The Risk Factors of Avascular Necrosis in Patients with Systemic Lupus Erythematosus: a Meta-analysis

The aim of this study was to determine the risk factors for avascular necrosis (AVN) in patients with systemic lupus erythematosus (SLE). Four electronic databases (PubMed, EMBASE, Ovid, and Science Direct) were searched for. The search was performed to identify the articles as to SLE with AVN before September 2013. The clinical and laboratory data were extracted, and a meta-analysis was performed to identify the risk factors for AVN in patients with SLE. Publication bias was assessed with funnel plot and Egger’s test. A total of 995 papers were found from the four databases; 16 studies were finally included. Pooled analysis showed the following result. The result showed that arthritis (odds ratio (OR)?=?2.448, 95 % confidence interval (CI)?=?1.617–3.707), cushingoid (OR?=?3.890, 95 % CI?=?1.591–9.510), gastrointestinal involvement (OR?=?2.054, 95 % CI?=?1.283–3.290), hypertension (OR?=?1.482, 95 % CI?=?1.093–2.008), oral ulcers (OR?=?1.877, 95 % CI?=?1.182–2.979), pleuritis (OR?=?2.302, 95 % CI?=?1.325–4.001), renal disease (OR?=?1.475, 95 % CI?=?1.124–1.936), and vasculitis (OR?=?2.591, 95 % CI?=?1.358–4.944) were relevant with AVN in SLE patients. Cytotoxic drug (OR?=?1.834, 95 % CI?=?1.065–3.156, P?=?0.029), the total cumulative dose (Standard Mean Difference (SMD) = 1.104, 95 % CI = 0.118–2.090, P = 0.028), maximum daily dose (SMD = 0.484, 95 % CI = 0.288–0.678, P < 0.001), and mean daily dose (SMD?=?1.305, 95 % CI?=?0.061–2.549, P?=?0.040) were significantly higher in AVN group. There were no significantly laboratory features that appeared in this pooled analysis. We conclude that arthritic, cushingoid, gastrointestinal involvement, hypertension, oral ulcers, pleuritis, renal disease, vasculitis, cytotoxic drug, and steroid treatment may contribute to AVN in SLE patients.     

Association of STAT4 rs7574865 with Susceptibility to Systemic Lupus Erythematosus in Iranian Population

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease with complex genetic inheritance that affecting different organs and systems. STAT4 has been newly identified as a susceptible gene in the development of SLE. According to recent studies, STAT4 has been associated with SLE in various populations. We investigated whether STAT4 single nucleotide polymorphisms (SNPs) were associated with susceptibility and clinical features of SLE in Iranian patients. The study group comprised 280 patients with SLE and 281 sex-, age-, and ethnicity-matched healthy controls of Iranian ancestry. Two SNPs (rs7574865 and rs7601754) were genotyped using the TaqMan MGB Allelic Discrimination method. Our results showed a significant association betweenrs7574865 T allele (odds ratio (OR)?=?1.50, 95 % CI?=?1.18–1.92, P?=?0.002) and susceptibility to SLE. The rs7574865TT genotype (P?=?0.02, OR?=?1.94, 95 % CI?=?1.74–3.19) and GT genotype (P?=?0.008, OR?=?1.71, 95 % CI?=?1.19–2.45) showed a significant association with the risk of SLE in the Iranian population. We concluded that STAT4 rs7574865 is associated with SLE susceptibility in the Iranian population and this SNP might be a factor in the pathogenesis of SLE. However, further studies are required to investigate the mechanism by which polymorphisms in this gene lead to SLE.     

Therapeutic drug monitoring and receiver operating characteristic curve prediction may reduce the development of linezolid-associated thrombocytopenia in critically ill patients

To investigate the risk factors associated with the development of thrombocytopenia, and define the thresholds of efficacy and safety in critically ill patients who received linezolid therapy. A retrospective study was performed in critically ill patients treated with linezolid. Risk factors associated with thrombocytopenia were identified via medical records and trough levels (C_min) measured during linezolid treatment. By establishing a logistic model, the risks were predicted by the receiver operating characteristic (ROC) curve and the thresholds of efficacy and safety were identified in the patients. Logistic analysis showed that, weight (OR?=?0.906; 95 % CI, 0.839–0.978; P?=?0.011), baseline platelet count (OR?=?0.989; 95 % CI, 0.977–1.000; P?=?0.049), C_min (OR?=?1.545; 95 % CI, 1.203–1.983; P?=?0.001), and APACHE II score (OR?=?1.130; 95 % CI, 1.003–1.273; P?=?0.044) were significant factors for linezolid-associated thrombocytopenia. The area under the ROC curve of the combined predictor was larger based on the above factors. When the Youden index was the maximum, the best optimal cut-off point was 205.6 on the ROC curve; when C_min?≥?2 mg/L, the probability of bacterial eradication was more than 80 %; when C_min?≥?6.3 mg/L, the probability of thrombocytopenia was more than 50 %. In clinical practice, when the calculating results of the combined predictor ≤205.6, the risk of the development of thrombocytopenia may be higher. Furthermore, maintenance of C_min between 2 and 6.3 mg/L over time may be helpful in retaining appropriate efficacy and reducing the associated thrombocytopenia.     

JAK2 rs10758669 Polymorphisms and Susceptibility to Ulcerative Colitis and Crohn's Disease: A Meta-analysis

In this meta-analysis, we aimed to clarify the impact of Janus kinase 2 (JAK2) rs10758669 polymorphisms on ulcerative colitis (UC) and Crohn's disease (CD) risk. Data were extracted, and pooled odd ratios (ORs) as well as 95 % confidence intervals (95 %CIs) were calculated. Eleven studies with 7009 CD patients, 7929 UC patients, and 19235 controls were included. The results showed that JAK2 rs10758669 polymorphism was associated with CD (AC vs. AA, OR?=?1.16, 95 %CI, 1.08–1.24; CC vs. AA, OR?=?1.29, 95 %CI, 1.17–1.43; AC?+?CC vs. AA, OR?=?1.19, 95 %CI, 1.11–1.27; CC vs. AA?+?AC, OR?=?1.19, 95 %CI, 1.09–1.31; C vs. A, OR?=?1.14, 95 %CI, 1.09–1.20) and UC susceptibility (AC vs. AA, OR?=?1.14, 95 %CI, 1.06–1.22; CC vs. AA, OR?=?1.33, 95 %CI, 1.20–1.47; AC?+?CC vs. AA, OR?=?1.18, 95 %CI, 1.10–1.27; CC vs. AA?+?AC, OR?=?1.24, 95 %CI, 1.12–1.36; C vs. A, OR?=?1.15, 95 %CI, 1.10–1.21). But no significant association was found between JAK2 rs10758669 polymorphism with CD in Asian. Either in adult-onset group or multi-age group, hospital-based group or population-based group, JAK2 rs10758669 polymorphism was associated with CD and UC susceptibility. This meta-analysis indicated that JAK2 rs10758669 polymorphism was a risk factor both for CD and UC, especially in Caucasian. The differences in age of onset and study design did not influence the associations obviously. Gene–gene and gene–environment interactions should be investigated in the future.     

Estrogen receptor alpha gene (ESR1) polymorphism and its interaction with smoking and drinking contribute to susceptibility of systemic lupus erythematosus

The aim of this study is to investigate the association of estrogen receptor alpha gene (ESR1) polymorphisms, additional gene–gene, and gene–environment interaction with systemic lupus erythematosus (SLE) risk. SNPStats (available online at http://bioinfo.iconcologia.net/SNPstats) was used to investigate the Hardy–Weinberg equilibrium (HWE) in controls and association between SNP and SLE risk. Generalized multifactor dimensionality reduction (GMDR) was used to screen the interactions among SNPs and environmental risk factors; SLE risk was significantly higher in carriers of rs2234693 C allele than those with TT (TC + CC versus TT), adjusted OR (95%CI) = 1.57 (1.21–2.06), and was also higher in carriers of rs9340799 G allele than those with AA (AG + GG versus AA), adjusted OR (95%CI) = 1.68 (1.24–2.13). However, we also find no association between rs2228480 and SLE risk after covariates adjustment. We found a significant two-locus model (p = 0.0010) involving rs2234693 and smoking; the cross-validation consistency of this model was 10/10, and the testing accuracy was 62.70%. Smokers with TC or CC of rs2234693 genotype have the highest SLE risk, compared to never-smokers with TT of rs2234693 genotype, OR (95%CI) was 2.50 (1.65–3.42), after covariates adjustment for gender, age, alcohol drinking, and BMI. We found that C allele of rs2234693 and G allele of rs9340799 within ESR1 gene, their interaction between rs2234693 and current smoking were all associated with increased SLE risk.     

The efficacy of fidaxomicin in the treatment of Clostridium difficile infection in a real-world clinical setting: a Spanish multi-centre retrospective cohort

The objective of this study was to evaluate the efficacy and safety of fidaxomicin in the real-life clinical setting. This was a retrospective cohort of patients with Clostridium difficile infection (CDI) treated with fidaxomicin in 20 Spanish hospitals between July 2013 and July 2014. Clinical cure, 30-day recurrence, 30-day mortality, sustained cure, and factors associated with the failure to achieve sustained cure were analyzed. Of the 72 patients in the cohort 41 (56.9 %) had a fatal underlying disease. There were 44 (61.1 %) recurrent episodes and 26 cases (36.1 %) with a history of multiple recurrences. Most episodes were severe (26, 36 %) or severe-complicated (14, 19.4 %). Clinical cure rate was 90.3 %, recurrence rate was 16.7 % and three patients (4.2 %) died during the follow-up period. Sustained cure was achieved in 52 cases (72.2 %). Adverse events were reported in five cases (6.9 %). Factors associated with the lack of sustained cure were cardiovascular comorbidity (OR 11.4; 95 %CI 1.9–67.8), acute kidney failure (OR 7.4; 95 %CI 1.3–43.1), concomitant systemic antibiotic treatment (OR 6.2; 95 %CI 1.1–36.8), and C-reactive protein value at diagnosis (OR 1.2 for each 1 mg/dl increase; 95 %CI 1.03–1.3). Fidaxomicin is an effective and well tolerable treatment for severe CDI and for cases with elevated recurrence risk.     

A population association study of vitamin D receptor gene polymorphisms and haplotypes with the risk of systemic lupus erythematosus in a Chinese population

The aim of the study is to investigate the association of vitamin D receptor (VDR) gene polymorphism, additional gene–gene interaction, and haplotype combination with systemic lupus erythematosus (SLE) risk. Pairwise linkage disequilibrium (LD) analysis was conducted using SNPstats. The association between four SNPs within VDR gene and SLE risk was investigated by logistic regression. Generalized multifactor dimensionality reduction (GMDR) was used to analyze the interaction among four SNPs. Four SNPs within VDR gene were selected for genotyping in this study, including rs2228570, rs1544410, rs7975232, and rs731236. The T allele of rs2228570 and the G allele of the rs1544410 were associated with increased MM risk, adjusted ORs (95%CI) were 1.61(1.25–2.11) and 1.78 (1.34–2.23), respectively. GMDR analysis suggested a significant two-locus model (P = 0.0010) involving rs1544410 and rs2228570, and in this model, the cross-validation consistency was 10/10, and the testing accuracy was 62.70%. The haplotype analysis indicated that the most common haplotype was rs1544410-A and rs7975232-G haplotype, the frequencies of which were 0.4701 and 0.5467 in case and control group. Haplotype containing the rs1544410-G and rs7975232-T alleles were associated with increased SLE risk, OR (95%CI) = 2.08 (1.47–2.72), P < 0.001. We found that rs2228570 and rs1544410 within VDR gene, their interaction and haplotype containing the rs1544410-G and rs7975232-T alleles were all associated with increased SLE risk.     

TNF-α-308 promoter G/A and PTPN22 (1858 C/T) genes polymorphisms in Egyptian patients with systemic lupus erythematosus

Tumor necrosis factor alpha (TNF-α) promoter gene polymorphism at position 308 and that of the protein tyrosine phosphatase nonreceptor type 22 (PTPN22) at position 1858 C/T have been inconsistently implicated as genetic risk factors for systemic lupus erythematosus (SLE) in some populations. We investigated the possible association of these polymorphisms with SLE susceptibility, and whether serum TNF-α level is related to different genotypes and disease activity in Egyptian SLE patients. TNF-α-308 G/A and PTPN22 C1858T polymorphisms were determined by PCR-restriction fragment length polymorphism analysis in 40 SLE patients and 40 unrelated healthy controls. Serum TNF-α level was measured by ELISA method. The median serum TNF-α was significantly higher in SLE patients than in controls (P?<?0.001). A significant positive correlation was detected between serum TNF-α and SLE activity index (r?=?0.723, P?<?0.001). There was no significant difference in TNF-α-308 G/A genotypes or allele frequency between SLE cases and controls (P?=?0.108 and P?=?0.133, respectively). Diabetes was the only clinical feature in SLE patients that showed significant higher frequency with GA genotype than with GG genotype (P?=?0.001). Risk estimation for the TNF-α-308 genotypes was of no significant (odds ratio?=?2.429; 95 % CI?=?0.8–7.2; P?=?0.108). Concerning PTPN22 1858 C/T, there was no significant difference in PTPN22 C/T genotypes or allele frequency between SLE cases and controls (P?=?0.152 and P?=?0.155, respectively). TNF-α-308 G/A and PTPN22 (1858 C/T) polymorphisms do not exhibit a significant influence on the susceptibility of SLE in Egyptian patients. However, serum TNF-α level could be a sensitive marker of SLE disease activity.     

The relevance of Tim-3 polymorphisms and F protein to the outcomes of HCV infection

Hepatitis C virus (HCV) is one of the major causes of liver inflammation. The aim of this study was to investigate the associations of T-cell immunoglobulin and mucin domain-3 (Tim-3) polymorphisms and the alternate reading frame protein (F protein) with the outcomes of HCV infection. Three single-nucleotide polymorphisms (SNPs; rs10053538, rs12186731, and rs13170556) of Tim-3 were genotyped in this study, which included 203 healthy controls, 558 hepatitis C anti-F-positive patients, and 163 hepatitis C anti-F-negative patients. The results revealed that the rs12186731 CT and rs13170556 TC and CC genotypes were significantly less frequent in the anti-F-positive patients [odds ratio (OR)?=?0.54, 95 % confidence interval (CI)?=?0.35–0.83, p?=?0.005; OR?=?0.26, 95 % CI?=?0.18–0.39, p?<?0.001; and OR?=?0.19, 95 % CI?=?0.10–0.35, p?<?0.001, respectively), and the rs13170556 TC genotype was more frequent in the chronic HCV (CHC) patients (OR?=?1.70, 95 % CI?=?1.20–2.40, p?=?0.002). The combined analysis of the rs12186731 CT and rs13170556 TC/CC genotypes revealed a locus-dosage protective effect in the anti-F-positive patients (OR?=?0.22, 95 % CI?=?0.14–0.33, p _trend?<?0.001). Stratified analyses revealed that the frequencies of the rs12186731 (CT?+?TT) genotypes were significantly lower in the older (OR?=?0.31, 95 % CI?=?0.15–0.65, p?=?0.002) and female (OR?=?0.30, 95 % CI?=?0.17–0.52, p?<?0.001) subgroups, and rs13170556 (TC?+?CC) genotypes exhibited the same effect in all subgroups (all p?<?0.001) in the anti-F antibody generations. Moreover, the rs13170556 (TC?+?CC) genotypes were significantly more frequent in the younger (OR?=?1.86, 95 % CI?=?1.18–2.94, p?=?0.007) and female (OR?=?2.38, 95 % CI?=?1.48–3.83, p?<?0.001) subgroups of CHC patients. These findings suggest that the rs12186731 CT and rs13170556 TC/CC genotypes of Tim-3 provide potential protective effects with the F protein in the outcomes of HCV infection and that these effects are related to sex and age.     

The PD-1 rs36084323 A > G polymorphism decrease cancer risk in Asian: A meta-analysis

The rs36084323 A?>?G polymorphism in programmed cell death-1(PD-1) gene has been reported to be associated with cancer risk. However, the results of previous studies were inconsistent. Therefore, we performed a meta-analysis to identify the potential association, by searching the PubMed, EMBASE, Cochrane Library, and the Chinese CNKI, WANFANG and CBM databases. Data were extracted and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated to assess the strength of the association. A total of 10 relevant studies involving 4445 cancer cases and 5126 controls were recruited. Overall, the results indicated that the PD-1 rs36084323 A?>?G polymorphism was not statistically associated with cancer risk. However, stratified analysis revealed that there was a statistically reduced cancer risk in Asians(G vs. A, OR?=?0.89, 95%CI:0.81–0.97, P?=?0.008, I²?=?48.8%; GG vs. AA, OR?=?0.79, 95% CI:0.66–0.94, P?=?0.008, I²?=?48.7%; GG/AG vs. AA, OR?=?0.87, 95%CI:0.76–0.98, P?=?0.017, I²?=?34.9%; GG vs. AG/AA, OR?=?0.85, 95%CI:0.75–0.97, P?=?0.027, I²?=?40%) and in the patients with EOC(AG vs. AA, OR?=?0.69, 95%CI:0.54–0.90, P?=?0.005, I²?=?0%; GG/AG vs. AA, OR?=?0.67, 95%CI:0.52–0.85, P?=?0.001, I²?=?0). Meta-regression showed that ethnicity (P?=?0.029) but not cancer types (P?=?0.792), source of controls (P?=?0.207) or ample size (P?=?0.585) were the sources of heterogeneity. This meta-analysis demonstrates the PD-1 rs36084323 A?>?G polymorphism is associated with decreased cancer risk in Asian, and suggests it could potentially serve as a biomarker to screen high-risk individuals. Large-scale and well-designed case-control studies are needed to enrich the evidence of this result.     

Epidemiology and outcome of primary community-acquired bacteremia in adult patients

We conducted this study to determine the associated factors and outcomes of community-acquired primary bacteremia (PB), to describe the most frequently isolated microorganisms, the antibiotic resistance pattern, and to guide the most appropriate antibiotic treatment. A total of 1,640 community-acquired bacteremia cases in nonneutropenic adults were consecutively enrolled from January 2003 to May 2006 and prospectively followed up. Nonconditional logistic regression methods were used with PB and death as dependent variables. Secondary bacteremia (SB) was present in 1,440 patients, and 200 (12%) cases were PB. The independent factors associated with PB were male sex (OR 1.69, 95%CI 1.27–2.25, P?=?0.001) and an ultimately or rapidly fatal prognosis for an underlying disease (OR 2.48, 95%CI 1.84–3.34, P?=?0.001). The most frequently isolated microorganisms in PB were E. coli and other enterobacteria (26 and 22%, respectively) and S. aureus (15%). There were 28 and 37% ciprofloxacin-resistant E. coli strains in SB and PB, respectively (P?=?0.2). Mortality was significantly higher in PB cases (13 vs 8%, P?=?0.04). The independent factors associated with mortality in PB were ultimately or rapidly fatal prognosis of underlying disease (OR 2.1, 95%CI 1.41–3.13, P?=?0.001), lack of fever at the moment of bacteremia (OR 2.38, 95%CI 1.18–4.76, P?=?0.02) and incorrect empirical antibiotic therapy (OR 2.01, 95%CI 1.22–3.33, P?=?0.006). The initial empiric antibiotic treatment was more frequently incorrect in PB than in SB, and this was a predictive factor for mortality in PB. The resistance pattern of E. coli, other enterobacteria and S. aureus in every setting should guide the most appropriate empirical treatment for PB.     

The rs1805193, rs5361, and rs5355 single nucleotide polymorphisms in the E-selectin gene (SEL-E) are associated with subclinical atherosclerosis: The Genetics of Atherosclerotic Disease (GEA) Mexican study

The aim of this study was to evaluate the association of rs1805193, rs5361, and rs5355 E-selectin gene single nucleotide polymorphisms (SNPs) with the risk of developing subclinical atherosclerosis (SA) in a group of Mexicans individuals. SNPs were determined by TaqMan genotyping assays in a group of 287 individuals with SA and 688 healthy controls. Under different models, the T allele of the 5′UTR G98?T (rs1805193) (OR?=?1.71, 95%CI: 1.00–2.93, pC_Co-dominant = 0.0006, OR?=?2.02, 95%CI: 1.21–3.38, pC_Dominant = 0.004, and OR?=?2.14, 95%CI: 1.34–3.44, pC_Additive = 0.0015) and the C allele of the Ser128Arg A561C (rs5361) (OR?=?1.60, 95%CI: 0.92–2.79, pC_Co-dominant = 0.012, OR?=?1.78, 95%CI: 1.04–3.06, pC_Dominant = 0.038, and OR?=?1.87, 95%CI: 1.13–3.11, pC_Additive = 0.016) polymorphisms were associated with an increased risk of development of SA. In the same way, under co-dominant model, the CT genotype of the Leu575Phe C1880T (rs5355) polymorphism was associated with an increased risk of SA as compared to CC genotype (OR?=?2.34, 95%CI: 1.33–4.11, pC?=?0.0035). All models were adjusted by traditional cardiovascular risk factors. In summary, this study demonstrates that the 5′UTR G98?T, Ser128Arg A561C, and Leu575Phe C1880T polymorphisms are associated with an increased risk of developing SA.     

Risk factors and clinical outcomes for carbapenem-resistant <Emphasis Type="Italic">Enterobacteriaceae</Emphasis> nosocomial infections

This study was aimed to determine the risk factors of Carbapenem-resistant Enterobacteriaceae (CRE) nosocomial infections and assess the clinical outcomes. A case-case–control design was used to compare two groups of case patients with control patients from March 2010 to November 2014 in China. Risk factors for the acquisition of CRE infections and clinical outcomes were analyzed by univariable and multivariable analysis. A total of 94 patients with CRE infections, 93 patients with Carbapenem-susceptible Enterobacteriaceae (CSE) infections, and 93 patients with organisms other than Enterobacteriaceae infections were enrolled in this study. Fifty-five isolates were detected as the carbapenemase gene. KPC-2 was the most common carbapenemase (65.5 %, 36/55), followed by NDM-1 (16.4 %, 9/55), IMP-4 (14.5 %, 8/55), NDM-5 (1.8 %, 1/55), and NDM-7 (1.8 %, 1/55). Multivariable analysis implicated previous use of third or fourth generation cephalosporins (odds ratio [OR], 4.557; 95 % confidence interval [CI], 1.971–10.539; P?<?0.001) and carbapenems (OR, 4.058; 95 % CI, 1.753-9.397; P?=?0.001) as independent risk factors associated with CRE infection. The in-hospital mortality of the CRE group was 57.4 %. In the population of CRE infection, presence of central venous catheters (OR, 4.464; 95 % CI, 1.332–14.925; P?=?0.015) and receipt of immunosuppressors (OR, 7.246; 95 % CI, 1.217–43.478; P?=?0.030) were independent risk factors for mortality. Appropriate definitive treatment (OR, 0.339; 95 % CI, 0.120–0.954; P?=?0.040) was a protective factor for in-hospital death of CRE infection. Kaplan–Meier curves of the CRE group had the shortest survival time compared with the other two groups. Survival time of patients infected with Enterobacteriaceae with a high meropenem MIC (≥8 mg/L) was shorter than that of patients with a low meropenem MIC (2,4, and?≤?1 mg/L). In conclusion, CRE nosocomial infections are associated with prior exposure to third or fourth generation cephalosporins and carbapenems. Patients infected with CRE had poor outcome and high mortality, especially high meropenem MIC (≥8 mg/L). Appropriate definitive treatment to CRE infections in the patient is essential.     

Predictors of a Functional Somatic Syndrome Diagnosis in Patients with Persistent Functional Somatic Symptoms

Background

Functional somatic syndromes (FSS) are characterized by the existence of multiple persistent functional somatic symptoms. Not many patients fulfilling the criteria for an FSS, receive a formal diagnosis, and it is unknown which factors explain this discrepancy. Patients that tend to worry and patients that gather more health information may have an increased chance of an FSS diagnosis. We hypothesized that high intelligence and high neuroticism increase the probability of an FSS diagnosis in patients with persistent functional somatic symptoms.

Purpose

This study aims to investigate patient factors that might be important in the process of syndrome labeling.

Methods

Our study was performed in a large, representative population cohort (n?=?976) in Groningen, The Netherlands, and included two assessment waves. Intelligence was measured using the General Aptitude Test Battery version B 1002-B. Neuroticism was measured using the 12-item neuroticism scale of the Eysenck Personality Questionnaire-Revised. Functional somatic symptoms were measured with the somatization section of the Composite International Diagnostic Interview. Current FSS diagnosis was assessed with a questionnaire. We performed multivariable logistic regression analyses including sum scores of neuroticism, intelligence scores, sex, number of functional somatic symptoms, and age as potential predictors of having an FSS diagnosis.

Results

From the 976 participants that completed measurements at follow-up, 289 (26.4 %) participants reported at least one persistent functional somatic symptom, and these subjects were included in the main analyses (38.4 % males, mean age of 55.2 years (SD?=?10.7), 36–82 years). High numbers of functional somatic symptoms ((OR)?=?1.320; 95 % (CI)?=?1.097–1.588), female sex (OR?=?9.068; 95 % CI?=?4.061–20.251), and high intelligence (OR?=?1.402; 95 % CI?=?1.001–1.963) were associated with an FSS diagnosis, while age (OR?=?0.989; 95 % CI?=?960–1.019) and neuroticism (OR?=?0.956; 95 % CI?=?0.872–1.048) were not.

Conclusion

This study suggests that high intelligence, but not high neuroticism, increases the chance of syndrome labeling in patients with persistent functional somatic symptoms.     

Lamivudine versus telbivudine in the treatment of chronic hepatitis B: a systematic review and meta-analysis

The purpose of this study was to evaluate the efficacy of lamivudine (LAM) versus telbivudine (LdT) in the treatment of chronic hepatitis B (CHB). Randomized controlled studies (RCTs) involving the use of LAM versus LdT in CHB patients were included in the study. Data were obtained from the Cochrane-controlled trials register, EMBASE and MEDLINE databases (1/1990 to 12/2011). Two reviewers performed quality assessment and extracted data independently. Eight RCTs were included in the main analysis. Eight eligible trials were included in the analysis. At the end of one-year treatment, LdT was better than LAM at the virological response (RR?=?1.43, 95 % CI?=?1.12–1.84, P?=?0.005), while less than LAM at the viral breakthrough (RR?=?0.34,95 % CI?=?0.25–0.48, P?<?0.00001), viral resistance (RR?=?0.41,95 % CI?=?0.28–0.58, P?<?0.00001), but there was no statistically significant difference in the biochemical response (RR?=?1.13,95 % CI?=?0.99–1.29, P?=?0.06), HBeAg seroconversion (RR?=?1.13,95 % CI?=?0.92–1.39, P?=?0.25), therapeutic response (RR?=?1.22,95 % CI?=?1.00–1.50, P?=?0.05) and adverse events (RR?=?1.07,95 % CI?=?1.00–1.14, P?=?0.05). The creatine kinase (CK) elevation occurred more frequently in the LdT group than in LAM group (RR?=?2.43,95 % CI?=?1.57–3.75, P?<?0.0001). When treatment prolonged to 2 years, LdT was better than LAM at the HBeAg seroconversion (RR?=?1.29,95 % CI?=?1.12–1.50, P?=?0.0007) and therapeutic response (RR?=?1.34,95 % CI?=?1.21–1.49, P?<?0.00001). LdT was more effective in inhibiting HBV replication and promoting HBeAg seroconversion than LAM for CHB patients, whereby adverse effects such as CK elevation must be paid attention to.     

Correlation between status of epidermal growth factor receptor mutation and distant metastases of lung adenocarcinoma upon initial diagnosis based on 1063 patients in China

The study aimed to explore the correlations between status of epidermal growth factor receptor (EGFR) mutations and distant metastases. A total of 1063 patients with lung adenocarcinoma indentified with status of EGFR mutations from August 2010 to May 2015 at Shanxi Cancer Hospital were enrolled. 456 patients were confirmed with EGFR mutations. The associations among EGFR mutations, clinical factors, and distant metastases at initial diagnosis were evaluated. Patients harboring EGFR mutation were more likely to be female (P < 0.001), with no smoking history (P < 0.001), brain metastases (P = 0.029), and higher ECOG performance scores (P = 0.025). The correlation between EGFR mutation status and distant metastases showed statistical significance both in univariate (P = 0.022) and in multivariate analysis (OR 1.573, 95 % CI 1.202–2.059, P = 0.001) especially in brain metastases (OR 1.675, 95 % CI 1.132–2.479, P = 0.010) and lung metastases (OR 1.571, 59 % CI 1.101–2.243 P = 0.013). Furthermore, the 19del mutations showed associations with brain metastases (OR 1.586, 95 % CI 1.028–2.447, P = 0.037), and lung metastases (OR 1.587, 95 % CI 1.065–2.346, P = 0.023). The exon 21 point mutations showed statistically significant differences in liver metastases (OR 1.987, 95 % CI 1.094–3.067, P = 0.024). In conclusion, the EGFR mutations in lung adenocarcinoma patients were independently correlated with distant metastases. Subgroup analyses showed that patients harboring 19del mutations presented different distant metastases compared with those harboring 21 point mutaions.     

Evaluation of glycemic control in patients with type 2 diabetes mellitus in Chinese communities: a cross-sectional study

This study aimed to evaluate the glycemic levels in Chinese patients with type 2 diabetes mellitus (T2DM) and to explore the factors related to the results of glycemic control. A total of 2454 T2DM patients from 11 communities were examined for glycosylated hemoglobin levels and glycemic control options. Potential factors related to the results of glycemic control were analyzed using logistic regression. Of all the patients, 55.3 % achieved the glycemic control target of HbA1c < 7 %. Multivariate analysis showed that male sex (OR 1.345, 95 % CI 1.022–1.769; P = 0.034), higher levels of fasting blood glucose (OR 1.954, 95 % CI 1.778–2.147; P < 0.001), and low-density lipoprotein cholesterol (OR 1.181, 95 % CI 1.020–1.367; P = 0.026) were significantly associated with poor glycemic control. The complexity of antidiabetics was also associated with poor glycemic control (P < 0.05). Compared to diet and exercise, insulin injection was most strongly associated with poor glycemic control (OR 6.210, 95 % CI 4.054–9.514; P < 0.001). Male patients with higher levels of total cholesterol, lower levels of high-density lipoprotein cholesterol, or longer diabetic durations showed poor glycemic control, which was not found in female patients. Glycemic control was not satisfactory in T2DM patients of Nanjing communities. Various factors are associated with poor results of glycemic control.     

T-Cell Immunoglobulin- and Mucin-Domain-Containing Molecule 3 Genetic Variants and HIV+ Non-Hodgkin Lymphomas

T cell immunoglobulin- and mucin-domain-containing molecule 3 (TIM-3) has been established as a negative regulatory molecule and plays a critical role in inflammatory diseases such as rheumatoid arthritis, hepatitis B and C, and human immunodeficiency virus (HIV)-related inflammation. Recent studies have shown that chronic inflammation may greatly affect the pathogenesis of non-Hodgkin lymphomas (NHL). The aim of this study was to investigate whether polymorphisms in the TIM-3 gene were associated with susceptibility to non-NHL and HIV-related NHL. Three polymorphisms in TIM-3 gene (?1516G/T, ?574G/T, and +4259T/G) were identified by polymerase chain reaction-restriction fragment length polymorphism in 434 NHL patients, 62 HIV-related NHL cases, and 512 healthy controls. Results showed that the prevalence of ?574GT genotype and +4259TG genotype were significantly increased in the NHL cases than in controls (odds ratio (OR)?=?2.72, 95 % confidence interval (CI)?=?1.50–4.92, p?=?0.0006 and OR?=?2.59, 95 % CI?=?1.49–4.49, p?=?0.0005, respectively). The ?1516G/T polymorphism did not reveal significant difference between patients and healthy controls. When analyzing the TIM-3 polymorphisms in HIV-related NHL patients, data showed that HIV+ NHL patients had higher prevalence of ?574GT or +4259TG genotypes than those cases without HIV infection (OR?=?3.48, 95 % CI?=?1.67–7.28, p?=?0.0005 and OR?=?2.92, 95 % CI?=?1.42–6.01, p?=?0.0026, respectively). These results suggested polymorphisms in TIM-3 gene could be new risk factors for NHL as well as HIV-related NHL and suggested a possible role of the inflammatory factor in these diseases.     

Associations between PXK and TYK2 polymorphisms and systemic lupus erythematosus: a meta-analysis

Objective

The aim of this study was to determine whether phox homology domain containing serine/threonine kinase (PXK) and tyrosine kinase 2 (TYK2) confer susceptibility to systemic lupus erythematosus (SLE).

Materials and methods

The authors conducted meta-analyses on associations between SLE susceptibility and the rs6445975 polymorphism of PXK and the rs2304256, rs12720270, rs280519, and rs1272036 polymorphisms of TYK2.

Results

A total of 13 separate comparisons studies were included in this meta-analysis. Meta-analysis identified an association between SLE and the 2 allele of the rs6445975 polymorphism in the overall population [odds ratio (OR)?=?1.151, 95?% confidence interval (CI)?=?1.086–1.291, P?=?1.8E?06]. Stratification by ethnicity identified a significant association between this polymorphism and SLE in Europeans (OR?=?1.198, 95?% CI?=?1.118–1.285, P?=?3.4E?07), but not in Asians. Meta-analysis identified a significant negative association between SLE and the 2 allele of the rs2304256 polymorphism in the overall population (OR?=?0.808, 95?% CI?=?0.659–0.990, P?=?0.040), and a significant negative association was found in Europeans, but not in Asians.

Conclusions

This meta-analysis shows that the rs6445975 polymorphism of PXK and the rs2304256 polymorphism of TYK2 are associated with the development of SLE in Europeans.