C-reactive protein and risk of fracture: a systematic review and dose-response meta-analysis of prospective cohort studies

This study systematically reviews prospective cohort studies evaluating the relationship between C-reactive protein (CRP) concentrations and subsequent fracture risk. The positive association cannot completely explain the existing evidence, and further studies are needed to demonstrate the shape of the association.

INTRODUCTION

We aimed to perform a systematic review and dose-response meta-analysis of published prospective studies evaluating associations of high-sensitivity CRP (hs-CRP) levels with fracture risk in general populations.

METHODS

We identified relevant studies by searching MEDLINE and EMBASE databases from their inception to May 20, 2014. We included published prospective studies evaluating the associations of hs-CRP levels with risk of fracture in general populations. Two reviewers working independently abstracted the data.

RESULTS

Eight prospective cohort studies involving 34,840 participants and 3,407 incident fracture events were eligible for the present analyses. A meta-analysis of six prospective studies showed that the overall risk for incident fracture in a comparison of individuals in the top tertile with those in the bottom tertile of baseline hs-CRP levels was 2.14 [95% confidence interval (CI) 1.51-3.05, I(2) = 62.3%]. The moderate heterogeneous disappeared when one study was excluded. However, the remaining two studies reported inconsistent results. One study with the biggest sample size showed a U-shaped association for CRP and fracture risk (the association was positive when CRP > 1 mg/L). Similarly, another study reported that per doubling of CRP was positive only when CRP > 3 mg/L.

CONCLUSION

In summary, the present analysis showed that the relationship between CRP concentrations and subsequent fracture risk is still inconsistent. The positive association cannot completely explain the existing evidence, and further larger prospective cohorts with more power are needed to demonstrate the shape of the association, especially for the relatively low CRP concentrations, such as less than 3 mg/L.

Evaluation of a 2-channel portable device and a predictive model to screen for obstructive sleep apnea in a laboratory environment

BACKGROUND

Various portable monitors for identifying obstructive sleep apnea (OSA) have been investigated and reported to enable accurate recording of OSA severity. However, more information is needed from different populations. This study was conducted to evaluate the efficiency of a portable 2-channel sleep apnea device (SleepView) for screening OSA in the Chinese population.

METHODS

Ninety-three consecutive subjects underwent simultaneous SleepView testing and laboratory polysomnography (PSG) monitoring. Data were collected and blindly analyzed. The efficiency of the SleepView device and a newly established predictive model for identifying OSA was evaluated in comparison with PSG.

RESULTS

Good agreement was evident between the SleepView and PSG based on the apnea-hypopnea index (AHI; r(2) = 0.84, P < .01). The median AHI yielded by the SleepView was higher than that of PSG: 33.2 (interquartile range of 10.5-53.3) versus 19.2 (interquartile range of 5.2-53.6). The sensitivity and specificity of the SleepView for a PSG AHI of ≥ 5 were 80.28% and 95.45%, respectively, and the cutoff was 16.8. The area under the receiver operating curve for PSG AHIs of ≥ 5, > 15, and > 30 was 0.923, 0.924, and 0.979, respectively. When the AHI and oxygen desaturation index calculated by the SleepView were combined with waist circumference, the new predictive model showed a higher sensitivity of 92.96% and a specificity of 95.45% for a PSG AHI of ≥ 5, and the corresponding area under the receiver operating curve was 0.983.

CONCLUSIONS

The SleepView device exhibited acceptable diagnostic accuracy for OSA in the Chinese population, especially in the severe OSA group. A practical predictive model comprising waist circumference, AHI, and oxygen desaturation index obtained with the SleepView was highly effective for screening even mild OSA. This simple and practical device may serve as a useful tool to screen for OSA. Further studies are required to validate the diagnostic efficiency of the SleepView in the home environment and in different populations.

Effects of beraprost sodium on renal function and inflammatory factors of rats with diabetic nephropathy

Beraprost sodium (BPS) is a prostaglandin analogue. We investigated its effects on rats with diabetic nephropathy. There were 20 rats each in the normal control group (NC), the diabetic nephropathy group (DN), and the BPS treatment group. The rats in DN and BPS groups were given a high-fat diet combined with low-dose streptozotocin intraperitoneal injections. The rats in the BPS group were given daily 0.6 mg/kg intraperitoneal injections of this drug. After 8 weeks, blood glucose, 24-h UAlb, Cr, BUN, hs-CRP, and IL-6 levels increased significantly in the DN group compared with the NC group; however, the body mass was significantly reduced in the DN group compared with the NC group. Blood glucose, urine output, 24-h UAlb, Cr, hs-CRP, and IL-6 levels were significantly lower in the BPS group than in the DN group; the body mass was significantly greater in the DN group. Therefore, we concluded that BPS can improve renal function and protect the kidneys of DN rats by reducing oxidative stress and generation of inflammatory cytokines; it also decreases urinary protein excretion of rats with diabetic nephropathy.

Fas/FasL in the immune pathogenesis of severe aplastic anemia

Fas/FasL protein expression of bone marrow hematopoietic cells was investigated in severe aplastic anemia (SAA) patients. Fas expression was evaluated in CD34(+), GlycoA(+), CD33(+), and CD14(+) cells labeled with monoclonal antibodies in newly diagnosed and remission SAA patients along with normal controls. FasL expression was evaluated in CD8(+) cells in the same manner. In CD34(+) cells, Fas expression was significantly higher in the newly diagnosed SAA group (46.59 ± 27.60%) than the remission (6.12 ± 3.35%; P < 0.01) and control (8.89 ± 7.28%; P < 0.01) groups. In CD14(+), CD33(+), and GlycoA(+) cells, Fas levels were significantly lower in the newly diagnosed SAA group (29.29 ± 9.23, 46.88 ± 14.30, and 15.15 ± 9.26%, respectively) than in the remission (47.23 ± 31.56, 67.22 ± 34.68, and 43.56 ± 26.85%, respectively; P < 0.05) and normal control (51.25 ± 38.36, 72.06 ± 39.88, 50.38 ± 39.88%, respectively; P < 0.05) groups. FasL expression of CD8(+) cells was significantly higher in the newly diagnosed SAA group (89.53 ± 45.68%) than the remission (56.39 ± 27.94%; P < 0.01) and control (48.63 ± 27.38%; P <0.01) groups. No significant differences were observed between the remission and control groups. FasL expression in CD8(+) T cells was significantly higher in newly diagnosed patients, and CD34(+), CD33(+), CD14(+), and GlycoA(+) cells all showed Fas antigen expression. The Fas/FasL pathway might play an important role in excessive hematopoietic cell apoptosis in SAA bone marrow. Furthermore, CD34(+) cells are likely the main targets of SAA immune injury.

Comparison of tetragonal and cubic tin as anode for Mg ion batteries

Using first-principles calculation based on density functional theory, diffusion of Mg atom into α- and β-Sn was investigated. The diffusion barriers are 0.395 and 0.435 eV for an isolated Mg atom in the α- and β-Sn, respectively. However, the diffusion barriers of the Mg atom decrease in the α-Sn, whereas they increase in the β-Sn, when an additional Mg atom was inserted near the original diffusing Mg atom, which is mainly due to strong binding of Mg-Mg atoms in the β-Sn. Therefore, it is better to use the α-Sn, rather than the β-Sn, as an anode material for Mg ion batteries.

High-resolution MRI of the intraparotid facial nerve based on a microsurface coil and a 3D reversed fast imaging with steady-state precession DWI sequence at 3T

BACKGROUND AND PURPOSE

3D high-resolution MR imaging can provide reliable information for defining the exact relationships between the intraparotid facial nerve and adjacent structures. The purpose of this study was to explore the clinical value of using a surface coil combined with a 3D-PSIF-DWI sequence in intraparotid facial nerve imaging.

MATERIALS AND METHODS

Twenty-one healthy volunteers underwent intraparotid facial nerve scanning at 3T by using the 3D-PSIF-DWI sequence with both the surface coil and the head coil. Source images were processed with MIP and MPR to better delineate the intraparotid facial nerve and its branches. In addition, the SIR of the facial nerve and parotid gland was calculated. The number of facial nerve branches displayed by these 2 methods was calculated and compared.

RESULTS

The display rates of the main trunk, divisions (cervicofacial, temporofacial), and secondary branches of the intraparotid facial nerve were 100%, 97.6%, and 51.4% by head coil and 100%, 100%, and 83.8% by surface coil, respectively. The display rate of secondary branches of the intraparotid facial nerve by these 2 methods was significantly different (P < .05). The SIRs of the intraparotid facial nerve/parotid gland in these 2 methods were significantly different (P < .05) at 1.37 ± 1.06 and 1.89 ± 0.87, respectively.

CONCLUSIONS

The 3D-PSIF-DWI sequence combined with a surface coil can better delineate the intraparotid facial nerve and its divisions than when it is combined with a head coil, providing better image contrast and resolution. The proposed protocol offers a potentially useful noninvasive imaging sequence for intraparotid facial nerve imaging at 3T.

Abstract P4-07-01: The Class I Selective PI3K Inhibitor GDC-0941 Enhances the Efficacy of Docetaxel in Human Breast Cancer Models by Increasing the Rate of Apoptosis

Docetaxel (DTX) is commonly used as a front-line treatment option for breast cancer but many patients ultimately relapse and succumb to disease progression. Phosphatidylinositol 3-kinases (PI3K) are lipid kinases that regulate breast tumor cell growth, migration and survival. Given that phosphatidylinositol 3-kinase (PI3K) is frequently activated in breast cancer and induces chemo-resistance, it is an attractive target for combination therapy with standard of care drugs such as DTX. The current study was intended to determine if GDC-0941, an orally bioavailable class I selective PI3K inhibitor, enhances the anti-tumor activity of DTX in human breast cancer models in vitro and in vivo. A panel of 25 breast tumor cell lines representing luminal, HER2+ and basal sub-types were treated with GDC-0941, DTX or the combination of both drugs and assayed for cellular viability, modulation of PI3K pathway markers and apoptosis induction. The combination of GDC-0941 and DTX decreased the cellular viability of breast tumor cell lines in vitro but with variable drug synergy. The addition of both drugs resulted in stronger synergistic effects in a sub-set of tumor cell lines that was not predicted by breast cancer sub-type or mutations within the PI3K pathway. Human xenografts of breast cancer cell lines and patient-derived tumors were utilized to assess efficacy of GDC-0941 and DTX in vivo. In these models, the best combination efficacy was detected when the two drugs were dosed within 1 hour of each other. We also observed that GDC-0941 increased the rate of apoptosis in cells arrested in mitosis upon co-treatment with DTX. Our data provides a preclinical rationale for evaluating GDC-0941 in combination with DTX for breast cancer treatment.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-07-01.

Abstract P5-19-02: Selective PI3K and dual PI3K/mTOR inhibitors enhance the efficacy of endocrine therapies in breast cancer models

Purpose: Phosphoinositide 3-kinases (PI3K) are lipid kinases that can regulate breast tumor cell growth, migration and survival. Standard of care drugs such as estrogen receptor (ER) antagonists including fulvestrant and tamoxifen, and aromatase inhibitors such as letrozole are indicated for the treatment of hormone receptor positive breast cancer. The current study is focused on investigating preclinical activity in breast cancer models, for GDC-0941, a class I PI3K inhibitor, GDC-0032, a PI3K inhibitor, and GDC-0980, a dual mTOR kinase and class I PI3K inhibitor. Investigation into PI3K inhibitor efficacy in combination with endocrine therapies is also explored.

Experimental Design: A panel of ER+ breast cancer cell lines were treated with GDC-0941, GDC-0032 and GDC-0980 either as single agents or in combination with fulvestrant or tamoxifen and assayed for cellular effects. MCF-7 cells ectopically expressing aromatase were utilized to test the efficacy of aromatase inhibitors in combination with PI3K inhibitors in vitro. In addition, human xenografts of breast cancer cell lines were employed to assess combination efficacy of PI3K inhibitors with fulvestrant and tamoxifen in vivo.

Results: Combination of GDC-0941, GDC-0032 or GDC-0980 with endocrine therapies resulted in a decrease in cellular viability and an increase in cell death. Synergy of PI3K inhibitor combinations with fulvestrant or tamoxifen was assessed using Combination Index (C.I.), and C.I. values as low as 0.1 indicated strong synergy in some contexts. Combination activity of PI3K inhibitors and letrozole was also observed in MCF7 cells expressing aromatase. In MCF-7 xenografts, the combination of GDC-0980, GDC-0032 and GDC-0941 enhanced activity of fulvestrant resulting in tumor regressions and tumor growth delay (116% tumor growth inhibition (TGI) for GDC-0980 and 91% TGI for GDC-0941 and GDC-0032). In addition, the combination of GDC-0941 or GDC-0032 with tamoxifen enhanced the efficacy of tamoxifen in vivo (83%TGI for GDC-0941 and 102%TGI for GDC-0032). Mechanism of action and biomarker studies are underway.

Conclusion: Collectively, the non-clinical efficacy data provide a strong rationale to evaluate the combination of PI3K inhibitors with anti-estrogen therapy in hormone receptor positive breast cancer.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-19-02.

A comparison of the clinical characteristics of women with recurrent major depression with and without suicidal symptomatology

BACKGROUND

The relationship between recurrent major depression (MD) in women and suicidality is complex. We investigated the extent to which patients who suffered with various forms of suicidal symptomatology can be distinguished from those subjects without such symptoms.

METHOD

We examined the clinical features of the worst episode in 1970 Han Chinese women with recurrent DSM-IV MD between the ages of 30 and 60 years from across China. Student's t tests, and logistic and multiple logistic regression models were used to determine the association between suicidality and other clinical features of MD.

RESULTS

Suicidal symptomatology is significantly associated with a more severe form of MD, as indexed by both the number of episodes and number of MD symptoms. Patients reporting suicidal thoughts, plans or attempts experienced a significantly greater number of stressful life events. The depressive symptom most strongly associated with lifetime suicide attempt was feelings of worthlessness (odds ratio 4.25, 95% confidence interval 2.9-6.3). Excessive guilt, diminished concentration and impaired decision-making were also significantly associated with a suicide attempt.

CONCLUSIONS

This study contributes to the existing literature on risk factors for suicidal symptomatology in depressed women. Identifying specific depressive symptoms and co-morbid psychiatric disorders may help improve the clinical assessment of suicide risk in depressed patients. These findings could be helpful in identifying those who need more intense treatment strategies in order to prevent suicide.

Urinary sediment ICAM-1 level in lupus nephritis

BACKGROUND

Urinary intercellular adhesion molecule-1 (ICAM-1) level is potentially a valuable biomarker of lupus nephritis (LN), but because ICAM-1 is a cell-surface molecule, soluble ICAM-1 level in urinary supernatant measured by ELISA may not be biologically relevant.

METHODS

The ICAM-1 level in urine sediment of 12 LN patients, 10 patients with pauci-immune necrotizing glomerulonephritis (NecGN), and six healthy controls were determined with a polymerase chain reaction (PCR)-based assay. The urinary sediment levels of miR-221, miR-222, miR-339-3P and miR-339-5P, which are involved in the regulation of ICAM-1 production, were also quantified.

RESULTS

LN patients had lower urinary sediment ICAM-1 levels than the other two groups (overall p = 0.034). In addition, urinary sediment ICAM-1 level inversely correlated with the estimated glomerular filtration rate (GFR) (r = -0.474, p = 0.026) but not other markers of lupus activity, or urinary sediment levels of miR-221, miR-222, miR-339-3P, or miR-339-5P. However, serum anti-dsDNA level inversely correlated with urinary sediment levels of miR-221 (r = -0.591, p = 0.043) and miR-222 (r = -0.689, p = 0.013), while urinary sediment miR-221 level also correlated with serum C3 level (r = 0.658, p = 0.02).

CONCLUSIONS

We conclude that urinary sediment ICAM-1 level was significantly reduced in LN, and the level inversely correlated with renal function. Urinary sediment miR-221 and miR-222 levels correlate with lupus disease activity and may serve as biomarkers of LN.

Characteristics of infradian and circadian rhythms in the persistent vegetative state

This retrospective study investigated the circadian and infradian characteristics of blood pressure and heart rate in 26 patients with traumatic head injury in a persistent vegetative state (PVS). Systolic and diastolic blood pressures and heart rate were measured every hour for the first 240 h (10 days) following hospital admission. These data were analysed for the presence of circadian and infradian rhythms using the least-squares fit of the cosine function with the single cosinor method. Infradian rhythms were defined as biological rhythms with a period of approximately 7 days (circaseptan rhythms). All the patients studied had circadian and circaseptan rhythms of systolic and diastolic blood pressures and heart rate. The amplitudes of all the circaseptan rhythms were significantly greater than those of the corresponding circadian rhythms. It was concluded that there was an altered association between circadian and infradian blood pressure and heart rate rhythms in patients in a PVS. Circadian and infradian rhythms were present, but the infradian rhythm had a greater amplitude than the circadian rhythm.

Changes in facial appearance after maxillomandibular advancement for severe obstructive sleep apnoea hypopnoea syndrome in Chinese patients: a subjective and objective evaluation

This study evaluates the outcome and change in facial appearance after maxillomandibular advancement (MMA) in Chinese adults with severe obstructive sleep apnoea hypopnoea syndrome (OSAHS). Twelve patients underwent MMA with adjunctive procedures for severe OSAHS. All underwent physical examination, Epworth Sleepiness Scale evaluation, cephalometry, polysomnography, and facial photographic assessment before and 6 months after MMA. The aesthetic plane (relationship of nose, lips, and chin) was used to judge soft tissue facial profile change after MMA. Postoperative cephalometric data were compared with normal occlusive standards and aesthetic norms. Pre- and postoperative aesthetic appearance was evaluated by 100 lay people using a 10-point visual analogue scale. The maxillomandibular complex (MMC) was advanced 5-10 mm (mean 7.4 mm). The success rate was 83%. All patients were satisfied with the functional and aesthetic results. Postoperative SNA, SNB, and posterior airway space increased and mandibular plane-to-hyoid distance decreased significantly in all patients. The lower lip was closer to EP than the preoperative and normal occlusive standard. In 11 of 12 patients, the lay aesthetic scores were significantly higher postoperatively. MMA is effective for Chinese adults with severe OSAHS. In most patients, facial appearance was more attractive after MMC advancement of 5-10 mm.

The value of multislice spiral CT features of cavitary walls in differentiating between peripheral lung cancer cavities and single pulmonary tuberculous thick-walled cavities

OBJECTIVES

Form discordance of cavity walls (FDCW) and form concordance of cavity walls (FCCW) in multislice spiral CT (MSCT) were investigated to determine their value in differentiating between peripheral lung cancer cavities and single pulmonary tuberculous thick-walled cavities. An assessment of the role of multiplanar reconstruction (MPR) in detecting FDCW and FCCW was also performed.

METHODS

MSCT cross-sectional images of 116 consecutive cases (including 60 cases with available MPR images) with peripheral lung cancer cavities and 118 consecutive cases (including 62 cases with available MPR images) with single pulmonary tuberculous thick-walled cavities (wall thickness >3 mm) were retrospectively analysed. According to the characteristics of cavitary internal and external walls on MSCT, these cavities were divided into two types (FDCW and FCCW). FDCW was further divided into three subtypes (FDCW-I, FDCW-II and FDCW-III); FCCW was further divided into two subtypes (FCCW-I and FCCW-II).

RESULTS

On the cross-sectional and MPR images, the total detection rate of FDCW-I and FDCW-III in peripheral lung cancer cavities was 76.7% (89/116) and 93.3% (56/60), respectively, whereas the total detection rate of FCCW-I and FCCW-II in single pulmonary tuberculous thick-walled cavities was 75.4% (89/118) and 91.9% (57/62), respectively.

CONCLUSIONS

FDCW-I, FDCW-III, FCCW-I and FCCW-II were valuable in differentiating between peripheral lung cancer cavities and single pulmonary tuberculous thick-walled cavities. MPR could improve the detection of FDCW-I and FDCW-III in peripheral lung cancer cavities and FCCW-I and FCCW-II in single pulmonary tuberculous thick-walled cavities.

DNAJB13 is a radial spoke protein of mouse '9+2' axoneme

It has been shown that DNAJB13, a type II heat shock protein 40, is highly expressed in the testis and is an axonemal component of mouse mature spermatozoa. By multi-tissue reverse transcription polymerase chain reaction, we found that Dnajb13 gene was expressed not only in the testis but also in several other ciliated cell-containing tissues like brain, lung and oviduct. Immunohistochemistry on mouse trachea and oviduct sections shown that DNAJB13 was present in the motile cilia of those tissues. To define further its localization in the axoneme, immunoelectron microscopy of mouse sperm flagella was performed and shown that DNAJB13 was localized to radial spokes of the axoneme. Taken together, our data indicate that DNAJB13 is a radial spoke protein of the mouse '9+2' axoneme.

Association of olfactory bulb volume and olfactory sulcus depth with olfactory function in patients with Parkinson disease

BACKGROUND AND PURPOSE

Olfactory dysfunction is commonly associated with IPD. We here report the association of OB volume and OS depth with olfactory function in patients with PD.

MATERIALS AND METHODS

Morphometric analyses by using MR imaging and the Japanese T&T olfactometer threshold test were used to evaluate olfactory structure and function in 29 patients with PD and 29 age- and sex-matched healthy controls.

RESULTS

The olfactory recognition thresholds were significantly higher in patients with PD than in healthy controls (3.82 ± 1.25 versus 0.45 ± 0.65, P<.001). Olfactory atrophy with reductions in the volume of the OB (37.30 ± 10.23 mm(3) versus 44.87 ± 11.84 mm(3), P<.05) and in the depth of OS (8.90 ± 1.42 mm versus 9.67 ± 1.24 mm, P<.05) was observed in patients with PD but not in controls. Positive correlations between olfactory performance and OB volumes were observed in both patients with PD (r=-0.45, P<.0001) and in controls (r=-0.42, P<.0001). In contrast, there was no significant correlation between the depth of OS and olfactory function in either cohort.

CONCLUSIONS

The results provide evidence that early olfactory dysfunction in patients with PD may be a primary consequence of damage to the OB. Neuroimaging of olfactory structures together with the assessment of olfactory function may be used to identify patients with PD.

Heparin-functionalized collagen matrices with controlled release of basic fibroblast growth factor

Tissue engineering scaffolds with controlled long-term release of growth factors are constructed in an attempt to mimic the intelligent ability of the extracellular matrix (ECM) to release endogenous growth factors. In this study, collagen sponges (Collagen group) were modified by N-(3-dimethylaminopropyl)-N-ethylcarbodiimide hydrochloride (EDC) and N-hydroxysuccinimide (NHS) crosslinking (EDC/NHS group) and heparin immobilization (EDC/NHS-H group), and subsequently seeded with human umbilical vein endothelial cells (HUVECs). Native and modified sponges were pre-adsorbed with basic fibroblast growth factor (bFGF) to evaluate the sustained release and bioactive maintenance of bFGF from the sponges. We found that modified collagen matrices permitted HUVECs to proliferate and migrate well and to distribute uniformly. The EDC/NHS-H group exhibited an excellent sustained-release profile and bioactive maintenance of the pre-adsorbed bFGF as compared with the Collagen and EDC/NHS groups. These results suggest that heparin-functionalized collagen matrices can support a controlled release of bFGF and thus, have potential as a tissue engineering scaffold.