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Metabolomic analysis of the serum and urine of rats exposed to diazinon, dimethoate, and cypermethrin alone or in combination 对单独或混合接触二嗪农、乐果和氯氰菊酯的大鼠血清和尿液进行代谢组学分析
Pub Date : 2024-01-02 DOI: 10.1186/s40360-023-00714-6
Yu-Jie Liang, Ding-Xin Long, Shanshan Wang, Hui-Ping Wang, Yi-Jun Wu
Multiple pesticides are often used in combination for plant protection and public health. Therefore, it is important to analyze the physiological changes induced by multiple pesticides exposure. The objective of this study was to investigate the combined toxicity of the widely-used organophosphorus and pyrethroid pesticides diazinon, dimethoate, and cypermethrin. Male Wistar rats were administrated by gavage once daily with the three pesticides individual or in combination for consecutive 28 days. The metabolic components of serum and urine samples were detected by using 1H nuclear magnetic resonance (NMR)-based metabolomics method. Histopathological examination of liver and kidneys and serum biochemical determination were also carried out. The results showed that after the 28-day subacute exposure, serum glutamic transaminase and albumin were significantly increased and blood urea nitrogen was significantly decreased in the rats exposed to the mixture of the pesticides compared with the control rats, suggesting that the co-exposure impaired liver and kidney function. Metabolomics analysis indicated that the indicators 14 metabolites were statistically significant altered in the rats after the exposure of the pesticides. The increase in 3-hydroxybutyric acid in urine or decrease of lactate and N-acetyl-L-cysteine in serum could be a potentially sensitive biomarker of the subchronic combined effects of the three insecticides. The reduction level of 2-oxoglutarate and creatinine in urine may be indicative of dysfunction of liver and kidneys. In summary, the exposure of rats to pesticides diazinon, dimethoate, and cypermethrin could cause disorder of lipid and amino acid metabolism, induction of oxidative stress, and dysfunction of liver and kidneys, which contributes to the understanding of combined toxic effects of the pesticides revealed by using the metabolomics analysis of the urine and serum profiles.
在植物保护和公共卫生方面,多种农药经常被混合使用。因此,分析接触多种农药所引起的生理变化非常重要。本研究旨在调查广泛使用的有机磷和拟除虫菊酯农药二嗪农、乐果和氯氰菊酯的综合毒性。研究人员对雄性 Wistar 大鼠进行了连续 28 天的灌胃试验,每天一次单独或混合使用这三种杀虫剂。采用基于 1H 核磁共振(NMR)的代谢组学方法检测血清和尿液样本中的代谢成分。此外,还对肝脏和肾脏进行了组织病理学检查,并测定了血清生化指标。结果表明,与对照组大鼠相比,亚急性暴露 28 天后,暴露于这两种农药混合物的大鼠血清谷丙转氨酶和白蛋白明显升高,血尿素氮明显降低,表明共同暴露损害了大鼠的肝肾功能。代谢组学分析表明,大鼠接触农药后,14 种代谢物的指标发生了显著的统计学变化。尿液中 3- 羟基丁酸的增加或血清中乳酸和 N- 乙酰-L-半胱氨酸的减少可能是这三种杀虫剂亚慢性综合影响的敏感生物标志物。尿液中 2-氧代戊二酸和肌酐水平的降低可能表明肝脏和肾脏功能出现障碍。总之,大鼠接触杀虫剂二嗪农、乐果和氯氰菊酯后,可能会导致脂质和氨基酸代谢紊乱、氧化应激诱导和肝肾功能障碍,这有助于通过尿液和血清代谢组学分析来了解杀虫剂的联合毒性效应。
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引用次数: 0
Prevalence and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city, southwestern Uganda 乌干达西南部姆巴拉拉市私人药房处方中潜在药物相互作用的发生率和相关因素
Pub Date : 2024-01-02 DOI: 10.1186/s40360-023-00719-1
Allan Phillip Lule, Ogwal Basil Delic, Keneth Katunguka, Francis Muwonge, Tadele Mekuriya Yadesa
Drug-drug interactions (DDIs) influence the effectiveness of medication and thus determine the treatment outcomes of diseases managed with pharmacotherapy. This study aimed to determine the prevalence, severity, and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city. DDIs were identified and classified basing on risk and severity using Lexicomp drug interaction database. STATA version 13 was used to analyze the collected data. Descriptive statistics were used to summarize the severity of potential DDIs identified. Bivariate and multivariate logistic regression was employed to identify different factors associated with the presence of potential DDIs. A total of 295 prescriptions from 18 private pharmacies were studied and the prevalence of clinically significant potential DDIs was 37.6%. About half (149, 50.5%) of the patients were females, the majority (199, 67.5%) were adults 18–59 years of age whereas most (208, 70.5%) had a comorbid condition. Over one half (162, 54.9%) of the prescriptions were received from hospitals and majority of the prescriptions had 4 drugs prescribed (n = 175, 59.32%). Having one or more comorbidities and prescribing of therapeutic drug categories including anti-fungal, antihypertensives, analgesics, or corticosteroids were significantly associated with potential DDIs. The prevalence of potential drug-drug interactions in outpatient setting in Mbarara city was high and majority of the potential DDIs were of moderate severity. Having 1 or more comorbidities and prescribing of therapeutic drug categories including antifungals, antihypertensives, analgesics, or corticosteroids were significantly associated with potential DDIs.
药物相互作用(DDI)会影响药物治疗的效果,从而决定药物治疗疾病的疗效。本研究旨在确定姆巴拉拉市私人药房处方中潜在药物相互作用的发生率、严重程度和相关因素。研究人员使用 Lexicomp 药物相互作用数据库,根据风险和严重程度对 DDIs 进行了识别和分类。使用 STATA 13 版对收集到的数据进行分析。描述性统计用于总结所发现的潜在 DDI 的严重程度。采用双变量和多变量逻辑回归来确定与潜在 DDIs 存在相关的不同因素。共研究了来自 18 家私人药房的 295 份处方,发现具有临床意义的潜在 DDI 的发生率为 37.6%。约一半的患者(149 人,占 50.5%)为女性,大多数(199 人,占 67.5%)为 18-59 岁的成年人,而大多数(208 人,占 70.5%)有合并症。超过一半(162,54.9%)的处方是从医院开出的,大多数处方开出了 4 种药物(175,59.32%)。患有一种或多种合并症以及处方的治疗药物类别(包括抗真菌药、降压药、镇痛药或皮质类固醇)与潜在的 DDIs 有显著相关性。在姆巴拉拉市的门诊环境中,潜在药物间相互作用的发生率很高,大多数潜在药物间相互作用的严重程度为中等。患有一种或多种并发症以及开具抗真菌药、降压药、镇痛药或皮质类固醇等治疗药物类别的处方与潜在的药物间相互作用有明显关联。
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引用次数: 0
Prediction of drug–drug interactions between roflumilast and CYP3A4/1A2 perpetrators using a physiologically-based pharmacokinetic (PBPK) approach 采用基于生理学的药代动力学(PBPK)方法预测罗氟司特与 CYP3A4/1A2 致效体之间的药物相互作用
Pub Date : 2024-01-02 DOI: 10.1186/s40360-023-00726-2
Guangwei Jia, Congcong Ren, Hongyan Wang, Caixia Fan
This study aimed to develop a physiologically-based pharmacokinetic (PBPK) model to predict changes in the pharmacokinetics (PK) and pharmacodynamics (PD, PDE4 inhibition) of roflumilast (ROF) and ROF N-oxide when co-administered with eight CYP3A4/1A2 perpetrators. The population PBPK model of ROF and ROF N-oxide has been successfully developed and validated based on the four clinical PK studies and five clinical drug-drug interactions (DDIs) studies. In PK simulations, every ratio of prediction to observation for PK parameters fell within the range 0.7 to 1.5. In DDI simulations, except for tow peak concentration ratios (Cmax) of ROF with rifampicin (prediction: 0.63 vs. observation: 0.19) and with cimetidine (prediction: 1.07 vs. observation: 1.85), the remaining predicted ratios closely matched the observed ratios. Additionally, the PBPK model suggested that co-administration with the three perpetrators (cimetidine, enoxacin, and fluconazole) may use with caution, with CYP3A4 strong inhibitor (ketoconazole and itraconazole) or with dual CYP3A41A2 inhibitor (fluvoxamine) may reduce to half-dosage or use with caution, while co-administration with CYP3A4 strong or moderate inducer (rifampicin, efavirenz) should avoid. Overall, the present PBPK model can provide recommendations for adjusting dosing regimens in the presence of DDIs.
本研究旨在开发一种基于生理学的药代动力学(PBPK)模型,以预测罗氟司特(ROF)和ROF N-氧化物与8种CYP3A4/1A2致效剂合用时的药代动力学(PK)和药效学(PD,PDE4抑制)变化。基于四项临床 PK 研究和五项临床药物相互作用(DDIs)研究,成功开发并验证了 ROF 和 ROF N-氧化物的群体 PBPK 模型。在 PK 模拟中,PK 参数的预测值与观察值的比值均在 0.7 至 1.5 之间。在 DDI 模拟中,除了 ROF 与利福平(预测值:0.63,观察值:0.19)和西咪替丁(预测值:1.07,观察值:1.85)的拖峰浓度比(Cmax)外,其余的预测比值与观察比值非常接近。此外,PBPK 模型表明,与三种致病因子(西咪替丁、依诺沙星和氟康唑)合用时应慎用,与 CYP3A4 强抑制剂(酮康唑和伊曲康唑)或与 CYP3A41A2 双抑制剂(氟伏沙明)合用时应减至半量或慎用,而与 CYP3A4 强或中度诱导剂(利福平、依非韦伦)合用时应避免。总之,本 PBPK 模型可为出现 DDI 时调整给药方案提供建议。
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引用次数: 0
Genetic prediction of antihyperglycemic drug targets and risk of epilepsy: a mendelian randomisation study 抗高血糖药物靶点和癫痫风险的基因预测:亡羊补牢随机化研究
Pub Date : 2024-01-02 DOI: 10.1186/s40360-023-00718-2
Kaiping Zhou, Huan Yang, Zhihao Xie, Weiping Wang, Zhenzhen Qu
A connection between diabetes and an increased risk of epilepsy has been suggested by observational studies. Animal studies have also shown that antihyperglycemic drugs can improve seizures. However, it is unclear whether antihyperglycemic drugs have a causal role in epilepsy in humans. To investigate this potential causal relationship, a Mendelian randomisation study was conducted using International League Against Epilepsy data as the discovery set and FinnGen data as the replication set. It was discovered that three antidiabetic drug target genes, ETFDH, CYP21A2 and CYP2D6, were involved in the occurrence of epilepsy. In particular, ETFDH was identified as a target gene in both the discovery set (inverse variance weighting [IVW], odds ratio [OR] = 1.018, 95% confidence interval [CI], 1.004–1.033, p = 0.009) and replication set (IVW, OR = 1.074, 95% CI, 1.034–1.114, p = 0.00016), and CYP21A2 was identified in the discovery set (IVW, OR = 1.029, 95% CI, 1.005–1.053, p = 0.016) and replication set (IVW, OR = 1.057, 95% CI, 1.001–1.116, p = 0.045) as having a causal association with an increased risk of epilepsy. Conversely, the CYP2D6 gene was found to be a protective factor for epilepsy in both the discovery set (IVW, OR = 0.0984, 95% CI, 0.969–0.998, p = 0.025) and replication set (IVW, OR = 0.977, 95% CI, 0.955–1.000, p = 0.046). A search of DrugBank revealed that metformin, an anti-glucose drug, is an inhibitor of the ETFDH gene and may have a potential therapeutic effect on epilepsy.
观察性研究表明,糖尿病与癫痫风险增加之间存在联系。动物研究也表明,降糖药物可以改善癫痫发作。然而,目前尚不清楚降糖药物对人类癫痫是否有因果关系。为了研究这种潜在的因果关系,我们以国际抗癫痫联盟的数据为发现集,以 FinnGen 的数据为复制集,进行了一项孟德尔随机研究。研究发现,ETFDH、CYP21A2 和 CYP2D6 这三个抗糖尿病药物靶基因与癫痫的发生有关。其中,ETFDH 在发现集(逆方差加权[IVW],比值比[OR]=1.018,95% 置信区间[CI],1.004-1.033,p = 0.009)和复制集(IVW,比值比[OR]=1.074,95% 置信区间[CI],1.034-1.114,p = 0.00016),而在发现集(IVW,OR = 1.029,95% CI,1.005-1.053,p = 0.016)和复制集(IVW,OR = 1.057,95% CI,1.001-1.116,p = 0.045)中发现 CYP21A2 与癫痫风险增加有因果关系。相反,在发现集(IVW,OR = 0.0984,95% CI,0.969-0.998,p = 0.025)和复制集(IVW,OR = 0.977,95% CI,0.955-1.000,p = 0.046)中发现,CYP2D6 基因是癫痫的保护因素。对 DrugBank 的搜索显示,二甲双胍是一种抗葡萄糖药物,是 ETFDH 基因的抑制剂,可能对癫痫有潜在的治疗作用。
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引用次数: 0
Pharmacokinetics and pharmacodynamics of perfluoropropane after intra-venous bolus injection of perflutren lipid microsphere injection (DEFINITY®) in healthy Chinese volunteers 健康中国志愿者静脉内注射全氟丙烷脂质微球注射液(DEFINITY®)后全氟丙烷的药代动力学和药效学研究
Pub Date : 2024-01-02 DOI: 10.1186/s40360-023-00729-z
Pengfei Li, Ping Du, Jun Peng, Zhixia Zhao, Huiling Li, Weiyue Yu, Shumin Wang, Lihong Liu
Definity is an ultrasound contrast agent consisting of phospholipids-encapsulated perfluoropropane (PFP), also known as perflutren, microspheres, which is initially designed to enhance echocardiographic ultrasound images. With no pharmacologic action, Definity can increase the backscatter of ultrasound resulting enhanced ultrasound signals. The objective of this study was to determine the pharmacokinetics (PKs), Pharmacodynamics (PDs) and safety of Definity in healthy male and female Chinese volunteers. A simple GC-MS method was developed and applied to simultaneously quantify PFP both in human whole blood and in expired air using Perfluorobutane (PFB) as internal standard. Meanwhile, the blood microbubble Doppler intensities were continuously monitored as companion PDs by a Doppler ultrasonography system using a non-imaging method. After intravenous infusion of 10 µL/kg of PFP within 30 seconds, the mean AUClast of the pharmacokinetic analysis set was 0.000653 (uL/mL)*min, the average AUC∞ was 0.001051 (uL/mL)*min. The main coefficient of variation of parameters were within 30%. In this trial, the blood drug concentration of female subjects was lower than that of males. Female Cmax, AUClast and AUC∞ were lower than males’, Tmax and t1/2 was close to males’, Vss and CL were slightly higher than males’. The concentration of PFP in the expired air of the subject reached the maximum value 1–2 min after administration and the PFP accumulation curve in the expired air began to become flat at 9.5–11 min after administration. The PFP in the expired air at the last sampling point of most subjects was still measurable. The results of the analysis showed that female subjects had slightly more and faster PFP excretion via the lungs than males. The change of blood drug concentration in this trial was related to the change process of Doppler signal intensity. The trend of the two was close, but the peak time of blood drug concentration was slightly delayed compared with the peak time of the Doppler signal intensity. The results showed that female tmax−pd, t10 was earlier than male, and women have lower AUCpd than men. The pharmacokinetics and pharmacodynamics of Definity in blood and expired air were systematically evaluated for the first time in this study. The PK/PD analysis results of this trial showed that the change of blood concentration was related to the change process of Doppler signal intensity, the trend of the two was close and expired air are the main excretion pathways of Definity. Definity was well tolerated by all subjects in the trial. This study was registered on 08 December 2017 at the Chinese Clinical Trial Registry (CTR20171087).
Definity 是一种超声造影剂,由磷脂包裹的全氟丙烷(PFP)微球组成,最初设计用于增强超声心动图图像。在没有药理作用的情况下,Definity 可增加超声波的反向散射,从而增强超声波信号。本研究的目的是测定 Definity 在健康男性和女性中国志愿者中的药代动力学(PKs)、药效学(PDs)和安全性。以全氟丁烷(PFB)为内标物,建立了一种简单的气相色谱-质谱(GC-MS)方法,用于同时定量检测人体全血和呼出空气中的全氟辛烷磺酸。与此同时,多普勒超声系统采用非成像方法连续监测血液微泡的多普勒强度作为伴生 PD。在 30 秒内静脉注射 10 µL/kg PFP 后,药代动力学分析集的平均 AUClast 为 0.000653 (uL/mL)*min,平均 AUC∞ 为 0.001051 (uL/mL)*min。各参数的主要变异系数均在 30% 以内。在本试验中,女性受试者的血药浓度低于男性。女性的 Cmax、AUClast 和 AUC∞ 均低于男性,Tmax 和 t1/2 与男性接近,Vss 和 CL 略高于男性。给药后 1-2 分钟,受试者呼出气体中的全氟辛烷磺酸浓度达到最大值,给药后 9.5-11 分钟,受试者呼出气体中的全氟辛烷磺酸累积曲线开始变得平缓。大多数受试者在最后一个采样点时,呼出空气中的全氟丙烷浓度仍可测量。分析结果表明,女性受试者通过肺部排出全氟丙烷的数量和速度略高于男性。本试验中血液中药物浓度的变化与多普勒信号强度的变化过程有关。两者的变化趋势接近,但与多普勒信号强度的峰值时间相比,血药浓度的峰值时间略有延迟。结果表明,女性的 tmax-pd、t10 早于男性,女性的 AUCpd 低于男性。本研究首次系统地评估了血液和呼出气体中笛非尼的药代动力学和药效学。该试验的PK/PD分析结果表明,血药浓度的变化与多普勒信号强度的变化过程有关,两者的变化趋势接近,呼出气体是递质的主要排泄途径。试验中所有受试者对迪芬尼的耐受性良好。本研究于2017年12月8日在中国临床试验注册中心注册(CTR20171087)。
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引用次数: 0
In diabetic male Wistar rats, quercetin-conjugated superparamagnetic iron oxide nanoparticles have an effect on the SIRT1/p66Shc-mediated pathway related to cognitive impairment 在糖尿病雄性 Wistar 大鼠体内,槲皮素共轭超顺磁性氧化铁纳米粒子对 SIRT1/p66Shc 介导的与认知障碍有关的通路有影响
Pub Date : 2023-12-21 DOI: 10.1186/s40360-023-00725-3
Mahnaz Karami Chamgordani, Akram Bardestani, Shiva Ebrahimpour, Abolghasem Esmaeili
Quercetin (QC) possesses a variety of health-promoting effects in pure and in conjugation with nanoparticles. Since the mRNA-SIRT1/p66Shc pathway and microRNAs (miRNAs) are implicated in the oxidative process, we aimed to compare the effects of QC and QC-conjugated superparamagnetic iron oxide nanoparticles (QCSPIONs) on this pathway. Through the use of the chemical coprecipitation technique (CPT), SPIONs were synthesized, coated with dextran, and conjugated with quercetin. Adult male Wistar rats were given intraperitoneal injections of streptozotocin to look for signs of type 1 diabetes (T1D). The animals were randomized into five groups: the control group got deionized water (DI), free QC solution (25 mg/kg), SPIONs (25 mg/kg), and QCSPIONs (25 mg/kg), and all groups received repeat doses administered orally over 35 days. Real-time quantitative PCR was used to assess the levels of miR-34a, let-7a-p5, SIRT1, p66Shc, CASP3, and PARP1 expression in the hippocampus of diabetic rats. In silico investigations identified p66Shc, CASP3, and PARP1 as targets of let-7a-5p and miR-34a as possible regulators of SIRT1 genes. The outcomes demonstrated that diabetes elevated miR-34a, p66Shc, CASP3, and PARP1 and downregulated let-7a-5p and SIRT1 expression. In contrast to the diabetic group, QCSPIONs boosted let-7a-5p expression levels and consequently lowered p66Shc, CASP3, and PARP1 expression levels. QCSPIONs also reduced miR-34a expression, which led to an upsurge in SIRT1 expression. Our results suggest that QCSPIONs can regulate the SIRT1/p66Shc-mediated signaling pathway and can be considered a promising candidate for ameliorating the complications of diabetes.
纯槲皮素(QC)和与纳米颗粒共轭的槲皮素具有多种促进健康的作用。由于 mRNA-SIRT1/p66Shc 通路和 microRNAs(miRNAs)与氧化过程有关,我们旨在比较 QC 和 QC 共轭超顺磁性氧化铁纳米粒子(QCSPIONs)对该通路的影响。我们采用化学共沉淀技术(CPT)合成了超顺磁性氧化铁纳米粒子,并在其表面涂上葡聚糖和槲皮素。给成年雄性 Wistar 大鼠腹腔注射链脲佐菌素,以寻找 1 型糖尿病(T1D)的症状。动物被随机分为五组:对照组为去离子水(DI)、游离 QC 溶液(25 毫克/千克)、SPIONs(25 毫克/千克)和 QCSPIONs(25 毫克/千克),所有组均在 35 天内重复口服给药。实时定量 PCR 被用来评估糖尿病大鼠海马中 miR-34a、let-7a-p5、SIRT1、p66Shc、CASP3 和 PARP1 的表达水平。硅学研究发现 p66Shc、CASP3 和 PARP1 是 let-7a-5p 的靶标,而 miR-34a 可能是 SIRT1 基因的调控因子。研究结果表明,糖尿病会升高 miR-34a、p66Shc、CASP3 和 PARP1,下调 let-7a-5p 和 SIRT1 的表达。与糖尿病组相比,QCSPIONs 提高了 let-7a-5p 的表达水平,从而降低了 p66Shc、CASP3 和 PARP1 的表达水平。QCSPIONs 还降低了 miR-34a 的表达,从而导致 SIRT1 的表达上升。我们的研究结果表明,QCSPIONs 可以调节 SIRT1/p66Shc 介导的信号通路,可被视为一种有望改善糖尿病并发症的候选药物。
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引用次数: 0
Addition of progesterone to feminizing gender-affirming hormone therapy in transgender individuals for breast development: a randomized controlled trial 在变性人的女性化性别确认激素疗法中添加黄体酮以促进乳房发育:随机对照试验
Pub Date : 2023-12-20 DOI: 10.1186/s40360-023-00724-4
Benthe A.M. Dijkman, Danithsia Helder, Lidewij S. Boogers, Noor C. Gieles, Jason O. van Heesewijk, Sjoerd te Slaa, Niels P.T.J. Liberton, Chantal M. Wiepjes, Christel J.M. de Blok, Martin den Heijer, Koen M.A. Dreijerink
Feminizing gender-affirming hormone therapy (GAHT) for transgender individuals traditionally includes estradiol and androgen deprivation. Research has demonstrated that breast size as a result of GAHT in transgender women is often limited. Therefore, transgender women often choose to undergo breast augmentation surgery. Progesterone is important for breast development in cisgender women during puberty. A potential role for progesterone in breast development in transgender women has not been investigated in a randomized controlled experimental set-up. The primary objective of this study is to explore the effects on breast volume of addition of oral progesterone to GAHT with estradiol in transgender women after vaginoplasty or orchiectomy. Secondary objectives include assessment of safety, satisfaction, mood, sleep and sexual pleasure. This is a non-blinded, non-placebo, randomized controlled trial using a factorial design in adult transgender individuals assigned male sex at birth who have undergone GAHT for at least one year and underwent vaginoplasty or orchiectomy. The study design allows for rapid assessment of potential synergistic effects of various dose combinations of estradiol and progesterone on breast volume change: Ninety participants will be randomized into six groups of 15 subjects each, receiving either the baseline dose of estradiol, the baseline dose of estradiol and progesterone 200 mg daily, the baseline dose of estradiol and progesterone 400 mg daily, twice the baseline dose of estradiol, twice the baseline dose of estradiol and progesterone 200 mg daily or twice the baseline dose of estradiol and progesterone 400 mg daily, all for a duration of 12 months. The main study parameters include changes in breast volume as determined by 3D measurements. Participants will be followed-up with laboratory testing including serum progesterone concentrations as well as surveys for satisfaction, mood, sleep quality and sexual pleasure. This study will indicate whether progesterone is safe and of additional value with regard to breast volume change in transgender individuals receiving feminizing GAHT. The results of this study will be useful for innovation of feminizing GAHT. WHO International Clinical Trials Registry Platform: EUCTR2020-001952-16-NL; date of registration: 12 December 2020 https://trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2020-001952-16-NL .
针对变性人的女性化性别确认激素疗法(GAHT)传统上包括雌二醇和雄激素剥夺疗法。研究表明,变性女性在接受 GAHT 治疗后,乳房的大小往往会受到限制。因此,变性女性通常会选择接受隆胸手术。在青春期,孕酮对顺性女性的乳房发育非常重要。关于孕酮在变性女性乳房发育中的潜在作用,目前还没有通过随机对照实验进行研究。本研究的主要目的是探讨在阴道成形术或睾丸切除术后的变性女性使用雌二醇 GAHT 的同时口服黄体酮对乳房体积的影响。次要目标包括评估安全性、满意度、情绪、睡眠和性快感。这是一项非盲法、非安慰剂、随机对照试验,采用因子设计,研究对象为出生时性别即为男性、接受 GAHT 治疗至少一年并接受阴道成形术或睾丸切除术的成年变性人。这种研究设计可以快速评估雌二醇和孕酮的不同剂量组合对乳房体积变化的潜在协同效应:90 名参与者将被随机分为 6 组,每组 15 人,分别接受基线剂量的雌二醇、基线剂量的雌二醇和黄体酮(每天 200 毫克)、基线剂量的雌二醇和黄体酮(每天 400 毫克)、两倍基线剂量的雌二醇、两倍基线剂量的雌二醇和黄体酮(每天 200 毫克)或两倍基线剂量的雌二醇和黄体酮(每天 400 毫克),持续时间均为 12 个月。主要研究参数包括通过 3D 测量确定的乳房体积变化。参与者将接受实验室检测,包括血清孕酮浓度以及满意度、情绪、睡眠质量和性快感调查。这项研究将说明黄体酮是否安全,以及对接受女性化 GAHT 治疗的变性人的乳房体积变化是否有额外价值。这项研究的结果将有助于女性化 GAHT 的创新。世界卫生组织国际临床试验注册平台:EUCTR2020-001952-16-NL;注册日期:2020 年 12 月 12 日 https://trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2020-001952-16-NL 。
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引用次数: 0
Effectiveness and safety of different doses of febuxostat compared with allopurinol in the treatment of hyperuricemia: a meta-analysis of randomized controlled trials 不同剂量非布索坦与别嘌醇治疗高尿酸血症的有效性和安全性对比:随机对照试验的荟萃分析
Pub Date : 2023-12-14 DOI: 10.1186/s40360-023-00723-5
Hong Xie, Nan Hu, Ting Pan, Jun-Cai Wu, Miao Yu, Deng-Chao Wang
The prevalence of hyperuricemia has increased steadily with the continuous improvement of living standards. Some studies have reported the clinical effectiveness and safety of different doses of febuxostat in comparison with allopurinol in hyperuricemia treatment, but the sample sizes of the studies have been small, and the results have been inconsistent. We designed this meta-analysis to evaluate the effectiveness and safety of different doses of febuxostat compared with allopurinol in the treatment of hyperuricemia. The Cochrane Library, Embase, PubMed, Web of Science and ClinicalTrials.gov databases were searched to identify randomized controlled trials (RCTs) comparing the use of febuxostat and allopurinol for the treatment of hyperuricemia. The effectiveness and safety of different doses of febuxostat and allopurinol in treating hyperuricemia were assessed using meta-analysis. A total of 11 randomized controlled trials were included in the meta-analysis. The results of the meta-analysis showed that the percentage of patients achieving serum uric acid levels of 6.0 mg/dL or less was higher among patients taking febuxostat (80 mg/d) than among patients taking allopurinol (200–300 mg/d) [RR = 1.79, 95% CI (1.55, 2.08), P < 0.00001]. However, there was no statistically significant difference in the percentage of patients achieving serum uric acid levels of 6.0 mg/dL or less between febuxostat (40 mg/d) and allopurinol (200–300 mg/d) [RR = 1.10, 95% CI (0.93, 1.31), P = 0.25]. There was also no statistically significant difference in the incidence of gout between the febuxostat (40 mg/d) and allopurinol (200–300 mg/d) [RR = 0.97, 95% CI (0.64, 1.49), P = 0.91] or between the febuxostat (80 mg/d) and allopurinol (200–300 mg/d) [RR = 1.13, 95% CI (0.81, 1.58), P = 0.48].No significant difference in the incidence of major adverse reactions as observed between the febuxostat (40 mg/d) and allopurinol (200–300 mg/d) [RR = 1.16; 95% CI (0.43, 3.16), P = 0.77] or between the febuxostat (80 mg/d) and allopurinol (200–300 mg/d) [RR = 1.06; 95% CI (0.79, 1.42), P = 0.70]. The incidence of adverse cardiovascular events did not differ significantly between the febuxostat (40 mg/d) and allopurinol (200–300 mg/d) [RR = 1.30; 95% CI (0.57, 2.95), P = 0.53] or between the febuxostat (80 mg/d) and allopurinol (200–300 mg/d) [RR = 1.79; 95% CI (0.74, 4.32), P = 0.20]. Febuxostat (80 mg/d) was associated with a higher percentage of patients achieving serum uric acid levels of 6.0 mg/dL or less than allopurinol (200–300 mg/d), however, febuxostat (80 mg/d) did not exhibit better efficacy in reducing the incidence of gout. More attention should be devoted to the adverse reactions caused by an increase in febuxostat doses.
随着生活水平的不断提高,高尿酸血症的发病率也在稳步上升。一些研究报道了不同剂量的非布司他与别嘌醇相比治疗高尿酸血症的临床有效性和安全性,但这些研究的样本量较小,结果也不一致。我们设计了这项荟萃分析,以评估不同剂量的非布司他与别嘌醇相比治疗高尿酸血症的有效性和安全性。我们检索了 Cochrane 图书馆、Embase、PubMed、Web of Science 和 ClinicalTrials.gov 数据库,以确定比较非布司他和别嘌醇治疗高尿酸血症的随机对照试验 (RCT)。通过荟萃分析评估了不同剂量的非布司他和别嘌醇治疗高尿酸血症的有效性和安全性。荟萃分析共纳入了 11 项随机对照试验。荟萃分析结果显示,服用非布索坦(80 毫克/天)的患者血清尿酸水平达到或低于 6.0 毫克/分升的比例高于服用别嘌醇(200-300 毫克/天)的患者[RR = 1.79,95% CI (1.55, 2.08),P < 0.00001]。然而,非布索坦(40 毫克/天)和别嘌醇(200-300 毫克/天)患者的血清尿酸水平达到或低于 6.0 毫克/分升的比例没有显著统计学差异[RR = 1.10,95% CI (0.93,1.31),P = 0.25]。非布索坦(40 毫克/天)与别嘌醇(200-300 毫克/天)[RR = 0.97,95% CI (0.64,1.49),P = 0.91]之间或非布索坦(80 毫克/天)与别嘌醇(200-300 毫克/天)[RR = 1.13,95% CI (0.81,1.58),P = 0.48]之间的痛风发病率也无明显统计学差异。非布索坦(40 毫克/天)与别嘌醇(200-300 毫克/天)[RR = 1.16;95% CI (0.43,3.16),P = 0.77]或非布索坦(80 毫克/天)与别嘌醇(200-300 毫克/天)[RR = 1.06;95% CI (0.79,1.42),P = 0.70]的主要不良反应发生率无明显差异。非布索坦(40 mg/d)与别嘌醇(200-300 mg/d)[RR = 1.30;95% CI (0.57,2.95),P = 0.53]之间或非布索坦(80 mg/d)与别嘌醇(200-300 mg/d)[RR = 1.79;95% CI (0.74,4.32),P = 0.20]之间的心血管不良事件发生率无显著差异。与别嘌醇(200-300 mg/d)相比,非布司他(80 mg/d)能使更多患者的血清尿酸水平达到或低于 6.0 mg/dL,但非布司他(80 mg/d)在降低痛风发病率方面并没有表现出更好的疗效。应更多地关注非布索坦剂量增加所引起的不良反应。
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引用次数: 0
Long-term survival in venous thromboembolic disease: rivaroxaban vs. warfarin – propensity score matching study 静脉血栓栓塞性疾病患者的长期生存:利伐沙班与华法林--倾向评分匹配研究
Pub Date : 2023-12-13 DOI: 10.1186/s40360-023-00712-8
Estefan Ramos-Isaza, Eduardo Tuta-Quintero, Alirio Bastidas-Goyes, Diana Diaz-Quijano, Carolina Aponte-Murcia, Julian Espitia-Angel, Daniel Pinto-Beltran, Johan Rincón-Hernández, Juan Sánchez-Cuellar, Jesus Pérez-Bueno, Luis F. Giraldo-Cadavid
Venous thromboembolic disease (VTE) is characterized by obstruction of venous blood flow by a thrombus. Survival data, frequency of disease recurrence, and bleeding rate in patients on anticoagulant therapy with warfarin compared to rivaroxaban in the Latin American population are limited in VTE. A retrospective cohort study with propensity score matching analysis was conducted in patients with pulmonary embolism and/or deep vein thrombosis anticoagulated with warfarin or rivaroxaban treated. Survival analysis was performed using a Kaplan-Meier curve for each of the intervention groups, and it was compared using a Log Rank test. Of 2193 potentially eligible patients with a suspected diagnosis of VTE, 505 patients entered the analysis; of these, 285 subjects were managed with warfarin and 220 anticoagulated with rivaroxaban. Major bleeding at 12 months occurred in 2.7% (6/220) of patients treated with Rivaroxaban, compared to 10.2% (29/285) in the Warfarin group in the unmatched population (p = 0.001). In the matched population, bleeding at 12 months occurred in 2.9% (6/209) of patients on Rivaroxaban and in 11.0% (23/209) of patients on Warfarin (p = 0.001). The survival rates at 6 months were 97.1% for Rivaroxaban and 97.6% for Warfarin (p = 0.76). At 12 months, the survival rates were 94.7% for Rivaroxaban and 95.7% for Warfarin (p = 0.61). In the treatment of VTE, there is no differences on 6 and 12-month survival or a reduction in the occurrence of new thromboembolic events when comparing rivaroxaban to warfarin. However, a lower risk of major bleeding is observed at 12 months with Rivaroxaban.
静脉血栓栓塞性疾病(VTE)的特点是血栓阻塞静脉血流。在拉丁美洲人群中,与利伐沙班相比,使用华法林进行抗凝治疗的 VTE 患者的生存数据、疾病复发频率和出血率都很有限。我们对使用华法林或利伐沙班进行抗凝治疗的肺栓塞和/或深静脉血栓患者进行了倾向得分匹配分析的回顾性队列研究。采用卡普兰-梅耶曲线对各干预组进行了生存率分析,并采用对数秩检验进行了比较。在 2193 名可能符合条件的疑似 VTE 患者中,有 505 名患者进入了分析;其中 285 人接受了华法林治疗,220 人接受了利伐沙班抗凝治疗。在接受利伐沙班治疗的患者中,2.7%(6/220)的患者在12个月时出现大出血,而在未配对人群中,华法林组的大出血发生率为10.2%(29/285)(P = 0.001)。在配对人群中,接受利伐沙班治疗的患者中有 2.9%(6/209)在 12 个月内发生出血,而接受华法林治疗的患者中有 11.0%(23/209)在 12 个月内发生出血(p = 0.001)。服用利伐沙班 6 个月后的存活率为 97.1%,服用华法林 6 个月后的存活率为 97.6%(p = 0.76)。12 个月时,利伐沙班的存活率为 94.7%,华法林的存活率为 95.7%(p = 0.61)。在治疗 VTE 方面,利伐沙班与华法林相比,在 6 个月和 12 个月的存活率上没有差异,新血栓栓塞事件的发生率也没有降低。不过,利伐沙班在 12 个月内发生大出血的风险较低。
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引用次数: 0
Host microbiome associated low intestinal acetate correlates with progressive NLRP3-dependent hepatic-immunotoxicity in early life microcystin-LR exposure 在早期微囊藻毒素-LR暴露中,与肠道低醋酸相关的宿主微生物群与渐进性NLRP3依赖性肝免疫毒性有关
Pub Date : 2023-12-13 DOI: 10.1186/s40360-023-00721-7
Madhura More, Somdatta Chatterjee, Punnag Saha, Dipro Bose, Ayushi Trivedi, Subhajit Roy, Saurabh Chatterjee
Microcystins (MCs), potent hepatotoxins pose a significant health risk to humans, particularly children, who are more vulnerable due to higher water intake and increased exposure during recreational activities. Here, we investigated the role of host microbiome-linked acetate in modulating inflammation caused by early-life exposure to the cyanotoxin Microcystin-LR (MC-LR) in a juvenile mice model. Our study revealed that early-life MC-LR exposure disrupted the gut microbiome, leading to a depletion of key acetate-producing bacteria and decreased luminal acetate concentration. Consequently, the dysbiosis hindered the establishment of a gut homeostatic microenvironment and disrupted gut barrier function. The NOD-like receptor family pyrin domain – containing 3 (NLRP3) inflammasome, a key player in MC-induced hepatoxicity emerged as a central player in this process, with acetate supplementation effectively preventing NLRP3 inflammasome activation, attenuating hepatic inflammation, and decreasing pro-inflammatory cytokine production. To elucidate the mechanism underlying the association between early-life MC-LR exposure and the progression of metabolic dysfunction associated steatotic liver disease (MASLD), we investigated the role of acetate binding to its receptor -G-protein coupled receptor 43 (GPR43) on NLRP3 inflammasome activation. Our results demonstrated that acetate-GPR43 signaling was crucial for decreasing NLRP3 protein levels and inhibiting NLRP3 inflammasome assembly. Further, acetate-induced decrease in NLRP3 protein levels was likely mediated through proteasomal degradation rather than autophagy. Overall, our findings underscore the significance of a healthy gut microbiome and its metabolites, particularly acetate, in the progression of hepatotoxicity induced by early life toxin exposure, crucial for MASLD progression. This study highlights potential therapeutic targets in gut dysbiosis and NLRP3 inflammasome activation for mitigating toxin-associated inflammatory liver diseases.
微囊藻毒素(MCs)是一种强效的肝脏毒素,对人类的健康构成重大威胁,尤其是儿童,他们更容易受到影响,因为他们摄入的水更多,在娱乐活动中接触的机会也更多。在此,我们以幼年小鼠为模型,研究了宿主微生物与醋酸盐的联系在调节因早期暴露于蓝藻毒素微囊藻毒素-LR(MC-LR)而引起的炎症中的作用。我们的研究发现,早期暴露于 MC-LR 会扰乱肠道微生物群,导致关键的醋酸盐产生菌减少和管腔醋酸盐浓度降低。因此,菌群失调阻碍了肠道平衡微环境的建立,并破坏了肠道屏障功能。NOD样受体家族含吡咯啉结构域3(NLRP3)炎性体是MC诱导肝毒性的一个关键角色,它在这一过程中扮演着核心角色,补充醋酸盐可有效阻止NLRP3炎性体的激活,减轻肝脏炎症,减少促炎细胞因子的产生。为了阐明早期MC-LR暴露与代谢功能障碍相关性脂肪性肝病(MASLD)进展之间的关联机制,我们研究了醋酸盐与其受体--G蛋白偶联受体43(GPR43)结合对NLRP3炎症小体激活的作用。我们的研究结果表明,醋酸-GPR43 信号传导对降低 NLRP3 蛋白水平和抑制 NLRP3 炎性体组装至关重要。此外,乙酸盐诱导的 NLRP3 蛋白水平下降可能是通过蛋白酶体降解而非自噬介导的。总之,我们的研究结果强调了健康的肠道微生物群及其代谢产物(尤其是醋酸盐)在早期毒素暴露诱导的肝毒性进展中的重要作用,这对 MASLD 的进展至关重要。这项研究强调了肠道菌群失调和 NLRP3 炎症小体激活的潜在治疗靶点,以减轻毒素相关的炎症性肝病。
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