Valery L, Valkar S, Valls Ferrer JA, Van Den Wollenberg W, Van Der Deijl PC, van der Graaf H, van Eldik N, van Gemmeren P, Van Nieuwkoop J, van Vulpen I, van Woerden MC, Vanadia M, Vandelli W, Vanguri R, Vaniachine A, Vankov P, Vardanyan G, Vari R, Varnes EW, Varol T, Varouchas D, Vartapetian A, Varvell KE, Vasquez JG, Vasquez GA, Vazeille F, Vazquez Schroeder T, Veatch J, Veeraraghavan V, Veloce LM, Veloso F, Veneziano S, Ventura A, Venturi M, Venturi N, Venturini A, Vercesi V, Verducci M, Verkerke W, Vermeulen JC, Vest A, Vetterli MC, Viazlo O, Vichou I, Vickey T, Vickey Boeriu OE, Viehhauser GHA, Viel S, Vigani L, Villa 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Zhemchugov A, Zhong J, Zhou B, Zhou C, Zhou L, Zhou L, Zhou M, Zhou M, Zhou N, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhukov K, Zibell A, Zieminska D, Zimine NI, Zimmermann C, Zimmermann S, Zinonos Z, Zinser M, Ziolkowski M, Živković L, Zobernig G, Zoccoli A, zur Nedden M, Zwalinski L. Erratum to: Measurement of the W boson polarisation in t t ¯ events from pp collisions at s = 8 TeV in the lepton + jets channel with ATLAS

[This corrects the article DOI: 10.1140/epjc/s10052-017-4819-4.].

Search for electroweak production of supersymmetric particles in final states with two or three leptons at s = 13 TeV with the ATLAS detector

A search for the electroweak production of charginos, neutralinos and sleptons decaying into final states involving two or three electrons or muons is presented. The analysis is based on 36.1 fb- 1 ofs = 13  TeV proton-proton collisions recorded by the ATLAS detector at the Large Hadron Collider. Several scenarios based on simplified models are considered. These include the associated production of the next-to-lightest neutralino and the lightest chargino, followed by their decays into final states with leptons and the lightest neutralino via either sleptons or Standard Model gauge bosons; direct production of chargino pairs, which in turn decay into leptons and the lightest neutralino via intermediate sleptons; and slepton pair production, where each slepton decays directly into the lightest neutralino and a lepton. No significant deviations from the Standard Model expectation are observed and stringent limits at 95% confidence level are placed on the masses of relevant supersymmetric particles in each of these scenarios. For a massless lightest neutralino, masses up to 580 GeV are excluded for the associated production of the next-to-lightest neutralino and the lightest chargino, assuming gauge-boson mediated decays, whereas for slepton-pair production masses up to 500 GeV are excluded assuming three generations of mass-degenerate sleptons.

Network meta-analysis of the relative efficacy of bariatric surgeries for diabetes remission

BACKGROUND

Bariatric surgery leads to a higher remission rate for type 2 diabetes mellitus than non-surgical treatment. However, it remains unsolved which surgical procedure is the most efficacious. This network meta-analysis aimed to rank surgical procedures in terms of diabetes remission.

METHODS AND FINDINGS

We electronically searched for randomized controlled trials in which at least one surgical treatment was included among multiple arms and the diabetes remission rate was included in study outcomes. A random-effects network meta-analysis was performed within a frequentist framework. The hierarchy of treatments was expressed as the surface under the cumulative ranking curve value. Results of the analysis of 25 eligible randomized controlled trials that covered non-surgical treatments and eight surgical procedures (biliopancreatic diversion [BPD], BPD with duodenal switch, Roux-en Y gastric bypass, mini gastric bypass [mini-GBP], laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, greater curvature plication and duodenal-jejunal bypass) showed that BPD and mini-GBP had the highest surface under the cumulative ranking curve values among the eight surgical treatments.

CONCLUSION

Current network meta-analysis indicated that BPD or mini-GBP achieved higher diabetes remission rates than the other procedures. However, the result needs to be interpreted with caution considering that these procedures were in the minority of bariatric surgeries.