Treatment outcomes amongst older people with HIV infection receiving antiretroviral therapy

OBJECTIVES

There is conflicting data regarding the response of older people with HIV (PWH) to antiretroviral therapy (ART). The objective of this study was to evaluate the long-term immunological and virological responses, changes in regimen, and adverse drug reactions (ADRs) in older participants (50+ years) compared with younger (18-34 years) and middle-aged (35-49 years) PWH.

METHODS

A retrospective review of medical records was conducted on 1622 participants who received ART in Yunnan Province, China, from 2010 to 2019. The study compared CD4+ T-cell counts, CD4+/CD8+ ratio, and relative numbers between different groups using the Kruskal-Wallis test. Cox proportional hazards regression models were used to identify variables associated with the occurrence of immune reconstitution insufficiency. The rates of immune reconstitution, incidence of ADRs, and rates of treatment change were analyzed using the chi-squared test or Fisher's exact test.

RESULTS

Over 95% achieved viral load 200 copies/ml or less, with no age-related difference. However, older participants exhibited significantly lower CD4+ T-cell counts and CD4+/CD8+ recovery post-ART (P < 0.001), with only 32.21% achieving immune reconstitution (compared with young: 52.16%, middle-aged: 39.29%, P < 0.001) at the end of follow-up. Middle-aged and elderly participants changed ART regimens more because of ADRs, especially bone marrow suppression and renal dysfunction.

CONCLUSION

Although the virological response was consistent across age groups, older individuals showed poorer immune responses and higher susceptibility to side effects. This underscores the need for tailored interventions and comprehensive management for older patients with HIV.

A new diterpenoid from the leaves and twigs of Croton lachnocarpus Benth

A new clerodane diterpenoid, crotolanin A (1), along with three known clerodane diterpenoids, crotoeurin B (2), teucvidin (3) and teucvin (4), was isolated from the ethanol extract of the leaves and twigs of Croton lachnocarpus Benth. Their structures were identified by extensive NMR spectroscopic and HRESIMS analyses. The dopaminergic neuroprotective activity of compounds 1-4 was tested by using transgenic Caenorhabditis elegans pathological model. Compound 2 alleviated dopaminergic neuron degeneration of worms induced by 6-hydroxydopamine (6-OHDA) that represented a potential therapy for Parkinson's disease (PD).

Zinc tungstate encapsulated into a scarce Zn(II)-viologen framework with photochromic, electrochromic and chemochromic properties

Smart chromic materials reacting to physicochemical stimuli are widely applied in optical switches, smart windows, and chemical sensors. Currently, most materials only respond to a single stimulus, but those that respond to multiple external stimuli are still in the minority. Herein, we report a novel porous zinc tungstate@metaloxoviologen framework [Zn3(Bcbpy)6(H2O)2]-[ZnW12O40]·6H2O (ZnW12@MV, H2BcbpyCl2 = 1,1'-bis(3-carboxybenzyl)-4,4'-bipyridinium dichloride), which shows multiple stimulus-responsive properties due to a combination of different functional motifs, namely, viologen electron acceptors, luminescent zinc-oxygen-clusters, porous cationic frameworks, and ZnW12O406- electron donors. Generally, the large-sized polyoxometalate (POM) anions serving as structure-directing agents can easily direct the formation of the oligomeric metaloxoviologen cations, mainly because POMs may break down some linkages leaving larger spaces for themselves. The large ZnW12O406- anions in ZnW12@MV are encapsulated into three-dimensional (3D) metaloxoviologen frameworks built up from the linkages of trinuclear zinc-oxygen clusters and Bcbpy viologens, which offer the first example of a 3D metaloxoviologen framework induced by large-sized POM anions. ZnW12@MV shows a reversible chromic response to X-ray/UV and electricity via different stimulus-induced electron transfers between electron-rich POM anions and electron-deficient metaloxoviologen frameworks, whereas the coloration changes are ascribed to the formation of radical and mixed-valence colored state ZnW12O406- species. The photochromic behavior is accompanied by photoluminescence quenching. The discriminative response to different-sized amines is attributed to the formation of viologen radicals through host-guest electron transfer. These results indicate that the multi-stimulus response ZnW12@MV can be applied in electrochromic devices, inkless erasable printing, and the detection of amines.

Ethyl caffeate attefnuates Aβ-induced toxicity in Caenorhabditis elegans AD models via the insulin/insulin-like growth factor-1 signaling pathway

The pathogenesis of Alzheimer's disease (AD), a multifactorial progressive neurodegenerative disease associated with aging, is unclear. Ethyl caffeate is a plant polyphenol that has been reported to have neuroprotective effects, but the mechanisms by which it acts are unclear. In this study, for the first time, we investigated the molecular mechanism of its anti-AD properties using the Caernorhabditis elegans model. The results of our experiments showed that ethyl caffeate delayed the paralysis symptoms of CL4176 to a different extent and reduced the exogenous 5-hydroxytryptophan-induced paralysis phenotype. Further studies revealed that ethyl caffeate lowered Aβ plaques and depressed the expression of Aβ monomers and oligomers, but did not influence the mRNA levels of Aβ. Moreover, it was able to bring paraquat-induced ROS levels down to near-standard conditions. Real-time quantitative PCR experiment showed a significant upregulation of the transcript abundance of daf-16, skn-1 and hsf-1, key factors associated with the insulin/insulin-like growth factor 1 (IGF-1) signaling pathway (IIS), and their downstream genes sod-3, gst-4 and hsp-16.2. It was further shown that ethyl caffeate activated the translocation of DAF-16 and SKN-1 from the cytoplasm to the nucleus and enhanced the expression of sod-3::GFP, gst-4::GFP and hsp-16.2::GFP in transgenic nematodes. This meant that the protection against Aβ toxicity by ethyl caffeate may be partly through the IIS signaling pathway. In addition, ethyl caffeate suppressed the aggregation of polyglutamine proteins in AM141, which indicated a potential protective effect against neurodegenerative diseases based on abnormal folding and aggregation of amyloid proteins. Taken together, ethyl caffeate is expected to develop as a potential drug for the management of AD.

Highly oxygenated germacrane-type sesquiterpenoids from the whole plant of Salvia cavaleriei H.Lév. and their biological activities

The entire plant Salvia cavaleriei H.Lév. (Lamiaceae) is used as a traditional Chinese herbal medicine. Its leaves are edible, and the flowers can be soaked in water to make a health-care tea. In an effort to find natural bioactive chemical components, twelve undescribed germacrane-type sesquiterpenoids, salcavalins A-L, were isolated from the whole plant of S. cavaleriei and were identified as analogs. This is the first study to isolate highly oxygenated germacrane-type sesquiterpenoids from this plant. The structures of these undescribed compounds were elucidated by various spectroscopic methods, and their absolute configurations were confirmed by single-crystal X-ray diffraction analysis with Cu Kα radiation and electronic circular dichroism calculations. The biological activity of these undescribed compounds on the production of tumor necrosis factor-alpha in lipopolysaccharide induced NR8383 cells was evaluated, and salcavalins I and K showed anti-inflammatory activity to some extent. Salcavalins A-C, F and L were found to be neuroprotective with antiparkinsonic potential in a nematode (Caenorhabditis elegans) model. In addition, salcavalins F and I displayed marked phytotoxic activity against radish seeds at a low concentration of 50 ppm. Our findings provide scientific justification to show that bioactive sesquiterpenoids from the edible herb have anti-inflammatory in vitro, neuroprotective and phytotoxic activities.

Bioactive diterpenoids and sesquiterpenoids with different skeletons from Salvia digitaloides Diels

Salvia has been regarded as a beneficial healing herb in ancient Egypt, Rome and Greece, and is listed as an official medicine in the pharmacopoeias of many countries worldwide. Currently, Salvia is widely used to flavor and preserve food. Here, two undescribed norabietane-type diterpenoids, sadigitaloides A and B, two undescribed germacrane-type sesquiterpenoids, sadigitaloides C and D, five undescribed guaiane-type sesquiterpenoid lactones, sadigitaloides E-I, two undescribed noreudesmane-type sesquiterpenoids, sadigitaloides J and K, one known diterpenoid, three known sesquiterpenoids, and three other types of known compounds were isolated from the 95% ethanol extract of the whole plants of Salvia digitaloides. Their structures and absolute configurations were characterized using 1D and 2D NMR spectroscopic techniques, electronic circular dichroism (ECD) calculations, HRESIMS experiments, and single-crystal X-ray diffraction analysis. Some compounds were evaluated for their anti-inflammatory activities against lipopolysaccharide (LPS)-induced TNF-α production in rat macrophage NR8383 cells. Sadigitaloide A showed noticeable anti-inflammatory activity at a concentration of 100.0 μM. At a concentration of 60 μM, sadigitaloide B exhibited better protection of dopaminergic neurons than the positive control n-butylidenephthalide in the Caenorhabditis elegans model injured by 6-OHDA. The phytotoxic activities of some compounds were attributed to considerable inhibitory effects on the growth of the roots and hypocotyls of Raphanus sativus L seedlings, especially cis, trans-abscisic acid, whose inhibition rates were much higher than those of glyphosate at concentrations ranging from 50 to 400 ppm. These results indicated that abietane-type diterpenoids possessed excellent anti-inflammatory and neuroprotective activities and further suggested that the low-molecular-weight compounds exhibited outstanding phytotoxic activities.

Caesalpinbondin A, a Novel Diterpenoid Lactone With an Unprecedented Carbon Skeleton from the Seeds of Caesalpinia bonduc

One novel diterpenoid lactone named caesalpinbondin A (1) that possesses an unprecedented tetracyclic ring system in which a 6/6/5-fused tricyclic ring and a 4,5-dimethyldihydrofuran-2(3H)-one were connected by a C-C single bond comprising a 5-(naphtho [2,3-b]furan-7-yl)dihydrofuran-2(3H)-one moiety was isolated from the seeds of Caesalpinia bonduc. Its chemical structure was established by extensive spectroscopic methods, and its absolute configuration was further determined by single-crystal X-ray diffraction analysis and electronic circular dichroism calculation. The biological evaluation suggested that compound 1 demonstrated potent anti-Alzheimer’s disease (AD) bioactivity, which could delay paralysis of transgenic AD Caenorhabditis elegans. A possible biogenetic pathway of 1 was also proposed.

Diterpenoid Caesalmin C Delays Aβ-Induced Paralysis Symptoms via the DAF-16 Pathway in Caenorhabditis elegans

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease in the world. However, there is no effective drug to cure it. Caesalmin C is a cassane-type diterpenoid abundant in Caesalpinia bonduc (Linn.) Roxb. In this study, we investigated the effect of caesalmin C on Aβ-induced toxicity and possible mechanisms in the transgenic Caenorhabditis elegans AD model. Our results showed that caesalmin C significantly alleviated the Aβ-induced paralysis phenotype in transgenic CL4176 strain C. elegans. Caesalmin C dramatically reduced the content of Aβ monomers, oligomers, and deposited spots in AD C. elegans. In addition, mRNA levels of sod-3, gst-4, and rpt-3 were up-regulated, and mRNA levels of ace-1 were down-regulated in nematodes treated with caesalmin C. The results of the RNAi assay showed that the inhibitory effect of caesalmin C on the nematode paralysis phenotype required the DAF-16 signaling pathway, but not SKN-1 and HSF-1. Further evidence suggested that caesalmin C may also have the effect of inhibiting acetylcholinesterase (AchE) and upregulating proteasome activity. These findings suggest that caesalmin C delays the progression of AD in C. elegans via the DAF-16 signaling pathway and that it could be developed into a promising medication to treat AD.

A new highly oxygenated germacranolide from Carpesium nepalense var. lanatum (C.B.Clarke) Kitam

A new highly oxygenated germacranolide, carcerlane A (1), together with four known highly oxygenated germacranolides (2-5), was isolated from an ethanol extract of the whole plant of Carpesium nepalense var. lanatum (C.B.Clarke) Kitam. The structures were determined by HRESIMS and extensive analysis of their spectroscopic data including IR, 1 D and 2 D NMR spectra. To our best knowledge, it was the first time to report the phytochemical investigation on this plant. The anti-Alzheimer's disease (AD) activities of 1-5 were evaluated using Caenorhabditis elegans AD pathological model. All the tested compounds showed that they have the anti-AD bioactivities of delaying worms paralysis.

[Zero profile anchored spacer(ROI-C) for the treatment of cervical spondylosis with osteoporosis]

OBJECTIVE

To investigate the clinical efficacy of zero-profile anchored spacer (ROI-C) in treating cervical spondylosis with osteoporosis.

METHODS

From May 2013 to May 2018, a total of 145 patients with cervical spondylosis were treated by ROI-C through anterior cervical spine approach. Among them, 31 patients were aged ≥60 years and had osteoporosis by bone density measurement, and they were retrospectively analyzed. Including 9 males and 22 females, aged 60-84 years old with an average of (69.12±7.65) years. There were 23 cases of single-segment fusion, 6 cases of two-stage fusion, and 2 cases of three-stage fusion;and 41 devices of ROI-C fusion was placed in the patients. Operation time and intraoperative blood loss were recorded;Japanese Orthopaedic Association (JOA) scores and visual analogue scale(VAS) were respectively used to evaluate the neurological function and neck pain before and after operation. The cervical curvature (expressed as Cobb angle), the height of the intervertebral space at the surgical segment, and the intervertebral fusion were observed at postoperative and follow-up periods were observed by image data.

RESULTS

All patients were followed up for 12-24(15.6±4.4) months after operation. The operation time were from 75 to 113 (101.33±10.25) min and intraoperative blood loss were from 14 to 51 (33.18 ± 16.56) ml. Among these 23 patients with fusion of single segment, the operation time were 75 to 98 (85.47±8.70) min and intraoperative blood loss were 14 to 30(21.18±6.56) ml. JOA scores of all included patients were increased from 9.66±2.12 preoperatively to 14.36±1.24 at the final follow-up (P<0.05);VAS scores were decreased form 4.21±0.83 preoperatively to 1.12± 0.57 at the final follow-up (P<0.05);Cobb angles of the cervical spine were improved from (13.14±4.54)° preoperatively to (22.31±5.42)° at the final follow-up(P<0.05);the heights of the intervertebral space were changed from (3.28±0.73) mm preoperatively to (4.87±0.45) mm at the final follow-up(P<0.05). All the fusions of the surgical segments were satisfactory at the final follow-up and no failure of the fusion device was found. At the final follow-up, no complications such as difficulty swallowing and hoarseness, etc. were reported.

CONCLUSION

Anterior cervical approach with ROI-C for the treatment of elderly patients with cervical spondylosis and osteoporosis had reliable clinical effect, short operation time, less intraoperative blood loss, and can effectively restore cervical curvature and intervertebral space height, and has advantages of fewer complications and higher successful rate of fusion.

[Research progress on identification of pharmacodynamic substance basis of traditional Chinese medicine based on target constituent knock-out/knock-in technology]

The effective material basis of traditional Chinese medicine(TCM) is an indispensable part of studies on TCM, and each technology has its advantages and disadvantages. The target constituent knock-out/knock-in technology has attracted much attention since it was proposed because of its unique advantages of regarding the extract of the formula as a whole, which can better reflect the characteristics of multi-component and multi-target integration and regulation of TCM. This method investigated the contribution of target constituent to the overall efficacy of a TCM by analyzing the changes in efficacy of the remaining formula before and after knock-out/knock-in of the target constitution. The application of this model not only facilitates studies of the effective constituents of TCM, but also help to develop the quality control standard of TCM. However, the application of this model is restricted due to the limitation of target constituent separation technology. By reviewing the literatures in recent years, this study summarized the research process and application of this method for a reference.