Abstract Purpose The goal of this study was to assess the effect of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on lipid profiles in patients with type 2 diabetes. Methods The MEDLINE, ...Embase, Cochrane Library, and ClinicalTrials.gov databases were searched from inception through October 31, 2013. Randomized controlled trials with available data were selected if they compared GLP-1 RAs with placebo and traditional antidiabetic drugs with a duration ≥8 weeks. The weighted mean difference for changes in lipid profiles was estimated by using the random effects model, and a network meta-analysis was performed to supplement direct comparisons. Findings Thirty-five trials with 13 treatments were included in the analysis. GLP-1 RAs decreased HDL-C with a range of –0.06 mmol/L (95% CI, –0.11 to –0.01) to –0.13 mmol/L (95% CI, –0.17 to –0.10) compared with thiazolidinediones, whereas thiazolidinediones were associated with a significant increase in HDL-C compared with placebo (0.09 mmol/L 95% CI, 0.06 to 0.12). A significant reduction in LDL-C was detected for all GLP-1 RAs versus placebo (range, –0.08 to –0.16 mmol/L), insulin (range, –0.10 to –0.19 mmol/L), and thiazolidinediones (range, –0.16 to –0.24 mmol/L). Exenatide, liraglutide 1.8 mg once daily, and taspoglutide decreased total cholesterol with a range of –0.16 mmol/L (95% CI, –0.26 to –0.06) to –0.27 mmol/L (95% CI, –0.41 to –0.12) versus placebo and thiazolidinediones (range, –0.26 to –0.37 mmol/L). The decreased effect was more evident in exenatide long-acting release and liraglutide 1.8 mg once daily. A significant reduction in triglyceride levels was observed with liraglutide 1.8 mg once daily (–0.30 mmol/L 95% CI, –0.49 to –0.11) and taspoglutide 20 mg once weekly (–0.17 mmol/L 95% CI, –0.31 to –0.01) versus placebo. Implications GLP-1 RAs were associated with modest reductions in LDL-C, total cholesterol, and triglycerides but no significant improvement in HDL-C. Further evidence is needed to determine if improvements in lipid profiles might translate into reductions in cardiovascular outcomes.
Abstract Background The roles of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in the occurrence of atrial fibrillation (AF) remain inconclusive. Methods ...We conducted a systematic review and meta-analysis of observational studies to evaluate the associations of MMPs and TIMPs in blood and atrial tissues with AF risk. A subgroup analysis was performed to explore the potential sources of heterogeneity. Results A total of 33 studies met our inclusion criteria. Patients with AF had significantly higher messenger RNA (mRNA) levels of MMP-1 in atrial tissue than did the controls, with a pooled standardized mean difference (SMD) of 0.54 (95% confidence interval CI, 0.30-0.78; P < 0.001). The positive pooled estimates of studies of MMP-2 and MMP-9 in circulating proteins and atrial tissue mRNA and proteins were likely to be susceptible to the effects of significant publication bias. Decreased circulating TIMP-2 levels were significantly associated with increased risk of AF, with a pooled SMD of −0.49 (95% CI, −0.97 to −0.01; P = 0.04). Conclusions Increased MMP-1 in tissue mRNA and decreased circulating TIMP-2 levels are significantly associated with increased AF risk. The positive associations of MMP-2 and MMP-9 in blood and atrial tissue with AF risk have significant publication bias. Prospective registries of biomarker research and strict confirmation to reporting guidelines are needed in this field.
Abstract Background The prevalence of gestational diabetes mellitus has increased markedly in recent years in China, mainly because of the introduction of new diagnostic criteria. We aimed to ...evaluate whether in the diagnosis of gestational diabetes mellitus, 1h and 2h glucose measurements have additional value compared with a single fasting plasma glucose measurement. Methods We included data from 6993 pregnant women who underwent a 2h 75g oral glucose-tolerance test at 22–28 weeks' gestation in the Born in Guangzhou Cohort Study in China. Outcomes included having a large for gestational age baby (≥90th percentile), caesarean section, spontaneous preterm birth, and pre-eclampsia. We calculated the area under the receiver operator characteristic curves (AUC) to assess the capacity of oral glucose-tolerance test values to predict outcomes. Findings The prevalence of large for gestational age babies was 10·8% (695 of 6448). The AUC for prediction of large for gestational age was greater for fasting plasma glucose than for 1h (0·604 vs 0·556, p=0·0002) and 2h glucose tests (0·604 vs 0·552, p<0·0001). Addition of 1h or 2h glucose values, or both, to the predictive model did not increase the AUC for fasting glucose (0·605 for addition of 1h and 2h values, p=0·564). Compared with women who had a fasting plasma glucose concentration lower than the 90th percentile, women with fasting plasma glucose equal or greater than the 90th percentile had a greater risk of having a large for gestational age baby (20·1% 129 of 641 vs 9·7% 566 of 5807, adjusted odds ratio 2·04, 95% CI 1·62–2·56), and post-load glucose concentrations had limited effect on that probability. Similarly, post-load glucose concentrations contributed little to the prediction of preeclampsia, spontaneous preterm birth, and caesarean section. Interpretation In the diagnosis of gestational diabetes mellitus in a Chinese population, a single fasting plasma glucose measurement can predict whether women are at increased risk of having a large for gestational age baby. Funding Guangzhou Science and Technology Bureau, Guangzhou, China
To investigate the outcomes of adjuvant whole breast radiation therapy (WBRT) in patients with invasive ductal carcinoma of the breast (breast IDC) receiving preoperative systemic therapy (PST) and ...breast-conserving surgery (BCS), and their prognostic factors, considering overall survival (OS), locoregional recurrence (LRR), distant metastasis (DM), and disease-free survival.
Patients diagnosed as having breast IDC and receiving PST followed by BCS were recruited and categorized by treatment into non-breast radiation therapy BRT (control) and WBRT (case) groups, respectively. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals (CIs).
Multivariate Cox regression analyses indicated that non-BRT, cN3, and pathologic residual tumor (ypT2–4) or nodal (ypN2–3) stages were poor prognostic factors for OS. The adjusted HRs (aHRs; 95% CIs) of the WBRT group to non-BRT group for all-cause mortality were 0.14 (0.03–0.81), 0.32 (0.16–0.64), 0.43 (0.23–0.79), 0.23 (0.13–0.42), 0.52 (0.20–1.33), and 0.34 (0.13–0.87) in the ypT0, ypT1, ypT2–4, ypN0, ypN1, and ypN2–3 stages, respectively. The aHRs (95% CIs) of the WBRT group to non-BRT group for all-cause mortality were 0.09 (0.00–4.07), 0.46 (0.26–0.83), 0.18 (0.06–0.51), 0.28 (0.06–1.34), 0.25 (0.10–0.63), 0.47 (0.23–0.88), and 0.32 in the cT0–1, cT2, cT3, cT4, cN0, cN1, and cN2–3 stages, respectively. The WBRT group exhibited significantly better LRR-free and DM-free survival than the non-BRT group, regardless of the clinical T or N stage or pathologic response after PST.
WBRT might lead to superior OS and LRR-free and DM-free survival compared with the non-BRT group, regardless of the initial clinical TN stage or pathologic response.
•Outcome patterns of adjuvant RT for patients with breast cancer receiving preoperative systemic therapy and breast-conserving surgery.•Non-breast radiation therapy, cN3, pathologic residual tumor (ypT2–4), or nodal (ypN2–3) stages are poor prognostic factors for survival.•The beneficial effects of RT are superior OS and LRR-free and DM-free survival compared with the non-RT group.
Case reports, tissue pathology, and autopsies have suggested that the hydrophilic polymer coating designed to improve endovascular deliverability and minimize vessel trauma can embolize and be ...associated with adverse outcomes such as ischemia, infarction, and death. This study sought to determine whether hydrophilic polymers shed off commercially available sheaths in a controlled in vitro environment, with the hypothesis that significant differences between coated and uncoated (control) sheaths would be found.
Six sheaths from each manufacturer, including Zenith Alpha abdominal endovascular stent grafts (Cook Medical), DrySeal sheaths (W.L. Gore & Associates), and Sentrant Introducer sheaths (Medtronic), were tested in an in vitro environment. Noncoated Check-Flo performer introducer sheaths (Cook Medical) were used as controls. Each test circuit ran for 150 minutes at an output of 3 L/min, the circuit was then drained and the fluid collected. Quantitative analysis included weighing the dried filter paper and using particle size light scattering to quantify the particle size and count. Attenuated total reflectance spectroscopy was also used.
Each of the three coated sheaths had significantly greater shedding compared with the control sheaths. The Cook Zenith alpha sheath had significantly more residue weight (2.87 ± 0.52 mg/L) than the Gore DrySeal (1.07 ± 0.06 mg/L) and Medtronic Sentrant introducer (0.98 ± 0.14 mg/L) sheaths. The average particle size was not significantly different between the coated and uncoated (control) sheaths. Attenuated total reflectance spectroscopy identified sheath particulate in the Cook Zenith Alpha and Medtronic Sentrant samples.
Polymer embolization was present and significantly greater in all three commercially available hydrophilic sheaths compared with the control group. Further investigation is needed into the clinical significance of these findings.
Hydrophilic polymer coatings have significantly enhanced patient outcomes after endovascular procedures. However, isolated case reports have raised concerns about the potential embolization of such coatings, leading to end-organ ischemia and damage. Our results confirm the presence of this phenomenon. This knowledge will enable patients, physicians, and manufactures to make informed decisions and take appropriate precautions. Furthermore, it is imperative to conduct further research to thoroughly characterize the embolization profile of different sheaths. Such investigations would contribute to our understanding of the problem and provide valuable information for manufactures to guide the development of safer and more reliable devices.
Summary Background Human infections with different avian influenza viruses—eg, H5N1, H9N2, and H7N9—have raised concerns about pandemic potential worldwide. We report the first human infection with a ...novel reassortant avian influenza A H10N8 virus. Methods We obtained and analysed clinical, epidemiological, and virological data from a patient from Nanchang City, China. Tracheal aspirate specimens were tested for influenza virus and other possible pathogens by RT-PCR, viral culture, and sequence analyses. A maximum likelihood phylogenetic tree was constructed. Findings A woman aged 73 years presented with fever and was admitted to hospital on Nov 30, 2013. She developed multiple organ failure and died 9 days after illness onset. A novel reassortant avian influenza A H10N8 virus was isolated from the tracheal aspirate specimen obtained from the patient 7 days after onset of illness. Sequence analyses revealed that all the genes of the virus were of avian origin, with six internal genes from avian influenza A H9N2 viruses. The aminoacid motif GlnSerGly at residues 226–228 of the haemagglutinin protein indicated avian-like receptor binding preference. A mixture of glutamic acid and lysine at residue 627 in PB2 protein—which is associated with mammalian adaptation—was detected in the original tracheal aspirate samples. The virus was sensitive to neuraminidase inhibitors. Sputum and blood cultures and deep sequencing analysis indicated no co-infection with bacteria or fungi. Epidemiological investigation established that the patient had visited a live poultry market 4 days before illness onset. Interpretation The novel reassortant H10N8 virus obtained is distinct from previously reported H10N8 viruses. The virus caused human infection and could have been associated with the death of a patient. Funding Emergency Research Project on human infection with avian influenza H7N9 virus, the National Basic Research Program of China, and the National Mega-projects for Infectious Diseases.
Summary Background Prophylactic treatment of individuals with latent Mycobacterium tuberculosis infection is an essential component of tuberculosis control in some settings. In China, the prevalence ...of latent tuberculosis infection, and preventive interventions against this disease, have not been systematically studied. We aimed to assess the prevalence of latent tuberculosis and its associated risk factors in rural populations in China. Methods Between July 1, and Sept 30, 2013, we undertook a baseline survey of a population-based, multicentre, prospective cohort study of registered residents (≥5 years old) at four study sites in rural China. Eligible participants were identified by door-to-door survey with a household sampling design. We screened participants for active tuberculosis and history of tuberculosis then used a tuberculin skin test and an interferon-γ release assay (QuantiFERON QFT) to test for latent infection. We used odds ratios (ORs) and 95% CIs to assess variables associated with positivity of QFT and tuberculin skin tests. Findings 21 022 (90%) of 23 483 eligible participants completed a baseline survey. Age-standardised and sex-standardised rates of skin-test positivity (≥10 mm) ranged from 15% to 42%, and QFT positivity rates ranged from 13% to 20%. Rates of positivity for the tuberculin skin test and the QFT test were low in study participants younger than 20 years and gradually increased with age (p for trend <0·0001). Rates of latent tuberculosis infection were higher for men than women (p<0·0001). Overall agreement between the tuberculin skin test and the QFT test was moderate (81·06%; kappa coefficient 0·485), with skin-test-only positive results associated with the presence of BCG scar, male sex, and ages of 60 years and older, and QFT-only positive results associated with male sex and ages of 60 years and older. Interpretation On the basis of findings showing that the performance of the tuberculin skin test might be affected by various factors including BCG vaccination and age, our results suggest that the prevalence of latent tuberculosis in China might be overestimated by skin tests compared with interferon-γ release assays. Funding The National Science and Technology Major Project of China, the Program for Changjiang Scholars and Innovative Research Team in University of China.
The progression of atrial fibrillation (AF) to a more sustained form is associated with increased symptoms and morbidity. The aims of the REgistry on Cardiac Rhythm DisORDers Assessing the Control of ...Atrial Fibrillation (RecordAF)–United States (US) cohort study were to identify the risk factors of AF progression and the effects of management approaches. RecordAF is the first worldwide, 1-year observational study of the treatment of community-based patients with recent-onset AF. We assessed AF progression at 12 months in the US cohort. AF progression was defined as a change of AF to a more sustained form (either paroxysmal becoming persistent or permanent, or persistent becoming permanent). The US cohort included 955 patients, with mean age of 68.9 years; 56.8% were men and 88.8% were white. At entry, 59.6% of patients were selected for rate-control and 40.4% for rhythm-control therapy. At 12 months, the management strategy was unchanged for 68.2% of the patients in the rate- and 77.7% of the patients in the rhythm-control groups. Overall, AF progression had occurred in 18.6% of patients at 12 months. The progression rate was significantly greater in the rate-control (27.6%) than in the rhythm-control (5.8%) group (p <0.001). Progression to permanent AF occurred in 16.4% of patients. In addition to a rate-control strategy, older age, AF rhythm at entry, persistent AF at baseline, and a history of stroke or transient ischemic attack independently predicted AF progression. Rate control was associated with AF progression, with a propensity score adjusted odds ratio of 2.67 (p <0.001). In conclusion, rate control was the preferred treatment of recent-onset AF in the US but was associated with more AF progression than rhythm control.
Background:
Traditional Chinese medicine (TCM) is widely integrated into cancer care in China. An overview in 2011 identified 2384 randomized and non-randomized controlled trials (RCTs, non-RCTs) on ...TCM for cancer published in the Chinese literature. This article summarizes updated evidence of RCTs on TCM for cancer care.
Methods:
We searched 4 main Chinese databases: China National Knowledge Infrastructure, Chinese Scientific Journal Database, SinoMed, and Wanfang. RCTs on TCM used in cancer care were analyzed in this bibliometric study.
Results:
Of 5834 RCTs (477 157 cancer patients), only 62 RCTs were indexed in MEDLINE. The top 3 cancers treated were lung, stomach, and breast cancer. About 4752 RCTs (81.45%) tested TCM combined with conventional treatment, and 1082 RCTs (18.55%) used TCM alone for treating symptoms and side-effects. Herbal medicine was the most frequently used TCM modality (5087 RCTs; 87.20%). The most frequently reported outcome was symptom improvement (3712 RCTs; 63.63%) followed by quality of life (2725 RCTs; 46.71%), and biomarkers (2384 RCTs; 40.86%). The majority of RCTs (4051; 69.44%) concluded there were beneficial effects using either TCM alone or TCM plus conventional treatment compared with conventional treatment.
Conclusion:
Substantial randomized trials demonstrated different types/stages of cancer were treated by various TCM modalities, alone or in combination with conventional medicine. Further evaluation on the effects and safety of TCM modalities focusing on outcomes such as quality of life is required.
Abstract Background The scientific evidence for the association of daily flavonoid and stilbene intakes with cardiovascular risk factors in Chinese adults has not been reported previously. Objective ...The aim of the study was to assess daily flavonoid and stilbene intakes and evaluate these compounds' association with cardiovascular risk factors such as serum lipids and carotid intima–media thickness in Chinese adults. Design A total of 1,393 subjects participated in this cross-sectional study from July 2008 to January 2010 in China. Dietary flavonoid and stilbene intakes as well as overall dietary intakes from foods and beverages were assessed with a quantitative food frequency questionnaire. Anthropometric measurements and cardiovascular risk factors including serum lipids, uric acid, and carotid intima–media thickness were examined. The relationship between flavonoids and stilbene intakes and these cardiovascular risk factors was examined using either partial correlation coefficients or analysis of covariance. Results The richest sources of flavonoids and stilbenes were the fruit group including apple, plum, pear, and peach, followed by the vegetable group containing lotus root and taro. The daily intake of total flavonoids, anthocyanidins, flavonols, flavones, isoflavones, and stilbene were 165.6 mg/day, 27.6 mg/day, 123.7 mg/day, 10.7 mg/day, 3.7 mg/day, and 0.3 mg/day, respectively. Higher daily consumption of anthocyanidins was associated with elevated serum high-density lipoprotein cholesterol (HDL-C) concentrations ( P trend=0.001), and higher total flavonoid and flavonol intakes were associated with lower serum triglycerides (TG) concentrations ( P trend=0.020 and P trend=0.035, respectively) and TG/HDL-C ratios ( P trend=0.040 and P trend=0.045, respectively) in female subjects. These significant relationships were not found in male subjects. Conclusions The daily intakes of flavonoid and stilbene were estimated in the present study, and higher dietary flavonoid intake was associated with improving lipid profile in Chinese women. The results indicate that dietary flavonoids may have beneficial effect on preventing cardiovascular diseases.
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