Osteoporosis drugs for prevention of clinical fracture in white postmenopausal women: a network meta-analysis of survival data.

By Bayesian random effects network meta-analysis stratified by prevalent vertebral fracture (PVF), we conclude that different effective drugs should be used to prevent fragility fractures according to postmenopausal women with or without PVF and that there are two drugs (i.e., parathyroid hormone (1-84) and abaloparatide) less tolerated than placebo. INTRODUCTION: No studies have compared various osteoporosis drugs in postmenopausal women (PMW) either with or without prevalent vertebral fracture (PVF). We aimed to compare them in the two different subgroups. METHODS: We searched different databases to select relevant studies. We performed Bayesian random effects network meta-analysis to synthesize hazard ratio (HR) and 95% confidence interval (CI) for clinical fracture stratified by PVF and to synthesize risk ratio (RR) for tolerability and vertebral fracture. RESULTS: We included 33 trials involving 79,144 PMW. In the PVF ≥ 50% subgroup, teriparatide (HR 0.39, 95% CI 0.28-0.57), romosozumab (HR 0.49, 95% CI 0.29-0.75), risedronate (HR 0.62, 95% CI 0.50-0.79), zoledronate (HR 0.67, 95% CI 0.47-0.96), and alendronate (HR 0.69, 95% CI 0.47-0.97) reduced clinical fracture risk. In the other subgroup, abaloparatide (HR 0.56, 95% CI 0.33-0.92), romosozumab (HR 0.67, 95% CI 0.47-0.95), and denosumab (HR 0.68, 95% CI 0.50-0.85) reduced clinical fracture risk. Five drugs reduced vertebral fracture risk in the PVF ≥ 50% subgroup whereas seven did in the other subgroup. All drugs did not increase withdrawal risk except for parathyroid hormone (1-84) (PTH) (RR 1.9, 95% CI 1.4-2.6) and abaloparatide (RR 1.6, 95% CI 1.2-2.3). CONCLUSION: Different effective drugs should be used to prevent fragility fractures according to PMW with or without PVF, and romosozumab is the only one which can reduce clinical and vertebral fractures in both of the two populations. PTH and abaloparatide are less tolerated than placebo whereas the eight other drugs assessed in the study have the same tolerability as placebo.

Double ventricular response in dual AV nodal pathways mimicking interpolated premature beat.

Double ventricular response in dual atrioventricular (AV) nodal pathways can result in nonreentrant supraventricular tachycardia. Since this condition was first described in 1979, around 20 cases have been reported. Here, we present the case of a patient with a confirmed diagnosis of double ventricular response in dual AV nodal pathways resembling an interpolated premature beat who underwent successful radiofrequency ablation of the slow pathway.

The association between GGCX, miR-133 genetic polymorphisms and warfarin stable dosage in Han Chinese patients with mechanical heart valve replacement.

WHAT IS KNOWN AND OBJECTIVE: Warfarin is a widely used anticoagulant with a narrow therapeutic index. Polymorphisms in the VKORC1, CYP2C9 and CYP4F2 genes have been verified to correlate with warfarin stable dosage (WSD). Whether any other genes or variants affect the dosage is unknown. The aim of our study was to investigate the relationship between GGCX, miR-133 variants and the WSD in Han Chinese patients with mechanical heart valve replacement (MHVR). METHODS: A total of 231 patients were enrolled in the study. Blood samples were collected for genotyping. The average WSD among subjects with different GGCX or miR-133 genotypes was compared. Regression analyses were performed to test for any association of genetic polymorphisms with WSD. RESULTS AND DISCUSSION: The warfarin dosage in patients with the GGCX rs699664 TT and rs12714145 TT genotypes was 3.77±0.93 (95% CI: 3.35-4.19) mg/d and 3.70±1.00 (95% CI: 3.32-4.09) mg/d, respectively. The GGCX rs699664 and rs12714145 genotypes were significantly associated with WSD (P<.05). But they were ruled out in the multivariate regression analysis. There were no significant differences in the average warfarin stable dosage between subjects with MIR133B rs142410335 wild-type and variant genotypes (P>.05). WHAT IS NEW AND CONCLUSION: The genotypes of GGCX rs699644 and rs12714145 were significantly associated with WSD (P<.05), but their contributions were not significant after accounting for other factors. MIR133B rs142410335 makes no significant contributions to warfarin stable dosage in Han Chinese patients with MHVR neither in univariate regression nor in multivariate regression analyses.

First Report of a Leaf Spot on Pepper Caused by Cladosporium oxysporum in China.

Pepper (Capsicum annuum L.) is an important vegetable crop grown in Liaoning Province of China. In June 2009, leaf spotting was observed on hot pepper cv. 37-74 in Wafangdian County of Liaoning Province. By August 2011, the disease had spread to Pulandian and Donggang Counties. Symptoms initially appeared on both sides of leaves as pinpoint chlorotic spots that enlarged and developed into irregular, brown lesions, 1 to 8 mm in diameter. To identify the pathogen, leaf pieces (3 to 5 mm) taken at the edge of lesions with both infected and healthy portions were surface disinfected by placing them in 75% ethanol for 5 s, then transferred to a 0.1% aqueous mercuric chloride solution for 30 s and rinsed with sterilized water three times. The sections were placed on potato dextrose agar (PDA) at 25°C in the dark. Ten pure fungal cultures were obtained from single spores. For growth rate determination and morphological description of colonies, single conidial isolates were inoculated on PDA, malt extract agar (MEA), and oatmeal agar (OA), and incubated at 25°C for 14 days in darkness. For studies of microscopic morphology, isolates were grown on synthetic nutrient agar (SNA) in slide cultures. Colonies grew up to 77 to 80 mm in diameter on PDA, 62 to 66 mm on MEA, and 58 to 60 mm on OA after 14 days. Conidiophores were straight to slightly flexuous. Conidia ranged in shape from subglobose or ovoid to subcylindrical. Macronematous conidiophores measured 40 to 670 × 3 to 5.5 µm with swellings, micronematous conidiophores 15 to 137 × 1.5 to 3.5 µm, terminal conidia 2 to 4 × 2 to 3 µm, and intercalary conidia 4 to 10 × 2.5 to 4 µm. Ramoconidia were rarely observed. Secondary ramoconidia were zero- to one-septate and measured 5.2 to 14.8 × 2.4 to 4 µm. On the basis of these characteristics, the isolates were identified as Cladosporium oxysporum (1). The internal transcribed spacer (ITS) region from isolate W10-02 was amplified using primers ITS1 and ITS4 and sequenced (GenBank Accession No. JQ775499). The 525-bp amplicons had 99% identity to C. oxysporum (GenBank Accession No. EF029816). On the basis of morphological characteristics and nucleotide homology, the isolate was identified as C. oxysporum. Koch's postulates were fulfilled in the laboratory on pepper leaves inoculated with C. oxysporum conidial suspensions (107 conidia ml-1). Eight inoculated 4-week-old seedlings were incubated under moist conditions for 8 to 10 days at 25°C. All leaf spots that developed on inoculated leaves were similar in appearance to those observed on diseased pepper in the field. C. oxysporum was reisolated from lesions and its identity was confirmed by morphological characteristics. C. oxysporum was first reported as a pathogen of pepper in the Sultanate of Oman (2). To our knowledge, this is the first report of C. oxysporum causing leaf spot on pepper in China. The outbreak and spread of this disease may decrease the yield of pepper in the northern regions of China. More studies are needed on the management strategy including the resistance of pepper cultivars against C. oxysporum. References: (1) K. Bensch et al. 2010. Stud. Mycol. 67:1, 2010. (2) A. M. Hammouda. Plant Dis. 76:536, 1992.