[Progress in methodological characteristics of clinical practice guideline for osteoarthritis]

At present, several clinical practice guidelines for the treatment of osteoarthritis have been developed by institutes or societies. The ultimate purpose of developing clinical practice guidelines is to formulate the process in the treatment of osteoarthritis effectively. However, the methodologies used in developing clinical practice guidelines may place an influence on the transformation and application of that in treating osteoarthritis. The present study summarized the methodological features of individual clinical practice guideline and presented the tools for quality evaluation of clinical practice guideline. The limitations of current osteoarthritis guidelines of China are also indicated. The review article might help relevant institutions improve the quality in developing guide and clinical transformation.

Abstract OT2-02-02: A randomized, open-label, multicenter, phase 1b/2 study of eribulin mesylate in combination with PEGylated recombinant human hyaluronidase in patients with human epidermal growth factor receptor 2-negative, high-hyaluronan metastatic breast cancer

Eribulin (ERI), a non-taxane microtubule inhibitor, is approved for treatment in patients (pts) with advanced or metastatic breast cancer (MBC) who have received ≥1 (European Union) or ≥2 (United States) prior chemotherapy regimens for metastatic disease, including an anthracycline and taxane in either the adjuvant or metastatic setting. In a phase 2 study, ERI has demonstrated single-agent activity in first line treatment of pts with human epidermal growth factor receptor 2-negative (HER2−) MBC. Hyaluronan (HA) is a major component of the tumor microenvironment, specifically within the stroma, and high levels of HA are associated with disease progression. In HA-High, triple-negative breast cancer (TNBC) xenografts, the anti-tumor effect of ERI was enhanced by addition of PEGylated recombinant human hyaluronidase (PEGPH20). PEGPH20 is an engineered enzyme under investigation for use in combination with anticancer therapies in pts with tumors that accumulate HA. PEGPH20 acts by temporarily degrading HA to reduce tumor interstitial pressure and decompress blood vessels, thus increasing access of anticancer agents and immune cells to tumor sites. This randomized, open-label, multicenter, study of ERI in combination with PEGPH20 vs ERI alone was designed to evaluate safety and tolerability and efficacy in pts with HER2−, HA-High, MBC previously treated with 0–1 systemic (cytotoxic or targeted) anticancer therapy.

The trial was activated in June 2016 and will enroll approximately 96 pts (aged ≥18 yrs; n=6–18 in phase 1b; n=84 randomized to obtain 80 evaluable pts in phase 2).Pts with measurable disease of ≥1 lesion ≥10 mm in long-axis diameter (nonlymph nodes) or ≥15 mm in short-axis diameter (lymph nodes) with ECOG PS of 0 or 1 will be included. Pts will be excluded for having had adjuvant chemotherapy within the past 6 months, hormonal/biological therapy within the past 3 wks, or radiation or small molecule targeted therapy within the past 2 wks. Pts will also be excluded if they were previously treated with ERI or any hyaluronidase agent.

Phase 1b includes at least 1 initial safety run-in cohort in which 6 pts (any HA level) will receive PEGPH20 3 μg/kg intravenous (IV) on days −1 and 7 of a 21-day cycle, each dose followed approximately 24 (±4) hours later with ERI 1.4 mg/m2 IV on days 1 and 8. Dose-limiting toxicity (DLT) will be assessed in the first cycle.The primary endpoint in phase 1b is the recommended phase 2 dose (RP2D) of the ERI and PEGPH20 combination, defined as the maximum dose at which ≤1 pt experiences a DLT.Alternatively, modified dose levels will be evaluated in additional cohorts.

In phase 2, HA-High pts will be stratified by TNBC vs other HER2− status and randomized to receive RP2D combination treatment or ERI alone. Pts with clinical benefit will remain on ERI or both study drugs until unacceptable toxicity or disease progression. The primary endpoint in phase 2 is objective response rate. Secondary endpoints include progression-free survival and overall survival. Exploratory endpoints include clinical benefit rate, disease control rate, and duration of response.

Citation Format: Alvarez RH, Savulsky C, Almonte A, Xing D, Lokker N, Chondros D. A randomized, open-label, multicenter, phase 1b/2 study of eribulin mesylate in combination with PEGylated recombinant human hyaluronidase in patients with human epidermal growth factor receptor 2-negative, high-hyaluronan metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-02-02.

A bioactive hyaluronic acid–based hydrogel cross-linked by Diels–Alder reaction for promoting neurite outgrowth of PC12 cells

In order to improve neurite outgrowth on the in situ formed hyaluronic acid–based hydrogel, furan and methacrylate groups were grafted on hyaluronic acid successively. Furthermore, a laminin-derived peptide CQAASIKVAV was covalently immobilized via the Michael addition. The furan- and peptide-modified hyaluronic acid was then cross-linked in situ by mixing with bismaleimide poly(ethylene glycol) at 37 °C to obtain a bioactive hyaluronic acid–based hydrogel. The hyaluronic acid derivatives were characterized by 1H NMR and Fourier transform infrared spectroscopy. The gelation, swelling, and mechanical property of the hydrogels were analyzed. The modulus of the hydrogel could be tuned by changing furan substitution degree, while the peptide concentration could be changed by the ratio of furan- and peptide-modified hyaluronic acid with hyaluronic acid–furan. In vitro culture of PC12 cells showed that the longest neurite outgrowth appeared on the hyaluronic acid–poly(ethylene glycol) hydrogel with the highest peptide content (the substitution degree of peptide in furan- and peptide-modified hyaluronic acid was 23 %) and a lower threshold modulus of 4.5 kPa. The furan and methacrylate-functionalized hyaluronic acid provides a versatile platform for diverse functionalization and can be used for modulation of other cell behaviors as well.

Estrogen alone or in combination with parathyroid hormone can decrease vertebral MEF2 and sclerostin expression and increase vertebral bone mass in ovariectomized rats

The study is about the regulatory effects of estrogen and parathyroid hormone (PTH) on sclerostin, a protein that inhibits the Wnt/β-catenin pathway. The results indicate that estrogen may down-regulate sclerostin expression and that estrogen displays synergistic action with PTH. These results provide a new perspective on the relationship between estrogen and bone.

PURPOSE

To investigate whether estrogen can down-regulate SOST and MEF2 (myocyte enhancer factor 2) expression and whether co-treatment with estrogen and PTH has a stronger effect on suppressing SOST than PTH applied alone in ovariectomized rats.

METHODS

Forty-three-month-old virgin female Sprague-Dawley (SD) rats were ovariectomized and divided into four groups (n = 10). Another ten age-matched rats received sham operations as controls. After allowing 8 weeks for the development of vertebral osteopenia, the rats were administered the drug intervention. For this intervention, the estrogen group was subcutaneously injected with 17β-estradiol at 25 μg/kg body weight, the PTH group was injected with 80 μg/kg synthetic human PTH (1-34), and the co-treatment group was concurrently treated with PTH and estrogen at the above dosage. The OVX group and sham group were treated with vehicle. The drug treatment was conducted for 12 weeks. After the lumbar spine bone mineral density (BMD) was measured, the rats were sacrificed, and the lumbar spine and blood were collected for qPCR, Western blot, immunohistochemistry and other tests.

RESULTS

Estrogen can down-regulate MEF2 and sclerostin expression, and co-treatment with estrogen and PTH has a stronger effect on suppressing MEF2 and SOST mRNA than PTH alone. The co-treatment group displayed slightly higher bone mass and biomechanical properties than the PTH group, but the differences were not significant.

CONCLUSIONS

Estrogen appears to be a regulator of sclerostin, and the effect may involve suppressing MEF2s. Combined treatment with PTH and estrogen is not more beneficial for vertebral bone mass and strength than treatment with PTH alone in ovariectomized rats.

Synthesis of poly(ester-carbonate) with a pendant acetylcholine analog for promoting neurite growth

The modification of biodegradable polyesters with bioactive molecules has become an important strategy for controlling neuron adhesion and neurite outgrowth in nerve regeneration. In this study we report a biodegradable poly(ester-carbonate) with a pendant acetylcholine analog, which a neurotransmitter for the enhancement of neuron adhesion and outgrowth. The acetylcholine-functionalized poly(ester-carbonate) (Ach-P(LA-ClTMC)) was prepared by copolymerizing l-lactide (LA) and 5-methyl-5-chloroethoxycarbonyl trimethylene carbonate (ClTMC), followed by quaternization with trimethylamine. The acetylcholine analog content could be modulated by changing the molar feeding fraction of ClTMC. The incorporation of the acetylcholine analog improved the hydrophilicity of the films, but the acetylcholine analog content did not significantly influence the surface morphology of the acetylcholine-functionalized films. The results of PC12 cell culture showed that the acetylcholine analog promoted cell viability and neurite outgrowth in a concentration-dependent manner. The longest length of neurite and the percentage of cells bearing neurites were obtained on the Ach-P(LA-ClTMC)-10 film. All the results indicate that the integration of the acetylcholine analog at an appropriate fraction could be an effective strategy for optimizing the existing biodegradable polyesters for nerve regeneration applications.

Association between use of benzodiazepines and risk of fractures: a meta-analysis

Benzodiazepines (BZDs) are some of the most commonly prescribed drugs in the world. It has been shown that BZD use could be associated with increased fracture risk. However, studies on the use of BZDs and fracture risk have yielded inconsistent results. Results from the present meta-analysis show that BZD use is associated with a moderate and clinically significant increase in the risk of fractures.

INTRODUCTION

The relationship between the use of BZDs and fracture risk has been neither well identified nor summarized. This meta-analysis reports on the use of BZDs, especially short-acting BZDs, and their correlation with a moderate and clinically significant increase in fracture risk. This analysis will provide evidence for clinicians to consider fracture risk when prescribing BZDs among the elderly population. This study was conducted to determine whether people who take BZDs are at an increased fracture risk.

METHODS

A systematic search of studies published through January 2013 was conducted using MEDLINE, EMBASE, OVID, and ScienceDirect. Case-control and cohort studies that assessed the relationship between BZD use and the risk of fractures were identified. Literature searches, study selections, methodological assessments, and data mining were independently conducted by two reviewers. Disagreements were resolved by consensus. STATA 12.0 software was used for the meta-analysis. Random effects models were used for pooled analysis due to heterogeneity among the studies.

RESULTS

There were 25 studies, including 19 case-control studies and 6 cohort studies, that met the inclusion criteria. Overall, the results of the meta-analysis indicated that BZD use was associated with a significantly increased fracture risk (relative risk (RR) = 1.25; 95% confidence intervals (CI), 1.17-1.34; p < 0.001). Increased fracture risk associated with BZD use was observed in participants aged ≥65 years old (RR = 1.26; 95% CI, 1.15-1.38; p < 0.001). When only hip fractures were included as the outcome measure, the RR increased to 1.35. However, subgroup meta-analyses showed that there was no significant association between BZD use and fracture risk in Eastern countries (RR = 1.27; 95% CI, 0.76-2.14; p = 0.362) as well as between long-acting BZD use and risk of fractures (RR = 1.21; 95% CI, 0.95-1.54; p = 0.12). After accounting for publication bias, we observed that the overall association between BZD use and fracture risk to be slightly weaker (RR = 1.21; 95% CI, 1.13-1.30) but still significant.

CONCLUSION

The results of this meta-analysis demonstrate that the use of BZD, especially short-acting BZD, is associated with a moderate and clinically significant increase in fracture risk. However, large prospective studies that minimize selection bias are necessary to determine a more accurate fracture risk associated with BZD use.

Association between aspartic acid repeat polymorphism of the asporin gene and susceptibility to knee osteoarthritis: a genetic meta-analysis

OBJECTIVE

Knee osteoarthritis (KOA) is a common disease that is characterized by the degeneration of joint cartilage in the knee. Genetic factors have been implicated in KOA. Recently, several genetic studies have suggested that susceptibility to KOA is affected by the number of aspartic acid (D) residues in the amino-terminal of the asporin protein, but evidence remains conflicting. Therefore, the objective of the present meta-analysis was to investigate whether or not the D-repeat polymorphism is associated with susceptibility to KOA.

METHODS

A systematic search of all relevant studies published through Dec 2012 was conducted using the MEDLINE, EMBASE, OVID, and ScienceDirect. Allelic counts were evaluated for the D14 and D13 alleles respectively. The included studies were only assessed in the analysis of the following allele model: D14 allele vs others alleles combined, D13 allele vs others alleles combined, and D14 allele vs D13 allele.

RESULTS

Seven studies (eight comparisons) with 5515 total participants (2334 KOA patients and 3181 controls), which involved four Caucasian and four Asian populations, were eligible for inclusion. Meta-analysis was conducted for genotype D14 vs others combined, D13 vs others combined, and D14 vs D13. In the stratification based on ethnicity, studies were divided into Caucasian and Asian populations. We did not detect positive association between KOA and the D14 allele in Asian populations (OR = 1.527, 95% CI: 0.879-2.653) and in Caucasian populations (OR = 1.053, 95% CI: 0.905-1.225). There was also no positive association between susceptibility to KOA and D13 allele in Asian populations (OR = 0.950, 95% CI: 0.732-1.233) and in Caucasian populations (OR = 0.866, 95% CI: 0.723-1.037).

CONCLUSION

The present results suggest that the D-repeat of asporin gene (ASPN) may not be a major susceptibility locus in the Caucasian and Asian populations with KOA. Because of the limitations of the present meta-analysis, accurate conclusions could not be drawn based on the current evidence, and further studies with large sample size are required.

Open reduction and internal fixation versus external fixation for unstable distal radial fractures: a meta-analysis

PURPOSE

To compare the clinical outcomes of open reduction and internal fixation (ORIF) versus the ones of closed reduction and external fixation (EF) in the treatment of distal radial fractures.

METHODS

We performed a meta-analysis of randomized controlled trials that compared the clinical results of ORIF to EF in the treatment of distal radial fractures. A systemic retrieve from PubMed, EMBASE, OVID and Cochrane Collaboration CENTRAL database resulted in 11 studies with 824 patients. We thus performed data synthesis using RevMan (version 5.1).

RESULTS

Superior statistical differences were observed for DASH scores (at 3, 6 and 12 months follow-up) grip strength (at 3 months follow-up), volar tilt (at 12 months follow-up), flexion and supination (at 3 months follow-up), and extension (at 3 and 6 months follow-up) in ORIF patients group, compared with those in EF group. We also found a significantly higher risk of infection associated with EF. There was no significant difference in the incidence of malunion and median nerve dysfunction.

CONCLUSION

Regarding surgical fixation of unstable distal radius fractures, ORIF yields significantly better subjective outcome (DASH scores) the first year after operation, restoration of anatomic volar tilt, and forearm flexion and extension at the end of the follow-up period. However, EF results in higher incidence of infection compared to ORIF. ORIF is equal to EF for either grip strength, or range of motion of the injured wrist, or incidence of malunion or median nerve dysfunction at the end of the follow-up period.

LEVEL OF EVIDENCE

Level II. Therapeutic study.

The percutaneous compression plate versus the dynamic hip screw for treatment of intertrochanteric hip fractures: a systematic review and meta-analysis of comparative studies

BACKGROUND

The use of a percutaneous compression plate (PCCP) provides a minimally invasive technique for the fixation of stable intertrochanteric femoral fractures. It has several theoretically potential advantages over the dynamic hip screw (DHS) such as shorten incision and lower incidence of wound infection.

HYPOTHESIS

PCCP have several advantages than DHS, such as reduced blood loss, transfusion, mortality, shorter operative time, and lower incidence of complications. This systematic review and meta-analysis was performed to identify the clinical outcomes and safety of patients with stable intertrochanteric hip fractures operated on using PCCP compared with DHS.

MATERIALS AND METHODS

A systematic search of all studies published through April 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and the Cochrane Central database. The randomized controlled trials (RCTs) and quasi-randomised control trials (qRCTs) that compared PCCP with DHS in treating adult patients with stable intertrochanteric hip fractures and provided data on safety and clinical effects were identified. Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies.

RESULTS

Nine studies encompassing 914 patients met the inclusion criteria. Overall, the result of meta-analysis indicated that over DHS, PCCP allowed significantly shorter operative time, reduced blood loss as well as transfusion, diminished incidence of cardiovascular events. However, there were no significant differences in length of hospitalization, rate of walking without help, early mortality and other complications.

DISCUSSION

Significant differences favoring PCCP were found with regard to operative time, blood loss, transfusion and lower incidence of cardiovascular events. However, owing to the limitations of this systematic review, future RCTs are still needed to confirm this data and the clinical efficiency of PCCP.

LEVEL OF EVIDENCE

Level II: low-powered prospective randomized trial.

PKM2 phosphorylates histone H3 and promotes gene transcription and tumorigenesis

Tumor-specific pyruvate kinase M2 (PKM2) is essential for the Warburg effect. In addition to its well-established role in aerobic glycolysis, PKM2 directly regulates gene transcription. However, the mechanism underlying this nonmetabolic function of PKM2 remains elusive. We show here that PKM2 directly binds to histone H3 and phosphorylates histone H3 at T11 upon EGF receptor activation. This phosphorylation is required for the dissociation of HDAC3 from the CCND1 and MYC promoter regions and subsequent acetylation of histone H3 at K9. PKM2-dependent histone H3 modifications are instrumental in EGF-induced expression of cyclin D1 and c-Myc, tumor cell proliferation, cell-cycle progression, and brain tumorigenesis. In addition, levels of histone H3 T11 phosphorylation correlate with nuclear PKM2 expression levels, glioma malignancy grades, and prognosis. These findings highlight the role of PKM2 as a protein kinase in its nonmetabolic functions of histone modification, which is essential for its epigenetic regulation of gene expression and tumorigenesis.

AKT-dependent phosphorylation of Niban regulates nucleophosmin- and MDM2-mediated p53 stability and cell apoptosis

Although Niban is highly expressed in human cancer cells, the cellular functions of Niban remain largely unknown. We demonstrate here that ultraviolet irradiation induces phosphorylation of Niban at S602 by AKT, which increases the association of Niban with nucleophosmin and disassociation of nucleophosmin from the MDM2 complex. This leads to the promotion of MDM2-p53 interaction and subsequent p53 degradation, thereby providing an antiapoptotic effect. Conversely, depletion of or deficiency in Niban expression promotes stabilization of p53 with increased cell apoptosis. Our findings illustrate a pivotal role for AKT-mediated phosphorylation of Niban in protecting cells from genotoxic stress-induced cell apoptosis.

Detection and widespread distribution of sodium channel alleles characteristic of insecticide resistance in Culex pipiens complex mosquitoes in China

Culex pipiens complex mosquitoes are widely distributed throughout China and are known to be important disease vectors. Two pyrethroid resistance associated mutations have been identified in Cx. pipiens complex (Diptera: Culicidae), but there is little information on the diversity and distribution of kdr alleles in pyrethroid resistance in Cx. pipiens complex mosquitoes in China. In the present study, we report on a modified three tube allele-specific (AS)-PCR method for detecting the 1014F and 1014S alleles. The new technique was applied to identify the distribution of the two alleles in natural Cx. pipiens complex populations in China. The results confirmed that the new method is both sensitive and specific. The 1014F allele was found in all 14 of the field populations tested (frequency ranged from 6.8 to 76.2%) and the 1014S allele was found in almost two-thirds (frequency from 2.4 to 28.6%), indicating that the genotypes known to be associated with pyrethroid resistance are widespread in China. The resistance-associated alleles were more common in southern Chinese sampling sites than in northern sites. The coexistence of the two resistant mutations in individual mosquitoes was also observed in five of the field populations. Two alternative mutations within the L1014 codon were identified in Culex pipiens molestus Forskal, 1775, including a non-synonymous mutation resulting in a 1014C substitution.

The Effects of Ananas comosus L. Leaves on Diabetic-Dyslipidemic Rats Induced by Alloxan and a High-Fat/High-Cholesterol Diet

The aim of this study is to demonstrate the effects of Ananas comosus L. leaves on diabetic-dyslipidemic rats. Hypoglycemic and hypolipidemic activities of the ethanolic extract of Ananas comosus L. leaves (EEACL) were evaluated in normal and alloxan-induced diabetic rats by oral glucose tolerance test and an olive oil load test. Anti-diabetic, anti-hyperlipidemic and anti-oxidative activities of EEACL were also investigated in diabetic-dyslipidemic rats induced by alloxan and a high-fat/high-cholesterol diet. EEACL at the dose of 0.40 g/kg significantly inhibited the increase in blood glucose in diabetic rats in oral glucose tolerance test, but did not cause any hypoglycerimic activity in normal rats. It also significantly inhibited the increase in postprandial triglycerides (TG) levels in both normal and diabetic rats in olive oil load test. After 15 days of treatment of diabetic dyslipidemic rats, EEACL significantly decreased blood glucose (-51.0%, P<0.01), TG (-50.1%, P<0.01), TC (-23.3%, P<0.01), LDL-c (-47.9%, P<0.01) and glycated albumin (-25.4%, P<0.01) levels, significantly increased serum high-density lipoprotein cholesterol levels (66.2%, P<0.01) and prevented lower body weight of diabetes (11.8%, P<0.05), significantly lowered lipid peroxidation productions of blood (-27.8%, P<0.01), brain (-31.6%, P<0.05), liver (-44.5%, P<0.01) and kidneys (-72.2%, P<0.05) compared with those in untreated diabetic dyslipidemic rats. These data suggest that EEACL has anti-diabetic, anti-dyslipidemic and anti-oxidative activities, which may be developed into a new plant medicine for treatment of diabetes and its complications.

Pharmacokinetics of Berberine in Rat Thalamus After Intravenous Administration of Coptidis Rhizoma Extract

A rapid and simple high-performance liquid chromatographic method for determination of berberine in rat thalamus was described in this study. Thalamus samples were pretreated by protein precipitation with methanol and acetonitrile. Berberine was determined using a Hypersil C 18 column with an isocratic mobile phase of acetonitrile — 0.05 M potassium dihydrogen phosphate (containing 0.5% triethylamine, pH 3.0) (30:70 v/v) and with UV detection at 265 nm. The lower limit of quantification for berberine in thalamus was 24 ng/ml, and the lowest concentration of berberine determined in rat thalamus samples was 47.5 ng/ml at 48 hours. The calibration curve for berberine was linear ( r 2 = 0.9994) over the concentration range 24–6000 ng/ml. At this concentration range, the overall recoveries (91.20%–93.24%) for berberine were determined and the accuracy of the intra- and inter-day assays from rat thalamus were less than 6% RSD. Following intravenous administration of 10.2 mg/kg of Coptidis Rhizoma (CR) extract containing 3 mg/kg berberine into rats, the thalamus level of berberine increased rapidly ( t 1/2α = 1.93 hours ), peaked at 2.48 hours with a concentration of 271 ng/g, and had a slow elimination rate ( t 1/2β = 14.6 hours ), which suggested that berberine might directly act on certain regions of the thalamus, have pharmacological effects on some cerebral dysfunctions, and be an active ingredient of Huang Lian Jie Du Tang for the treatment of cerebral disease.

[Effect of Euphorbia kansui on urination and kidney AQP2, IL-1beta and TNF-alpha mRNA expression of mice injected with normal saline]

OBJECTIVE

To observe the effect of Euphorbia kansui (E. KS) alcohol extracts on urination and kidney-related expressions of mice injected with normal saline and to discuss its impact on kidney.

METHOD

Mice intraperitoneally injected with normal saline were observed for urination and changes in kidney-related histiocytic factors of after intragastrical administration of E. KS and compared with normal mice.

RESULT

E. KS alcohol extracts can promote urination of mice injected with normal saline and enhance peripheral serum creatinine, with no obvious pathological change showed in tissue sections. It had a certain effect on reducing AQP2 expression and enhancing TNF-alpha expression.

CONCLUSION

Euphorbia kansui in large dose has a remarkable effect on kidney but may be accompanied with pathological reactions to some extent, especially the dose of 1.2 g x kg(-1). The pathological reactions may be related with increased serum creatinine and TNF-alpha expression.

PI3K p55γ promoter activity enhancement is involved in the anti-apoptotic effect of berberine against cerebral ischemia-reperfusion

Berberine is a candidate clinical neuroprotective agent against ischemic stroke. In the present study, we examined the influence of the PI3K/Akt pathway in mediating the anti-apoptotic effects of berberine. Oxygen-glucose deprivation and reoxygenation of nerve growth factor-differentiated PC12 cells and primary neurons, and bilateral common carotid artery occlusion in mice were used as in vitro and in vivo ischemia models. We found that the anti-apoptotic effects of berberine against ischemia were indeed mediated by the increased phosphor-activation of Akt (higher p-Akt to total Akt), leading to the intensified phosphorylation of Bad and the decreased cleavage of the pro-apoptotic protease caspase-3. Berberine action is specific for PI3K, rather than the upstream receptor tyrosine kinase. The anti-apoptotic effect is maintained in the presence of tyrosine kinase inhibitor genistein and the epidermal growth factor receptor inhibitor PD153035, but is suppressed by the PI3K inhibitor Ly294002 and the Akt inhibitor Akti-1/2.The unique PI3K regulatory subunit p55γ was upregulated by berberine during ischemia-reperfusion and was not blocked by these inhibitors. We constructed a reporter plasmid to detect PI3K p55γ promoter activity and found that berberine enhanced PI3K p55γ promoter activity during cerebral ischemia-reperfusion.

Satisfaction with continuous glucose monitoring in adults and youths with Type 1 diabetes

AIMS

To describe satisfaction with continuous glucose monitoring in Type 1 diabetes; to correlate continuous glucose monitoring satisfaction scores with usage; and to identify common themes in perceived benefits and barriers of monitoring reported by adults, youths and the parents of youths in the Juvenile Diabetes Research Foundation continuous glucose monitoring trials.

METHODS

The Continuous Glucose Monitoring Satisfaction Scale questionnaire was completed after 6 months of monitoring. Participants also answered open-ended queries of positive and negative attributes of continuous glucose monitoring.

RESULTS

More frequent monitoring was associated with higher satisfaction for adults (n = 224), youths (n = 208) and parents of youths (n = 192) (all P < 0.001) in both the 'benefits' and 'hassles' sub-scales of the Continuous Glucose Monitoring Satisfaction Scale, but the greatest differences between the two groups involved scores on hassle items. Common barriers to monitoring use included insertion pain, system alarms and body issues; while common benefits included glucose trend data, opportunities to self-correct out-of-range glucose levels and to detect hypoglycaemia.

CONCLUSIONS

As frequent use of continuous glucose monitoring is associated with improved glycaemic control without increased hypoglycaemia it is important to overcome barriers, reinforce benefits and set realistic expectations for this technology in order to promote its more consistent and frequent use in individuals with Type 1 diabetes.