Medication adherence and costs of medical care among patients with Parkinson's disease: an observational study using electronic medical records.

BACKGROUND: Adherence to antiparkinsonian drugs (APDs) is critical for patients with Parkinson's disease (PD), for which medication is the main therapeutic strategy. Previous studies have focused on specific disorders in a single system when assessing clinical factors affecting adherence to PD treatment, and no international comparative data are available on the medical costs for Chinese patients with PD. The present study aimed to evaluate medication adherence and its associated factors among Chinese patients with PD using a systematic approach and to explore the impact of adequate medication adherence on direct medical costs. METHODS: A retrospective analysis was conducted using the electronic medical records of patients with PD from a medical center in China. Patients with a minimum of two APD prescriptions from January 1, 2016 to August 15, 2018 were included. Medication possession ratio (MPR) and proportion of days covered were used to measure APD adherence. Multiple linear regression analysis was used to identify factors affecting APD adherence. Gamma regression analysis was used to explore the impact of APD adherence on direct medical costs. RESULTS: In total, 1,712 patients were included in the study, and the mean MPR was 0.68 (± 0.25). Increased number of APDs and all medications, and higher daily levodopa-equivalent doses resulted in higher MPR (mean difference [MD] = 0.04 [0.03-0.05]; MD = 0.02 [0.01-0.03]; MD = 0.03 [0.01-0.04], respectively); combined digestive system diseases, epilepsy, or older age resulted in lower MPR (MD = -0.06 [-0.09 to -0.03]; MD = -0.07 [-0.14 to -0.01]; MD = -0.02 [-0.03 to -0.01], respectively). Higher APD adherence resulted in higher direct medical costs, including APD and other outpatient costs. For a 0.3 increase in MPR, the two costs increased by $34.42 ($25.43-$43.41) and $14.63 ($4.86-$24.39) per year, respectively. CONCLUSIONS: APD adherence rate among Chinese patients with PD was moderate and related primarily to age, comorbidities, and healthcare costs. The factors should be considered when prescribing APDs.

Designing a multi-epitope vaccine against Peptostreptococcus anaerobius based on an immunoinformatics approach.

Peptostreptococcus anaerobius is an anaerobic bacterium, which has been found selectively en-riched in the fecal and mucosal microbiota of colorectal cancer (CRC) patients. Emerging evidence suggest P. anaerobius may contribute to the development of CRC in human. In this study, we designed a multi-epitope chimeric vaccine against P. anaerobius PCWBR2, a recently identified adhesin that interacts directly with colon cell lines by binding α2/ß1 integrin frequently overexpressed in human CRC tumors and cell lines. Immunoinformatics tools predicted six cytotoxic T lymphocyte epitopes, five helper T lymphocyte epitopes, and six linear B lymphocyte epitopes. The predicted epitopes were joined with AAY or GPGPG linkers and a previously reported TLR4 agonist was added to the vaccine construct's N terminal as an adjuvant using EAAAK linkers and the order of epitopes was optimized. Further in silico analysis revealed that the vaccine construct possesses satisfactory antigenicity, allergenicity, solubility, physicochemical properties, adjuvant-TLR4 molecular docking, and immune profile characteristics. Our study provided a promising design for vaccines against P. anaerobius.

Metagenomic and metabolomic analyses reveal synergistic effects of fecal microbiota transplantation and anti-PD-1 therapy on treating colorectal cancer.

Anti-PD-1 immunotherapy has saved numerous lives of cancer patients; however, it only exerts efficacy in 10-15% of patients with colorectal cancer. Fecal microbiota transplantation (FMT) is a potential approach to improving the efficacy of anti-PD-1 therapy, whereas the detailed mechanisms and the applicability of this combination therapy remain unclear. In this study, we evaluated the synergistic effect of FMT with anti-PD-1 in curing colorectal tumor-bearing mice using a multi-omics approach. Mice treated with the combination therapy showed superior survival rate and tumor control, compared to the mice received anti-PD-1 therapy or FMT alone. Metagenomic analysis showed that composition of gut microbiota in tumor-bearing mice treated with anti-PD-1 therapy was remarkably altered through receiving FMT. Particularly, Bacteroides genus, including FMT-increased B. thetaiotaomicron, B. fragilis, and FMT-decreased B. ovatus might contribute to the enhanced efficacy of anti-PD-1 therapy. Furthermore, metabolomic analysis upon mouse plasma revealed several potential metabolites that upregulated after FMT, including punicic acid and aspirin, might promote the response to anti-PD-1 therapy via their immunomodulatory functions. This work broadens our understanding of the mechanism by which FMT improves the efficacy of anti-PD-1 therapy, which may contribute to the development of novel microbiota-based anti-cancer therapies.

Comparative analysis of transcriptional profiles of Schistosoma japonicum adult worms derived from primary-infected and re-infected water buffaloes.

BACKGROUND: Schistosoma japonicum (S. japonicum) is an important zoonotic parasite that is prevalent in China and parts of Southeast Asia. Water buffaloes are an important reservoir and the main transmission sources of S. japonicum. However, self-curing and resistance to re-infection have been observed in water buffaloes. RESULTS: In this study, we compared the morphometry and differences in transcriptional expression of adult S. japonicum worms recovered from primary-infected and re-infected water buffaloes using Illumina RNA-sequencing (RNA-Seq) technology. Results of morphometry analysis revealed that adult S. japonicum worms recovered from re-infected water buffaloes were runtish with smaller organs. The ventral length of male worms was shorter in re-infected buffaloes (328 ± 13 vs 273 ± 8 µm, P < 0.05), and in female worms the oral sucker length (44 ± 3 vs 33 ± 5 µm, P < 0.05), ovary length (578 ± 23 vs 297 ± 27 µm, P < 0.05) and width (150 ± 8 vs 104 ± 9 µm, P < 0.05) were shorter, with fewer eggs in the uteri (41 ± 2 vs 12 ± 1, P < 0.05). Of 13,605 identified genes, 112 were differentially expressed, including 51 upregulated and 61 downregulated genes, in worms from re-infected compared with primary-infected water buffaloes. Gene ontology (GO) enrichment analysis revealed that GO terms such as "oxidation-reduction process", "calcium-dependent phospholipid binding", "lipid binding" and "calcium ion binding" were significantly enriched in downregulated genes, whereas GO terms related to metabolism and biosynthesis were significantly enriched in upregulated genes. The results revealed that the downregulation of some important genes might contribute to a reduction in worm numbers and maldevelopment of surviving worms in re-infected water buffaloes. Furthermore, upregulation of genes related to metabolic processes and biosynthesis might be a compensatory mechanism of worms in disadvantageous environments. CONCLUSIONS: To our knowledge, our results present the first large-scale transcriptional expression study identifying the differences between adult S. japonicum worms from primary-infected and re-infected water buffaloes, and particularly emphasize differential expression that may affect the survival and growth of worms in re-infected water buffalo. This will provide new insight into screening for anti-schistosome targets and vaccine candidates.

Seasonal Dynamics of Gastrointestinal Nematode Infections of Goats and Emergence of Ivermectin Resistance in Haemonchus contortus in Hubei Province, China.

INTRODUCTION: Gastrointestinal nematodes (GINs) are a major constraint to the survival and productivity of animals. In southern China, goats are the most important small domestic ruminants. METHODS: From May 2013 to May 2017, we conducted a longitudinal study of hircine GIN infections in Huangshantou Town, Gongan County, Hubei Province, China, using fecal egg counts. RESULTS: Our investigation revealed that the GINs of goats in Hubei Province have changed significantly. Over 90% of eggs detected in the first month of investigation, May 2013, belonged to the species Haemonchus contortus and Chabertia sp. There was no seasonal variation in positive rates (PRs) of GINs, but the mean eggs per gram (EPG) of GINs were higher between April and July than between September and November (P < 0.05). The gradual increase in the percentage of H. contortus eggs among all detected eggs during our research and the low cure rate of IVM mass treatment revealed the emergence of IVM resistance in H. contortus. After the implementation of an integrated GIN control strategy, which included two mass treatments (one in April/May with ABZ and another in September/October with IVM + ABZ), in 2016 and 2017, both the PRs and EPG of GINs were significantly reduced. CONCLUSION: The results presented here reveal that controlling GINs of small ruminants in small farms in southern China requires an integrated control strategy that should include monitoring of infection and anthelmintic resistance, and increased farmer education on the importance of using the appropriate drugs at the correct dose.

High resistance of water buffalo against reinfection with Schistosoma japonicum.

Schistosomiasis is a zoonotic parasitic disease threatening tens of millions people and farm animals. Water buffalos are a major reservoir for schistosomiasis and a control target. Epidemiological surveys suggest that buffalos can develop resistance against Schistosoma japonicum reinfection. In the present paper, relative to control animals, we report an over 97% worm burden reduction after two rounds of infection with S. japonicum and treatment with Praziquantel (PZQ). Relative to control animals, shorter length of female worms, and lower egg counts (over 87.7% reduction rates) were observed in reinfected buffalos. We also found that the reinfected buffalos had significantly higher levels of IL-4, IL-10, and IFN-γ, 4-9 weeks after the secondary infection, and a significantly higher level of specific IgG antibodies before infection. Our results confirmed that after infection buffalos develop resistance against S. japonicum reinfection, and that this resistance is mainly due to acquired immunity. These findings may aid in the future vaccine design for water buffalos.

Mobile phone text messaging for pharmaceutical care in a hospital in China.

We have developed a mobile pharmacy service system (MPSS) to deliver individualized pharmaceutical care via text messages sent to the mobile phones of patients. The text messages were: (1) reminders about medication - from the day following discharge, reminder messages were automatically sent to patients approximately 10 minutes before their medication was due to be taken. The system stopped sending messages when the prescription ran out and suggested that patients should come to hospital to renew any prescribed medicines; (2) practical information about medicines, such as information about methods of administration; (3) information about adverse drug reactions. In a 3-month trial in a general hospital, 100 patients were provided with pharmaceutical care using the MPSS for an average of 3.5 medicines per patient (range 1-9). They received pharmaceutical care for an average of 12 days per patient (range 3-19). A survey was then conducted which indicated that most patients were satisfied with the pharmaceutical care provided by MPSS through text messages, and that they had positive attitudes despite some limitations. The use of the MPSS should improve pharmaceutical care, widen the knowledge of pharmacists, reduce the burden on pharmacy staff, improve pharmacist-patient interaction, and improve the effect and safety of medication.