The association between HLA-DQB1 polymorphism and antituberculosis drug-induced liver injury: a Case-Control Study

WHAT IS KNOWN AND OBJECTIVE

Research on genetic factors associated with antitubercular drug-induced liver injuries (ATLI) has been reported. However, most of the research has focused on genetic polymorphisms of genes encoding metabolic enzymes, including NAT2, GST and CYP450. It is probable that the immune system also contributes to the onset of drug adverse effects. A few small studies have explored the possible association of HLA genes with drug-induced liver injuries (DILI), but more supportive evidence from larger studies or prospective cohort designs is needed. We aim to explore the possible association of HLA-DQB1 gene polymorphisms with ATLI in a case-control study.

METHODS

A case-control study design was used. ATLI was recorded in a prospectively followed-up cohort of patients receiving antituberculosis treatment. Identified cases were matched with control tuberculosis patients within the same cohort but with no adverse effects in 1 : 1 ratio. We used the sequence-based typing method to determine the HLA-DQB1 genotypes. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression.

RESULTS AND DISCUSSION

Eighty-nine cases were included in this case-control study. HLA-DQB1 typing was successful for 177 subjects. No association between frequency of HLA-DQB1 genotypes and ATLI was statistically significant in univariate analyses. Multivariate analysis using the conditional logistic regression model revealed that the individuals with two DQB1*05 alleles were at higher risk of ATLI than control subjects. The OR was 5.28 adjusted for use of liver protective drugs and weight (10/88 VS 2/88, 95% CI: 1.134-24.615, P = 0.034). Analysis according to the liver injury type showed that both mixed liver injury patients and cholestatic/mixed liver injury patients had higher proportions of DQB1*05 : 02 alleles (P values were 0.028 and 0.005, respectively).

WHAT IS NEW AND CONCLUSION

This study suggests that ATLI was more likely in subjects of HLA-DQB1*05/*05 genotype. Further studies are needed to verify this association.

An observational study of patient satisfaction with fesoterodine in the treatment of overactive bladder: effects of additional educational material

AIM

To compare the effects of additional educational material on treatment satisfaction of overactive bladder (OAB) patients treated with a muscarinic receptor antagonist.

METHODS

In an observational study of OAB patients being treated by their physician with fesoterodine for 4 months (FAKTEN study), sites were randomised to providing standard treatment or additional educational material including the SAGA tool. Patient satisfaction was assessed by three validated patient-reported outcomes including the Treatment Satisfaction Question. Because of premature discontinuation of the study, descriptive statistical analysis was performed.

RESULTS

A total of 431 and 342 patients received standard treatment or additional educational material, respectively. At study end, 76.1% [95% CI = 71.3, 80.4] of patients with standard care and 79.6% [95% CI = 74.4, 84.1] with additional SAGA tool were satisfied with treatment (primary end-point). Comparable outcomes with and without the additional educational material were also found in various patient subgroups, at the 1-month time point, and for the other patient-reported outcomes. A notable exception was the subgroup of treatment-naïve patients in which the percentage of satisfied patients was 77.2% vs. 89.5% with standard treatment and additional SAGA tool, respectively (post hoc analysis).

DISCUSSION AND CONCLUSIONS

In an observational study, most overactive bladder patients were satisfied with fesoterodine treatment. Because of the small sample size, the study does not support or refute the hypothesis that adding the SAGA tool will improve patient satisfaction with treatment. The potential effect of additional educational material in treatment-naïve patients warrants further dedicated studies.

Staging accuracy of endoscopic ultrasound for esophageal cancer after neoadjuvant chemotherapy: a meta-analysis and systematic review

This study aims to evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer after neoadjuvant chemotherapy (NAC). Articles were searched in Medline, Pubmed, Cochrane Database of Systemic Reviews, Google scholar, and EMBASE. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratio (DOR). Pooling was conducted using either fixed-effects model or random-effects model depending on the heterogeneity across studies. Sixteen studies (n = 724) were included in this analysis. The pooled sensitivity and specificity of EUS to diagnose T1 stage tumor was 23% (95% confidence interval [CI] 16-32%) and 95% (95%CI 93-97%), respectively. For T2 stage, EUS had a pooled sensitivity and specificity of 29% (95%CI 19-41%) and 84% (95%CI 77-88%). The pooled sensitivity and specificity of EUS were 81% (95%CI 72-88%) and 42% (95%CI 33-52%) in determining T3 stage tumor. To diagnose T4 stage tumor, EUS had a pooled sensitivity of 43% (95%CI 31-56%) and specificity of 96% (95%CI 94-97%), respectively. In determining N stage, the pooled sensitivity and specificity of EUS were 69% (95%CI 58-79%) and 52% (95%CI 42-62%). EUS is a moderately accurate technique in staging esophageal cancer after NAC. Its sensitivity is relatively high in T3 while specificity is high in other T stages (T1, T2, and T4). Tumors restaged by EUS as T4 should not be assigned to surgery because it is very likely to be inoperable. EUS is not reliable for N staging with its poor sensitivity and specificity. Subgroup analysis shows that staging accuracy did not improve with time.

Crosstalk between miR-34a and Notch Signaling Promotes Differentiation in Apical Papilla Stem Cells (SCAPs)

Stem cells from the apical papilla (SCAPs) are important for the formation and regeneration of root dentin. Here, we examined the expression of Notch signaling components in SCAPs and investigated crosstalk between microRNA miR-34aand Notch signaling during cell differentiation. We found that human SCAPs express NOTCH2, NOTCH3, JAG2, DLL3, and HES1, and we tested the relationship between Notch signaling and both cell differentiation and miR-34a expression. NOTCH activation in SCAPs inhibited cell differentiation and up-regulated the expression of miR-34a, whereas miR-34a inhibited Notch signaling in SCAPs by directly targeting the 3'UTR of NOTCH2 and HES1 mRNA and suppressing the expression of NOTCH2, N2ICD, and HES1. DSPP, RUNX2, OSX, and OCN expression was consequently up-regulated. Thus, Notch signaling in human SCAPs plays a vital role in maintenance of these cells. miR-34a interacts with Notch signaling and promotes both odontogenic and osteogenic differentiation of SCAPs.

Heparin-binding EGF-like growth factor and miR-1192 exert opposite effect on Runx2-induced osteogenic differentiation

Osteoblast differentiation is a pivotal event in bone formation. Runt-related transcription factor-2 (Runx2) is an essential factor required for osteoblast differentiation and bone formation. However, the underlying mechanism of Runx2-regulated osteogenic differentiation is still unclear. Here, we explored the corresponding mechanism using the C2C12/Runx2(Dox) subline, which expresses Runx2 in response to doxycycline (Dox). We found that Runx2-induced osteogenic differentiation of C2C12 cells results in a sustained decrease in the expression of heparin-binding EGF-like growth factor (HB-EGF), a member of the epidermal growth factor (EGF) family. Forced expression of HB-EGF or treatment with HB-EGF is capable of reducing the expression of alkaline phosphatase (ALP), a defined marker of early osteoblast differentiation. HB-EGF-mediated inhibition of ALP depends upon activation of the EGFR and the downstream extracellular signal-regulated kinase, c-Jun N-terminal kinase mitogen-activated protein kinase pathways as well as phosphatidylinositol 3-kinase/Akt pathway. Runx2 specifically binds to the Hbegf promoter, suggesting that Hbegf transcription is directly inhibited by Runx2. Runx2 can upregulate miR-1192, which enhances Runx2-induced osteogenic differentiation. Moreover, miR-1192 directly targets Hbegf through translational inhibition, suggesting enhancement of Runx2-induced osteogenic differentiation by miR-1192 through the downregulation of HB-EGF. Taken together, our results suggest that Runx2 induces osteogenic differentiation of C2C12 cells by inactivating HB-EGF-EGFR signaling through the downregulation of HB-EGF via both transcriptional and post-transcriptional mechanisms.

The cardiovascular effects of glucagon-like peptide-1 receptor agonists: a trial sequential analysis of randomized controlled trials

WHAT IS KNOWN AND OBJECTIVE

Glucagon-like peptide-1 (GLP-1) receptor agonists are a new class of antidiabetic drugs. Their wider use for the treatment of patients with type 2 diabetes mellitus has led to concerns about its cardiovascular effects. However, the robustness of data leading to those concerns is unclear. The purpose of this study is to systematically assess the robustness of the available evidence on the adverse cardiovascular effects of GLP-1 receptor agonists in patients with type 2 diabetes.

METHODS

The Cochrane library, MEDLINE, EMBASE and www.clinicaltrials.gov were searched from inception through to 25 January 2013. Randomized controlled trials (RCTs) were selected if they compared GLP-1 receptor agonists with placebo or other drugs with a duration ≥12 weeks. Mantel-Haenszel odds ratio (MH-OR) of cardiovascular events with 95% confidence interval (CI) was estimated using a random effects model. Trial sequential analysis based on required information size with an assumption of plausible reductions in relative risk in the low-bias trials, 5% risk of a type I error and 20% risk of a type II error was used to explore the robustness of available evidence.

RESULTS

Fifty-eight trials were included in the analysis (10 466 patients receiving GLP-1 receptor agonists and 7138 patients receiving comparators, respectively). Overall, the OR for cardiovascular events with GLP-1 receptor agonists was 0·52 (95% CI: 0·27-0·99) compared with placebo and 0·84 (95% CI: 0·52-1·36) with active controls. Trial sequential analyses showed that the actual accumulated sample size was only 11% (7445 of 65 212) and 13% (10 157 of 79 198) of the required information size for placebo-controlled trials and active-controlled trials, respectively. These results indicate that there is still insufficient evidence on cardiovascular events.

WHAT IS NEW AND CONCLUSION

GLP-1 receptor agonists do not seem to show any increased risk of cardiovascular events However, the available data from RCTs remain insufficient to confirm an absence of detrimental effect. More long-term trials and population-based studies are required to provide the necessary reassurance on the cardiovascular safety of GLP-1 receptor agonists.

Tuning interlayer exchange coupling of co-doped TiO2/VO2 multilayers via metal-insulator transition

Reversibly switching interlayer exchange coupling (IEC) of magnetic semiconductor multilayers between ferromagnetic (FM) and antiferromagnetic (AFM) modes is a difficult but key issue for fabricating semiconductor giant magnetoresistance devices. Here, we show that such tunable IEC is achievable around room temperature in Co-doped TiO2/VO2 diluted magnetic semiconductor multilayers. On the basis of first-principles calculations of electronic structure and fermiology, it is clarified that, associated with the metal-insulator transition (MIT) of nanosized VO2 spacers, exotic short-range magnetic orders are developed in the multilayers so that the IEC can be tuned reversibly from FM mode to AFM mode by varying temperature crossing the MIT (∼340  K).

Making health care safer II: an updated critical analysis of the evidence for patient safety practices

OBJECTIVES

To review important patient safety practices for evidence of effectiveness, implementation, and adoption.

DATA SOURCES

Searches of multiple computerized databases, gray literature, and the judgments of a 20-member panel of patient safety stakeholders.

REVIEW METHODS

The judgments of the stakeholders were used to prioritize patient safety practices for review, and to select which practices received in-depth reviews and which received brief reviews. In-depth reviews consisted of a formal literature search, usually of multiple databases, and included gray literature, where applicable. In-depth reviews assessed practices on the following domains: • How important is the problem? • What is the patient safety practice? • Why should this practice work? • What are the beneficial effects of the practice? • What are the harms of the practice? • How has the practice been implemented, and in what contexts? • Are there any data about costs? • Are there data about the effect of context on effectiveness? We assessed individual studies for risk of bias using tools appropriate to specific study designs. We assessed the strength of evidence of effectiveness using a system developed for this project. Brief reviews had focused literature searches for focused questions. All practices were then summarized on the following domains: scope of the problem, strength of evidence for effectiveness, evidence on potential for harmful unintended consequences, estimate of costs, how much is known about implementation and how difficult the practice is to implement. Stakeholder judgment was then used to identify practices that were "strongly encouraged" for adoption, and those practices that were "encouraged" for adoption.

RESULTS

From an initial list of over 100 patient safety practices, the stakeholders identified 41 practices as a priority for this review: 18 in-depth reviews and 23 brief reviews. Of these, 20 practices had their strength of evidence of effectiveness rated as at least "moderate," and 25 practices had at least "moderate" evidence of how to implement them. Ten practices were classified by the stakeholders as having sufficient evidence of effectiveness and implementation and should be "strongly encouraged" for adoption, and an additional 12 practices were classified as those that should be "encouraged" for adoption.

CONCLUSIONS

The evidence supporting the effectiveness of many patient safety practices has improved substantially over the past decade. Evidence about implementation and context has also improved, but continues to lag behind evidence of effectiveness. Twenty-two patient safety practices are sufficiently well understood, and health care providers can consider adopting them now.

A stochastic optimization approach for integrated urban water resource planning

Urban water is facing the challenges of both scarcity and water quality deterioration. Consideration of nonconventional water resources has increasingly become essential over the last decade in urban water resource planning. In addition, rapid urbanization and economic development has led to an increasing uncertain water demand and fragile water infrastructures. Planning of urban water resources is thus in need of not only an integrated consideration of both conventional and nonconventional urban water resources including reclaimed wastewater and harvested rainwater, but also the ability to design under gross future uncertainties for better reliability. This paper developed an integrated nonlinear stochastic optimization model for urban water resource evaluation and planning in order to optimize urban water flows. It accounted for not only water quantity but also water quality from different sources and for different uses with different costs. The model successfully applied to a case study in Beijing, which is facing a significant water shortage. The results reveal how various urban water resources could be cost-effectively allocated by different planning alternatives and how their reliabilities would change.

Aldosterone perturbs adiponectin and PAI-1 expression and secretion in 3T3-L1 adipocytes

Aldosterone is considered as a new cardiovascular risk factor that plays an important role in metabolic syndrome; however, the underlying mechanism of these effects is not clear. Hypoadiponectinemia and elevated circulating concentration of plasminogen activator inhibitor-1 (PAI-1) are causally associated with obesity-related insulin resistance and cardiovascular disease. The aim of the present study is to investigate the effect of aldosterone on the production of adiponectin and PAI-1 in 3T3-L1 adipocytes. Northern and Western blot analyses revealed that aldosterone treatment inhibited adiponectin mRNA expression and secretion and simultaneously enhanced PAI-1 mRNA expression and secretion in a time- and dose-dependent manner. Rosiglitazone did not prevent aldosterone's effect on adiponectin or PAI-1 expression. In contrast, tumor necrosis factor (TNF)-α produced dramatic synergistic effects on adiponectin and PAI-1 expression when added together with aldosterone. Furthermore, the effects of aldosterone on adiponectin and PAI-1 expression appear to be mediated through glucocorticoid receptor (GR) but not mineralocorticoid receptor (MR). These results suggest that the effects of aldosterone on adiponectin and PAI-1 production are one of the underlying mechanisms linking it to insulin resistance, metabolic syndrome and cardiovascular disease.

A reproducible route to p-ZnO films and their application in light-emitting devices

Although great efforts have been made, reproducible p-type doping is still one of the largest hurdles that hinders the optoelectronic applications of ZnO. In this Letter, a reproducible route to p-type ZnO films employing lithium-nitrogen as a dual-acceptor dopant has been demonstrated, and p-i-n structured light-emitting devices (LEDs) have been constructed. Obvious purple emissions have been observed from the LEDs, confirming the applicability of the p-type ZnO films in optoelectronic devices. The results reported in this Letter provide a reproducible route to p-type ZnO films, and thus may lay a solid ground for future optoelectronic applications of ZnO.

The Golden Potato Cyst Nematode Globodera rostochiensis Pathotype Ro1 in the Saint-Amable Regulated Area in Quebec, Canada

The golden potato cyst nematode, Globodera rostochiensis (Wollenweber, 1923) Behren, is an economically important parasite of potato (Solanum tuberosum L. subsp. tuberosum) and is recognized as a quarantine pest internationally (2). This pest attacks potato plants and causes stunting of the haulm and the root system, leaf yellowing, and tuber yield losses (2). The pathotype scheme proposed by Kort et al. distinguishes five pathotypes (Ro1, Ro2, Ro3, Ro4, and Ro5) of G. rostochiensis using differential Solanum clones (1). Several resistance genes and quantitative trait loci (QTL) that have been identified in wild Solanum species confer resistance to different G. rostochiensis pathotypes and have been introgressed into commercial potato cultivars (2). Determining G. rostochiensis pathotype(s) is essential to implement efficient management strategies, which include using resistant potato varieties. G. rostochiensis was discovered in the municipality of Saint-Amable, Quebec (QC), Canada in 2006 (3) and was subsequently characterized (4). In this study, cysts were collected from 11 representative infested fields and confirmed to be G. rostochiensis (3). The pathotypes of these nematodes were assessed on seven differential clones (S. tuberosum subsp. tuberosum cv. Desiree, S. tuberosum × S. andigena cv. Maris Piper, S. kurtzianum hybrid 60.21.19, S. vernei hybrid 62.33.3, S. vernei hybrid 58.1642/4, S. vernei hybrid 65.346/19, and S. multidissectum hybrid P55/7) in 2007 and 2009. Briefly, in each 1-liter plastic pot containing 907 g (2 lbs) of soil (3:1 loam/grit v v-1), a single differential Solanum clone was planted and 15 cysts from 1 of 11 fields were inoculated. Five replicates were set up for each Solanum-nematode combination and the pots were arranged in a completely randomized design in a greenhouse at 22°C with a 16-h light period per day. Nine weeks after inoculation, cysts were extracted from each pot and counted. Reproduction factor (Rf) for each replicate was calculated (Rf = Pf/Pi; Pf is the final cyst number and Pi is the initial cyst number added to each pot). Rf values were used to categorize the differential clones into two groups, "susceptible" leading to increase in nematode numbers (Rf > 1) and "resistant" resulting in decrease in nematode numbers (Rf ≤ 1) (1). Our results in 2007 and 2009 were consistent and the pathotype of the nematodes collected from all the fields were identified as Ro1. To our knowledge, this is the first time that the pathotype of G. rostochiensis in the Saint-Amable regulated area was identified. Accordingly, potato cultivars carrying genes or QTL resistant to G. rostochiensis pathotype Ro1 can be used to reduce the nematode numbers in infested fields in the Saint-Amable area, QC. References: (1) J. Kort et al. Nematologica 23:333, 1977. (2) R. J. Marks and B. B. Brodie. Potato Cyst Nematodes: Biology, Distribution, and Control. 1st ed. CAB International, Wallingford, 1998. (3) F. Sun et al. Plant Dis. 91:908, 2007. (4) Q. Yu et al. Can. J. Plant Pathol. 32:264, 2010.

Estimating nutrient releases from agriculture in China: an extended substance flow analysis framework and a modeling tool

Agriculture related pollution has attracted the attention of policy makers as well as scientists in China as its contribution to water impairment has increased, and quantitative information at the national and regional levels is being sought to support decision making. However, traditional approaches are either time-consuming, expensive (e.g. national surveys) or oversimplified and crude (e.g. coefficient methods). Therefore, this study proposed an extended substance flow analysis (SFA) framework to estimate nutrient releases from agricultural and rural activities in China by depicting the nutrient flows in Chinese agro-ecosystems. The six-step process proposed herein includes: (a) system definition; (b) model development; (c) database development; (d) model validation; (e) results interpretation; and (f) uncertainty analysis. The developed Eubolism (Elementary Unit based nutrient Balance mOdeLIng in agro-ecoSysteM) model combined a nutrient balance module with an emission inventory module to quantify the nutrient flows in the agro-ecosystem. The model was validated and then applied to estimate the total agricultural nutrient loads, identify the contribution of different agricultural and rural activities and different land use types to the total loads, and analyze the spatial pattern of agricultural nutrient emissions in China. These results could provide an entire picture of agricultural pollution at the national level and be used to support policy making. Furthermore, uncertainties associated with the structure of the elementary units, spatial resolution, and inputs/parameters were also analyzed to evaluate the robustness of the model results.

Structure validation of an integrated waterworks model for trihalomethanes simulation by applying regional sensitivity analysis

A previously developed integrated waterworks model for trihalomethanes simulation was validated by applying a new framework for comprehensive model structure validation. The proposed framework followed the procedure of regional sensitivity analysis and also involved correlation analysis and frequency distribution analysis. Through such an analysis framework, a deep insight into model structure and parameters could be gained besides the traditional focuses on model validation, i.e. model performance and rationality of model parameters. The integrated waterworks model, to which the framework was applied, was proved to give good predictions of the simulated variables, and the identified values of model parameters coincided well with the reported values in the literature. The model was also found to have a large proportion of sensitive parameters, no distinct correlations among parameters, and thus a balanced structure. Moreover, most of the sensitive parameters could be well identified and the associated uncertainties significantly reduced. A detailed investigation into the sensitivity, identifiability, and uncertainty of model parameters showed that the model conceptualization was in good agreement with accepted scientific principles and anticipated system behaviors. All these results, therefore, supported the validity and trustworthiness of the model. In addition, further opportunities for refining the model were also proposed.