Analysis of osteoporosis treatment patterns with bisphosphonates and outcomes among postmenopausal veterans

PurposeAdherence and persistence with bisphosphonates are frequently poor, and stopping, restarting, or switching bisphosphonates is common. We evaluated bisphosphonate change behaviors (switching, discontinuing, or reinitiating) over time, as well as fractures and costs, among a large, national cohort of postmenopausal veterans.MethodsFemale veterans aged 50 + treated with bisphosphonates during 2003–2011 were identified in Veterans Health Administration (VHA) datasets. Bisphosphonate change behaviors were characterized using pharmacy refill records. Patients' baseline disease severity was characterized based on age, T-score, and prior fracture. Cox Proportional Hazard analysis was used to evaluate characteristics associated with discontinuation and the relationship between change behaviors and fracture outcomes. Generalized estimating equations were used to evaluate the relationship between change behaviors and cost outcomes.ResultsA total of 35,650 patients met eligibility criteria. Over 6800 patients (19.1%) were non-switchers. The remaining patients were in the change cohort; at least half displayed more than one change behavior over time. A strong, significant predictor of discontinuation was ≥ 5 healthcare visits in the prior year (11–23% more likely to discontinue), and discontinuation risk decreased with increasing age. No change behaviors were associated with increased fracture risk. Total costs were significantly higher in patients with change behaviors (4.7–19.7% higher). Change-behavior patients mostly had significantly lower osteoporosis-related costs than non-switchers (22%–118% lower).ConclusionsMost bisphosphonate patients discontinue treatment at some point, which did not significantly increase the risk of fracture in this majority non-high risk population. Bisphosphonate change behaviors were associated with significantly lower osteoporosis costs, but significantly higher total costs.     

Apoptosis-inducing effect of Akebia saponin D from the roots of Dipsacus asper Wall in U937 cells

Methanol extracts of the root of Dipsacus asper Wall (Dipsacaceae) were found to exhibit apoptosis-inducing activities in U937 (human monocyte-like histiocytic) cells. Investigation of the active n-BuOH fraction led to the isolation of akebia saponin D (ASD). Structure was established by spectroscopic methods. Treatment of U937 cells with ASD induced apoptosis in a dose dependent manner. ASD exerted strong cytotoxicity against human and murine leukemia cells. It is significantly increased the subG1 cell population and expression of p53 and Bax gene. And also ASD enhanced NO production from RAW264.7 macrophage cells. Taken together, these results strongly indicate that ASD may exert apoptosis-inducing activity via induction of apoptosis through activation chiefly via the nitric oxide and apoptosis-related p53 and Bax gene expression. These data provide scientific evidence that Dipsacus asper Wall can be useful as a chemopreventive agent.     

KIOM-79 prevents S100b-induced TGF-β1 and fibronectin expression in mouse mesangial cells

Aim of the study

In this study, we investigated whether KIOM-79 inhibits transforming growth factor-beta 1 (TGF-β1) and fibronectin expression in mouse mesangial cells cultured under S100b, a specific ligand of the receptor for advanced glycation end products (RAGE).

Materials and methods

Cell counting kit (CCK-8) assay was employed to evaluate the viability of KIOM-79-treated mesangial cells. The effect of KIOM-79 on S100b-induced TGF-β1 and fibronectin expression was investigated using RT-PCR, ELISA, and Western blot on mesangial cells.

Results

KIOM-79 (up to 50 μg/ml) appeared to have no effect on cell viability. S100b induced an increase in the expression TGF-β1 and fibronectin. Expression of TGF-β1 and fibronectin was inhibited significantly by KIOM-79 treatment in mesangial cells. KIOM-79 also inhibited the expression of NF-kB and inactivated p38 mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase (ERK) 1/2 in mesangial cells. KIOM-79 pretreatment inhibited increased malondialdehyde (a product of lipid peroxidation and a marker for oxidative stress) levels in S100b-induced mesangial cells.

Conclusions

These data demonstrate that KIOM-79 inhibits expression of TGF-β1 and fibronectin through inactivation of MAPK/ERK1/2 signaling, reduction in malondiadehyde levels, and inhibition of NF-kB in mesangial cells cultured under diabetic conditions. KIOM-79 could be beneficial for preventing of the development of diabetic complications such as nephropathy.     

Tai chi for breast cancer patients: a systematic review

The objective of this review was to assess the effectiveness of tai chi for supportive breast cancer care. Eleven databases were searched from inception through December 2009. Controlled trials testing tai chi in patients with breast cancer that assessed clinical outcome measures were considered. The selection of studies, data extraction, and validations were performed independently by two reviewers. Risk of bias was assessed using Cochrane criteria. Three randomized clinical trials (RCTs) and four non-randomized controlled clinical trials (CCTs) met our inclusion criteria. The three RCTs tested the effects of tai chi on breast cancer care compared with walking exercise, psychological support therapy, or spiritual growth or standard health care and showed no significant differences between tai chi and these control procedures in quality of life and psychological and physical outcome measures. The meta-analysis also failed to demonstrate significant effects of tai chi compared with control interventions (n = 38, SMD, 0.45, 95% CI −0.25 to 1.14, P = 0.21; heterogeneity: χ² = 0.23, P = 0.63; I ² = 0%). All of the four CCTs showed favorable effects of tai chi. Three trials suggested effectiveness in psychological and physical outcome measures, whereas one study was too poorly reported to be evaluated in detail. All of the CCTs had a high risk of bias. Collectively, the existing trial evidence does not show convincingly that tai chi is effective for supportive breast cancer care. Future studies should be of high methodological quality, with a particular emphasis on including an adequate control intervention.     

Association analyses of the INSIG2 polymorphism in the obesity and cholesterol levels of Korean populations

Background  

While INSIG2 has been reported to be associated with BMI in many populations, conflicting results have prevented consensus over its role. In analyses of mice and cell cultures the gene has been found to be involved in the regulation of cholesterol synthesis; however, no relationship has been found with cholesterol metabolism in human epidemiological research. Therefore, this study attempts to assess the effect of rs7566605 near INSIG2 on both obesity- and cholesterol-related traits in Koreans.     

Spinal cholinergic mechanism of the relieving effects of electroacupuncture on cold and warm allodynia in a rat model of neuropathic pain

This study was performed to determine whether spinal cholinergic systems mediate the relieving effects of electroacupuncture (EA) on cold and warm allodynia in a rat model of neuropathic pain. For neuropathic surgery, the right superior caudal trunk was resected at the level between the S1 and S2 spinal nerves innervating the tail. Two weeks after the injury, the intrathecal (i.t.) catheter was implanted. Five days after the catheterization, the rats were injected with atropine (non-selective muscarinic antagonist, 30 μg), mecamylamine (non-selective nicotinic antagonist, 50 μg), pirenzepine (M₁ muscarinic antagonist, 10 μg), methoctramine (M₂ antagonist, 10 μg) or 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP) (M₃ antagonist, 10 μg). Ten minutes after the injection, EA was applied to the ST36 acupoint for 30 min. The cold and warm allodynia were assessed by the tail immersion test [i.e., immersing the tail in cold (4°C) or warm (40°C) water and measuring the latency of an abrupt tail movement] before and after the treatments. The i.t. atropine, but not mecamylamine, blocked the relieving effects of EA on cold and warm allodynia. Furthermore, i.t. pirenzepine attenuated the antiallodynic effects of EA, whereas methoctramine and 4-DAMP did not. These results suggest that spinal muscarinic receptors, especially M₁ subtype, mediate the EA-induced antiallodynia in neuropathic rats. J. H. Park and S. K. Kim have contributed equally to this work.     

Puerarin suppresses AGEs-induced inflammation in mouse mesangial cells: A possible pathway through the induction of heme oxygenase-1 expression

Puerarin is a natural product isolated from Puerarin lobata and has various pharmacological effects, including anti-hyperglycemic and anti-allergic properties. In the present study, we investigated the effect of puerarin against advanced glycation end products (AGEs)-induced inflammation in mouse mesangial cells. Puerarin acts by inducing the expression of heme oxygenase-1 (HO-1) in a dose- and time-dependent manner. Puerarin was able to enhance phosphorylation of protein kinase C (PKC) δ, but not PKC α/β II, in a time-dependent manner. Induction of HO-1 expression by puerarin was suppressed by GF109203X, a general inhibitor of PKC, and by rottlerin, a specific inhibitor of PKC δ. However, induction was not suppressed by Gö6976, a selective inhibitor for PKC α/β II. Additionally, the knockdown of endogenous PKC δ by small interfering RNA (siRNA) resulted in the inhibition of HO-1 expression and Akt phosphorylation. Puerarin increased antioxidant response element (ARE)-Luciferase activity in a dose- and time-dependent manner in transfected mouse mesangial cells. Mutation of the ARE sequence abolished puerarin-induced HO-1 expression. Furthermore, puerarin treatments resulted in a marked increase in NF-E2 related factor-2 (Nrf-2) translocation, leading to up-regulation of HO-1 expression. However, transfection of Nrf-2 specific siRNA abolished HO-1 expression. Pretreatment with puerarin inhibited the expressions of COX-2, MMP-2 and MMP-9. But, these effects were reversed by ZnPP, an inhibitor of HO-1. Taken together, our results demonstrate that puerarin-induced expression of HO-1 is mediated by the PKC δ-Nrf-2-HO-1 pathway and inhibits N-carboxymethyllysine (CML)-induced inflammation in mouse mesangial cells.     

Simultaneous determination of four marker components in Yukmijihwang Tang by high performance liquid chromatography/diode array detector

Simultaneous determination method of four marker components, paeoniflorin, loganin, 5-hydroxymethyl-2-furaldehyde and paeonol in traditional herbal medicine, Yukmijihwang tang, was developed to achieve rapidly and systematic quality control by high performance liquid chromatography coupled with diode array detection. To develop this high performance liquid chromatography method, C₁₈ column (5 μm, 120 Å, 4.6 mm × 150 mm) was used with gradient elution of water and methanol as mobile phase. Validation of the chromatography method was evaluated by linearity, recovery, and precision test. Calibration curves of standard components showed excellent linearity with R² > 0.9990. Limits of detection and limits of quantification were in the ranges 0.01–0.02 and 0.04–0.07 μg/mL, respectively. The relative standard deviations of data of the intra-day and inter-day experiments were less than 1.15% and 3.76%, respectively. The results of recovery test were found to range from 94.88 to 107.43% with relative standard deviation values 0.07–2.66%. The results of validation suggested that this method was very accurate and stabilized.     

Identification of marker compounds in herbal drugs on TLC with DART-MS

This study was conducted to provide a more versatile and specific information on Thin Layer Chromatographic (TLC) analysis of medicinal plants. TLC plates developed with the extract of herbal medicines were analyzed with direct analysis in real time (DART) ion source. Three well known herbal drugs were extracted and developed on a silica-coated TLC plate with the conditions pre-established in Korean Pharmacopoeia IX. The developed plate was placed between the DART ion source and TOF-MS analyzer to get real time mass spectra from the bands on the TLC plate directly. The marker coumarin compounds, decursin and decursinol were successfully identified from the TLC plate developed with Angelicae gigantis radix, along with alkaloid compounds of rutaecarpine and evodiamine from Evodiae fructus, and lignan molecules of gomisin A, N, and schisandrin from Schisandrae fructus. This hyphenation system of TLC and DART-MS could provide unique and specific information on the major constituents of crude plant drug on TLC through uncovering high resolution mass number of each band on the TLC plate directly in real time.