Short-term effect of fenofibrate on C-reactive protein: A meta-analysis of randomized controlled trials

<p>Abstract</p> <p>Background</p> <p>C-reactive protein (CRP) is positively associated with risk for cardiovascular disease and all-cause mortality. Some but not all randomized and non-randomized clinical trials found significant associations between fenofibrate therapy and CRP but the direction and magnitude of the association varied across studies. The duration of treatment, patient populations and sample sizes varied greatly, and most short-term studies (i.e., ≤ 12 weeks) had fewer than 50 patients. In this study we meta-analyzed randomized clinical trials to determine the short-term effect of fenofibrate on CRP.</p> <p>Methods</p> <p>Two reviewers independently searched PubMed and other online databases for short-term randomized clinical trials that reported CRP concentrations before and after fenofibrate treatment. Of the 81 studies examined, 14 studies with 540 patients were found eligible. Data for the change in CRP and corresponding measures of dispersion were extracted for use in the meta-analysis.</p> <p>Results</p> <p>The weighted mean CRP concentrations before and after fenofibrate therapy were 2.15 mg/L and 1.53 mg/L (-28.8% change), respectively. Inverse-variance weighted random effects meta-analysis revealed that short-term fenofibrate treatment significantly lowers CRP by 0.58 mg/L (95% CI: 0.36-0.80). There was significant heterogeneity between studies (Q statistic = 64.5, <it>P</it>< 0.0001, I²= 79.8%). There was no evidence of publication bias and sensitivity analysis revealed that omitting any of the 14 studies did not lead to a different conclusion from the overall meta-analysis result.</p> <p>Conclusion</p> <p>Short-term treatment with fenofibrate significantly lowers CRP concentration. Randomized trials that will recruit patients based with high baseline CRP concentrations and with change in CRP as a primary outcome are needed.</p

Association between Foot Posture Asymmetry and Static Stability in Patients with Knee Osteoarthritis: A Case-Control Study

Background. Interlimb asymmetries are considered to be closely related to knee osteoarthritis (KOA), but foot posture asymmetries in patients with KOA are scarcely reported. Objectives. We aimed to explore the asymmetrical difference in foot posture between the healthy adults and KOA patients and the relationship between foot posture asymmetry and static stability. Methods. 21 subjects suffering from KOA in the patient group (PG) and 21 healthy adults in the control group (CG) were included in this study. Foot postures on both feet were evaluated by using the foot posture index (FPI); subsequently, asymmetrical FPI scores between two feet were calculated for the two groups. Meanwhile, all the participants were tested with a standing on Dynamic and Static Balancing Instrument (Pro-kin 254P, TecnoBody Company, Italy) for bilateral stability assessment, and center of pressure (COP) parameters including sway length (SL, mm) and sway area (SA, mm2) were recorded. Results. Compared to CG, a larger percentage of supinated feet was examined in relatively severe legs (5, 23.81%), relatively moderate legs (4, 19.05%), and merged results (9, 21.43%) of PG (P<0.05), and the percentage of severe asymmetry (38.1%) was higher in the PG (P<0.05). Moreover, these relationships between the absolute value of asymmetry score and SL or SA were significant in CG and PG, the P values below 0.01. Conclusions. Foot posture asymmetry is significantly associated with static stability both in KOA patients and healthy adults, and more severe asymmetry in foot posture was observed in KOA patients, so it is critical to evaluate foot posture asymmetry for treatment and rehabilitation for patients with KOA

Nutrient removal efficiency in a rice-straw denitrifying bioreactor

Rice straw was used as a carbon source in a denitrifying bioreactor, for the removal of nutrients from agricultural drainage. Nutrient removal efficiency was evaluated by: (a) nutrient loading rates (low, medium, and high); (b) hydraulic retention time, and (c) comparison with another carbon source (woodchip). The results show that concentrations of nitrate nitrogen (NO-N), ammonia nitrogen (NH-N), total nitrogen (TN), and orthophosphate phosphorus (PO-P) in the rice-straw bioreactor effluents were reduced by 53%, 25%, 40%, and 35%, respectively, compared with influents at the medium nutrient loading rate (NO-N: 10-15mgNL, NH-N: 10-15mgNL, PO-P: 1.0-1.5mgPL) and long hydraulic retention time (HRT, 24h), with a corresponding denitrification rate (DR) of 0.40mgNLh. Moreover, the rice-straw bioreactor showed significantly higher (

The Efficacy of Backward Walking on Static Stability, Proprioception, Pain, and Physical Function of Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objective. Impaired static stability and proprioception have been observed in individuals with knee osteoarthritis (KOA), which serves as a major factor increasing risk of fall. This study aimed to investigate the effects of backward walking (BW) on static stability, proprioception, pain, and physical function in KOA patients. Methods. Thirty-two subjects with knee osteoarthritis were randomly assigned to either an BW group (BG, n = 16) or a control group (CG, n = 16). The participants in the BG received combination treatment of a 4-week BW training and conventional treatments, while those in the CG was treated with conventional treatments alone. All the participants were tested for the assessment of static stability [center of pressure (COP) sway, including sway length (SL, mm) and sway area (SA, mm2)] and proprioception [average trajectory error (ATE, %) and completion time (CT, second)]. Additionally, pain and knee function scores were measured by the numerical rating scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, respectively. The assessments were conducted before and after intervention. Results. The COP sway (SA and SL), ATE, NRS, and WOMAC showed a significant decline at week 4 in the two groups in contrast to their baseline (P0.05). Conclusion. BW is an effective adjunct to conventional treatment in reducing pain, improving physical function and static stability for KOA patients. It should be taken into consideration when developing rehabilitation programs for people with KOA

Characterization of a Fungal Virus Representing a Novel Genus in the Family <i>Alphaflexiviridae</i>

Sclerotinia sclerotiorum is an ascomycetous fungus and hosts various mycoviruses. In this study, a novel fungal alphaflexivirus with a special genomic structure, named Sclerotinia sclerotiorum alphaflexivirus 1 (SsAFV1), was cloned from a hypovirulent strain, AHS31. Strain AHS31 was also co-infected with two botourmiaviruses and two mitoviruses. The complete genome of SsAFV1 comprised 6939 bases with four open reading frames (ORFs), a conserved 5′-untranslated region (UTR), and a poly(A) tail in the 3′ terminal; the ORF1 and ORF3 encoded a replicase and a coat protein (CP), respectively, while the function of the proteins encoded by ORF2 and ORF4 was unknown. The virion of SsAFV1 was flexuous filamentous 480–510 nm in length and 9–10 nm in diameter. The results of the alignment and the phylogenetic analysis showed that SsAFV1 is related to allexivirus and botrexvirus, such as Garlic virus X of the genus Allexivirus and Botrytis virus X of the genus Botrevirus, both with 44% amino-acid (aa) identity of replicase. Thus, SsAFV1 is a novel virus and a new genus, Sclerotexvirus, is proposed to accommodate this novel alphaflexivirus

The Role of Toxicity-Related Regimen Changes in the Development of Antiretroviral Resistance

In an effort to evaluate factors associated with the development of antiretroviral (ARV) resistance, we assessed the prevalence of toxicity-related regimen changes and modeled its association to the subsequent development of ARV resistance in a cohort of treatment-naive individuals initiating ARV therapy (ART). A retrospective analysis of patients initiating ART was conducted at the UAB 1917 Clinic from 1 January 2000 to 30 September 2007. Cox proportional hazards models were fit to identify factors associated with the development of resistance to \u3e/=1 ARV drug class. Among 462 eligible participants, 14% (n=64) developed ARV resistance. Individuals with \u3e/=1 toxicity-related regimen change (HR=3.94, 95% CI=1.09-14.21), initiating ART containing ddI or d4T (4.12, 1.19-14.26), and from a minority race (2.91, 1.16-7.28) had increased risk of developing resistance. Achieving virologic suppression within 12 months of ART initiation (0.10, 0.05-0.20) and higher pretreatment CD4 count (0.85 per 50 cells/mm(3), 0.75-0.96) were associated with decreased hazards of resistance. Changes in ART due to drug intolerance were associated with the subsequent development of ARV resistance. Understanding the role of ARV drug selection and other factors associated with the emergence of ARV resistance will help inform interventions to improve patient care and ensure long-term treatment success

Bos taurus contribution in Nellore (Bos indicus) breed.

A espécie Bos indicus, particularmente a raça Nelore, é grande maioria no rebanho bovino da região acima do trópico no Brasil. Embora a habilidade desses animais em resistir às doenças parasitárias, condições climáticas e pastagens de baixa qualidade enalteçam a utilização em larga escala desta raça, estes animais não são considerados bons conversores de alimento e, conseqüentemente, precoces em comparação aos seus homólogos Bos taurus. Durante a formação das raças zebuínas brasileiras, houve uma participação das linhas maternas de Bos taurus, que pode ser demonstrada pela contribuição majoritária do genoma mitocondrial desta subespécie. Embora em escala muito menor, estima-se que exista também uma participação destas linhas maternas no genoma nuclear. O objetivo deste trabalho foi iniciar os estudos para estimar esta participação. Para os estudos foram utilizados 104 animais da raça Nelore e 8 animais de diferentes raças européias. Cinco regiões do DNA que produzem fragmentos microssatélites taurus/indicus específicos (HEL1, HEL9, ETH225, ILSTS005 e INRA063) foram amplificadas com a utilização de primers marcados com sondas fluorescentes. Os fragmentos foram submetidos à eletroforese em gel de poliacrilamida desnaturante 6% e visualizados após excitação com laser. No total foram encontrados 23 alelos para os microssatélites analisados o que representa uma média de 4,6±1,82 alelos por locus. Amplificou-se também uma região do DNA satélite 1711b que posteriormente foi digerida com a enzima de restrição Msp I. Verificou-se a existência de três possíveis genótipos entre os animais Nelore mtDNA Bos taurus e mtDNA Bos indicus. Os animais europeus analisados apresentaram sempre o mesmo padrão de restrição. A comparação dos componentes de variância do tamanho dos alelos intra e inter população usando os fragmentos microssatélites permitem a separação dos animais Bos taurus dos animais Nelore, mas não dos Nelore de origem materna distinta. No entanto, a freqüência de alelos indicus específicos nos microssatélites e de padrões de digestão do DNA satélite também indicus específicos sugerem uma participação da ordem de aproximadamente 6% do genoma taurus na população de gado Nelore.Bos indicus specie, especially Nellore breed is responsible for the majority of Brazilian tropical herd. These animals are notably capable to endure parasite infection as well as hot weather and low quality feed. In one hand this qualities suggest the large scale application of this breed, but in other hand this same breed is well characterized as bad food converter and consequently far from having good precocity status compared with its Bos taurus homologues. It has been reported a matrilineal European participation in Zebu cattle since its introduction in American lands. This hybridization is confirmed by the majority contribution of Bos taurus mtDNA in these animals. Although in a much lower frequency, we hypothesize a Bos taurus cow participation in nuclei genome. The main aim of this work was to give the firsts steps towards the estimation of this participation. A total of 104 Nellore and 8 animals of different European breeds were used for DNA analysis. Five microsatellites fragments (HEL1, HEL9, ETH225, ILSTS005 e INRA063) were amplified applying primers with fluorescent dye. Amplified fragments were used in 6% polyacrilamide electrophoresis and visualized after laser excitation. Overall 23 alleles were detected averaging 4.6±1,82/locus. Variance components of microsatellites allele size comparisons allowed the formation of two clusters separating both subspecies. No significant variation was observed between Nellore with different maternal origins. A satellite 1711b DNA was also amplified and digested with the restriction enzyme Msp I. Three possible genotypes were identified in Nellore animals harboring B. taurus and B. indicus mtDNA. European originated animals always showed the same restriction pattern. Finally B. indicus specific microsatellite allele and satellite 1711b digestion patterns frequency allowed the estimation of 6% of B. taurus contribution in purebred Nellore. These results are discussed in terms of application in cattle genetic improvement

Darunavir Outcomes Study: Comparative Effectiveness of Virologic Suppression, Regimen Durability, and Discontinuation Reasons for Three-Class Experienced Patients at 48 Weeks

Several new antiretroviral (ARV) agents for treatment experienced HIV-infected patients have been approved since June 2006, including darunavir (DRV) and raltegravir (RAL). While efficacious in clinical trials, the effectiveness, durability, and tolerability of these new ARVs remains understudied in the context of routine clinical care. The Darunavir Outcomes Study is a prospective cohort study of three-class ARV-experienced patients changing regimens at the 1917 Clinic after 1/7/2006. All treatment decisions were at the discretion of primary providers. Multivariate (MV) logistic regression for 48 week VL <400c/ml and Cox models for regimen durability were completed. Propensity score methods controlled for sociodemographics. Among 108 patients, mean age of 46, 48% were white, 80% male, with prior exposure to a mean 10.5 ARVs. Overall, 64% of patients achieved 48-week VL <400 c/ml. In MV modeling DRV/rll (OR = 5.77;95%CI = 1.62–20.58) and RAL (OR = 3.84;95%CI = 1.23–11.95) use increased odds of 48-week suppression. Use of these agents exhibited a trend towards prolonged regimen durability in Cox models. Among those highly ARV-experienced, regimens containing DRV/r and/or RAL were more likely to achieve 48-week VL <400 c/ml and exhibited a trend towards prolonged durability. New agents have transformed the treatment landscape for ARV-experienced patients, with effectiveness in routine clinical care mirroring efficacy in clinical trials