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The combination of Chinese and Western Medicine in the management of rheumatoid arthritis: A real-world cohort study across China

Front Pharmacol. 2022 Oct 6;13:933519. doi: 10.3389/fphar.2022.933519. eCollection 2022.

ABSTRACT

Objective: To investigate the efficacy of Integrative medicine (IM), compare with Western medicine (WM), in the treatment of rheumatoid arthritis (RA) in a cohort study. Methods: This is a cohort study with recruitment of RA patients from 10 hospitals in China. The primary outcome was change in disease activity score 28 (DAS28) during 4 follow-up visits. Generalized estimating equation (GEE) models that controlled for variables were used to investigate a time trend and assess group differences in the primary outcome and secondary outcomes after propensity score matching (PSM). Results: A total of 3195 patients with RA received IM (n = 1379, 43.2%) or WM (n = 1816, 56.8%). Following 1:1 propensity score matching, 1,331 eligible patients prescribed IM were compared to 1,331 matched patients prescribed WM. The GEE analysis with PSM showed that the IM was more beneficial to significantly decrease the levels of VAS, PGA and PhGA (VAS: odds ratio (OR), 0.76; 95% CI, 0.63-0.92; p = 0.004; PGA: OR, 0.76; 95% CI, 0.64-0.92; p = 0.007; and PhGA: OR, 0.77; 95% CI, 0.64, 0.93; p = 0.004), and reduce DAS28 (OR, 0.84; 95% CI, 0.73-0.98; p = 0.030) in the per-protocol population. Conclusion: This study suggests that compare to WM, IM has advantages in improving RA-related outcomes. However, the statistical significance might not reveal significant clinical difference. Further studies should be focused on specific treatment strategies and/or disease stages.

PMID:36278204 | PMC:PMC9582451 | DOI:10.3389/fphar.2022.933519

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Retinoblastoma protein as an intrinsic BRD4 inhibitor modulates small molecule BET inhibitor sensitivity in cancer

Nat Commun. 2022 Oct 23;13(1):6311. doi: 10.1038/s41467-022-34024-y.

ABSTRACT

Bromodomain and extraterminal (BET) proteins including BRD4 play important roles in oncogenesis and immune inflammation. Here we demonstrate that cancer cells with loss of the retinoblastoma (RB) tumor suppressor became resistant to small molecule bromodomain inhibitors of BET proteins. We find that RB binds to bromodomain-1 (BD1) of BRD4, but binding is impeded by CDK4/6-mediated RB phosphorylation at serine-249/threonine-252 (S249/T252). ChIP-seq analysis shows RB knockdown increases BRD4 occupancy at genomic loci of genes enriched in cancer-related pathways including the GPCR-GNBIL-CREB axis. S249/T252-phosphorylated RB positively correlates with GNBIL protein level in prostate cancer patient samples. BET inhibitor resistance in RB-deficient cells is abolished by co-administration of CREB inhibitor. Our study identifies RB protein as a bona fide intrinsic inhibitor of BRD4 and demonstrates that RB inactivation confers resistance to small molecule BET inhibitors, thereby revealing a regulatory hub that converges RB upstream signaling onto BRD4 functions in diseases such as cancer.

PMID:36274096 | DOI:10.1038/s41467-022-34024-y

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Circulating LncRNAs landscape as potential biomarkers in breast cancer

Cancer Rep (Hoboken). 2022 Oct 23:e1722. doi: 10.1002/cnr2.1722. Online ahead of print.

ABSTRACT

BACKGROUND: In Iran, the delay in diagnosis and treatment of breast cancer results in low survival rates.

AIM: It is essential to characterize new therapeutic targets and prognostic breast cancer biomarkers. The rising evidence suggested that long non-coding RNAs (lncRNAs) expression levels are deregulated in human cancers and can use as biomarkers for the rapid diagnosis of breast cancer.

METHODS: In the present study, a quantitative real-time polymerase chain reaction (qRT-PCR) technique was used to measure 20 oncogenic and tumor suppressor lncRNAs expression levels in whole blood samples of female breast cancer patients and healthy women. Receiver operating characteristic curve (ROC) was used to assess the diagnostic value of each selected lncRNA as a biomarker.

RESULTS: The results revealed that some circulating lncRNAs (MEG3, NBAT1, NKILA, GAS5, EPB41L4A-AS2, Z38, and BC040587) were significantly down-regulated in breast cancer patients compared to healthy women. In contrast, other circulating lncRNAs (H19, SPRY4-IT1, XIST, UCA1, AC026904.1, CCAT1, CCAT2, ITGB2-AS, and AK058003) were significantly up-regulated in breast cancer patients compared to controls. It was shown that the expression levels of NKILA, and NBAT1 lncRNAs were related to tumor size, and BC040587 expression level related to age, node metastasis, tumor size, and grade (p < .05). The association between H19 and SPRY4-IT1 lncRNAs with HER-2 was confirmed statistically (p < .05). ROC curves illustrated that the blood levels of SPRY4-IT1, XIST, and H19 lncRNAs have excellent potential in discriminating breast cancer from the healthy controls, showing an AUC of 1.0 (95% CI 1.0-1.0, p = .00), 0.898 (95% CI 0.815-0.981, p = .00), and 0.848 (95% CI 0.701-0.995, p = .01), respectively.

CONCLUSION: In conclusion, the expression levels of circulating H19 and SPRY4-IT1 lncRNAs in breast cancer patients could consider as the prognostic biomarkers and therapeutic targets in breast cancer, because of their excellent power in discriminating breast cancer from healthy individuals and the significant correlation of H19, and SPRY4-IT1 lncRNAs with clinicopathological traits. We also suggest the possible application of BC040587 lncRNA as a diagnostic and prognostic indicator to assess tumor progression in case of verification in larger patients’ cohorts.

PMID:36274054 | DOI:10.1002/cnr2.1722

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Congenital cytomegalovirus infection in newborns born to HIV-infected mothers

Enferm Infecc Microbiol Clin (Engl Ed). 2022 Oct 20:S2529-993X(22)00198-8. doi: 10.1016/j.eimce.2022.03.014. Online ahead of print.

ABSTRACT

INTRODUCTION: Congenital citomegalovirus (CMVc) infection is more common in children exposed to HIV during pregnancy, with reported rates in pre-ART era from 2 to 7%. The use of combined antiretroviral treatment (ARTc) could be a determining factor in reducing this risk of CMV transmission. The aim of this study was to describe the epidemiology of CMVc infection in newborns of HIV-infected mothers at Hospital Universitario 12 de Octubre, Madrid, Spain, from 2000 to 2017.

MATERIAL AND METHODS: An observational and retrospective study was carried out. Epidemiological and clinical variables were collected. Statistical analysis was performed with the SPSS 24.0 computer program.

RESULTS: 288 mother-infant pairs were included in the study. We observed a CMVc rate of 2.1% (95% CI 0.9-4.9).

CONCLUSIONS: The rate of CMVc in HIV-exposed children observed was lower than that reported in pre-ARTc era but seems higher than those described in general population.

PMID:36274043 | DOI:10.1016/j.eimce.2022.03.014

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Normative values of the alpha angle and triangular index measured from the hip radiographs of an African population

J Med Imaging Radiat Sci. 2022 Oct 20:S1939-8654(22)00374-5. doi: 10.1016/j.jmir.2022.09.023. Online ahead of print.

ABSTRACT

INTRODUCTION: Undetected femoroacetabular impingement (FAI), caused by asphericity of the femoral head, has been implicated as a leading cause of hip osteoarthritis in later stages. Two known types of impingement of the femur head with the acetabulum include the cam-type and pincer type, and the alpha angle and triangular index are indices applied in determining the presence of FAI in a hip radiograph.

OBJECTIVE: To determine the normal range and upper limit of normal of the alpha angle and triangular index of an African population using non-pathological hip radiographs.

MATERIALS AND METHODS: Hip radiographs of 104 subjects reported to be normal were retrospectively studied. The images were reassessed jointly by three radiographers and afterwards by three consultant radiologists. The alpha angle and triangular index of selected radiographs were measured with appropriate electronic callipers. Values obtained were correlated with the age and gender of the patients.

RESULTS: The mean ± SD of the alpha angle for the population studied was 46.70 ± 12.340 with a range of 33.300-96.820 (males: 45.09 ± 12.030, females: 47.32 ± 12.370), and the upper limit of normal obtained was 79.160. The mean triangular index was 1.71±1.38 with a range of 0.03-5.98 (males: 1.77 ± 1.39, females: 1.65 ± 1.36), 4.12 being the upper limit of normal. There was no statistically significant difference between measurements of both indices with age and gender. However, there was excellent agreement between and within raters for both measurements (alpha angle: 0.992; triangular index: 0.924).

CONCLUSION: The upper limits of normal for the alpha angle and triangular index of the studied population are 79.160 and 4.12. Age and gender were independent of the values measured, and the measurements demonstrated excellent inter-rater and intra-rater agreement. A normal range is thus provided, with upper limits beyond which a possible femoroacetabular impingement may be diagnosed.

PMID:36274033 | DOI:10.1016/j.jmir.2022.09.023

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Association between social connectedness and stress or anxiety among older cancer survivors during the 2020-2021 winter surge of the COVID-19 pandemic

J Geriatr Oncol. 2022 Oct 12:S1879-4068(22)00239-9. doi: 10.1016/j.jgo.2022.10.005. Online ahead of print.

ABSTRACT

INTRODUCTION: Our goal was to estimate a relative decreased rate of social connectedness to family and friends, increased rate of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic, and investigate the association between social connectedness and stress or anxiety among a nationally representative sample of older adults with cancer history.

MATERIALS AND METHODS: We used population-based, nationally representative cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 Community Supplement. The study cohort included community-living Medicare beneficiaries aged 65 years and older who self-reported cancer history (other than skin cancer) (n = 1650). Sample weights were applied to account for the complex survey design, with results generalizable to 8.5 million Medicare beneficiaries with cancer history. The outcome was self-reported feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. The independent variable was social connectedness, defined as feeling less socially connected to family and friends during the 2020-2021 winter surge of the COVID-19 pandemic. We conducted weighted descriptive statistics and multivariable logistic regression analyses.

RESULTS: Overall, 42.5% of beneficiaries reported decreased social connectedness to family and friends, and 37.8% reported increased feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. After adjusting for all covariates, participants who reported decreased social connectedness had 154% higher odds of increased feelings of stress or anxiety (adjusted odds ratio [AOD] = 2.54, 95% confidence interval [CI] = 2.00-3.20, p ≤0.001) compared to those who reported more or about the same social connectedness to family and friends. The odds of increased feelings of stress or anxiety were also higher for those who self-reported as Hispanic vs. non-Hispanic White beneficiaries (AOR = 1.35, 95% CI = 1.10-1.73, p = .016), women vs. men (AOR = 1.85, 95%CI = 1.43-2.38, p ≤0.001), and those who reported depression history vs. not reporting depression history (AOR = 2.55, 95% CI = 1.86-3.48, p ≤0.000).

DISCUSSION: An estimated 3.6 million older adults with cancer history reported decreased social connectedness to family and friends, and 3.2 million reported increased feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. Identifying these adults and referring them to appropriate supportive care resources and services are essential to help them cope with negative feelings.

PMID:36274031 | DOI:10.1016/j.jgo.2022.10.005

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Three-dimensional evaluation of condylar position after mandibular reconstruction with a fibula free flap-comparison of different surgical techniques

Int J Oral Maxillofac Surg. 2022 Oct 20:S0901-5027(22)00415-5. doi: 10.1016/j.ijom.2022.10.003. Online ahead of print.

ABSTRACT

Three-dimensional positional changes of the temporomandibular joint after mandible reconstruction using microvascular fibula flaps were investigated in 58 patients. The results of preoperative virtually planned surgery, intraoperative resection- and cutting-guided surgery, and non-guided surgery were compared. Pre- and postoperative computed tomography data of each patient were processed and superimposed digitally. The condyle deviations and rotations along the axes and planes of the skull, as well as Euclidean distances, were determined. Reliability analyses, descriptive statistics, and non-parametric tests were performed with the alpha level set at P = 0.05. Reliability proved to be excellent for all variables. The median Euclidean distance was 2.07 mm for the left condyle and 2.11 mm for the right condyle. Deviations of ≥ 10 mm occurred in nine (16%) cases. The maximum deviation occurred in the horizontal plane and the least deviation in the sagittal plane. Median rotation was ≤ 1.4° around all axes. The condylar displacements did not differ significantly between the different surgical techniques investigated. The three-dimensional measurement method applied is highly reliable for evaluating the three-dimensional condylar position after mandibular reconstruction.

PMID:36274023 | DOI:10.1016/j.ijom.2022.10.003

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Single-dose versus prolonged antibiotic prophylaxis for alveolar bone grafting in cleft patients

Int J Oral Maxillofac Surg. 2022 Oct 20:S0901-5027(22)00414-3. doi: 10.1016/j.ijom.2022.10.002. Online ahead of print.

ABSTRACT

The increase in antimicrobial resistance requires a critical discussion of antibiotic applications. Postoperative antibiotic prophylaxis is still common for intraoral bone transplantation. However, no guidelines exist for alveolar bone grafting (ABG) in cleft patients. This study compared the infection rate between prolonged and single-dose prophylaxis for this procedure, with the null hypothesis of no difference between the two groups. In total, 109 ABG procedures in 94 cleft patients performed by two surgeons were included. Patients received either prolonged or single-dose antibiotic prophylaxis. The complication rate was compared between the groups. Fifty-nine patients (34 male, 25 female) received prolonged prophylaxis (group 1), while 35 (23 male, 12 female) had just a single dose (group 2). Median age at surgery differed between the two groups, but not significantly (P = 0.72). One relevant surgical site infection was observed among patients with postoperative antibiotic application, while no infections occurred in the single-dose prophylaxis group (1.7% vs. 0%); this difference was not statistically significant (P = 0.84). The duration of hospitalization was longer in group 1. The reduction of antibiotic prophylaxis to a single dose did not increase the infection rate. The results strongly encourage reducing antibiotic prophylaxis for ABG procedures in cleft patients.

PMID:36274022 | DOI:10.1016/j.ijom.2022.10.002

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The quality of parenting in reproductive donation families: A meta-analysis and systematic review

Reprod Biomed Online. 2022 Aug 14:S1472-6483(22)00636-8. doi: 10.1016/j.rbmo.2022.08.099. Online ahead of print.

ABSTRACT

This review examined whether the absence of a genetic link with one or both parents in families using reproductive donation induced a different quality of parenting from that found in families with spontaneous conception or autologous assisted reproductive technology (AUT-ART), where the genetic mother carries the pregnancy and both parents have a genetic link with their children. MEDLINE, PsycINFO and PubMed were searched for English-language studies published from January 1993 to October 2021. A total of 45 studies were included in the systematic review, and 11 in the meta-analysis. The meta-analysis showed that in reproductive donation families, where there was no genetic link between parents and children, there were higher positive parental values (P = 0.007) and lower negative parental values (P = 0.007) than for parents and children in families that had spontaneously conceived. No statistically significant differences emerged when the reproductive donation families were compared with the AUT-ART families. The study showed that the quality of parenting was not conditioned by the presence or absence of a genetic link; instead, it was influenced by the processes underlying family building, such as the desire to have a child, the involvement of both parents in the childcare and the quality of disclosure.

PMID:36274013 | DOI:10.1016/j.rbmo.2022.08.099

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Impact of botulinum toxin for facial aesthetics on psychological well-being and quality of life: Evidence-based review

J Plast Reconstr Aesthet Surg. 2022 Aug 27:S1748-6815(22)00506-X. doi: 10.1016/j.bjps.2022.08.063. Online ahead of print.

ABSTRACT

BACKGROUND: There has been a steady growth of non-surgical minimally invasive procedures. In parallel, an ever-broadening range of clinicians has been engaging with botulinum toxin (BoNT) for aesthetic procedures, with reportedly compound positive impact on social health and psychological well-being.

OBJECTIVE: To identify and critically appraise current literature on the impact of BoNT injections into the upper face, as a sole treatment/combination with other modalities on facial aesthetics, psychological well-being, and quality-of-life.

METHODS: An evidence-based review was performed using advanced search from PubMed, Cochrane Library of Systematic Reviews, and Central Register of Controlled Trials databases . Only literature from inception to August, 2021 were considered. Eligibility criteria included human studies, FDA-approved BoNT applications, formulations, and dosages as a sole/multimodal approach; studies including patient-reported outcome tools psychometrically validated and facial lines-specific. Observer-reported outcome instruments were also considered for a thorough evaluation of outcomes.

RESULTS: Based on data investigations and participant assessments, all studies showed statistically significant improvement in psychosocial well-being and quality-of-life domains with a trend for highest impact when multiple upper facial areas are treated in a multimodal approach.

CONCLUSION: Aesthetic BoNT showed links to true health benefits for well-selected patients in addition to physical amelioration. However, the biological rational remains ambiguous. Well-designed controlled trials are needed, without pharmaceutical laboratories bias, in real clinical scenarios of patients paying for the interventions, often involving multiple areas with/without combined treatments. The persistence of positive outcomes following repetitive treatments provided by less experienced practitioners, potentially involving suboptimal patient selection and/or aesthetic results, warrants further investigation.

PMID:36274011 | DOI:10.1016/j.bjps.2022.08.063