Comparative Efficacy and Acceptability of 12 Phosphorus-Lowering Drugs in Adults with Hyperphosphatemia and Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Hyperphosphatemia is associated with cardiovascular morbidity and mortality in adults with chronic kidney disease (CKD). Drug therapy has an irreplaceable role in the management of hyperphosphatemia. OBJECTIVES: We aimed to compare and rank phosphorus-lowering drugs, including phosphate binder and nonphosphate binder, in hyperphosphatemia adults with CKD. METHODS: We did a systematic review and frequentist random-effect network meta-analysis. We searched in PubMed, Cochrane Library, Web of Science, and Embase from inception to February 1, 2023, for randomized controlled trials of 12 phosphorus-lowering drugs in adults with hyperphosphatemia and CKD. Primary outcomes were efficacy (changes in serum phosphorus) and acceptability (treatment withdrawals due to any cause). We ranked each drug according to the value of surface under the cumulative ranking curve. We applied the Confidence in Network Meta-Analysis frameworks to rate the certainty of evidence. This study was registered with PROSPERO, number CRD42022322270. RESULTS: We identified 2,174 citations, and of these, we included 94 trials comprising 14,459 participants and comparing 13 drugs or placebo. In terms of efficacy, except for niacinamide, all drugs lowered the level of serum phosphorus compared with placebo, with mean difference ranging between -1.61 (95% credible interval [CrI], -2.60 to -0.62) mg/dL for magnesium carbonate and -0.85 (-1.66 to -0.05) mg/dL for bixalomer. Only ferric citrate with odds ratios 0.56 (95% CrI: 0.36-0.89) was significantly associated with fewer dropouts for acceptability. Of the 94 trials, 43 (46%), 7 (7%), and 44 (47%) trials were rated as high, moderate, and low risk of bias, respectively, the certainty of the evidence was moderate to very low. CONCLUSIONS: Magnesium carbonate has the best phosphorus-lowering effect in hyperphosphatemia adults with CKD; considering efficacy and acceptability, ferric citrate shows evidence to be the most appropriate drug with or without dialysis.

Efficacy and safety of tenapanor in hemodialysis patients with hyperphosphatemia: A systematic review and meta-analysis of randomized placebo-controlled trials.

BACKGROUND: The effects of tenapanor in reducing serum phosphorus in hemodialysis patients with hyperphosphatemia are uncertain and no relevant meta-analysis has been conducted. We performed a meta-analysis of randomized placebo-controlled trials to evaluate the efficacy and safety of tenapanor. METHODS: All randomized controlled trials of tenapanor were searched up to 1 August 2022. The primary endpoint was the change in serum phosphorus level from baseline with tenapanor and placebo. Data on drug-related adverse events (AEs), gastrointestinal AEs and diarrhea were collected to determine the safety of tenapanor. RESULTS: There were 533 patients throughout five trials that were eligible. Tenapanor significantly lowered blood phosphorus level by 1.79 mg/dl in the mean difference than the placebo. Diarrhea, gastrointestinal AEs, and drug-related AEs were more severe than placebo. CONCLUSIONS: This meta-analysis showed that although drug side effects were common, tenapanor significantly reduced serum phosphorus level in hemodialysis patients.

Surgical management of Marjolin ulcer with the anterolateral thigh free flap: a retrospective analysis.

INTRODUCTION: MU is an aggressive entity, and extended surgical resection is the primary treatment. The defects from an MU extended resection need repair using free flaps, of which the ALT free flap is the most common. OBJECTIVE: This study described the feasibility and application value of the ALT free flap in repairing defects after MU resection. MATERIALS AND METHODS: Fifteen patients with MU had repairs with ALT free flaps and were treated by the authors' unit from June 2015 through June 2021. All defects were repaired with 1 ALT free flap except for 1 case that required 2 flaps. RESULTS: The average age of the 11 male and 4 female patients was 52 years (range, 36-71 years). Defect sizes ranged from 8 cm × 5.5 cm to 21 cm × 13.5 cm (mean size, 10.9 cm × 6.5 cm). Flap sizes ranged from 10 cm × 7.5 cm to 23 cm × 15.5 cm (mean size, 12.9 cm × 8.5 cm). All flaps survived completely except for 1 flap in which re-exploration was needed. CONCLUSIONS: The individualized ALT free flap may be selected based on the receiving area characteristics and has certain clinical application value in defect repair after MU resection.

Association between serum Galectin-3 and periodontitis in patients with type 2 diabetes mellitus.

OBJECTIVES: This study aims to investigate the correlation between serum Galectin-3 levels and the risk of periodontitis in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 140 patients with T2DM admitted to the endocrinology department of Weifang People's Hospital, Affiliated to Weifang Medical College from July 2021 to November 2022 were selected and divided into T2DM without periodontitis group (T2DM group, n=67) and T2DM with periodontitis group (T2DMP group, n=73) according to whether they were combined with periodontitis. In the same period, 65 non-periodontitis volunteers with normal blood glucose were selected as healthy control group (NC group). Blood samples of all subjects were collected, and serum Galectin-3 levels and related laboratory indices were detected and compared among the three groups. RESULTS: Serum Galectin-3 levels in the NC, T2DM, and T2DMP groups were 3.81 (3.49, 4.15), 4.82 (4.25, 5.26), and 6.83 (5.19, 7.28) ng/mL, respectively. After adjusting for the influence of baseline data by multiple linear regression, serum Galectin-3 levels in the T2DMP and T2DM groups were significantly higher than those in the NC group (all P<0.05). Multiple linear regression analysis showed that serum Galectin-3 levels were positively correlated with homeostatic model of the insulin resistance index (ß=0.254, 95%CI:0.089-0.419, P=0.003), glycosylated hemoglobin A1c (ß=0.397, 95%CI: 0.049-0.745, P=0.026), and clinical attachment loss (ß=0.298, 95%CI: 0.024-0.572, P=0.033). After adjusting for the effects of covariates, binary logistic regression showed that serum Galectin-3 levels were significantly associated with the risk of periodontitis in patients with T2DM (OR=2.146, 95%CI: 1.260-3.655, P=0.005). Trend test showed that the risk of periodontitis in patients with T2DM increased with increasing serum Galectin-3 levels (Ptrend=0.011). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of serum Galectin-3 in predicting T2DM periodontitis was 0.861 (95%CI: 0.801-0.920, Z=11.806, P<0.001). CONCLUSIONS: Serum Galectin-3 levels were elevated in patients with T2DM and pe-riodontitis and associated with the risk of periodontitis.

[Effect of non-surgical periodontal therapy on level of serum soluble intercellular adhesion molecule-1 and glycated hemoglobin A1c in patients with type 2 diabetes and chronic periodontitis].

OBJECTIVE: To evaluate the effects of non-surgical periodontal treatment on clinical periodontal measurements, glycemic control, and level of serum soluble intercellular adhesion molecule-1 (sICAM-1) in type 2 diabetes mellitus with chronic periodontitis patients. METHODS: Patients with type 2 diabetes and chronic periodontitis were selected and classified into well-controlled group[glycated hemoglobin Ac(GHbA1)<7.00%, n=30, DMCP1 group] and poorly-controlled group (GHbAc > or = 7.00%, n = 30, DMCP2 group). Thirty systemically healthy patients with chronic periodontitis were recruited as control group (CP group). All subjects underwent non-surgical periodontal therapy. Plaque index(PLI), sulcus bleeding index(SBI), bleeding on probing (BOP), probing depth(PD), clinical attachment loss (CAL), serum sICAM-1 concentration, and the value of fasting plasma glucose(FPG), GHbAc were recorded at baseline, 1 and 3 months after periodontal treatment. RESULTS: The three study groups showed significant improvements for the levels of PD, SBI, PLI, BOP, and serum sICAM-1 concentration at 1 and 3 months after non-surgical periodontal treatment (P < 0.05). The level of CP group and DMCP1 group also showed significant improvements for the levels of CAL (P < 0.05), but no significant change was found in DMCP2 group (P > 0.05). At 3 months after periodontal treatment, GHbA1c levels in DMCP2 group significantly decreased by 1.12% (P < 0.05), whereas no significant changes were found in CP and DMCT groups (P > 0.05). CONCLUSION: Non-surgical periodontal treatment can siginificantly improve periodontal health status in patients with type 2 diabetes and periodontitis, reduce the level of serum sICAM-1, and can reduce the level of GHbA1c in poorly controlled type 2 diabetic patients.

SLC gene-modified dendritic cells mediate T cell-dependent anti-gastric cancer immune responses in vitro.

Dendritic cells (DCs) are potent professional antigen-presenting cells (APCs) with the ability to prime naïve T cells, and play an important role in the initiation and regulation of immune responses. In this study, we constructed a recombinant adenovirus carrying the SLC gene (Ad-SLC), and detected the biological effects of Ad-SLC-modified DCs as an adjuvant for the initiation of gastric cancer immune responses. Human DCs were transfected with Ad-SLC and the recombinant adenovirus carrying the ß-galactosidase gene, Ad-LacZ, respectively. Modified DCs were pulsed with the cell lysate antigen of SGC-7901 cells (a type of gastric cancer cell line) and co-cultured with autologous T cells. The T cells were harvested and incubated with SGC-7901 cells and the cytotoxic function of the T cells was detected. Based on the data, the expression of mature DC phenotypes CD83 and CCR7 was upregulated after transfection with Ad-SLC and the chemotaxis function of DCs was augmented after transfection with Ad-SLC. Moreover, the expression of RANTES in DCs was upregulated by Ad-SLC transfection, while expression levels of IL-12p70 and IL-10 were not significantly altered. When co-cultured with autologous T cells, DCs modified with the SLC gene and pulsed with SGC-7901 cell lysates significantly promoted the proliferation of autologous T cells and induced Th1 differentiation, and displayed a strong cytotoxicity to SGC-7901 cells. In conclusion, Ad-SLC promoted DC maturation, enhancing the ability of DCs for T-cell chemotaxis and T-cell stimulation, and induced specific anti-gastric cancer cellular immunity. Recombinant Ad-SLC-modified DCs may be used as an adjuvant to induce an effective anti-gastric cancer immune response.

[Sero-epidemiological investigation on hepatitis B among permanent residents in Shenzhen area].

OBJECTIVE: To understand the infection status and epidemiological features of HBV in permanent residents of Shenzhen city. METHODS: A multi-stage stratified random sampling method was performed for questionnaire survey to permanently-registered residents of 1-59 years old in Luohu and Baoan district of Shenzhen in 2010, and blood samples of the subjects were collected. Hepatitis B virus-related surface antigen (HBsAg) and hepatitis B virus surface antibody (anti-HBs) were detected with ELISA. RESULTS: The total 3771 studied population showed 252 HBsAg positive and 2712 anti-HBs positive residents with the standardization prevalence as 9.73% and 72.83% , respectively. The difference of the prevalence of HBsAg and anti-HBs between males and females were not statistically significant (P > 0.05). The prevalence of HBsAg was reduced with increasing age. The differences of the prevalence of HBsAg between Shenzhen permanent registered and non-permanent registered population were not significant, but the prevalence of anti-HBs in Permanent registered residents (78.32%) was higher than in non-permanent (66.03%, χ(2) = 41.613, P < 0.001). The prevalence of HBsAg was significantly different in various occupational and educational levels. Peasants had the highest prevalence (24.13%) and medical workers had the highest prevalence of anti-HBs (89.10% ). People with junior high school education had the highest prevalence of HBsAg (12.76%) and the lowest of anti-HBs (62.45%). Population with high-level education had the highest prevalence of anti-HBs(81.00% average). The prevalence of HBsAg was over 10% in people who were born in Shenzhen and Guangdong province, and the anti-HBs was the highest in Shenzhen population with the prevalence as 74.48% and 76.47% , respectively. CONCLUSION: In the Shenzhen resident population, the overall prevalence of HBV was lower than the average level of Guangdong province, but higher than the national wide.

[Effect of different porcelain-fused-to-metal crown inner metal materials on the level of soluble intercellular adhesion molecule-1 and interleukin-1beta in gingival crevicular fluid].

OBJECTIVE: To investigate the effect of different inner metal materials of porcelain-fused-to-metal (PFM) crown on periodontal tissue by means of measuring the level of soluble intercellular adhesion molecule-1 (sICAM-1) and interleukin-1beta (IL-1beta) in gingival crevicular fluid (GCF) after PFM restorations. METHODS: 30 teeth were divided into three groups (Ni-Cr alloy group, Co-Cr alloy group and Au-Pt alloy group, 10 teeth each group), and restored by Ni-Cr alloy, Co-Cr alloy and Au-Pt alloy PFM crown according grouping. At the point of pre-restoration, 6-month and 12-month after cementation, the clinical parameters including plaque index (PLI), gingival index (GI) and gingival crevice depth (GCD) were detected, and GCF was collected from labial and lingual of mesial site and distal site. The level of sICAM-1 and IL-1beta were detected. RESULTS: At the point of 6-month and 12-month after cementation, Ni-Cr alloy group showed significant difference for GI, GCD and all GCF indexes when compared to pre-restoration, Co-Cr alloy group and Au-Pt alloy group (P < 0.05). At the point of 12-month after cementation, Co-Cr alloy group showed significant difference for GI, GCD and all GCF indexes when compared to pre-restoration and Au-Pt alloy group (P < 0.05). All indexes have no significant difference for Au-Pt alloy group during the 12-month experiment times when compared to pre-restoration (P > 0.05). CONCLUSION: Non-noble metal has bad effect on the periodontal tissue.