Efficacy and Safety of Risankizumab in Patients with Psoriatic Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

Currently, the cause of psoriatic arthritis (PsA) is unknown, and the effectiveness of current drug treatments is unsatisfactory. In March 2019, the US Food and Drug Administration (FDA) approved risankizumab, a humanized immunoglobulin G1 (IgG1) monoclonal antibody targeting the p19 subunit of interleukin (IL)-23, for the treatment of PsA in adults. This study aimed to conduct a meta-analysis of double-blind, randomized, placebo-controlled trials to evaluate the effectiveness and safety of risankizumab in moderate-to-severe PsA.

METHODS

We conducted a thorough search of relevant databases from the establishment of the databases to October 1, 2023. We conducted a meta-analysis using Stata 12.0 and utilized I2 and Egger tests to assess heterogeneity and publication bias among the studies. Bias assessment was performed using the risk bias map and bias risk summary diagram generated by Revman5.4 software. The review protocols were registered on PROSPERO (CRD42023451894) and adhered to the preferred reporting item of system evaluation (PRISMA) guideline.

RESULTS

Six randomized controlled trials (RCTs) involving 5038 patients with PsA treated with either risankizumab or placebo were included in the analysis. At 24 weeks, the risankizumab group demonstrated a significantly higher American College of Rheumatology-20 (ACR20) response rate compared to the placebo group (RR 1.760, 95% CI 1.568-1.977, P < 0.001). Additionally, the risankizumab group showed a significantly higher Minimal Disease Activity (MDA) response rate compared to the placebo group (RR 1.827, 95% CI 1.048-3.184, P < 0.05). The risankizumab group also exhibited improvement in Short Form 36 Questionnaire (SF-36) score (SMD 0.51, 95% CI 0.33-0.69, P < 0.001), with significantly lower Health Assessment Questionnaire Disability Index (HAQ-DI) score (SMD - 0.27, 95% CI - 0.37 to - 0.17, P < 0.001) and higher Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) score (SMD 0.27, 95% CI 0.20-0.35, P < 0.001) compared to the placebo group. Moreover, the risankizumab group had a significantly lower Psoriasis Area and Severity Index (PASI) score (SMD - 6.12, 95% CI - 10.02 to 2.23, P < 0.001). A study by Mease et al. indicated that patients receiving risankizumab generally demonstrated numerical improvements in the Leeds Enthesitis Index (LEI), although the small sample size limits the evidence. Further research is necessary to provide evidence-based guidelines. There were no significant differences in the incidence of serious adverse events (SAE) and serious treatment-emergent adverse events (STEAE) between the risankizumab and placebo groups (RR 0.76, 95% CI 0.45-1.28, P = 0.31; RR 0.99, 95% CI 0.49-1.99, P = 0.97, respectively), and the overall incidence of adverse events (AE) was not comparable (RR 1.10, 95% CI 0.63-1.94, P = 0.73).

CONCLUSION

Risankizumab showed superior efficacy across multiple outcome measures compared to placebo, with no significant increase in adverse events. Our findings endorse risankizumab as an excellent treatment option for PsA, offering valuable insights for clinicians and patients when choosing appropriate therapeutic interventions.

TRIAL REGISTRATION

Retrospectively registered (CRD42023451894, 16 August 2023).

Network pharmacology and molecular docking-based investigation on traditional Chinese medicine Astragalus membranaceus in oral ulcer treatment

To analyze the mechanism of Astragalus membranaceus (AM) in molecular level in the oral ulcer (OU) treatment with reference to network pharmacology. Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform database was used in screening the AM active components and AM action targets; GeneCards database was used to screen OU targets; the common target were screened by Venny online tool; Cytoscape software was applied to construct the target gene regulation map of AM active components; STRING database was used to construct the protein-protein interaction network and the key targets were screened as per degree value; gene ontology enrichment and KEGG pathway enrichment of interactive genes were calculated through David database. There were 17 active ingredients and 429 target spots in Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform database. There are 606 target genes for OU in GeneCards database. There are 67 common targets, including 10 key targets: IL10, IL6, TNF, IL1B, CXCL8, CCL2, TLR4, IL4, ICAM1, and IFNG. It involves 30 gene ontology terms and 20 KEGG signal channels. The molecular docking results showed that quercetin and kaempferol had a good binding activity with IL6, IL1B, TNF, and CCL2. Network pharmacological analysis shows that AM can regulate multiple signal pathways through multiple targets to treat OU.

[Labor progression characteristics of primiparous term singleton pregnant women complicated with adenomyosis]

Objective: To analyze the labor progression characteristics of primiparous term singleton pregnant women with adenomyosis. Methods: From April 2014 to May 2021, pregnant women underwent regular antenatal examination in Peking University Third Hospital were enrolled in this retrospective study, 109 primiparous term pregnant women with adenomyosis who underwent singleton, primipara, cephalic and vaginal delivery were referred as the adenomyosis group, while 109 pregnant women without adenomyosis primiparous term pregnant women at the same time were referred as the control group. The general clinical information, labor process intervention, pregnancy outcomes and labor course time of the two groups were analyzed. Results: (1) General clinical conditions: the pre-pregnancy uterine volume of the adenomyosis group was larger than that of the control group [(66.8±23.7) vs (41.4±13.1) cm³, P<0.05]. The proportion of assisted reproductive pregnancy and endometriosis in the adenomyosis group were higher than those in the control group [31.2% (34/109) vs 7.3% (8/109); 31.2% (34/109) vs 5.5% (6/109); all P<0.05]. There were no significant differences in maternal age, gestational age at delivery, pre-pregnancy body mass index, gestational weight gain, gravidity, incidence of pregnancy complications (gestational diabetes mellitus, pre-eclampsia and thyroid diseases) and premature rupture of membranes between the two groups (all P>0.05). (2) Labor process intervention and maternal and fetal outcomes: postpartum hemorrhage was higher in the adenomyosis group than the control group (median: 300 vs 260 ml, P=0.018). There were no significant differences in the proportion of labor onset, use of oxytocin, artificial rupture of membranes, perineal laceration Ⅲ and above, episiotomy, newborn weight and 1-minute Apgar score between the two groups (all P>0.05). (3) Time of labor process: there were no significant differences between the two groups in the time required for the first stage, third stage, total stage and cervical dilation 0-1, 1-2, 2-3, 3-4, 4-5, 5-6, 6-7 cm (all P>0.05). The time required for cervical dilation 7-8, 8-9, 9-10 cm and the second stage of labor in adenomyosis group (median: 20, 18, 15 and 12 minutes, respectively) were shorter than those of the control group (median: 23, 23, 23 and 26 minutes, respectively), and the differences were statistically significant (all P<0.05). (4) The effect of endometriosis on labor: there was no significant difference in the effect of endometriosis on labor in adenomyosis group (P>0.05). Conclusions: The labor process of primiparous term pregnant women with adenomyosis is significantly accelerated after the cervical dilatation for 7 cm, which should be closely observed. The third stage of labor course is managed aggressively with drugs to prevent postpartum hemorrhage.

[Application of mathematical models of infectious diseases in the evaluation of COVID-19 transmission risk at mass gatherings]

The SARS-CoV-2 Omicron variant is rampant in Europe and the United States, and the Delta variant has caused several small-scale outbreaks in China. It is particularly important to simulate the transmission risk of novel coronavirus pneumonia (COVID-19) during large-scale events, so as to ensure a good preparation of personnel, materials, isolation sites and other support work in advance. Taking the Beijing 2022 Winter Olympic Games as an example, this study introduces the use of mathematical models to simulate the entry risks, closed-loop risks and prevention and control measures of athletes, officials and other stakeholders of the Olympic Games. In the simulation results on January 19, 2022, the estimated number of Olympic Games-related infections who were identified at borders was 357 (95%CI: 153-568) and the observed number was 323. The estimated number of "seed" cases that entered the closed-loop of Olympics Games was 195 (95%CI: 43-335), and the observed number of cases in the closed-loop was 212. This study demonstrates the important role of mathematical models of infectious diseases in the pragmatic application of preventive medicine and public health.

[Detection of drug resistance genes of mycobacterium tuberculosis by rolling circle amplification technique with multicolor fluorescent probes]

The aim of this study was to construct a simple, rapid and ultra-sensitive optical biosensing technique based on rolling circle amplification (RCA), and to apply it to multiple detection of drug-resistant genes of mycobacterium tuberculosis. The common mutation sites of isoniazid, rifampicin and streptomycin resistance genes are katG315 (AGC➝ACC), rpoB531 (CAC➝TAC) and rpsL43 (AAG➝AGG). For these three gene sites, from February 2020 to May 2021, in the Department of Laboratory Medicine of the First Affiliated Hospital of Army Military Medical University, the padlock probe (PLP), primers and capture probes were designed. And a solid-phase RCA constant temperature amplification reaction system based on magnetic beads was constructed and the experimental parameters were optimized. The RCA products were accurately captured by the multicolor fluorescent probes (Cy3/Cy5/ROX), and the single-tube multiple detection of three mutation genes was realized. The sensitivity, specificity and linear range of this method were further verified. The results showed that the response range of katG315 in the same reaction system ranged from 1.0 pmol/L to 0.1 nmol/L. The response range of rpoB531 and rpsL43 ranged from 1.0 pmol/L to 50.0 pmol/L and 1.0 pmol/L to 20.0 pmol/L, and the method had good specificity and sensitivity, and could accurately identify single base mutations in mixed targets, with the minimum detection limit as low as 1.0 pmol/L. The recoveries of simulated serum samples were 95.0%-105.2%. In conclusion, the constant temperature amplification multiple detection method constructed in this study can quickly realize the single-tube multiple detection of three drug resistance mutation sites. This technology is low-cost, simple and rapid, and does not rely on large equipment, providing a new analysis method for pathogen drug resistance gene detection.

Controllable valley filter in graphene topological line defect with magnetic field

The extended line defect of graphene is an extraordinary candidate in valleytronics while the high valley polarization can only occur for electrons with high incidence angles which brings about tremendous challenges to experimental realization. In this paper, we propose a novel quantum mechanism to filter one conical valley state in the line defect of graphene by applying a local magnetic field. It is found that due to the movement of the Dirac points, the transmission profiles of the two valleys are shifted along the injection-angle axis at the same pace, resulting in the peak transmission of one valley state being reduced drastically while remaining unaffected for the other valley state, which induces nearly perfect valley polarization. The valley polarization effect can occur for all the incident angle and plays a key role in graphene valleytronics.

[2019-nCoV: new challenges from coronavirus]

The outbreak of pneumonia caused by the novel coronavirus 2019-nCoV in Wuhan, Hubei province of China, at the end of 2019 shaped tremendous challenges to China's public health and clinical treatment. The virus belongs to the β genus Coronavirus in the family Corornaviridae, and is closely related to SARS-CoV and MERS-CoV, causing severe symptoms of pneumonia. The virus is transmitted through droplets, close contact, and other means, and patients in the incubation period could potentially transmit the virus to other persons. According to current observations, 2019-nCoV is weaker than SARS in pathogenesis, but has stronger transmission competence; it's mechanism of cross-species spread might be related with angiotensin-converting enzyme Ⅱ (ACE2), which is consistent with the receptor SARS-CoV. After the outbreak of this disease, Chinese scientists invested a lot of energy to carry out research by developing rapid diagnostic reagents, identifying the characters of the pathogen, screening out clinical drugs that may inhibit the virus, and are rapidly developing vaccines. The emergence of 2019-nCoV reminds us once again of the importance of establishing a systematic coronavirus surveillance network. It also poses new challenges to prevention and control of the emerging epidemic and rapidly responses on scientific research.

Adherence to the 2006 American Heart Association's Diet and Lifestyle Recommendations for cardiovascular disease risk reduction is associated with bone mineral density in older Chinese

This cross-sectional study investigated the association between the modified 2006 American Heart Association Diet and Lifestyle Recommendations (AHA-DLR) and bone mineral density in Chinese adults. We found that better adherence to the AHA-DLR associated with higher bone mineral density (BMD) at multiple sites.

INTRODUCTION

Accumulating evidence shows that cardiovascular disease (CVD) and osteoporosis are associated with each other, yet little research has focused on whether strategies to reduce CVD risk could also benefit bone health. We aimed to assess the association between adherence to the modified 2006 American Heart Association Diet and Lifestyle Recommendations (AHA-DLR) and BMD in Chinese adults.

METHODS

We included 2092 women and 1051 men aged 40-75 years in this community-based cross-sectional study. Dietary information was assessed using a 79-item food frequency survey through face-to-face interviews at baseline (2008-2010) and 3 years later (2011-2013). Adherence to the AHA-DLR was assessed using modified diet and lifestyle scores (American Heart Association Diet and Lifestyle Score (AHA-DLS)) adjusted for bone health. BMD for the whole body, lumbar spine, total hip, femur neck, and trochanter sites was measured using dual-energy X-ray absorptiometry in 2011-2013.

RESULTS

After adjusting for potential covariates, greater adherence to the modified AHA-DLS was positively and dose-dependently associated with BMD. The mean BMD was 1.93-3.11% higher in quartile 4 (vs. 1) (all p values <0.01) at multiple sites. Five-unit increases in the modified AHA-DLS score were associated with 4.20-6.07, 4.44-8.51, and 3.36-4.67 mg/cm² increases in BMD at multiple sites for the total subjects, males, and females, respectively (all p values <0.01).

CONCLUSIONS

Better adherence to the AHA-DLR shows protective associations with BMD at multiple sites in the middle-aged and elderly Chinese population.

[Durability of protective effect of resin-based coating material on root surface]

OBJECTIVE

To compare the durability of resin-based root-surface coating material and all-in-one self-etching adhesive on root surface in vitro.

METHODS

Human extracted premolars or molars with intact roots were selected. The cementum was removed using a periodontal scaler to expose root dentin. The root surface was coated with an acid-resistant nail varnish, leaving a window of 3 mm×3 mm on the exposed dentin.The window was covered with either PRG Barrier Coat (PRG) or Clearfil S3 Bond (CS3). After water aging for 14 d, specimens were immersed in acid buffer at pH 4.5 for 4 d and the demineralization buffer was changed every 24 h. Then the specimen was split longitudinally through the center of the 'window' and the cross-sectional surface was observed with scanning electron microscope (SEM). After fixed and dehydrated, the prepared samples were coated with platinum. The coating material, root dentin and the interface was observed by scanning electron microscope (SEM). The thickness of the coating material was measured on the SEM images. Regarding toothbrush wear test, coronal dentindisks were prepared and covered with PRG and CS3, respectively. After storage in water for 24 h, the specimen was subjected to the toothbrush wear tester for 100, 200, 300, 500, 700, 1 500 brushing cycles. A slurry of fluoride toothpaste (1:2 ratio of toothpaste and deionized water by weight) was used and the brushing load was 300 N. The surface microstructure of remaining coating material was analyzed using SEM. The wear depths were determined by a profilometer. Statistical analysis was performed with SPSS 20.0 by one-way ANOVA. The level of significance was at 0.05.

RESULTS

Application of PRG Barrier Coat produced a coating layer of (47.1±27.3) μm, while CS3 presented a thin film of (5.7±2.1) μm in thickness. The exposed dentin was hermetically sealed and no obvious gap was observed at the interface in both PRG and CS3 groups. There was no dentin demineralization observed in both groups after water aging. The wear depths of PRG and CS3 increased along with the numbers of brushing cycles. PRG wore at a significant lower pace than CS3 did (P<0.05).

CONCLUSION

PRG coating resin had similar performances as CS3 on protecting root dentin from demineralization after water aging. What's more, PRG demonstrated a higher toothbrush wear resistance than CS3. We concluded that PRG Barrier Coat contained S-PRG filler may be an effective coating material for protecting exposed root from both chemical and mechanical challenges. Further studies should be carried out to evaluate the long-term reliability of the rootsurface coating materials under the clinical setting.

Disorder effect on the integer quantum Hall effect in trilayer graphene

We numerically investigate the disorder effect on the integer quantum Hall effect in a trilayer graphene (TLG) system by use of the Kubo formula. For a clean sample, both Bernal (ABA) and rhombohedral (ABC) stacked TLGs display the same quantum rule with abnormal quantized Hall plateaus σxy = νe(2)/h (ν =± 6, ± 10, ± 14,…) in the band center and normal quantized Hall plateaus at the band edges. In the presence of disorder, the Hall plateaus become obscure and the higher plateaus disappear first with the increase of the disorder; however, the Hall plateaus of the ABA-stacked TLG are destroyed more readily in comparison with the ABC-stacked one. The longitudinal conductance minimums of the system corresponding to the Hall plateaus become narrower and thinner with disorder, and those of the ABC-stacked TLG are comparatively more stable than those of the ABA structure. The findings indicate that the l = 3 chiral quasiparticles with cubic energy dispersion in ABC-stacked TLG have comparatively stronger immunity to the disorder than the l = 1 and 2 chiral quasiparticles in the ABA counterpart.

A phenomenological approach to the anisotropic magnetoresistance and planar Hall effect in tetragonal La(2/3)Ca(1/3)MnO3 thin films

A La(2/3)Ca(1/3)MnO(3) Hall bar with its long dimension roughly along the hard axis [110] was fabricated on a single-crystal-like tensilely strained film on SrTiO(3)(001). The anisotropic magnetoresistance (AMR) and planar Hall effect (PHE) have been studied at various external magnetic fields and temperatures. A phenomenological model in the high field limit is developed, and the galvanomagnetic tensor based on a tetragonal symmetry 4/mmm (D(4h)), applicable to epitaxial films on a substrate, has been obtained by expanding the tensor to the sixth order. The derived in-plane transverse resistance R(xy) shows a sin2φ(M) angular dependence, while the longitudinal R(xx) is constituted by not only a two-fold cos2φ(M) term, but also a four-fold cos4φ(M) term due to the square symmetry of the lattice. The model is in good agreement with the experimental results in high fields, while deviations are observed near the {100} easy axis with the decreasing field. Close inspection of the fitting parameters reveals the evolution of these term weights with temperature and magnetic field, which is distinct from conventional ferromagnetic metals and cannot be explained by the phenomenological model. An alternative mechanism for AMR, stemming from the magnetization-induced local orbit deformation through spin-orbit interaction, as previously proposed by O'Donnell et al, may be prevalent in manganites and other systems of complicated crystal structure.

Preparation, microstructure and hydrogen sorption properties of nanoporous carbon aerogels under ambient drying

Organic aerogels are prepared by the sol-gel method from polymerization of resorcinol with furfural. These aerogels are further carbonized in nitrogen in order to obtain their corresponding carbon aerogels (CA); a sample which was carbonized at 900 °C was also activated in a carbon dioxide atmosphere at 900 °C. The chemical reaction mechanism and optimum synthesis conditions are investigated by means of Fourier transform infrared spectroscopy and thermoanalyses (thermogravimetric/differential thermal analyses) with a focus on the sol-gel process. The carbon aerogels were investigated with respect to their microstructures, using small angle x-ray scattering (SAXS), transmission electron microscopy (TEM) and nitrogen adsorption measurements at 77 K. SAXS studies showed that micropores with a radius of gyration of <0.35 ± 0.07 to 0.55 ± 0.05 nm were present, and TEM measurements and nitrogen adsorption showed that larger mesopores were also present. Hydrogen storage properties of the CA were also investigated. An activated sample with a Brunauer-Emmett-Teller surface area of 1539 ± 20 m(2) g(-1) displayed a reasonably high hydrogen uptake at 77 K with a maximum hydrogen sorption of 3.6 wt% at 2.5 MPa. These results suggest that CA are promising candidate hydrogen storage materials.