Observation of clinical efficacy of rt-PA intravenous thrombolytic treatment for patients combined with grade 0-1 diabetic foot by Wagner classification and acute ischemic stroke

OBJECTIVE

To evaluate the safety and efficacy of rt-PA intravenous thrombolytic treatment for patients with diabetic foot (DF) and acute ischemic stroke.

PATIENTS AND METHODS

A retrospective analysis was performed on 76 patients admitted between June 2012 to December 2015 presenting with acute ischemic stroke and Grade 0-1 DF a (Wagner classification). The treatment group consisted of 44 patients who received rt-PA intravenous thrombolytic treatment, while 32 cases in the control group did not. Both groups received monitored dietary therapy and hypoglycemic drugs to control their blood glucose levels. In the treatment group, patients received rt-PA intravenous thrombolytic treatment 4.5h after the onset of ischemic stroke. Physical parameters like color change of sick-foot skin, conditions of ulcer concrescence, changes of skin temperature, and promotion of pain scores were observed in both the groups.

RESULTS

The improvement in the rt-PA intravenous thrombolytic treatment group was higher than that in general treatment group, and the difference between them had statistical significance (p<0.01). Though the improvement of foot symptoms of patients who received rt-PA intravenous thrombolytic was better than that of the control group; there was no obvious statistical difference in the incidence of adverse events between the treatment group and the control group.

CONCLUSIONS

rt-PA can reduce the level serum fibrinogen, promotes local microcirculation and nutrition metabolism of diabetic foot, and improve the clinical prognosis of patients with diabetic foot, but will not increase the incidence of adverse events at the same time.

Phosphorylation of NFAT3 by CDK3 induces cell transformation and promotes tumor growth in skin cancer

The nuclear factor of activated T cells (NFAT) family proteins are transcription factors that regulate the expression of pro-inflammatory cytokines and other genes during the immune response. Although the NFAT proteins have been extensively investigated in the immune system, their role in cancer progression remains controversial. Here, we report that NFAT3 is highly expressed in various skin cancer cell lines and tumor tissues. Knockdown of endogenous NFAT3 expression by short hairpin RNA (shRNA) significantly inhibited tumor cell proliferation, colony formation and anchorage-independent cell growth. Furthermore, results of the mammalian two-hybrid assay showed that cyclin-dependent kinase 3 (CDK3) directly interacted with NFAT3 and phosphorylated NFAT3 at serine 259 (Ser259), which enhanced the transactivation and transcriptional activity of NFAT3. The phosphorylation site of NFAT3 was critical for epidermal growth factor (EGF)-stimulated cell transformation of the HaCaT immortalized skin cell line and mutation of NFAT3 at Ser259 led to a reduction of colony formation in soft agar. We also found that overexpressing wildtype NFAT3, but not mutant NFAT3-S259A, promoted A431 xenograft tumor growth. Importantly, we showed that CDK3, NFAT3 and phosphorylated NFAT3-Ser259 were highly expressed in skin cancer compared with normal skin tissues. These results provided evidence supporting the oncogenic potential of NFAT3 and suggested that CDK3-mediated phosphorylation of NFAT3 has an important role in skin tumorigenesis.

[Current smoking status and awareness of tobacco hazard in adults in Beijing, 2014]

Objective: To understand the status of current smoking and awareness of hazard in adults in Beijing, 2014. Methods: A total of 19 815 subjects were randomly selected with stratified multi-stage cluster sampling from 180 communities of 36 townships of 16 districts in Beijing. Each subject received a standardized questionnaire interview. Results: The current smoking rate of the adults was 26.6% (5 253/19 738), which was higher in men (52.2%) than in women (3.6%) and higher in suburb area (28.9%) than in urban area (25.0%). The adults aged 50-59 had higher rate of current smoking. The daily smoking rate was 23.7% (4 677/19 738). The average age when smoking started was 19.2 years. On average, one smoker consumed 15.2 cigarettes per day. The average score for smoking hazard awareness was 5.8, which was higher in smokers than in non-smokers (5.5 vs. 6.0) (t=-9.854, P=0.000). In the smokers, 5.7% (298/5 213) intended to give up smoking within one month. Doctors gave advice to stop smoking for 66.0% of current smokers. The current smoking rate of patients with chronic disease was 31.8% (3 703/11 628), and 5.5% (202/3 686) of them intended to stop smoking within one month. Conclusions: The smoking rate was still high in men in Beijing. The age of starting smoking every day decreased among younger people. The levels of awareness of tobacco hazard and passive smoking were still low. The willingness of smoking cessation was low. The rate of doctor giving smoking cessation advice was low.

Focused screening of mitochondrial metabolism reveals a crucial role for a tumor suppressor Hbp1 in ovarian reserve

Granulosa cells (GCs) are tightly associated with fertility and the fate of ovarian follicles. Mitochondria are the central executers of apoptosis. However, the genetic basis underlying mitochondrial modulation in GCs during the ovarian development is poorly understood. Here, CRISPR/Cas9-mediated genetic screening was used to identify genes conferring mitochondrial metabolism in human GCs. The results uncovered roles for several tumor suppressors, including HBP1, in the augmentation of mitochondrial function. Focused analysis revealed that high-mobility group (HMG)-box transcription factor 1 (Hbp1) levels regulate mitochondrial biogenesis, which is associated with global changes in transcription including Tfam. The systemic or granulosa-specific but not oocyte-specific ablation of Hbp1 promoted follicle growth and oocyte production, and is associated with the reduced apoptotic signals in mouse GCs. Consistent with increased mitochondrial function and attenuated GC apoptosis, the regulation of Hbp1 conferred substantial protection of ovarian reserve. Thus, the results of the present study provide a critical target to understand the control of the reproductive lifespan.

[Influences of genetic and environmental factors on smoking related behaviors among male twin adults in China]

OBJECTIVE

To analyze the influences of genetic and environmental factors on smoking behavior, smoking cessation and onset age of smoking less than 20 years in male twin adults.

METHODS

A face-to-face questionnaire was conducted to collect data from 6 458 pair male twins aged ≥25 years registered in 9 provinces(municipality)in China. The heritability of three smoking related behaviors were calculated by using structural equation models.

RESULTS

The ACE models were the best models of the three dimensions of smoking, i.e. smoking behavior, smoking cessation and onset age of smoking less than 20 years for male twins, and the corresponding heritability of these behaviors were 0.26(0.19-0.34), 0.27(0.19-0.37)and 0.05(0.00-0.14), respectively. When adjusted for area and age, the heritability of these three behaviors were 0.26(0.19-0.34), 0.31(0.00-0.74)and 0.05(0.00-0.14), respectively.

CONCLUSIONS

All the three smoking related behaviors were affected by genetic factors, but environment factors had more effect on them. For smoking cessation, the heritability was highest, but the influence of environmental factors was lowest. Meanwhile, for onset age of smoking, the influence of environmental factors was highest.

Synthetic Capillaries to Control Microscopic Blood Flow

Capillaries pervade human physiology. The mean intercapillary distance is only about 100 μm in human tissue, which indicates the extent of nutrient diffusion. In engineered tissue the lack of capillaries, along with the associated perfusion, is problematic because it leads to hypoxic stress and necrosis. However, a capillary is not easy to engineer due to its complex cytoarchitecture. Here, it is shown that it is possible to create in vitro, in about 30 min, a tubular microenvironment with an elastic modulus and porosity consistent with human tissue that functionally mimicks a bona fide capillary using "live cell lithography"(LCL) to control the type and position of cells on a composite hydrogel scaffold. Furthermore, it is established that these constructs support the forces associated with blood flow, and produce nutrient gradients similar to those measured in vivo. With LCL, capillaries can be constructed with single cell precision-no other method for tissue engineering offers such precision. Since the time required for assembly scales with the number of cells, this method is likely to be adapted first to create minimal functional units of human tissue that constitute organs, consisting of a heterogeneous population of 100-1000 cells, organized hierarchically to express a predictable function.

Chinese military medical teams in the Ebola outbreak of Sierra Leone

The 2014-2015 Ebola virus disease (EVD) epidemic in West Africa was the largest in history. The three most affected countries, Guinea, Liberia and Sierra Leone, have faced enormous challenges in controlling transmission and providing clinical care for patients with EVD. The Chinese government, in response to the requests of the WHO and the governments of the affected countries, responded rapidly by deploying Chinese military medical teams (CMMTs) to the areas struck by the deadly epidemic. A total of three CMMTs, comprising 115 military medical professionals, were rotationally deployed to Freetown, Sierra Leone to assist with infection prevention and control, clinical care and health promotion and training. Between 1 October 2014 and 22 March 2015, the CMMTs in Sierra Leone admitted and treated a total of 773 suspected and 285 confirmed EVD cases. Among the 285 confirmed cases, 146 (51.2%) patients survived after treatment. In addition, the CMMTs maintained the record of zero infections among healthcare workers and zero cross-infections between quarantined patients. In this manuscript, we aim to give an overview of the mission, and share our best practices experience on predeployment preparedness, EVD holding and treatment centre building and EVD case management.

Fyn is a redox sensor involved in solar ultraviolet light-induced signal transduction in skin carcinogenesis

Solar ultraviolet (UV) light is a major etiological factor in skin carcinogenesis, with solar UV-stimulated signal transduction inducing pathological changes and skin damage. The primary sensor of solar UV-induced cellular signaling has not been identified. We use an experimental system of solar simulated light (SSL) to mimic solar UV and we demonstrate that Fyn is a primary redox sensor involved in SSL-induced signal transduction. Reactive oxygen species (ROS) generated by SSL exposure directly oxidize Cys488 of Fyn, resulting in increased Fyn kinase activity. Fyn oxidation was increased in mouse skin after SSL exposure, and Fyn knockout (Fyn^−/−) mice formed larger and more tumors compared to Fyn wildtype mice when exposed to SSL for an extended period of time. Murine embryonic fibroblasts (MEFs) lacking Fyn as well as cells in which Fyn expression was knocked down were resistant to SSL-induced apoptosis. Furthermore, cells expressing mutant Fyn (C448A) were resistant to SSL-induced apoptosis. These findings suggest that Fyn acts as a regulatory nexus between solar UV, ROS and signal transduction during skin carcinogenesis.

HOI-02 induces apoptosis and G2-M arrest in esophageal cancer mediated by ROS

Reactive oxygen species (ROS) are chemically reactive molecules that perform essential functions in living organisms. Accumulating evidence suggests that many types of cancer cells exhibit elevated levels of ROS. Conversely, generation of ROS has become an effective method to kill cancer cells. (E)-3-hydroxy-3-(4-(4-nitrophenyl)-2-oxobut-3-en-1-yl) indolin-2-one, which is an NO2 group-containing compound designated herein as HOI-02, generated ROS and, in a dose-dependent manner, decreased esophageal cancer cell viability and inhibited anchorage-independent growth, followed by apoptosis and G2-M arrest. Moreover, results of an in vivo study using a patient-derived xenograft mouse model showed that HOI-02 treatment suppressed the growth of esophageal tumors, without affecting the body weight of mice. The expression of Ki-67 was significantly decreased with HOI-02 treatment. In addition, the phosphorylation of c-Jun, and expression of p21, cleaved caspase 3, and DCFH-DA were increased in the HOI-02-treated group compared with the untreated control group. In contrast, treatment of cells with (E)-3-(4-(4-aminophenyl)-2-oxobut-3-en-1-yl)-3-hydroxyindolin-2-one, which is an NH2 group-containing compound designated herein as HOI-11, had no effect. Overall, we identified HOI-02 as an effective NO2 group-containing compound that was an effective therapeutic or preventive agent against esophageal cancer cell growth.

Optimal blood pressure levels in patients undergoing intravenous thrombolysis for AIS

AIM

We wished to define the most optimal blood pressure ranges in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis treatment.

METHODS

The study comprised 626 patients with AIS who underwent the treatment with recombinant tissue plasminogen activator. The patients were randomly assigned to receive either conservative blood pressure lowering regimen (N.=302, target systolic blood pressure of 151-185 mmHg) or intensive blood pressure lowering regimen (N.=324, target systolic blood pressure of 141-150 mm Hg). The outcomes were occurrence of intracranial hemorrhages and survival after 3 months post-treatment.

RESULTS

Patients who received intensive blood pressure lowering regimen showed significantly lower rates of intracranial hemorrhage and mortality. Also, these patients demonstrated a trend to better overall condition.

CONCLUSION

Intensive blood pressure lowering regimen warrants a safe and effective intravenous thrombolysis in patients with AIS, and the targeted systolic blood pressure levels should be within 141-150 mmHg.

Neonatal Overfeeding in Female Mice Predisposes the Development of Obesity in their Male Offspring via Altered Central Leptin Signalling

The prevalence of obesity among child-bearing women has increased significantly. The adverse consequences of maternal obesity on the descendants have been well accepted, although few studies have examined the underlying mechanisms. We investigated whether neonatal overfeeding in female mice alters metabolic phenotypes in the offspring and whether hypothalamic leptin signalling is involved. Neonatal overfeeding was induced by reducing the litter size to three pups per litter, in contrast to normal litter size of 10 pups per litter. Normal and neonatally overfed female mice were bred with normal male mice, and offspring of overfeeding mothers (OOM) and control mothers (OCM) were generated. We examined body weight, daily food intake, leptin responsiveness and the number of positive neurones for phosphorylated-signal transducer and activator of transcription 3 (pSTAT3) along with neuropeptide Y (NPY) in the arcuate nucleus of the hypothalamus (ARH) and NPY in the nucleus tractus solitarius (NTS) of the brain stem. The body weight and daily food intake of OOM were significantly higher than those of OCM. Leptin significantly reduced food intake and increased the number of pSTAT3 positive neurones in the ARH of OCM mice, whereas no significant changes in food intake and pSTAT3 neurones were found in leptin-treated OOM mice. The number of NPY neurones in the ARH and NTS of the OOM mice was significantly higher than that of OCM mice. The results of the present study indicate that the obese phenotype from mothers can be passed onto the subsequent generation, which is possibly associated with hypothalamic leptin resistance.

Small-molecule inhibitors targeting the DNA-binding domain of STAT3 suppress tumor growth, metastasis and STAT3 target gene expression in vivo

Signal transducer and activator of transcription 3 (STAT3) is constitutively activated in malignant tumors and has important roles in multiple aspects of cancer aggressiveness. Thus targeting STAT3 promises to be an attractive strategy for treatment of advanced metastatic tumors. Although many STAT3 inhibitors targeting the SH2 domain have been reported, few have moved into clinical trials. Targeting the DNA-binding domain (DBD) of STAT3, however, has been avoided due to its 'undruggable' nature and potentially limited selectivity. In a previous study, we reported an improved in silico approach targeting the DBD of STAT3 that resulted in a small-molecule STAT3 inhibitor (inS3-54). Further studies, however, showed that inS3-54 has off-target effect although it is selective to STAT3 over STAT1. In this study, we describe an extensive structure and activity-guided hit optimization and mechanistic characterization effort, which led to identification of an improved lead compound (inS3-54A18) with increased specificity and pharmacological properties. InS3-54A18 not only binds directly to the DBD and inhibits the DNA-binding activity of STAT3 both in vitro and in situ but also effectively inhibits the constitutive and interleukin-6-stimulated expression of STAT3 downstream target genes. InS3-54A18 is completely soluble in an oral formulation and effectively inhibits lung xenograft tumor growth and metastasis with little adverse effect on animals. Thus inS3-54A18 may serve as a potential candidate for further development as anticancer therapeutics targeting the DBD of human STAT3 and DBD of transcription factors may not be 'undruggable' as previously thought.

Safety and effectiveness of intravenous thrombolysis with recombinant tissue plasminogen activator in eighty years and older acute ischemic stroke patients

OBJECTIVE

To explore the safety and efficacy of intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) in elderly (≥ 80 years old) acute ischemic stroke (AIS) patients.

PATIENTS AND METHODS

The clinical data of patients who were treated in Tianjin Huanhu Hospital from June 2012 to November 2013 were retrospectively analyzed; amongst them 404 patients had received IVT with rt-PA and 200 patients had not received IVT. Among ≥ 80 years' old patients, 204 had received IVT and 200 had not. And, the 404 patients who had received IVT, they were divided into two subgroups: elderly (≥ 80 years of age; n = 204) and controls (< 80 years old; n = 200). The incidence of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), case-fatality rate, and other prognostic indicators were compared.

RESULTS

Among all ≥ 80 years' old patients, the IVT subgroup had significantly superior good outcome rates than the non-IVT subgroup at 24-h and 3-month, along with significantly lower case-fatality rate. But for the patients those who had received IVT, the incidence of ICH and the 7-day case-fatality rate were not significantly increased in both the elderly and control subgroups. The 24-h and 3-month good outcome rates were not significantly different between these two subgroups as well.

CONCLUSIONS

IVT with rt-PA is a safe and effective treatment for ≥ 80 year's old AIS patients.

FBXO32, a new TGF-β/Smad signaling pathway target gene, is epigenetically inactivated in gastric cardia adenocarcinoma

FBXO32 has recently been identified as a TGF-β/Smad signaling pathway target gene, involved in regulating cell survival and may be transcriptionally silenced by epigenetic mechanisms in some kind of carcinomas. The present study was to investigate the role and promoter methylation status of FBXO32 in gastric cardia adenocarcinoma (GCA), and determine the prognostic significance of FBXO32 in GCA. Bisulfite Conversion-Specific and Methylation-Specific PCR, real-time RT-PCR and immunohistochemical staining methods were used to detect the methylation status and expression of FBXO32 in GCA samples. The frequency of FBXO32 methylation in GCA tumor tissues (44.6%) was significantly higher than that in corresponding normal tissues (3.6%) and was associated with TNM stage, pathological differentiation, distant metastasis or recurrence and upper gastrointestinal cancers (UGIC) family history. Decreased mRNA and protein expression of FBXO32 was observed in GCA tumor tissues and was associated with FBXO32 promoter methylation status. A positive correlation between FBXO32 and p-Smad2/3, Smad4 protein expression was also found in clinical specimens. GCA patients in stage III and IV, with positive UGIC family history, and hypermethylation and down-expression of FBXO32 were most likely to develop metastatic disease and also showed the worse survival. In all, aberrant hypermethylation of FBXO32 may be one of the mechanisms that lead to loss or down expression of the gene in GCA, FBXO32 may be a functional tumor suppressor and reactivation of FBXO32 gene may has therapeutic potential and may be used as a prognostic marker for GCA patients.

Analysis on the correlation factors for hemorrhagic transformation after intravenous thrombolytic therapy

OBJECTIVE

To examine the correlation factors for hemorrhagic transformation after intravenous thrombolytic therapy, so as to improve the forecast about hemorrhagic transformation in the process of thrombolysis, and provide theoretical basis for prognosis of the patients.

PATIENTS AND METHODS

A total of 1223 patients with intravenous thrombolytic therapy including NIHSS score before intravenous thrombolytic therapy and MRS score by follow-up of three months after intravenous thrombolytic therapy were enrolled in this study, and related clinical data were collected. t test, χ2 test and logistic regression analysis were used to find the correlation factors for hemorrhagic transformation.

RESULTS

Single-factor analysis found hypertension, diabetes mellitus, history of stroke and collateral circulation insufficiency had statistical significances between each type of hemorrhage group groups. Amongst of the history of hypertension, diabetes and stroke was correlation factor for prognosis.

CONCLUSIONS

Intravenous thrombolysis hemorrhagic transformation associated with these factors including the vessel wall, blood composition and biochemical markers.

Study on the effect of urinary kallidinogenase after thrombolytic treatment for acute cerebral infarction

OBJECTIVE

To evaluate the safety and efficacy of urinary kallidinogenase for recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolytic treatment in patients with acute cerebral infarction.

PATIENTS AND METHODS

All 200 patients with acute cerebral infarction were randomized 1:1 into an experimental group (100 cases) and a control group (100 cases). Patients in the control group were administrated rt-PA (0/9 mg/kg) while patients in the experimental group were given urinary kallidinogenase by intravenous drip (0.15 PNAU/d, for 7 days) after rt-PA intravenous thrombolytic treatment (0.9 mg/kg). The main evaluation index was NIHSS and BI.

RESULTS

Compared to the control group, the NIHSS scores were significantly lower 7 and 90 days after thrombolytic therapy (t = 2.391, 2.714; p < 0.05). BI scores were obviously higher at 90 days after thrombolytic therapy in the experimental group (t = 2.675, p < 0.05).

CONCLUSIONS

Urinary kallidinogenase may improve the treatment effect for rt-PA intravenous thrombolytic treatment in patients with acute cerebral infraction.