Relationship between serum vitamin D levels and thyroid- and parathyroid-related diseases: a Mendelian randomisation study.

Previous studies have indicated an association between vitamin D and thyroid- and parathyroid-related diseases. However, it remains unclear whether it is a cause of the disease, a side effect of treatment or a consequence of the disease. The Mendelian randomisation (MR) study strengthens the causal inference by controlling for non-heritable environmental confounders and reverse causation. In this study, a two-sample bidirectional MR analysis was conducted to investigate the causal relationship between serum vitamin D levels and thyroid- and parathyroid-related diseases. Inverse variance weighted, weighted median and MR-Egger methods were performed, the Cochran Q test was used to evaluate the heterogeneity and the MR-PRESSO and MR-Egger intercepts were utilised to assess the possibility of pleiotropy. The Bonferroni-corrected significance threshold was 0·0038. At the Bonferroni-corrected significance level, we found that vitamin D levels suggestively decreased the risk of benign parathyroid adenoma (OR = 0·244; 95 % CI 0·074, 0·802; P = 0·0202) in the MR analyses. In the reverse MR study, a genetically predicted risk of thyroid cancer suggestively increased the risk of elevated vitamin D (OR = 1·007; 95 % CI 1·010, 1·013; P = 0·0284), chronic thyroiditis significantly increased the risk of elevated vitamin D (OR = 1·007; 95 % CI 1·002, 1·011; P = 0·0030) and thyroid nodules was significantly decreased the vitamin D levels (OR = 0·991; 95 % CI 0·985, 0·997; P = 0·0034). The findings might be less susceptible to horizontal pleiotropy and heterogeneity (P > 0·05). This study from a gene perspective indicated that chronic thyroiditis and thyroid nodules may impact vitamin D levels, but the underlying mechanisms require further investigation.

Anastrozole for the prevention of breast cancer in high-risk postmenopausal women: cost-effectiveness analysis in the UK and the USA.

PURPOSE: The effectiveness of anastrozole for breast cancer prevention has been demonstrated. The objective of this study was to evaluate the cost-effectiveness of anastrozole for the prevention of breast cancer in women with a high risk of breast cancer and to determine whether anastrozole for the primary prevention of breast cancer can improve the quality of life of women and save health-care resources. METHODS: A decision-analytic model was used to assess the costs and effects of anastrozole prevention versus no prevention among women with a high risk of breast cancer. The key parameters of probability were derived from the IBIS-II trial, and the cost and health outcome data were derived from published literature. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for the two strategies,One-way and probabilistic sensitivity analyses were performed. RESULTS: In the base case, the incremental cost per QALY of anastrozole prevention was £125,705.38/QALY in the first 5 years compared with no prevention in the UK, above the threshold of WTP (£3,000/QALY),and in the 12-year period, the ICER was £8,313.45/QALY, less than WTP. For the US third-party payer, ICER was $134,232.13/QALY in the first 5 years and $8,843.30/QALY in the 12 years, both less than the WTP threshold ($150,000/QALY). CONCLUSION: In the UK and US, anastrozole may be a cost-effective strategy for the prevention of breast cancer in high-risk postmenopausal women. Moreover, the longer the cycle of the model, the higher the acceptability. The results of this study may provide a scientific reference for decision-making for clinicians, patients, and national medical and health care government departments.

One-pot synthesis of 4-(imidazol-1-yl)indole derivatives through a sequential dearomatization and Ag-catalyzed cyclization/Cs2CO3-mediated addition/aromatization reaction.

A convenient one-pot assembly of 4-(imidazol-1-yl)indole derivatives from easily accessible o-alkynylanilines and imidazoles has been developed. The sequential dearomatization and Ag(I)-catalyzed cyclization/Cs2CO3-mediated conjugate addition/aromatization cascade reactions exhibit high efficiency and excellent selectivity. The combined use of a silver(I) salt and cesium carbonate is significant for facilitating this domino transformation. The 4-(imidazol-1-yl)indole products could be easily converted to the corresponding derivatives and might be valuable in biological chemistry and medicinal science.

Linoleic acid from the endophytic fungus Diaporthe sp. HT-79 inhibits the growth of Xanthomonas citri subsp. citri by destructing the cell membrane and producing reactive oxygen species (ROS).

Citrus canker disease caused by Xanthomonas citri subsp. citri (Xac) severely influences the quality and quantity of citrus fruits. The current management of this disease mainly relies on the application of copper-associated chemicals, which poses a threat to human health and the environment. The present study isolated an endophytic fungus HT-79 from the healthy navel orange tree, whose crude fermentation product significantly inhibited the growth of Xac. The strain HT-79 was identified as a species of the Diaporthe genus. The petroleum ether extract (PEE) of the crude fermentation product of HT-79 exhibited remarkable activity against Xac with a MIC (minimum inhibitory concentration) value of 0.0625 mg/mL, significantly better than the positive control CuSO4 (MIC = 0.125 mg/mL). Bioassay-guided isolation of PEE resulted in the discovery of one highly potent anti-Xac subfraction, namely fraction 5 (MIC = 0.0156 mg/mL). Gas chromatography-mass spectrometry (GC-MS) analysis revealed that fraction 5 mainly consisted of palmitic acid (18.17%), ethyl palmitate (15.66%), linoleic acid (6.80%), oleic acid (18.32%), ethyl linoleate (21.58%), ethyl oleate (15.87%), and ethyl stearate (3.60%). Among these seven compounds, linoleic acid (MIC = 0.0078 mg/mL) was found to be the most potent against Xac, followed by oleic acid (MIC = 0.0156 mg/mL), while all others were less pronounced than CuSO4. Linoleic acid highly inhibited the growth of Xac via the destruction of the cell membrane and overproduction of reactive oxygen species (ROS). A preliminary in vivo experiment revealed that linoleic acid was effective in the control of citrus canker disease.

Cyclo-(Phe-Tyr) as a novel cyclic dipeptide compound alleviates ischemic/reperfusion brain injury via JUNB/JNK/NF-κB and SOX5/PI3K/AKT pathways.

Ischemic/reperfusion (IR) can cause adverse reactions including apoptosis, oxidative stress, and inflammation, but the existing therapeutic strategies have been limited. Moreover, the regulation of microglia plays an important role in brain injury after reperfusion. Hence, it is imperative to find new and effective drugs for modulating microglia to treat IR brain injury. Cyclic peptide compound cyclo-(Phe-Tyr) (Sparganin C, SC) is a compound isolated from Sparganii Rhizoma. However, the protective effects of SC on the central nervous system are rather unclear. In an attempt to elucidate the protective effects and mechanism of SC on cerebral damage induced by the IR, we used a middle cerebral artery occlusion reperfusion (MCAO/R) model in rats and discovered that SC significantly decreased the size of cerebral infarcts, improved neurological scores, and blocked inflammatory and oxidative factor release. Using RNA-Seq and metabolomics association analyses, SC was shown to have a protective impact through the JUNB and SOX5-related pathways. Metabolomic analysis revealed twenty-eight differentially expressed biomarkers. In addition, the detection of SC content in brain tissue using LC/MS revealed that SC had blood-brain barrier penetration. To investigate the mechanism, we established an in vitro BV2 cell oxygen-glucose deprivation/reperfusion (OGD/R) model and used siRNA as well as an inhibitor. The protective effects of SC were dependent on the JUNB and SOX5 to inhibit inflammation and apoptosis in microglia. Our findings revealed for the first that SC against IR injury by reducing inflammation and apoptosis while simultaneously acting as potential therapeutic lead compound for ischemic stroke.

Benefits of applying virtual reality in pelvic movement training through a Wii Fit: a randomized controlled trial.

BACKGROUND: Pelvic movement training has become compulsory for part of medical students. An increasing amount of research has focused on the influence of virtual reality (VR) on learning effectiveness. However, its application to pelvic floor muscles or pelvic movement training is still in its infancy. We compared the effectiveness of conventional pelvic movement training with or without VR-assisted pelvic movement training for student learning. METHODS: We recruited 44 university students (16 male and 28 female participants; average age = 19.7 ± 0.31 years) who had not previously received pelvic movement education or training. The participants were randomly assigned into traditional and experimental groups to acquire pelvic movements and relevant knowledge. The traditional group received conventional classes (about 15 min), whereas the experimental group received both conventional classes and VR-assisted teaching (additional VR session took approximately 25-45 min depending on the speed of movement of each participant). The participants were asked to control the trajectory of the centre of pressure on the Wii Fit balance board and build-in games to learn pelvic movements. We conducted evaluations before, immediately after, and 2 weeks after the experiment, based on the scores of written and practical examinations. The experimental group was also asked to complete a questionnaire during the posttest. RESULTS: We carried out two-way repeated measures ANOVA and discovered that the written examination scores indicated a significant Time × Group interaction (p=0.015). In each group, the written and practical examinations in the posttest and follow-up test exhibited significantly improved results compared with the baseline value (p <0.001, except for traditional group of written exam in follow up test vs. baseline p=0.001). The written examination in the follow-up test did not decline significantly compared with those in the posttest, but the practical examination in the follow-up test was decline significantly compared with those in the posttest (p=0.033). The experimental group had superior overall performance in the practical examinations than the traditional group (experimental group: mean = 76.27, 95% confidence level [CI] = 70.84-81.71; traditional group: mean = 64.21, 95% CI = 58.78-69.65). No significant difference in the written examination between two groups. The percentage for agreement ratio on the usefulness, ease of use, users' intention to continue using the VR-assisted teaching is high (95.5-100%). CONCLUSIONS: The results of this study suggested that conventional and conventional + VR teaching were both effective. However, the incorporation of VR stimulated learning motivation and facilitated precise performance of pelvic movements. It is recommended that pelvic floor muscles training could be supplemented with VR or games to increase students' motivation and understanding how to perform pelvic movements.

Reliability and validity of the Chinese version of the LMC Skills, Confidence & Preparedness Index (SCPI) in patients with type 2 diabetes.

BACKGROUND: A variety of diabetes self-management instruments have been developed but few of them consist of the preparedness for diabetes self-management behavior. The novel psychometric evaluation tool "the LMC Skills, Confidence & Preparedness Index (SCPI)" measures three key aspects of a patient's diabetes self-management: knowledge of the skill, confidence in being able to perform skill and preparedness to implement the skill. The objective of this study was to translate, adapt and validate the SCPI for use in Chinese adult patients with type 2 diabetes. METHODS: This study followed the guideline recommended by the American Academy of Orthopaedic Surgeons Evidence Based Medicine Committee (AAOS) to indigenize the scale. Forward and back translation, and cross-cultural language debugging were completed according to the recommended steps. A convenience sample of Chinese patients with type 2 diabetes (n = 375) were recruited from a university-affiliated hospital in Shanghai. The validity (criterion, discriminant validity, and construct validity), reliability (internal consistency and test-retest reliability) and the interpretability of the instrument were examined. The content validity was calculated by experts' evaluation. RESULTS: The Chinese version of SCPI (C-SCPI) has good internal consistency with a Cronbach's alpha of 0.92. The ceiling effects of the preparedness subscales is 21%. The criterion validity of three dimensions of C-SCPI was established with significantly moderate correlations between the DKT, DES-SF and SDSCA (p < 0.05). The S-CVI of the whole scale was 0.83. Except for entry 21, the I-CVI values of all entries were greater than 0.78. The C-SCPI has also shown good discriminative validity with statistically significant differences between the patients with good and poor glycemic control. Confirmatory factor analysis showed that modified results indicate that the fitting degree of the model is good, χ2/df = 2.775, RMSEA = 0.069, CFI = 0.903, GFI = 0.873, TLI = 0.889, IFI = 0.904. The test-retest reliability coefficient was 0.61 (p < 0.01). CONCLUSION: We established a Chinese version of SCPI through translation and cross-cultural adaptation. The C-SCPI is reliable and valid for assessment of the level of self-management in Chinese patients with type 2 diabetes.

Role of Remote Monitoring in Detection of Atrial Arrhythmia, Stroke Reduction, and Use of Anticoagulation Therapy　- A Systematic Review and Meta-Analysis.

BACKGROUND: The effect of remote monitoring (RM) in atrial arrhythmia detection, stroke reduction, and anticoagulation therapy remains unknown, particularly for patients with implantable or wearable cardiac devices.Methods and Results:We performed a systematic review and meta-analysis to evaluate the role of RM in atrial arrhythmia detection, stroke reduction and anticoagulation therapeutic intervention. Online databases were queried to include randomized controlled trials comparing detection of atrial arrhythmia and stroke risk between patients undergoing RM and those receiving in-office (IO) follow-up. Outcomes and complications of RM-guided anticoagulation therapy and conventional therapy in patients with atrial fibrillation were also reviewed. A total of 16 studies were included. Compared with patients receiving IO follow-up, patients undergoing RM had a significantly higher detection rate of atrial arrhythmia (risk ratio [RR], 1.363; 95% confidence interval [CI], 1.147-1.619), and a lower risk of stroke (RR, 0.539; 95% CI, 0.301-0.936). The higher rate of atrial arrhythmia was only noted in patients with wearable devices (RR, 4.070; 95% CI, 2.408-6.877), and the lower risk of stroke was only noted in patients with cardiovascular implantable electronic devices (CIED) (RR, 0.513; 95% CI, 0.265-0.996). CONCLUSIONS: RM is effective for atrial arrhythmia detection in patients using wearable devices and for reducing the risk of stroke in patients with CIED.

Four New C9 Metabolites from the Sponge-Associated Fungus Gliomastix sp. ZSDS1-F7-2.

Four new structurally related metabolites, one γ-lactone named gliomasolide F (1), one δ-lactone named gliomasolide G (2), and two medium-chain fatty acids named gliomacids A⁻B (3⁻4), each containing nine carbons in total, were identified from the sponge-associated fungus Gliomastix sp. ZSDS1-F7-2. The planar chemical structures of these novel C9 metabolites were elucidated by nuclear magnetic resonance (NMR) spectroscopic methods, in connection with the analysis of high-resolution mass spectrometry (HRMS) and infrared (IR) data. The absolute configuration of 1, was determined by comparisons of experimental circular dichroism (CD) and optical rotation (OR) value with corresponding ones computed by quantum chemistry. The relative configuration of 2 was determined by the Nuclear Overhauser effect spectroscopy (NOESY) spectrum, while its absolute configuration was tentatively determined in view of the biogenetic and biosynthetic relationships between 1 and 2. Compounds 3⁻4, originally as an inseparable mixture, were successfully isolated after chemical modifications. The stereo-chemistries of compounds 3⁻4 were assumed by comparison of 13C NMR with those of the similar moiety reported in literature, in addition to the biogenetic and biosynthetic relationships with 1. The plausible biosynthetic relationships among these four C9 metabolites were supposed. Biologically, compounds 1⁻4 showed no cytotoxic effect against HeLa cell line at concentrations up to 25 μg/mL, while 1 exhibited moderate antifouling activity against the settlement of Balanus amphitrite larvae with IC50 being 12.8 μg/mL and LC50 > 25 μg/mL. The co-occurrence of macrolides gliomasolides A—E and four C9 metabolites in the same fermentation culture made us assume that these C9 metabolites might be biosynthetic building blocks toward the construction of more complex macrolides such as gliomasolides A—E or other unidentified polyketides.

Effects of pilates on patients with chronic non-specific low back pain: a systematic review.

[Purpose] To evaluate the effects of Pilates on patients with chronic low back pain through a systematic review of high-quality articles on randomized controlled trials. [Subjects and Methods] Keywords and synonyms for "Pilates" and "Chronic low back pain" were used in database searches. The databases included PubMed, Physiotherapy Evidence Database (PEDro), Medline, and the Cochrane Library. Articles involving randomized controlled trials with higher than 5 points on the PEDro scale were reviewed for suitability and inclusion. The methodological quality of the included randomized controlled trials was evaluated using the PEDro scale. Relevant information was extracted by 3 reviewers. [Results] Eight randomized controlled trial articles were included. Patients with chronic low back pain showed statistically significant improvement in pain relief and functional ability compared to patients who only performed usual or routine health care. However, other forms of exercise were similar to Pilates in the improvement of pain relief and functional capacity. [Conclusion] In patients with chronic low back pain, Pilates showed significant improvement in pain relief and functional enhancement. Other exercises showed effects similar to those of Pilates, if waist or torso movement was included and the exercises were performed for 20 cumulative hours.

Influenza A(H6N1) Virus in Dogs, Taiwan.

We determined the prevalence of influenza A virus in dogs in Taiwan and isolated A/canine/Taiwan/E01/2014. Molecular analysis indicated that this isolate was closely related to influenza A(H6N1) viruses circulating in Taiwan and harbored the E627K substitution in the polymerase basic 2 protein, which indicated its ability to replicate in mammalian species.

Natural A(H1N1)pdm09 influenza virus infection case in a pet ferret in Taiwan.

Ferrets have demonstrated high susceptibility to the influenza virus. This study discusses a natural 2009 pandemic influenza A (H1N1) (A(H1N1)pdm09) virus infection in a pet ferret (Mustela putorius furo) identified in Taiwan in 2013. The ferret was in close contact with family members who had recently experienced an influenza-like illness (ILI). The ferret nasal swab showed positive results for influenza A virus using one-step RT-PCR. The virus was isolated and the phylogenetic analysis indicated that all of the eight segmented genes were closely related to the human A(H1N1)pdm09 virus linage isolated in Taiwan. This study may provide a perspective view on natural influenza A virus transmission from the local human population into pet ferrets.

Amide proton transfer-weighted MRI in predicting pathological types of brain metastases in lung Cancer.

Most brain metastases originate from lung cancer. The majority of cases of lung cancer can be categorized into squamous carcinoma and adenocarcinoma,necessitating distinct clinical treatments and yielding diverse prognoses.Therefore,accurate preoperative evaluation of pathological types through imaging techniques is essential. The objective of this study is to assess the capability of amide proton transfer-weighted(APTw) MRI in predicting the pathological types of brain metastases in lung cancer.Additionally,it seeks to evaluate whether APTw MRI can provide additional value to diffusion-weighted imaging(DWI) at MRI·In this study,a total of 32 participants(mean age,60 ± 9 years;14 men) underwent evaluation,comprising 9 with squamous carcinoma and 23 with adenocarcinoma.Interestingly,adenocarcinoma demonstrated elevated APTw values(2.70 ± 0.81% vs 1.82 ± 0.47%;P = 0.001) and a higher apparent diffusion coefficient(ADC) value(1.00 ± 0.40 × 10-3 mm2/s vs 0.77 ± 0.13 × 10-3 mm2/s;P<0.05) in comparison to squamous carcinoma. The area under the receiver operating characteristic curve(AUC) of APTw and ADC in distinguishing between squamous carcinoma and adenocarcinoma were found to be 0.84 and 0.63,respectively.Moreover,the combined area under the receiver operating characteristic curve of the two techniques is 0.84. Amide proton transfer-weighted has the potential to predict the pathological types of brain metastases in lung cancer.

Changes in Combined Lifestyle Risks and the Transition of Activities of Daily Living in the Elderly Population of Taiwan: Evidence from the Taiwan Longitudinal Study on Aging.

Functional ability decline occurs with age. This study aims to investigate the associations between the lifestyle factors-exercising, food consumption, and smoking-and the functional ability of the activities of daily living (ADL) by gender. The data were obtained from the Taiwan longitudinal study on aging, a national cohort study. The cross-sectional results demonstrated that the frequency of exercising was negatively associated with ADL in both men and women. Dairy products were positively associated with ADL in men. The longitudinal results illustrated that current and consistent exercising were negatively associated with changes in ADL scores over 4- and 8-year periods in both men and women. Seafood consumption was negatively associated with changes in the subsequent 4-year ADL scores. Past smoking was positively associated with changes in subsequent 4-year ADL scores in men, while current smoking was positively associated with changes in subsequent 8-year ADL scores in women. Therefore, consistent exercising, food consumption, and smoking were associated with ADL functional ability in elderly people, and the associations differed by gender. Elders exercising consistently had good ADL performance and maintained their ADL ability better, especially women. Seafood consumption decreased the risk of ADL decline, while smoking increased the risk of ADL decline.

Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States?

BACKGROUND: Circulating tumor cell (CTC) counting may be a useful non-invasive biomarker that helps patients choose first-line treatment options. Nevertheless, the cost of CTC inspection may impose an economic burden on patients, necessitating the simultaneous consideration of both its clinical effectiveness and cost. We evaluated the cost-effectiveness of CTC count-guided chemotherapy and endocrine therapy as first-line therapy for HR+/HER2-metastatic breast cancer (MBC) from the perspective of US payers. METHODS: Based on the STIC CTC trial, a Markov model was constructed for three health states, and health outcomes were measured in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to assess the robustness of the incremental cost per QALY. RESULTS: The base-case analysis revealed that CTC count-driven treatment was associated with improved effectiveness by 0.07 QALYs and increased the overall cost by $9187.05 compared with clinician-driven first-line treatment choices, leading to an ICER of $138 354.15 per QALY. One-way sensitivity analysis indicated that the model was most sensitive to the cost of treatment for neutropenia and the utility for PFS; probability sensitivity analysis indicated that CTC count-driven treatment choices would be considered the cost-effective option at a willingness-to-pay threshold of $150 000 per QALY. CONCLUSIONS: The findings of this cost-effectiveness analysis suggest that, at the current price of CTC enumeration, choosing first-line treatment options based on CTC count is a cost-effectiveness approach for treating patients with HR+/HER2- MBC in the US.

Bicomponent core/sheath melt-blown fibers for air filtration with ultra-low resistance.

With the escalating air pollution and frequent outbreaks of airborne diseases, there is a growing demand for personal protective filtration media. Melt-blown nonwovens have proven to be highly effective in capturing tiny particles, but their tightly packed fiber assemblages are more resistant to airflow and less comfortable to breathe. Here, we present a one-step melt-blown spinning process for the production of bicomponent core/sheath (BCS) crimped fibers and their application in high-efficiency, low-resistance air filtration. Fiber curl is caused by unbalanced internal stresses resulting from differences in the structure components, resulting in uneven shrinkage inside and outside the fibers. The resulting CM@S-2 filtration media features a uniform fiber curl and a porous fiber mesh structure, which reduces air filtration resistance. Under the same filtration conditions, the filtration efficiency of CM@S-2 (96.58% vs. 95.58%), filtration resistance (56.1 Pa vs. 108.0 Pa), quality factor (0.061 Pa-1vs. 0.029 Pa-1), and dust holding capacity (10.60 g m-2vs. 9.10 g m-2) were comparable to those of the single-component polypropylene filters. The filtration efficiency of the CM@S-2 remained above 94.0% after 30 days of indoor storage. Computational Fluid Dynamics (CFD) simulation demonstrated that crimped fibers effectively reduce pressure surges on the filter media caused by fiber accumulation. In comparative tests with commercial masks, the CM@S-2 cartridge masks demonstrated superior air permeability compared to commercial masks under similar filtration conditions. In conclusion, the bicomponent core/sheath melt-blown fibers significantly reduce air resistance and show excellent potential for application in protective masks.

SGLT-2 inhibitors are beneficial in reducing the risk of thyroid cancer: findings from a Mendelian randomization study.

OBJECTIVE: Previous studies have investigated the association between diabetes medications and thyroid cancer, but the results have not been conclusive. This study used a Mendelian randomization approach to investigate the causal relationship between diabetes medications and thyroid cancer (TC). METHODS: Exposures were six major diabetes medications target, while outcomes were TC and its differentiated forms, including papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). Mendelian randomization was conducted using IVW, MR-Egger, and weighted median methods. Tests for heterogeneity, horizontal pleiotropy, and leave-one-out were also performed. RESULTS: In European populations, SGLT2 inhibitors were significantly negatively associated with TC (OR 0.051, 95% CI 0.006-0.465, P = 0.0082) as well as PTC (OR 0.034, 95% CI 0.003-0.411, P = 0.0079), while no correlation was found with FTC. These findings remained consistent even after applying the Bonferroni correction. CONCLUSIONS: The evidence suggests that SGLT2 inhibitors could be potential therapeutic targets for TC, especially for PTC, in European populations. However, further large-scale randomized controlled trials are necessary to verify their ability to reduce the risk of and treat these types of cancer.

A meta-analysis of the impact of pharmacist interventions on clinical outcomes in patients with type-2 diabetes.

OBJECTIVE: To evaluate the effects of pharmacist interventions in type-2 diabetes patients by collecting and evaluating literature. METHODS: A systematic search was conducted across six databases, including CNKI, Wanfang Data, VIP, PubMed, Web of Science, and Cochrane Library, from January 2001 to January 2023. Randomized controlled trials evaluating the clinical outcomes of pharmacist interventions on type-2 diabetes patients were searched, and data were extracted and analysed by RevMan version 5.4 software. RESULTS: A total of 35 studies involving 4827 patients were included. Meta-analysis demonstrated that pharmacist interventions had an influence on improving patients' HbA1c (MD=-0.70), LDL-C (MD=-5.51), SBP (MD=-4.58), DBP (MD=-1.90], BMI (MD=-0.47) and FBG (MD=-19.82), but there was no evidence from the study that pharmacist interventions could significantly improve HDL-C (MD=-0.61), TC (MD=-5.12) or TG (MD=-3.14). In addition, medication adherence was significantly improved. CONCLUSION: Pharmacist interventions significantly improved HbA1c, BP, and LDL-C control levels, BMI, and medication adherence in type-2 diabetes patients, but there was no evidence from this study that pharmacist interventions significantly improved HDL-C, TC, or TG. PRACTICE IMPLICATIONS: Effective pharmacist interventions are important to improve type-2 diabetes patients' clinical outcomes.

Network analysis of microbiome and metabolome to explore the mechanism of raw rhubarb in the protection against ischemic stroke via microbiota-gut-brain axis.

Ischemic stroke (IS) has attracted worldwide attention due to the high mortality and disability rate. Raw rhubarb (RR) is a traditional medicinal plant and whole-food that has been used in China for its various pharmacological activities, such as antioxidant and anti-inflammatory properties. Recent pharmacological research has shown the role of RR against IS, but its mechanism of action remains unclear, particularly in the context of the brain-gut axis. To address this gap in knowledge, the present study was conducted in the middle cerebral artery occlusion/reperfusion (MCAO/R) model with the aim of investigating the effects of RR on regulating the intestinal microbiota barrier and metabolism and thereby reducing inflammatory response so as to improve the IS. The results showed that pre-treatment of RR attenuated cerebral infarct area and inflammation response in MCAO rats. Furthermore, RR also improved intestinal barrier function, including the integrity and permeability of the intestinal barrier. Additionally, RR intervention significantly attenuated gut microbiota dysbiosis caused by ischemic stroke, especially the increased Firmicutes. Notably, the pseudo-germ-free (PGF) rats further demonstrated that the anti-stroke effect of RR might rely on intestinal microbiota. In addition, the UPLC/Q-Orbitrap-MS-Based metabolomics revealed the disrupted metabolic profiles caused by MCAO/R, and a total of 11 differential metabolites were modulated by RR administration, especially bile acids. Further correlation analysis and network pharmacology analysis also demonstrated a strong association between specific bacteria, such as Firmicutes and bile acids. In conclusion, our work demonstrated that RR could effectively ameliorate ischemic stroke by modulating the microbiota and metabolic disorders.