Efficacy of Oral Medication in Weight Loss Management: A Systematic Review and Network Meta-Analysis

PURPOSE

This systematic review was conducted to determine which type of oral medication for obesity provides the best weight loss effect.

METHODS

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline. For this systematic review, we used 3 databases for journal searches: PubMed, ScienceDirect, and Scopus. This study only included randomized controlled trials or open-label clinical trials. There was no year limit used in the journal search for this systematic review.

FINDINGS

Eighteen randomized controlled trials, with a total population of 12,259 patients, were included. Of 18 studies, 15 were used for network meta-analysis. Based on the results of the network meta-analysis, weight loss was found in phentermine/topiramate (mean difference [MD], -3.28; 95% CI, -4.47 to -2.09), semaglutide (MD, -2.92; 95% CI, -4.38 to -1.46), phentermine (MD, -2.31; 95% CI, -3.82 to -0.81), naltrexone/bupropion (MD, -1.68; 95% CI, -2.87 to -0.49), topiramate (MD, -1.67; 95% CI, -2.86 to -0.48), and orlistat (MD, -1.44; 95% CI, -2.32 to -0.55). There were no significant differences among the groups. However, compared with placebo, all oral obesity therapies provide better benefits in weight loss (MD, -2.12; 95% CI, -2.64 to -1.59; P ≤ 0.00001).

IMPLICATIONS

Oral antiobesity drugs provide better weight loss than placebo. However, some side effects can be incurred by utilizing the drug for weight loss, especially related to the gastrointestinal system. Nonetheless, in clinical settings, consideration should be given to particular patients to reduce risk of side effects.

Effects of Metformin on Postprandial Blood Pressure, Heart Rate, Gastric Emptying, GLP-1, and Prevalence of Postprandial Hypotension in Type 2 Diabetes: A Double-Blind Placebo-Controlled Crossover Study

ARTICLE HIGHLIGHTS

Postprandial hypotension (PPH) occurs frequently in type 2 diabetes. Metformin has cardiovascular effects independent of its glucose-lowering capacity, which may modulate the risk of PPH. We investigated the effects of metformin on postprandial blood pressure, including PPH events, heart rate, glucose, insulin, glucagon-like peptide 1 (GLP-1), and gastric emptying, in individuals with type 2 diabetes. Metformin attenuated postprandial decrease in blood pressure and reduced PPH events, in association with augmentation of plasma GLP-1, slowed gastric emptying, and increased heart rate, in type 2 diabetes. These findings establish novel cardiovascular effects of metformin that may mitigate the risk of PPH in type 2 diabetes.

Investigating socioeconomic disparities in prescribing new diabetes medications in individuals with type 2 diabetes and very high cardiovascular risk in the Netherlands

AIMS

This study aims to analyze prescription patterns of new diabetes medication and assess socioeconomic disparities in their initiation among individuals with T2DM with very high cardiovascular risk.

METHODS

Individuals diagnosed with T2DM and very high cardiovascular risk were identified (N = 10,768) based on general practitioner's electronic health record data. SGLT-2is and GLP-1RAs prescription patterns were examined. Furthermore, the association between SES and the prescription of SGLT-2is and GLP-1RAs in 2022 was investigated.

RESULTS

Despite the increase in prescription rates of SGLT-2is and GLP-1RAs between 2019 and 2022, approximately 85 % and 93 % of eligible individuals did not receive SGLT-2is and GLP-1RAs in 2022, respectively. We found a positive association between SGLT-2is prescription and SES in only the 4th quintile compared to 1st quintile (referent) in the fully adjusted model (OR 1.29 95 % CI:1.08-1.54).

CONCLUSIONS

The prescription rates among eligible individuals highlight significant room for improvement in aligning prescribing practices with guidelines. We found no profound socioeconomic gradient in initiation of SGLT-2is and GLP-1RAs. The latter may be due to guidelines' clear indication of the eligible population and GP education. Future development and potential disparities in initiation and maintenance should be monitored to ensure equitable prescribing.

Sarcopenia and the management of spinal disease in the elderly

Sarcopenia, generally defined by the loss of skeletal mass and function, may disproportionately affect elderly individuals and heavily influence spinal disease. Muscle atrophy is associated with myriad clinical problems, including thoracic kyphosis, increased sagittal vertical axis (SVA), spinal implant failures, and postoperative complications. As such, the aim of this narrative review is to synthesize pertinent literature detailing the intersection between sarcopenia and the impact of sarcopenia on the management of spine disease. Specifically, we focus on the domains of etiology, diagnosis and assessment, impact on the cervical and lumbar spine, spinal augmentation procedures, neoplastic disease, whiplash injury, and recovery/prevention. A narrative review was conducted by searching the PubMed and Google Scholar databases from inception to July 12, 2024, for any cohort studies, systematic reviews, or randomized controlled trials. Case studies and conference abstracts were excluded. Diagnosis of sarcopenia relies on the assessment of muscle strength and quantity/quality. Strength may be assessed using clinical tools such as gait speed, timed up and go (TUG) test, or hand grip strength, whereas muscle quantity/quality may be assessed via computed tomography (CT scan), magnetic resonance imaging (MRI), and dual-energy X-ray absorptiometry (DXA scan). Sarcopenia has a generally negative impact on the clinical course of those undergoing cervical and lumbar surgery, and may be predictive of mortality in those with neoplastic spinal disease. In addition, severe acceleration-deceleration (whiplash) injuries may result in cervical extensor muscle atrophy. Intervention and recovery measures include nutrition or exercise therapy, although the evidence for nutritional intervention is lacking. Sarcopenia is a widely prevalent pathology in the advanced-age population, in which the diagnostic criteria, impact on spinal pathology, and recovery/prevention measures remain understudied. However, further understanding of this therapeutically challenging pathology is paramount, as surgical outcome may be heavily influenced by sarcopenia status.

Tackling the complexity of obesity in the US through adaptation of public health strategies

Obesity prevalence continues to rise in the US despite more than two decades of recommendations and guidelines for its prevention and management. The encouragement of individuals to adopt a healthy diet and lifestyle has remained the focus of clinical interventions and recommendations despite these efforts alone proving ineffective for long-term weight management. There are many recognized barriers to obesity prevention and management in community and clinical settings including political factors, social determinants of health, weight bias and stigma, and inequities in access to treatment and insurance coverage. We discuss these barriers in more detail and attempt to identify areas where public health and healthcare approaches can be better aligned, allowing for better advocating by public health officials to enable a more meaningful and population-level change in obesity prevention and management in the US.

An Italian Survey on the Management of Pediatric Convulsive Status Epilepticus: More Than Just a Pharmacological Choice

BACKGROUND AND PURPOSE

To explore specialists' opinions on the current management of pediatric convulsive status epilepticus (CSE) in Italy and the main factors influencing the applicability of guidelines.

METHODS

We conducted a national survey of child neurologists, pediatric emergency physicians, and intensivists. Within the multidisciplinary Italian Paediatric Status Epilepticus (IPSE) Group, a web-based 48-multiple-choice questionnaire was developed to explore treatment choices, use of internal protocols and guidelines, and self-perceived competencies in the treatment of CSE.

RESULTS

Responses were received from 250 clinicians from 34 Italian hospitals (response rate 71%). Intravenous midazolam (iv-MDZ) was the preferred benzodiazepine (BDZ) when iv access was available (90%). When iv-access was unavailable, 75% of clinicians used BDZs; rectal diazepam was the most indicated (65.6%). Concerning second-line treatment, the choices were equally distributed between phenytoin (55.2%), levetiracetam (52.4%), and phenobarbital (52.4%). MDZ infusion at a dosage < 0.23 mg/kg/h was also a frequent choice (38%). A PICU in the hospital influenced this latter choice, resulting in a significantly greater use of iv-MDZ by pediatric emergency physicians working in these hospitals. Answers' variability was related to organizational aspects such as the availability of on-duty specialists and diagnostic tools in emergency settings.

CONCLUSIONS

This survey confirmed that first-line treatment of pediatric CSE relied on iv-MDZ and that the heterogeneity of therapeutic choices started from the second-line treatment in real life. The survey also highlighted the need to consider the organizational heterogeneity among settings and to involve different specialties in an integrated and feasible approach.

Global Health & Population Project on Access to Care for Cardiometabolic Diseases (HPACC). Reduced insulin use and diabetes complications upon introduction of SGLT-2 inhibitors and GLP1-receptor agonists in low- and middle-income countries: A microsimulation

BACKGROUND

Diabetes mellitus, particularly type 2 diabetes, is a growing health concern in low- and middle-income countries (LMICs). The potential impact of newer diabetes medications, such as glucagon-like peptide 1 (GLP-1) receptor agonists and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, on insulin dosage and health outcomes in these settings is not well understood.

METHODS AND FINDINGS

We developed a microsimulation model to estimate the impact of treating patients with type 2 diabetes who use insulin with GLP-1 receptor agonists or SGLT-2 inhibitors in LMICs. The model utilized data from the Global Health and Population Project on Access to Care for Cardiometabolic Diseases (HPACC) dataset, encompassing surveys from 79 countries and clinical trial data to estimate insulin dose reduction. We incorporated weight-based insulin dosing formulas and hazard ratios for severe hypoglycemia, cardiovascular and renal outcomes, side effects of new therapies, and mortality. The primary outcome was the change in insulin dosage, and secondary outcomes were disability-adjusted life years (DALYs) lost per 1,000 person-years by diabetes complication (micro- and macro-vascular). Our results indicate that the addition of GLP-1 receptor agonists or SGLT-2 inhibitors could reduce insulin dosage by 8.2 IU/day (IQR: 6.9, 9.5) and 5.3 IU/day (IQR: 4.5, 6.2), respectively. The median DALYs lost per 1,000 person-years decreased from 2.20 (IQR: 1.49, 4.02) to 1.01 (IQR: 0.61, 1.86) with GLP-1 receptor agonists and 1.25 (IQR: 0.81, 2.29) with SGLT-2 inhibitors. Primary benefits arose from weight loss, decreased cardiorenal disease, and decreased mortality, with smaller DALY benefits from the prevention of severe hypoglycemia. Key limitations include the inability to differentiate between type 1 and type 2 diabetes in some datasets and reliance on assumptions from clinical trials conducted primarily in high-income countries.

CONCLUSIONS

The introduction of GLP-1 receptor agonists and SGLT-2 inhibitors for managing type 2 diabetes in LMICs could significantly reduce insulin dosage and associated health risks, leading to improved outcomes and reduced disability. These findings suggest that expanding access to these newer diabetes medications in LMICs could have substantial public health benefits.

Influence of Body Mass Index on the Clinicopathological Features of Papillary Thyroid Carcinoma in a Chinese Population

Background: Previous studies suggested a relationship between obesity and a high risk of thyroid cancer. However, the association between high body mass index (BMI) and the aggressiveness of papillary thyroid carcinoma (PTC) is controversial. In this study, we aimed to investigate the impact of excess BMI on histopathologic aggressiveness of PTC in a Chinese population. Methods: Between January 2015 and September 2020, 4369 PTC patients who were tested for BRAF mutation at Jiangyuan Hospital were enrolled. Logistic regression analyses were used to evaluate the associations between BMI and clinicopathological features of PTC as well as tumor BRAF mutational status. Results: Of 4369 PTC patients, the mean BMI was 24.06 ± 3.49 kg/m2, and BRAFV600E mutations were detected in 3528 (80.8%) patients. BMI ≥24.0 at initial surgery was associated with tumor multifocality and bilaterality, but not with advanced tumor stage, extrathyroidal extension (ETE), ratio of positive lymph nodes >0.3, distant metastasis, or BRAFV600E mutation. Conclusion: Our present study suggested that compared to patients with a normal BMI, overweight and obese patients had a greater risk of multifocality and bilaterality of PTC. No significant associations were observed between higher BMI and the more advanced tumor-node-metastasis stage or BRAFV600E mutational status.

β-Glucan-based superabsorbent hydrogel ameliorates obesity-associated metabolic disorders via delaying gastric emptying, improving intestinal barrier function, and modulating gut microbiota

The global obesity epidemic and its associated metabolic syndrome highlight the urgent need for new weight-loss therapies that provide high efficacy and patient compliance. Herein, we propose a novel, noninvasive approach using an orally administered β-glucan-based superabsorbent hydrogel (βC-MA hydrogel) to improve obesity-associated metabolic disorders. Results demonstrated that βC-MA hydrogel functioned as a dynamic exoskeleton within the gastrointestinal tract, slowing gastric emptying and reducing the digestion and absorption of ingested food. Furthermore, βC-MA hydrogel alleviated hepatic lipid accumulation and prevented hepatic steatosis and fibrosis by regulating the expression levels of key genes involved in lipid metabolism, including Cd36, SREBP 1c, FAS, ACC1, Cpt1a, and HSL, thereby limiting the progression of nonalcoholic fatty liver disease. In addition, βC-MA hydrogel reduced intestinal inflammation by lowering tumor necrosis factor-α and interleukin-6 levels while enhancing gut barrier function through increased expression of claudin-1, ZO-1, and MUC2. Finally, βC-MA hydrogel, enriched with obesity-negative probiotics such as Akkermansia, norank_f__Muribaculaceae, and Faecalibaculum, promoted the production of short-chain fatty acids. Consequently, βC-MA hydrogel significantly reduced body weight and fat accumulation and improved blood glucose and lipid levels, with efficacy comparable to semaglutide therapy and superior to β-glucan and sodium carboxymethylcellulose interventions. Overall, these findings suggest that βC-MA hydrogel could serve as a promising next-generation ingestible medical device for alleviating diet-induced obesity and related metabolic disorders by modulating food digestion and absorption, improving intestinal inflammation and barrier function, and regulating gut microbiota composition.

Low Skeletal Muscle Mass: A Strong Predictive Factor for Surgical Complications After Free Forearm Flap Reconstruction in Oral Cancer Patients

BACKGROUND

Low skeletal muscle mass (SMM) is a predictive factor for complications in patients undergoing major head and neck cancer surgery. This study aims to identify the predictive value of low SMM for postoperative complications in patients who underwent free forearm flap (FAFF) reconstructions after oral cancer resections.

METHODS

A retrospective study was performed with all patients who underwent FFAF between 2003 and 2020 for an oral cavity reconstruction after cancer ablation. Free flap related, any postoperative complications and hospital stay were investigated.

RESULTS

Low SMM was associated with an increased risk of free flap associated complications (OR 2.14; 95% CI 1.02-4.39, p = 0.029). Low SMM was associated with severe complications (Clavien-Dindo ≥ III) (OR 1.46; 95% CI 1.20-2.09, p = 0.02).

CONCLUSIONS

Low SMM is a strong predictive factor for free flap related surgical complications in patients undergoing FAFF reconstruction after resection of oral cancer.

Preoperative SGLT2 Inhibitor Use and Postoperative Diabetic Ketoacidosis

Importance

Case reports of postoperative diabetic ketoacidosis in patients using sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications underlie guidance by the US Food and Drug Administration to withhold SGLT2i medication for at least 3 days prior to surgery. Given the potential negative consequences associated with preoperative medication withholding, a large-scale evaluation of the risk of diabetic ketoacidosis in this population is needed.

Objective

To estimate the association between preoperative SGLT2i medication use and postoperative diabetic ketoacidosis in a population of patients who underwent a variety of emergency surgeries. Emergency surgery was chosen given the assumption that a patient would be unable to withhold their SGLT2i medication per the current guidance.

Design, Setting, and Participants

This retrospective cohort study was conducted among a nationwide sample of patients aged 18 years or older with type 2 diabetes who were enrolled in commercial or Medicare fee-for-service insurance plans and who underwent 1 of 13 emergency surgeries between January 1, 2016, and December 15, 2022. Emergency surgeries were defined as those occurring on the same day or the 1 to 2 days after an emergency department claim. Data were analyzed from November 2023 through December 2024.

Exposure

SGLT2i medication use.

Main Outcomes and Measures

Diabetic ketoacidosis, defined by diagnosis codes, in the 0 to 14 days after surgery.

Results

Among 34 671 patients with type 2 diabetes who underwent emergency surgery (mean [SD] age, 63.9 [14.0] years; 19 175 female [55.3%] and 15 496 male [44.7%]), the most common surgeries were laparoscopic cholecystectomy (9385 patients) and transurethral procedures (12 246 patients). There were 2607 patients (7.5%) who used SGLT2i medications and 32 064 patients (92.5%) who did not. Unadjusted incidence of diabetic ketoacidosis was 127 patients (4.9%) for those exposed to SGLT2i medications and 1115 patients (3.5%) for those unexposed. After accounting for covariates, including demographic characteristics, indicators of diabetic severity, comorbidities, and surgery type, the incidence of the outcome was 3.8% for those exposed to SGLT2i medications and 3.5% for those unexposed. The average treatment effect [ATE] was 0.2% (95% CI, -1.7% to 2.2%). Results were robust to alternate specifications (eg, intensive care unit-level care as the outcome: ATE, -1.0%; 95% CI, -2.9% to 1.1%).

Conclusions and Relevance

This study found that preoperative use of SGLT2i medications in patients undergoing emergency surgery was not associated with an increased risk for postoperative diabetic ketoacidosis compared with no use of SGLT2i medications. These findings may justify liberalizing current guidance on preoperative SGLT2i medication withholding periods.

Effect of Self-efficacy, Disease Perception, Social Support, Anxiety, and Depression on Self-management in Young Patients With Stroke

ABSTRACT

BACKGROUND: Better self-management of chronic diseases may benefit patient functional status, medication effectiveness, lifestyle, and psychosocial health. Self-efficacy, disease perception, social support, anxiety, and depression are determinants of self-management behaviors in individuals with chronic illnesses. There remains a gap in the empirical exploration of the influence of these factors on self-management behaviors in young Chinese stroke survivors. This study examined how these factors affect specific self-management behaviors. METHODS: Validated instruments were used to evaluate patient self-efficacy, disease perception, social support, anxiety, and depression in a cross-sectional study. Structural equation modeling was used to examine the hypothesis. RESULTS: Self-efficacy and social support showed a positive correlation with self-management (0.421 and 0.446, respectively; P < .001). Disease perception, anxiety, and depression were negatively correlated with self-management (-0.158 and -0.336, respectively; P < .05). The structural equation model fit the data very well; social support had a direct positive effect on self-management ( t = 3.002, P < .05) and self-efficacy ( t = 5.773, P < .001). However, the presence of social support had a positive impact on reducing anxiety and depression ( t = -5.046, P < .001). Furthermore, self-efficacy positively affected self-management ( t = 1.226, P < .05), whereas anxiety and depression ( t = -1.190, P < .05) and disease perception ( t = -1.068, P < .05) had adverse effects on self-management. CONCLUSION: Medical staff and caregivers can improve patient self-management by helping them recognize the disease, reducing negative perceptions, communicating more for better understanding and care, intervening in anxiety and depression, and promoting mental health. This is especially important for young stroke patients.

What Are the Experiences, Views and Perceptions of Patients, Carers and Clinicians of Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs)? A Scoping Review

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a pharmacological treatment option for both diabetes and weight loss. Qualitative evidence is vital in providing greater understanding of patients, practitioners and carers experience of taking or delivering GLP-1 RAs. This evidence can inform the current or future configuration and delivery of services. We conducted a scoping review to better understand the quantity, nature and key characteristics of qualitative primary evidence which explores the experiences, views and perceptions of patients, carers and clinicians regarding the use of GLP-1 RAs.

METHODS

Four bibliographic databases were searched on 10 July 2024: MEDLINE, APA PsycInfo via Ovid, CINAHL Ultimate via EBSCOhost, ProQuest Dissertations and Theses Global via ProQuest. We also searched Google Scholar, two clinical trials registries, the pre-print server medRxiv and conducted citation searches. We sought qualitative research about the experiences of patients, carers and practitioners about any aspect of taking or prescribing GLP-1RAs, for any indication. Study selection and data extraction were performed by two independent reviewers. The included studies were collated, and their characteristics were described.

RESULTS

After de-duplication 1545 titles and abstracts were screened for relevance, with 77 full-text articles assessed for eligibility, resulting in 25 included studies. More studies were focused on type 2 diabetes (n = 12) than weight loss (n = 9) or any indication (n = 4). The experiences of carers were not represented. No one area of experience (e.g. different indications or viewpoints) was well represented, either due to the absence or narrow focus of studies or lack of an in-depth analytical approach.

CONCLUSION

Whilst primary qualitative evidence exploring patient and clinician experience of GLP-1 RAs was identified in this scoping review, the findings highlight a need for more robust qualitative research to be conducted across all user groups, in particular involving carers, and especially for the indication of weight loss within service settings. This evidence gap needs to be urgently addressed to ensure GLP-1 RAs are appropriately prescribed and patients and carers receive support from services suited to their needs.

PATIENT OR PUBLIC CONTRIBUTION

Seventeen public collaborators contributed to the search by suggesting additional search terms, helping define the population for inclusion and contributing to protocol development. Their thoughts on the findings of the review helped form the basis for the discussion of this paper.

Pharmacological treatment options for metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes mellitus: A systematic review

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely related to type 2 diabetes mellitus (T2DM) through a common root in insulin resistance. The more severe stage, metabolic dysfunction-associated steatohepatitis (MASH), increases the risk for cardiovascular complications, liver cirrhosis and hepatocellular carcinoma. Several trials investigating established antidiabetic-drugs in patients with T2DM and MASLD have yielded promising results. Therefore, we aimed to systematically review the effect of T2DM-drug treatment on MALSD parameters.

METHODS

Medical databases were searched until January 2025 for controlled trials in patients with T2DM and MASLD/MASH. Studies that evaluated the effect of T2DM-medication on the severity of MASLD/MASH in T2DM patients were included. The quality of the studies was assessed by three independent reviewers using a set of Cochrane risk-of-bias tools.

RESULTS

Of 1748 references, 117 studies fulfilled the inclusion-criteria and were assessed for eligibility in full-text. Fifty-two articles were included. Data included a total of 64.708 patients and study populations ranged from 9 to 50.742. Heterogeneity in study-design and analysis hampered the comparability of the results. Most evidence was present for GLP-1 receptor agonists, SGLT2-inhibitors and PPAR-γ-agonists for regression of liver fibrosis and MASH.

CONCLUSION

Studies on the value of T2DM-drug treatment in the improvement of MASLD vary significantly in study design, size and quality. GLP-1 receptor agonists, PPAR-γ-agonists, SGLT2-inhibitors may all be preferred pharmacological interventions for patients with MASLD/MASH and T2DM. Newer agents like dual GLP-1/GIP or triple GLP-1/GIP/Glucagon agonists will likely play an important role in the treatment of MASLD/MASH in the near future.

Identification of polyreactive antibodies by high throughput enzyme-linked immunosorbent assay and surface Plasmon resonance

The assessment of polyreactivity is usually carried out by enzyme linked immunosorbent assay (ELISA) using biochemically diverse target antigens with different biochemical properties, including charge and hydrophobicity, and comprising proteins, carbohydrates, nucleic acids and lipids, some of which are heterogenous in nature. Here we explored polyreactivity ELISAs based on probes of defined molecular weight, which we were also able to directly transition to a polyreactivity assay using surface plasmon resonance (SPR). Using a panel of previously characterized clinical antibodies we obtain results compatible with previous polyreactivity studies, but with potential for high throughput analysis following kinetic measurements in the early discovery process. We find ELISA is more sensitive for the detection of polyreactivity in antibodies, and with potential lower throughput, compared to SPR, but may lack the linear sensitivity of SPR.

Analysis of specialist doctors' behavior towards SGLT2 inhibitors prescription in Indonesia: A qualitative study

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have a broad range of clinical indications and are recommended by various guidelines for the management of diabetes, heart failure, and chronic kidney disease. However, prescribing rates for these agents are suboptimal towards various intended indications in many countries, including Indonesia. The aim of this study was to analyze the prescribing practices of SGLT2is among endocrinologists, cardiologists, and nephrologists in Indonesia. A qualitative method was utilized to provide a comprehensive understanding of this phenomenon. Semi-structured online interviews were performed with 18 participants, comprising seven specialized doctors as primary informants; eight key informants representing pharmacies, governmental bodies, and pharmaceutical marketing representatives; and three patients as supplementary informants. Furthermore, closed observations of two specialist doctors were undertaken as an additional data collection method. Informants were recruited using criterion and snowball sampling methods. The Theoretical Domains Framework was used as an interview guide; all interviews were audio visual-recorded, transcribed verbatim, and subsequently analyzed for thematic content with NVivo version 12. Seven themes emerged concerning the prescribing behavior of SGLT2is: socioeconomic status, therapeutic rationality, utilization barriers, utilization optimization, the urge to prescribe, therapeutic expectations and targets, and aspects of the health system and ethical considerations. Most informants possessed favorable perspectives regarding using SGLT2is when prescribed appropriately, yet specific elements necessitate enhancement to refine therapeutic justification, including initiatives to incorporate SGLT2is into the national formulary.

Frailty in randomized controlled trials of glucose-lowering therapies for type 2 diabetes: An individual participant data meta-analysis of frailty prevalence, treatment efficacy, and adverse events

BACKGROUND

The representation of frailty in type 2 diabetes trials is unclear. This study used individual participant data from trials of newer glucose-lowering therapies to quantify frailty and assess the association between frailty and efficacy and adverse events.

METHODS AND FINDINGS

We analysed IPD from 34 trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP1) receptor agonists, and dipeptidyl peptidase 4 (DDP4) inhibitors. Frailty was quantified using a cumulative deficit frailty index (FI). For each trial, we quantified the distribution of frailty; assessed interactions between frailty and treatment efficacy (HbA1c and major adverse cardiovascular events [MACE], pooled using random-effects network meta-analysis); and associations between frailty and withdrawal, adverse events, and hypoglycaemic episodes. Trial participants numbered 25,208. Mean age across the included trials ranged from 53.8 to 74.2 years. Using a cut-off of FI > 0.2 to indicate frailty, median prevalence was 9.5% (IQR 2.4%-15.4%). Applying a higher threshold of FI > 0.3, median prevalence was 0.5% (IQR 0.1%-1.5%). Prevalence was higher in trials of older people and people with renal impairment however, even in these higher risk populations, people with FI > 0.4 were generally absent. For SGLT2 inhibitors and GLP1 receptor agonists, there was a small attenuation in efficacy on HbA1c with increasing frailty (0.08%-point and 0.14%-point smaller reduction, respectively, per 0.1-point increase in FI), below the level of clinical significance. Findings for the effect of treatment on MACE (and whether this varied by frailty) had high uncertainty, with few events occurring in trial follow-up. A 0.1-point increase in the FI was associated with more all-cause adverse events regardless of treatment allocation (incidence rate ratio, IRR 1.44, 95% CI 1.35-1.54, p < 0.0001), adverse events judged to the possibly or probably related to treatment (1.36, 1.23, to 1.49, p < 0.0001), serious adverse events (2.09, 1.85, to 2.36, p < 0.0001), hypoglycaemia (1.21, 1.06, to 1.38, p = 0.012), baseline risk of MACE (hazard ratio 3.01, 2.48, to 3.67, p < 0.0001) and with withdrawal from the trial (odds ratio 1.41, 1.27, to 1.57, p < 0.0001). The main limitation was that the large cardiovascular outcome trials did not include data on functional status and so we were unable to assess frailty in these larger trials.

CONCLUSIONS

Frailty was uncommon in these trials, and participants with a high degree of frailty were rarely included. Frailty is associated very modest attenuation of treatment efficacy for glycaemic outcomes and with greater incidence of both adverse events and MACE independent of treatment allocation. While these findings are compatible with calls to relax HbA1c-based targets in people living with frailty, they also highlight the need for inclusion of people living with frailty in trials. This would require changes to trial processes to facilitate the explicit assessment of frailty and support the participation of people living with frailty. Such changes are important as the absolute balance of risks and benefits remains uncertain among those with higher degrees of frailty, who are largely excluded from trials.

Effects of GLP-1 receptor agonist therapy on resolution of steatohepatitis in non-alcoholic fatty liver disease: a systematic review and meta-analysis

Background

Non-alcoholic fatty liver disease (NAFLD) is common, can progress to cirrhosis and hepatic decompensation, and has no approved medical therapy in Canada.

Objective

We conducted a systematic review on whether glucagon-like peptide-1 receptor agonists (GLP-1RA) improve non-alcoholic steatohepatitis (NASH) compared to standard care in NAFLD.

Methods

We searched Medline Ovid, EMBASE(Elsevier), Cochrane CENTRAL, Clinical Trials.gov, and the World Health Organization International Clinical Trials Registry Platform in November 2023 for randomized controlled trials. Inclusion criteria included patients ≥13 years with NAFLD receiving GLP-1RA for ≥6 months compared to standard care/placebo. Cochrane risk-of-bias 2.0 tool was used for each outcome. After screening results in duplicate, we performed meta-analysis and reported odds ratios (OR) for dichotomous and mean difference of change score for continuous outcomes.

Results

Six studies with 478 patients met inclusion criteria; 3 studies reported on the primary endpoint resolution of NASH. GLP-1RA likely leads to resolution of NASH (OR 4.45 (95% CI 1.92, 10.3)) and reduction in liver steatosis on imaging (-5.09% (95% CI -7.49, -2.69), but little to no reduction in liver stiffness on imaging (mean difference -0.17 kPa (95% CI -0.34, 0)).

Interpretation

Treatment with GLP-1RA in NAFLD patients for ≥6 months can probably lead to improvement in NASH on liver biopsy and reduce liver steatosis on imaging. Whether improvements in steatosis on biopsy or imaging results in clinically significant outcomes need to be elucidated as the effects of GLP-1RA on liver fibrosis are unclear; larger ongoing trials may provide more definitive answers. Protocol Registration: PROSPERO-CRD42023472186.

Association of Perioperative Glucagon-like Peptide-1 Receptor Agonist Use and Postoperative Outcomes

OBJECTIVE

To assess rates of surgical complications and postoperative readmission in diabetic patients with and without active perioperative prescriptions for glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications.

BACKGROUND

With the rapid growth of GLP-1 RA use in the United States, it is important to understand the potential effect of these drugs on surgical outcomes broadly.

METHODS

In this retrospective, observational cohort analysis, patients with a diagnosis of type 1 or type 2 diabetes undergoing a surgical procedure at a multicenter quaternary-care health care system between February 2020 and July 2023 were included. Propensity score matching was performed between procedures in patients with and without an active GLP-1 RA prescription. The primary outcome was 30-day readmission, and secondary outcomes were documented dehiscence, infection, hematoma, and bleeding within 180 days after surgery.

RESULTS

Among 74,425 surgical procedures in 21,772 patients included in the analysis, 27.2% were performed in the setting of an active GLP-1 RA prescription. In 13,129 patients [48.0% men, 52.0% women; median (interquartile range) age, 67 (57, 75)], 35,020 procedures were propensity score matched. After matching, the active GLP-1 RA prescription group had a significantly reduced risk of 30-day readmission [relative risk (RR): 0.883; 95% CI: 0.789-0.987; P = 0.028; number needed to treat (NNT): 219; 95% CI: 191-257], postoperative wound dehiscence (RR: 0.711; 95% CI: 0.577-0.877; P = 0.001; NNT: 266; 95% CI: 202-391), and postoperative hematoma (RR: 0.440; 95% CI: 0.216-0.894; P = 0.023; NNT: 1786; 95% CI: 652-2416). No significant differences were seen in rates of infection and bleeding.

CONCLUSIONS

An active perioperative GLP-1 RA prescription in patients with diabetes was associated with significant reductions in risk-adjusted readmission, wound dehiscence, and hematoma, and no difference in infection and bleeding rates. Further study is warranted to elucidate any causal association.

Beyond glycated haemoglobin: Modelling contemporary management of type 2 diabetes with the updated Cardiff model

AIMS

Recommendations on the use of newer type 2 diabetes (T2D) treatments (e.g., SGLT2 inhibitors and GLP-1 receptor agonists [RA]) in contemporary clinical guidelines necessitate a change in how T2D models approach therapy selection and escalation. Dynamic, person-centric clinical decision-making considers factors beyond a patient's HbA1c and glycaemic targets, including cardiovascular (CV) risk, comorbidities and bodyweight. This study aimed to update the existing Cardiff T2D health economic model to reflect modern T2D management and to remain fit-for-purpose in supporting decision-making.

MATERIALS AND METHODS

The Cardiff T2D model's therapy selection/escalation module was updated from a conventional, glucose-centric to a holistic approach. Risk factor progression equations were updated based on UKPDS90; the cardio-kidney-metabolic benefits of SGLT2i and GLP-1 RA were captured via novel risk equations derived from relevant outcomes trial data. The significance of the updates was illustrated by comparing predicted outcomes and costs for a newly diagnosed T2D population between conventional and holistic approaches to disease management, where the latter represents recent treatment guidelines.

RESULTS

A holistic approach to therapy selection/escalation enables early introduction of SGLT2i and GLP-1 RA in modelled pathways in a manner aligned to guidelines and primarily due to elevated CV risk. Compared with a conventional approach, only considering HbA1c, patients experience fewer clinical events and gain additional health benefits.

CONCLUSIONS

Predictions based on a glucose-centric approach to therapy are likely to deviate from real-world observations. A holistic approach is more able to capture the nuances of contemporary clinical practice. T2D modelling must evolve to remain robust and relevant.

Effectiveness and Safety of Oral Azvudine for Elderly Hospitalized Patients With COVID-19: A Multicenter, Retrospective, Real-World Study

Azvudine is recommended as a priority treatment for patients with Coronavirus Disease 2019 (COVID-19) during Omicron wave in China, but its efficacy and safety in elderly patients is unknown. In this multicenter, retrospective study, we identified 19763 elderly patients (aged over 60 years) with COVID-19 from nine hospitals in Henan Province, China. The primary outcome is all-cause death and the secondary outcome is composite disease progression. After propensity score matching, 4109 Azvudine recipients and 4109 matched controls is included, with average age of 75.15 years. Kaplan-Meier analysis reveales a notably survival and progression-free benefit in Azvudine treatment. The Cox analysis shows that compared with controls, Azvudine recipients have a 33% lower risk of all-cause death (95% confidence Interval (CI): 0.580-0.772, p < 0.001), but have no significant difference in composite disease progression (hazard ratio: 0.93, 95% CI: 0.833-1.046, p = 0.234). Subgroup analysis suggested Azvudine have a stronger protective effect in patients concomitant with antibiotics. Three sensitive analyses confirm the robustness of the findings. The safety of Azvudine in elderly patients is acceptable. These findings indicate that Azvudine therapy can reduce the rate of all-cause death in hospitalized elderly patients with COVID-19, and without obvious adverse events.

Elevated urinary fatty acid-binding protein 4 level predicts future renal dysfunction and poor prognosis in Japanese patients with diabetes: a longitudinal cohort study

Background

Fatty acid-binding protein 4 (FABP4) is an adipokine secreted from adipocytes and macrophages and is also expressed in injured, but not normal, glomerular endothelial cells. Elevated levels of urinary FABP4 (U-FABP4) have been reported to be associated with glomerular damage and increased proteinuria.

Methods

The associations of levels of U-FABP4 at baseline with future events including renal dysfunction defined by a 30% decline in estimated glomerular filtration rate (eGFR) and all-cause death were investigated in 660 patients with diabetes (type 1/2, 57/603).

Results

During a follow-up period (median: 62 months), 90 patients (13.6%) developed renal dysfunction, and 66 patients (10.0%) died (median follow-up period 65 months). Kaplan-Meier survival curves showed that there were significant differences in cumulative incidences for a 30% decline in eGFR and all-cause death in patients divided by the tertiles of U-FABP4 level. Furthermore, multivariable Cox proportional hazard models with a restricted cubic spline showed that hazard ratios for a 30% decline in eGFR and all-cause death increased with a higher level of logarithmically transformed (log) U-FABP4 after adjustment for age, sex, type of diabetes, body mass index, current smoking habit, duration of diabetes, comorbidities of hypertension and dyslipidemia, eGFR, and the categorical classification of urinary albumin-creatinine ratio. The addition of log U-FABP4 to traditional risk factors significantly increased the discriminatory capacities for renal dysfunction in net reclassification improvement and integrated discrimination improvement and for all-cause death in NRI.

Conclusion

U-FABP4 is a predictive biomarker for future renal dysfunction and poor prognosis in patients with diabetes.

Neuroendocrine tumors and diabetes mellitus: which treatment and which effect

Diabetes mellitus (DM) and neuroendocrine tumors (NET) can exert unfavorable effects on each other prognosis. In this narrative review, we evaluated the effects of NET therapies on glycemic control and DM management and the effects of anti-diabetic therapies on NET outcome and management. For this purpose, we searched the PubMed, Science Direct, and Google Scholar databases for studies reporting the effects of NET therapy on DM as well as the effect of DM therapy on NET. The majority of NET treatments appear to impair glycaemic control, both inducing hypoglycemic or, more commonly, hyperglycemia and even new-onset DM. However, glucose metabolism imbalance can be effectively managed by modulating anti-diabetic therapy and adopting an appropriate nutritional approach. On the other hand, the effects of anti-diabetic treatment, like insulin, sulfonylureas, thiazolidinediones, ipeptidyl-peptidase-4 inhibitors, Glucagon-like peptide-1 receptor agonists, and Sodium-glucose cotransporter-2 inhibitors on NET are unclear. Recently, metformin has been investigated in patients with gastroenteropancreatic NET resulting in improved progression free survival suggesting a potential antineoplastic role. Finally, the management of DM in patients with NET is of great clinical relevance to correctly perform radiological procedures and even more functional imaging procedures, as well as to optimize the therapy and avoid treatment withdrawal or discontinuation. In conclusion, understanding the mechanisms underlying therapy-induced DM and implementing appropriate monitoring and management strategies of DM are essential for optimizing NET patient outcome and quality of life.

Identification of Risk Factors and Predictive Indicators for Tigecycline-Associated Hypofibrinogenemia

To investigate the prevalence, clinical manifestations, and risk factors of hypofibrinogenemia after tigecycline use, which can disrupt coagulation and potentially hinder antimicrobial therapy. This observational study was conducted from January to December 2021 at a tertiary general hospital in China. All patients over 18 years old who received tigecycline for more than 48 h were included. After treatment with tigecycline, patients were divided into two groups based on fibrinogen plasma concentrations of less than 2.0 g/L. Multivariable logistic regression was performed to identify risk factors for hypofibrinogenemia associated with tigecycline. A total of 50 patients (mean age 71.3 ± 20.2 years) were analyzed. The median duration of treatment was 8 days (range: 3 to 20 days). Among the 24 patients who developed hypofibrinogenemia, three gastrointestinal bleeding events were observed, and four of these patients required fibrinogen administration. We identified the total therapeutic dose (odds ratio (OR) = 15.28, 95% confidence interval (CI) 2.10-111.02, p = 0.01) and a baseline direct bilirubin level greater than 0.4 mg/dL (OR = 5.79, 95% CI 1.13-27.98, p = 0.04) as risk factors for tigecycline-induced hypofibrinogenemia. Conversely, a baseline fibrinogen level (OR = 0.53, 95% CI 0.29-0.97, p = 0.04) appeared to be a protective factor. Healthcare professionals should be aware that the administration of tigecycline may be associated with hypofibrinogenemia and severe adverse reactions. Regular monitoring of coagulation is essential, particularly for patients with liver dysfunction, low baseline fibrinogen levels, elevated baseline direct bilirubin levels, or those receiving higher total therapeutic doses.

Nutritional intake as a determinant of high-speed resistance and multicomponent training efficacy on strength in older women at risk of sarcopenia. A randomized clinical trial

BACKGROUND AND AIM

Despite advances in research on training and nutritional supplementation, it is largely unknown how micronutrient intake modulates the response to training in older adults. This study investigates the relationship between nutrient intake and response to training in older women at risk of sarcopenia.

METHODS

A randomized clinical trial with two parallel groups (high-speed resistance training (H-RT) and multicomponent training (MT)) was conducted over a 32-week intervention involving 80 older women at risk of sarcopenia (mean age: 77.36 ± 6.71 years). A food frequency questionnaire was administered to assess whether nutrient intake influenced strength outcomes measured by the Five Times Sit-to-Stand Test (5STS) and other functional variables.

RESULTS

Significant improvements in the five times sit to stand test (5STS) were observed in both groups post-intervention (p < 0.001), with no significant differences between them (p = 0.127), suggesting comparable effectiveness. In both groups, lower levels of vitamin B12 (H-RT: rp = -0.52; MT: rp = -0.50) and vitamin D (H-RT: rp = -0.55; MT: rp = -0.69) were associated with worse 5STS performance. Additionally, in the H-RT group, lower levels of vitamin E (rp = -0.36), magnesium (rp = -0.48), iron (rp = -0.43), and potassium (rp = -0.47) were also correlated with poorer performance.

CONCLUSIONS

The results indicate that improvements in strength are related to micronutrient sufficiency rather than macronutrient sufficiency. Deficiencies in vitamin D and B12 negatively impacted muscle strength gains in both H-RT and MT, while vitamin E, potassium, magnesium, and iron influenced H-RT outcomes. The lesser effect of micronutrient deficiencies on MT suggests it may be more suitable for individuals with mild deficiencies, as it requires fewer specific nutrients for muscle strength.

REGISTRATION

The study is registered at ClinicalTrials.gov under the identifier NCT05870046.

The association between sedentary lifestyle and the prevalence of sarcopenia with the mediation role of systematic inflammation index, 25-hydroxyvitamin D, and testosterone: A nationwide cross-sectional study

BACKGROUND

While there is some evidence of the association between sedentary behavior and sarcopenia risk, it remains unclear whether systematic inflammation index (SII), 25(OH)D, and testosterone can mediate this association. This study aims to investigate whether sedentary behavior is associated with the prevalence of sarcopenia in the US population and further examine its potential mediators which have not been thoroughly explored, thereby presenting a novel approach to understanding the mechanism between sedentary behavior and sarcopenia.

METHODS

We conducted a cross-sectional study involving a representative sample of the US national population of 9902 adults aged 18 years or older from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. The participants with sarcopenia were identified by Dual-energy X-ray (DXA) absorptiometry. Weighted multivariable logistic regressions based on the complex survey designs were used to explore the associations between a sedentary lifestyle and the risk of sarcopenia and restricted cubic spline (RCS) regression was used to examine the non-linear association. Causal mediation analysis using the quasi-Bayesian Monte Carlo method was applied to identify the mediating role of SII, 25(OH)D, and testosterone as potential mediators.

RESULTS

A total of 358 participants (3.6 %) had sarcopenia. Compared to those in the lowest quartile of sedentary time, participants in the highest quartile had a hazard ratio of 1.631 (95 % CI: 1.162 to 2.289) for the prevalence of sarcopenia. A non-linear relationship (P for non-linearity <0.001) between sedentary time and the risk of sarcopenia was observed using the RCS method. The odds ratio for sarcopenia was highest (OR = 3.427) when the sedentary time was 1080 min daily. Furthermore, SII, 25(OH)D, and testosterone showed a significant mediation in the association between sedentary time and sarcopenia risk, with a mediation effect of 3.39 %, 10.3 %, and 8.56 %, respectively.

CONCLUSIONS

This study demonstrated novel findings of the association between sedentary behavior and sarcopenia in the US population. Our study found that sedentary time was associated with the prevalence of sarcopenia. Vitamin D, SII, and testosterone served as mediating factors in the association of sedentary time with the risk of sarcopenia.

Unravelling exosome paradigm: Therapeutic, diagnostic and theranostics application and regulatory consideration

In the recent decade, extracellular vesicles (EVs) have been released from nearly all the kingdoms, modulating intercellular communication and maintaining the human body's homeostasis by regulating different cellular processes. Among EVs, exosomes are the emerging field in biopharmaceuticals. They have lipid bilayer ranging from 30 to 150 nm in size and encompass DNA, RNA, protein lipids, etc. Their sources are widespread, easy to acquire, and cost-effective in manufacturing. This review focuses on the detailed classification of exosomes existing in nature, knowledge and application of omics, therapeutic, diagnostic and theranostic application of exosomes. It covers diseases such as cancer, infectious diseases (viral, bacterial, fungal infections), neurodegenerative diseases, metabolic diseases, lifestyle diseases (diabetes, cardiovascular, gastric disorder (IBD)), autoimmune disorders and their biodistribution. This article unfolds the recent progress in the exosomes arena and covers all the regulatory considerations (FDA, EMA, and other nations) involved with it. Moreover, a detailed discussion about clinical trials and its manifestation with exosomes and challenges associated with their isolation procedures, reproducibility, and safety concerns.

HD6277 Suppresses Muscle Atrophy by Promoting Myogenic Factors and Inhibiting Proteolysis in Aged Mice

BACKGROUND

G protein-coupled receptor 40 (GPR40) acts as a modulator of various physiological functions, including glycaemic lowering, anti-inflammation and antioxidative stress, in several tissues. However, the role of GPR40 in skeletal muscles remains unclear.

METHODS

To investigate the roles of muscle GPR40, C2C12 myoblasts and myotubes were stimulated with palmitate and HD6277, a GPR40 agonist. Muscle strength and myofiber thickness were measured in obese and aged mice fed HD6277.

RESULTS

In C2C12 myoblasts, the addition of HD6277 induced phosphorylated Akt levels and expression of the myogenic factors, myogenin (MyoG), myocyte enhancer factor 2C (Mef2c) and myosin heavy chain (MyHC, p < 0.05). These changes resulted in accelerated muscle differentiation from myoblasts to myotubes (MyHC-positive area +56.52%; myotube width +34.08% vs. Veh, p < 0.05). In C2C12 myotubes, a palmitate-mediated decrease in the phosphorylation of forkhead box protein O1A (FOXO1A) and increase in the expression of E3 ubiquitin ligases, atrogin-1 and muscle RING-finger protein 1 (MuRF1) were reversed by HD6277 (p < 0.05). Additionally, HD6277 inhibited palmitate-induced apoptotic events such as the Bcl-2 (Bcl2)-associated X protein (Bax)/Bcl-2 ratio, caspase 3 cleavage and nuclear fragmentation in C2C12 myoblasts and myotubes (p < 0.05). These beneficial HD6277-mediated actions disappeared after the addition of an Akt inhibitor (p < 0.05). Similar to in vitro studies, HD6277 administration in obese and aged mice increased myogenic factors and decreased E3 ubiquitin ligase expression and apoptotic events (p < 0.05). HD6277 increased muscle strength (+9.88% vs. Aged, p < 0.05) and myofiber thickness (+29.01% vs. Aged, p < 0.05) in aging mice but only improved myofiber thickness (+11.84% vs. HFD, p < 0.05) in obese mice.

CONCLUSION

HD6277 can increase myogenic factors and reduce E3 ligase-mediated proteolysis to inhibit muscle atrophy in aged mice. Our results suggest that GPR40 agonists may have potential as therapeutic agents for sarcopenia.

Renin angiotensin system-induced muscle wasting: putative mechanisms and implications for clinicians

Renin angiotensin system (RAS) alters various mechanisms related to muscle wasting. The RAS system consists of classical and non-classical pathways, which mostly function differently. Classical RAS pathway, operates through angiotensin II (AngII) and angiotensin type 1 receptors, is associated with muscle wasting and sarcopenia. On the other hand, the non-classical RAS pathway, which operates through angiotensin 1-7 and Mas receptor, is protective against sarcopenia. The classical RAS pathway might induce muscle wasting by variety of mechanisms. AngII reduces body weight, via reduction in food intake, possibly by decreasing hypothalamic expression of orexin and neuropeptide Y, insulin like growth factor-1 (IGF-1) and mammalian target of rapamycin (mTOR), signaling, AngII increases skeletal muscle proteolysis by forkhead box transcription factors (FOXO), caspase activation and muscle RING-finger protein-1 transcription. Furthermore, AngII infusion in skeletal muscle reduces phospho-Bad (Ser136) expression and induces apoptosis through increased cytochrome c release and DNA fragmentation. Additionally, Renin angiotensin system activation through AT1R and AngII stimulates tumor necrosis factor-α, and interleukin-6 which induces muscle wasting, Last but not least classical RAS pathway, induce oxidative stress, disturb mitochondrial energy metabolism, and muscle satellite cells which all lead to muscle wasting and decrease muscle regeneration. On the contrary, the non-classical RAS pathway functions oppositely to mitigate these mechanisms and protects against muscle wasting. In this review, we summarize the mechanisms of RAS-induced muscle wasting and putative implications for clinical practice. We also emphasize the areas of uncertainties and suggest potential research areas.

Activating Striatal Parvalbumin Interneurons to Alleviate Chemotherapy-Induced Muscle Atrophy

BACKGROUND

Cisplatin is a widely used chemotherapeutic agent for treating solid tumours. Still, it induces severe side effects, including muscle atrophy. Understanding the mechanisms of cisplatin-induced muscle loss and exploring potential therapeutic strategies are essential. Parvalbumin (PV) interneurons in the striatum play a crucial role in motor control, and recent studies suggest that their activation may alleviate motor deficits. This study investigates the effects of chemogenetic activation of PV interneurons on cisplatin-induced muscle atrophy and motor dysfunction in mice.

METHODS

Wild-type C57BL/6 mice and transgenic hM3Dq mice were used in this study. Cisplatin (3 mg/kg) was administered intraperitoneally for 7 days to induce muscle atrophy. Mice were then treated with clozapine-n-oxide (CNO) to activate PV interneurons. Muscle strength and endurance were assessed using grip strength measurements, the inverted grid test and the wire hang test. Neuromuscular junction (NMJ) integrity was examined via histological analysis. Exercise intervention was also included, using a treadmill with a 15° incline for 60 min at varying speeds during seven consecutively days.

RESULTS

Cisplatin treatment significantly reduced body weight (p < 0.001), grip strength (forelimb strength: p < 0.001, four-limb strength: p < 0.001), endurance (inverted grid test: p = 0.047, wire hang test: p = 0.014) and NMJ integrity (partially innervated NMJs: p = 0.0383). PV interneuron activation with CNO improved spontaneous motor activity in cisplatin-treated mice, as evidenced by a significant increase in total travel distance (p = 0.049) in the open-field test. Histological analysis showed a reduced ratio of partially innervated NMJs in the PV-cre group compared to the control virus group (p = 0.0441). Muscle strength also improved significantly, with forelimb grip strength increased (p < 0.001) and four-limb grip strength increased (p = 0.018). Muscle wet-weight ratios were significantly higher in the PV-cre group (quadriceps: p = 0.030). Exercise intervention significantly improved grip strength (forelimb: p < 0.001, four-limb: p = 0.002), muscle endurance (four-limb hang test: p = 0.048) and muscle weight (quadriceps: p = 0.015, gastrocnemius: p = 0.022), with an increase in muscle fibre cross-sectional area (p = 0.0018).

CONCLUSION

Activation of PV interneurons significantly alleviates cisplatin-induced motor deficits and muscle atrophy by improving spontaneous motor activity, NMJ integrity and muscle function. It has a similar effect to short-term exercise and may offer a promising therapeutic strategy for mitigating chemotherapy-induced muscle atrophy.

Clinical Characteristics of SARS-COV-2 Omicron Variant in Acute Myeloid Leukemia and Acute Lymphocytic Leukemia Patients: A Multi-Center Retrospective Study

BACKGROUND

The death rate of hematological malignancies is high, and the death rate of patients with COVID-19 infection is further increased. Although there have been expert consensus and relevant guidelines to introduce the recommendations of the guidelines for patients with hematological malignancies complicated with COVID-19 infection, there is limited understanding of the clinical characteristics of Chinese patients with acute leukemia complicated with COVID-19 infection.

AIMS

This study aimed to analyze the clinical manifestations, mortality, and determinants of viral shedding duration in Chinese AL patients infected with COVID-19.

METHODS

We conducted a retrospective study of 100 AL patients with COVID-19 infection in Henan Province, China, from December 1, 2022, to January 31, 2023. Data on demographics, leukemia subtype, symptoms, treatments (antibiotics/antivirals), and viral shedding duration were collected. Follow-up was conducted over three months to assess mortality. Univariate and multivariate analyses were performed to identify risk factors.

RESULTS

The median age was 49.5 years (58% male, 42% female), with 76% having acute myeloid leukemia (AML) and 24% acute lymphoblastic leukemia (ALL). Most patients (86%) were asymptomatic. Antibiotics and antivirals were administered to 35% and 25% of patients, respectively. Severe cases and fatalities exhibited prolonged viral shedding. Neutropenic patients on antibiotics had significantly extended shedding duration, whereas antiviral therapy or delayed primary disease management shortened it. The overall mortality rate was 6%. Univariate analysis identified neutropenia as a key mortality risk factor, though multivariate analysis showed no significant associations.

CONCLUSION

Early antiviral treatment may reduce viral shedding duration and potentially mitigate symptom severity and mortality in AL patients with COVID-19. Neutropenia emerged as a critical factor influencing outcomes. These findings underscore the importance of tailored therapeutic strategies for this high-risk population.

Effectiveness and Safety of Pharmacologic Therapies for Migraine in the Emergency Department: A Systematic Review and Bayesian Network Meta-analysis

STUDY OBJECTIVE

We performed a systematic review and Bayesian network meta-analysis to determine which pharmacologic therapies are relatively more effective and safer for migraine in adult patients who present to the emergency department (ED).

METHODS

We searched MEDLINE, Embase, and Web of Science from inception to February 9, 2024. Eligible studies were randomized controlled trials that enrolled adult participants presenting to ED with migraine and compared one pharmacologic therapy to another or placebo. Outcomes were as follows: 1) adequate pain relief at 2 hours, 2) change in pain intensity at 1 hour, 3) need for rescue drug at 2 hours, and 4) significant adverse reaction. We extracted data according to PRISMA-network meta-analysis and appraised trials using Cochrane RoB 2. For dichotomous outcomes, we performed Bayesian network meta-analysis to calculate odds ratios with 95% credible intervals; for continuous outcomes, we performed frequentist network meta-analysis to calculate mean differences with 95% confidence intervals. We assessed confidence using Confidence in Network Meta-analysis. We used Surface under the cumulative ranking curve (SUCRA) to rank agents.

RESULTS

Chlorpromazine intravenous (IV)/intramuscular (IM) (SUCRA=87.3%) was most likely to be superior for "adequate pain relief at 2 hours" (24 trials; n=2,361); metoclopramide IV-ibuprofen IV (SUCRA=94.6%) was most likely to be superior for "need for rescue drug" (not needing rescue drug) at 2 hours (27 trials; n=2,942); dexamethasone IV (SUCRA=79.5%) was most likely to be superior for "significant adverse reaction" (not causing adverse reaction) (22 trials; n=2,450). The network for change in pain intensity demonstrated statistically significant incoherence at the overall level. Confidence in network meta-analysis estimates (certainty of evidence) varied and was mostly "low" or "very low," limiting the validity of the probabilistic analyses.

CONCLUSIONS

According to Bayesian network meta-analysis, ibuprofen IV is definitely among the least effective for adequate pain relief; chlorpromazine IV/IM is definitely among the most effective; valproate IV is definitely among the least effective, and ketorolac IV/IM is possibly among the least effective as single agents. The relative safety of the pharmacologic therapies cannot be determined with sufficient certainty.

Collagen peptides alleviate hyperglycemia in mice by modulating insulin resistance, glucose metabolism and gut microbiota

In vitro studies have demonstrated that collagen peptides (CP) inhibit the activity of dipeptidyl peptidase-IV. However, the relationship between the AMPK-mediated insulin signaling pathway and gut microbiota modulation in Type 2 Diabetes Mellitus (T2DM) remains underexplored. Current research investigated the hypoglycemic mechanisms associated with CP intervention in a T2DM mouse model induced by a high-fat diet and streptozotocin (STZ). The findings revealed that administering CP (400 mg/kg/day) for 4 weeks significantly eased symptoms such as polydipsia, polyphagia, weight loss, and organ damage in diabetic mice. Following CP intervention, diabetic mice exhibited notable reductions in blood glucose and lipid levels, as well as decreased abundance ratios of Firmicutes and Bacteroides, whereas increased short-chain fatty acid concentration in the gut microbiota and the serum GLP-1 level, accompanied by a substantial decrease in the serum insulin resistance index. Furthermore, in the livers of mice post-CP intervention, there was an upregulation of IRS1, the increase of p-AMPK/AMPK and p-GSK3β/GSK3β (P < 0.01), coupled with downregulation of PEPCK and FoxO1 expression (P < 0.05), thereby facilitating glycogen synthesis, regulation of insulin sensitivity, and inhibition of glucose production. These results provide foundational insights into the potential of collagen peptide intervention in managing and preventing T2DM.

BMI and sex disparity in uric acid level improvement in patients with obesity and diabetes following laparoscopic sleeve gastrectomy

BACKGROUND

The potential improvement in uric acid (UA) levels following laparoscopic sleeve gastrectomy (LSG) in patients with obesity and type II diabetes mellitus (T2DM) has not been systematically studied. Our aim was to investigate the influencing factors of UA level improvement following LSG and its correlation with glucose metabolism and lipid metabolism.

METHODS

A total of 392 patients with obesity and T2DM were prospectively recruited from 1 November 2022 to 31 December 2023. All patients underwent LSG surgery and were followed at 1, 2, 3, 6, 12 months after surgery. The presurgical and postsurgical levels of body-mass index(BMI), UA and indicators of glucose metabolism and lipid metabolism were recorded.

RESULTS

Distinct UA improvement was observed between males and females and among different BMI groups following LSG. Female patients exhibited more sustained and greater recovery of UA level up to 12 months than male patients in all BMI groups, although male patients showed a sharper UA level decrease in the first two months. Furthermore, patients with BMI ≥ 37.5 appeared to have significantly greater UA level decrease than other patients up to 12 months. UA level improvement showed significant correlation with BMI improvement in all three BMI groups in females while only in BMI 28-32.5 group in males. For glucose metabolism, a significant linear correlation between UA level changes and fasting blood glucose (FBG), fasting blood insulin (FBI), glycosylated hemoglobin A1c (HbA1c) and C-peptide (CP) was found in patients with presurgical elevated UA level group, and in female patients for FBI and CP. For lipid metabolism, a significant linear correlation was only observed between UA level changes and HDL in female and those with high presurgical UA levels.

CONCLUSIONS

Sex and presurgical BMI appeared to influence the UA improvement following LSG. Females and those with presurgical elevated UA levels exhibited the most significant UA level alleviation. UA level changes also correlated with glucose metabolism and lipid metabolism.

Comparative effects of different beverages on weight loss in adults: a systematic review and network meta-analysis of randomized trials

BACKGROUND

There is a lack of clarity on the comparative effects of different beverages on weight loss in adults.

OBJECTIVE

This study aimed at quantifying and ranking the effects of different beverages on weight loss.

METHODS

We searched PubMed, Scopus, and Web of Science up to January 2023. We included randomized trials evaluating the comparative effects of two or more beverages, or compared a beverage against a control group (water, no intervention), for weight loss in adults. We conducted a random-effects network meta-analysis (NMA) with a Bayesian framework to estimate mean difference [MD] and 95% credible interval [CrI].

RESULTS

In total, 78 randomized trials with 4168 participants were eligible. Low/no-calorie sweetened beverages (LNCSB) was effective for weight loss compared with water (MD: -0.79 kg, 95% CrI: -1.35, -0.18), milk (MD: -0.80 kg, 95% CrI: -1.59, -0.01), fruit juice (MD: -0.83 kg, 95% CrI: -1.47, -0.13), sugar-sweetened beverages (SSB) (MD: -1.08 kg, 95% CrI: -1.65, -0.50), and no intervention (MD: -1.19 kg, 95% CrI: -1.93, -0.41). However, in sensitivity analyses, no significant effect was seen in trials with a low risk of bias and those that implemented calorie restriction. LNCSB drinking was effective for waist circumference reduction compared with water (MD: -1.85 cm, 95% CrI: -3.47, -0.22). The certainty of evidence from most comparisons was rated low.

CONCLUSIONS

This study suggested evidence of low certainty that intake of LNCSBs can result in a small weight loss when used as a substitute for other beverages. Considering the low certainty of evidence, more research is needed to compare the effects of different beverages on body weight.

TRIAL REGISTRATION

Not applicable, but the protocol of this systematic review was registered at PROSPERO (registration number: CRD42023407937).

Whey Protein Supplementation in Older Adults With Type 2 Diabetes Undergoing a Resistance Training Program: A Double-Blind Randomized Controlled Trial

BACKGROUND/OBJECTIVE

This study aims to analyze the effect of whey protein (WP) supplementation on glycemic control, muscle strength, quality of life, and body composition in older adults with non-insulin-dependent diabetes undergoing a resistance training program.

METHODS

A double-blind, placebo-controlled, randomized study was carried out with older adults with Type 2 diabetes. Body composition, food intake, muscle strength, glycemic profile, markers of renal function, cardiopulmonary capacity, and quality of life were evaluated. Older adults were randomized into a supplementation group with 33 g of WP consumed twice a week on days of resistance training for 12 weeks supplemented group and a placebo group.

RESULTS

In total, 39 older adults were randomized into two groups, 19 in the supplement group and 20 in the placebo group. Both groups showed improvement in muscle strength, with the WP group failing to exceed that of the control group. WP supplementation slightly increased blood urea compared with the placebo group (p = .05), but values remained within normal limits. The group that used WP showed a small improvement in mental health, according to the 12-Item Short-Form Health Survey questionnaire, but without clinically important improvements.

CONCLUSION

Both groups showed improvements in muscle strength and mass, regardless of supplementation, showing that resistance exercises performed twice a week can contribute to the nonprogression of sarcopenia in older adults with Type 2 diabetes. More studies are needed to determine the safe and effective amount of supplementation to improve muscle strength without renal impairment in older adults with diabetes.

Effects of residual inflammatory and cholesterol risks on cardiovascular events with evolocumab in patients with acute coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND

Evolocumab has shown significant reductions in low-density lipoprotein cholesterol (LDL-C) levels and incident cardiovascular events among acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Nonetheless, the potential modification of evolocumab's effectiveness by baseline inflammatory risk remains unclear. We aimed to assess evolocumab's effectiveness based on baseline neutrophil-to-lymphocyte ratio (NLR) and evaluate residual inflammatory and cholesterol-related risks across varying on-treatment NLR and LDL-C levels.

METHODS

This multicentric, retrospective analysis enrolled consecutive patients with ACS undergoing PCI and exhibiting elevated LDL-C at the First Affiliated Hospital of Zhengzhou University and Zhongda Hospital Southeast University between March 2019 and August 2021. Patients were categorized into evolocumab and standard-of-care treatment groups based on evolocumab administration. Hazard ratios for the primary composite outcome-including myocardial infarction, ischemic stroke, cardiac death, unplanned coronary revascularization, and hospitalization due to unstable angina-comparing baseline NLR quartiles were computed using multivariable Cox regression. We assessed evolocumab's impact on the primary outcome across median-based NLR dichotomization and evaluated the outcome across 1-month NLR and LDL-C levels.

RESULTS

The median baseline NLR was 2.99 (IQR: 2.14-4.69), remaining stable following evolocumab therapy. Each NLR quartile increase heightened the risk of primary outcome by 29% (95% CI, 17-42%; P < 0.01). The relative risk reductions with evolocumab were consistent across NLR categories (P-interaction > 0.05), but absolute risk reductions were higher in high-NLR patients (2.9% vs. 6.2%). Residual inflammatory and cholesterol risks, indicated by on-treatment NLR and LDL-C, independently correlated with the primary outcome (P < 0.001).

CONCLUSIONS

Higher baseline NLR is associated with increased cardiovascular risk in ACS/PCI patients. Relative risk reductions with evolocumab were consistent across NLR categories, while absolute risk reductions were more significant in high-NLR patients. Minimized risk is observed in patients with the lowest on-treatment NLR and LDL-C levels.

Adherence to exercise intervention for community-dwelling older adults with sarcopenia: a systematic review and meta-analysis

BACKGROUND

Exercise is a highly recommended nonpharmacological intervention for older adults with sarcopenia. Poor exercise adherence is a main factor affecting treatment efficacy. However, evidence for overall adherence to exercise and intervention characteristics affecting adherence in this population remains unknown.

OBJECTIVE

To determine whether community-dwelling older adults with sarcopenia adhere to exercise programmes, what intervention components are used to improve adherence and how adherence relates to intervention characteristics and efficacy.

METHODS

Seven electronic databases and relevant systematic reviews were searched to identify randomised controlled trials (RCTs). The capability, opportunity, motivation and behaviour model with behaviour change techniques (BCTs) were used to categorise adherence intervention components. Random-effects meta-analysis and meta-regression analyses were employed.

RESULTS

Seventeen RCTs with 2975 participants were included in this review. The pooled estimate of adherence rates for exercise interventions amongst older adults with sarcopenia was 85% (95% CI: 0.79-0.89, range: 71%-100%). Nine BCTs were identified from the included studies. Exercise with programme durations (<24 weeks) (P = 0.01) might be associated with higher adherence rates compared with programme durations (≥24 weeks). However, exercise adherence was not associated with intervention efficacy.

CONCLUSION

Adherence to exercise interventions in community-dwelling older adults with sarcopenia is relatively high and may be affected by programme duration. Most studies incorporated only a small number of BCTs into their exercise interventions. Such an approach may be insufficient to enhance adherence in this population effectively. Future studies with theory-informed interventions to improve adherence in the field of exercise for older people with sarcopenia are needed.

Physical exercise for primary sarcopenia: an expert opinion

Sarcopenia is the age-related loss of skeletal muscle mass and function. Recently, research has focused on defining diagnostic criteria for this condition, now recognized as a muscle disease with a specific identifying code (ICD-10: M62.84). The diagnostic process for sarcopenia involves several stages, including the use of dedicated questionnaires and objective measurements of muscle strength and mass. According to international guidelines, therapeutic exercise is recommended to improve muscle mass, muscle strength, and physical performance. However, much of the supporting evidence comes from studies on non-sarcopenic elderly patients. Among types of therapeutic exercise, guidelines mainly emphasize muscle strengthening. The prescription of therapeutic exercise must consider the clinical and functional conditions of the patient (e.g., the presence of severe sarcopenia) and patient preferences. Muscle strengthening should target large muscle groups and include low-intensity resistance exercise for strength improvement, or high-intensity resistance exercise for additional benefits in muscle mass and function. Evidence suggests that an ideal therapeutic exercise program for sarcopenic patients should be multimodal, incorporating muscle strengthening, aerobic exercise, and balance control programs. This approach could enhance patient adherence by offering variety. Although multimodal therapeutic exercise improves muscle mass and function, these benefits can be lost during prolonged physical inactivity. Therefore, the exercise prescription must define intensity, volume (repetitions and sets), frequency, rest intervals, and duration, tailored to the type of exercise. Aerobic training programs improve endurance and optimize mitochondrial function. Balance training, important for reducing the risk of falls, should be done at least three times a week. Muscle strengthening should be done at least two days a week, starting at 50%-60% of 1 repetition maximum (RM) and progressing to 60%-80% of 1 RM, with approximately 10 exercises per session. Adopting comprehensive prescription protocols, such as those proposed in this paper, can significantly aid in the functional recovery and well-being of patients with sarcopenia.

Positive association between stress hyperglycemia ratio and ICU mortality in patients with pulmonary embolism: A retrospective study

BACKGROUND

Measurement of the Stress Hyperglycemia Ratio (SHR) aims to reduce the influence of prolonged chronic glycemic variables on stress hyperglycemia levels, which are associated with clinical outcomes. Nevertheless, the correlation between SHR and the risk of all-cause Intensive Care Unit (ICU) mortality in patients with pulmonary embolism(PE) remains unclear.

METHODS

Data for this retrospective study were o btained from the MIMIC IV2.2 database. The participants were divided into four groups based on the SHR quartiles. The primary outcome measured was 28-day ICU mortality. We employed Cox proportional hazards regression analysis and restricted cubic splines to evaluate the correlation between the SHR and clinical outcomes in patients with PE.

RESULTS

The study included 1185 patients, of which 53.3% were male. The rates of mortality observed in the ICU were 19.8%. By conducting multivariable Cox proportional hazards, it was determined that the SHR was independently associated with a heightened risk of 28-day ICU mortality (HR = 1.83 per 1-point increment, 95% CI = 1.07-3.13, p = 0.028).The analysis using restricted cubic splines showed that there was a consistent and gradually increasing risk of all-cause mortality as the SHR increased. This indicates that a higher SHR is associated with a higher risk of ICU mortality.

CONCLUSIONS

Elevated SHR was strongly linked to a higher risk of clinical outcomes in patients with PE. As an effective measure of stress hyperglycemia, SHR demonstrated superior performance in predicting risks compared to solely evaluating glycemia or HbA1c upon admission.

PTEN: A Novel Diabetes Nephropathy Protective Gene Related to Cellular Senescence

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD). The current diagnostic and therapeutic approaches need to be improved. Cellular senescence has been implicated in the pathogenesis of DN, but its precise role remains unclear. This study aimed to identify key pathogenic genes related to cellular senescence in DN and explore their potential as diagnostic biomarkers. Using transcriptomic data from GEO datasets (GSE96804, GSE30122, GSE142025, and GSE104948) and cellular senescence-related genes sourced from the GenAge database, we integrated multiple bioinformatics approaches, including differential expression analysis, weighted gene co-expression network analysis (WGCNA), machine learning and protein-protein interaction (PPI), to identify diagnostic genes. PTEN was identified as a key diagnostic gene. Immune infiltration analysis revealed that PTEN expression is positively correlated with macrophage M2 and dendritic cell resting infiltration and negatively correlated with monocytes and neutrophils. snRNA analysis revealed that PTEN is mainly expressed in mesangial cells. Finally, RT-PCR results revealed that the mRNA expression of PTEN was upregulated in kidneys from db/db mice. Additionally, high-glucose treatment significantly upregulated PTEN expression in cultured human mesangial cells. This study identifies PTEN as a potential diagnostic biomarker for DN which may contribute to early detection and personalized therapeutic strategies.

Distinct Effects of Wheat and Black Bean Consumption on Postprandial Vascular Responses in People with Arterial Stiffness: A Pilot Randomized Cross-Over Study

Background/Objective: Postprandial vascular responses impact vascular health. This study investigated whether eating pulses or whole grains can acutely relax blood vessels in people with arterial stiffness. Methods: A single-blinded, controlled randomized cross-over clinical trial was conducted to compare the effects of pulses (¾ cup black beans) versus whole grains (¾ cup whole wheat kernels, also known as wheat berries) versus white rice (¾ cup) on postprandial vascular responses in males and females with established arterial stiffness (n = 9, 3M/6F, 50-64 years old). Peripheral and central hemodynamic measurements were obtained non-invasively prior to and 2 h after food consumption and were compared by t-test within a food type. Results: Peripheral and central systolic blood pressure was increased (4%) after eating white rice but not after the consumption of wheat or beans. A marked decline in augmentation index at 75 bpm (arterial stiffness) from 26.1 ± 3.6% to 16.2 ± 2.0% was observed 2 h after eating whole wheat but not beans or white rice. All foods slightly decreased heart rate at 2 h but had limited effects on other parameters of circulatory or heart health. Conclusions: Eating whole wheat or beans acutely improved overall vascular and heart health when compared to white rice. The effects of wheat and beans were distinct, with whole wheat having a major positive effect on blood vessel stiffness. The findings suggest that regular inclusion of both whole wheat and beans in the diet would be beneficial for improving cardiovascular health in persons exhibiting signs of arterial dysfunction, thus providing a potential therapeutic benefit for individuals who are at risk of heart attack and stroke. The study was registered (NCT05818358) on ClinicalTrials.gov.

Global cardiovascular disease burden attributable to high low-density lipoprotein cholesterol, 1990-2021: An age-period-cohort analysis of the global burden of disease study 2021

BACKGROUND AND AIMS

To deepen the understanding of global trends in the cardiovascular disease (CVD) burden attributed to high low-density lipoprotein cholesterol (LDL-C).

METHODS AND RESULTS

Utilizing data from the Global Burden of Disease study spanning from 1990 to 2021, an age-period-cohort analysis was conducted to evaluate global trends in mortality and disability-adjusted life years (DALYs) of CVD attributed to high LDL-C. Joinpoint regression analysis was employed to identify periods of the most significant changes. The findings indicate a significant increase in the global number of deaths from CVD linked to high LDL-C from 1990 to 2021. However, both the age-standardized mortality rate and DALYs rate exhibited a downward trend, with women experiencing a more pronounced decline than men. The age-standardized rate was lower in countries with higher Socio-demographic Index (SDI) compared to those with lower SDI. Notably, there were significant reductions in CVD mortality during the periods of 1994-1998 and 2003-2007.

CONCLUSION

This study underscores the critical role of high LDL-C as a risk factor in the global burden of CVD. Investigating gender differences, regional disparities, and variations among different age groups of CVD is essential for developing intervention strategies and health policies.

Nonleisure-time physical activity as a protective factor against sarcopenia in hemodialysis patients: a prospective cohort study

Objectives

Sarcopenia is prevalent among individuals undergoing maintenance hemodialysis (MHD) and is influenced by sedentary lifestyles. Although leisure-time physical activities have been shown to prevent sarcopenia in patients undergoing MHD, the impact of nonleisure-time physical activities on sarcopenia has not yet been examined in prospective studies.

Methods

This prospective cohort study, conducted in 2020 with a 12-month follow-up, included stable MHD patients without baseline sarcopenia. Sarcopenia was diagnosed according to the 2019 Asian Working Group for Sarcopenia criteria. Physical activity was assessed using the International Physical Activity Questionnaire. Additionally, demographic, dietary, nutritional, and laboratory data were collected. Modified Poisson regression analysis was employed to evaluate the impact of physical activity on the risk of developing sarcopenia.

Results

Among the 196 MHD patients who completed the 1-year follow-up, 29 (14.8%) developed sarcopenia. The average total physical activity was 1,268 METs/week, with leisure-time activity averaging 300 METs/week and nonleisure-time activity averaging 724 METs/week. Adjusted analyses indicate that leisure-time physical activities do not significantly affect the risk of sarcopenia (RR = 0.920, 95% CI = 0.477-1.951; P > 0.05), whereas nonleisure-time physical activities are significantly associated with a reduced risk of sarcopenia (RR = 0.449, 95% CI = 0.248-0.814).

Conclusion

Actively participating in physical activities (nonleisure-time physical activities) can reduce the incidence of sarcopenia in patients undergoing MHD. Promoting such activities may be an effective strategy to enhance physical fitness and mitigate sarcopenia risk among this population.

An Indian Consensus on Sarcopenia: Epidemiology, Etiology, Clinical Impact, Screening, and Therapeutic Approaches

The burden of sarcopenia in India continues to be of significant concern. Its diagnosis is challenging due to the lack of standardized cutoffs for assessing muscle strength, quantity, and function among Indians. This consensus aims to identify features of sarcopenia in Indians and provide culturally relevant recommendations for its management. An expert panel from diverse medical specialties across India arrived at a consensus using the modified Delphi method. The panel recommended that a baseline handgrip strength (HGS) cutoff value of <27.5 kg in males and 18.0 kg in females be defined as low muscle strength for the Indian population. All patients with comorbidities should be screened for sarcopenia. In people with sarcopenia, resistance exercise and nutrition with specialized nutrients such as protein, beta-hydroxy-beta-methylbutyrate (HMB), and micronutrients for at least 3 months were recommended as key interventions.

Advances in the study of the correlation between balanoposthitis and skin microecology

Balanoposthitis is a common heterogeneous skin condition involving the glans penis and prepuce, and is seen from infancy to old age. Its predisposing factors are intertrigo, lengthy foreskin, localized irritation, and mucosal injury. The itching and skin inflammation at the glans penis seriously affects the quality of life of patients. As a result of advances in high-throughput sequencing technology, the prepuce microbial colonization patterns and glans penis are now known better. Previous studies have shown that an imbalance of flora can cause balanoposthitis. This article summarizes the progress of research on balanoposthitis and skin microecology, and provides a direction for the subsequent exploration of immunological mechanisms in balanoposthitis.

Supplementation of mixed Lactobacillus alleviates metabolic impairment, inflammation, and dysbiosis of the gut microbiota in an obese mouse model

Introduction

Obesity is a complex metabolic disease, which is often accompanied with impaired glucose and lipid metabolism and chronic inflammation. Probiotics have been considered as a strategy for treating obesity, while the genus of Lactobacillus is the most commonly tested and approved probiotics. Some multi-strain probiotics were proven to produce synergistic effects on treating obesity as compared to mono-strain ones.

Methods

The purpose of this study was to investigate the anti-obesity effect of a new probiotic formation contained Lactobacillus plantarum L14, Lactobacillus paracasei L9, Lactobacillus rhamnosus GG, and Lactobacillus sakei X-MRS-2, designated as L-PPRS. Multi-strain probiotics L-PPRS was shown to have a better antiadipogenic effect than mono-strain probiotics in 3T3-L1 cell. Subsequently, L-PPRS was orally supplemented to a high-fat diet (HFD) induced obese mouse model for two kinds of treatment course, a short-term (8 weeks) one and a long-term (12 weeks) one.

Results

We found that intervention of L-PPRS not only significantly inhibited weight gain in HFD-fed mice, but also improved glucose tolerance, insulin sensitivity and reduced serum lipid levels. Furthermore, L-PPRS intervention reduced fat accumulation in the adipose tissue and the liver, and ameliorated the antioxidant capacity of liver in HFD-fed mice. L-PPRS intervention modulated the expression of lipid-metabolic genes, and exhibited excellent anti-inflammatory effect. In addition, L-PPRS intervention restored the dysbiosis of gut microbiota via reducing the Firmicutes/ Bacteroidetes ratio, and increasing the abundance of beneficial intestinal bacteria. In conclusion, this study proved that L-PPRS could effectively prevent the development of obesity and its associated abnormalities, and the long-term supplementation of L-PPRS provided a more profound benefit than the short-term.

Discussion

This study highlights the potential of L-PPRS as an effective anti-obesity strategy.