[Exploration of thrombus histological composition and clinical effect in mechanical thrombectomy of acute ischemic stroke]

Objective: To explore histological composition of thrombus and clinical effect in mechanical thrombectomy of acute ischemic stroke. Methods: From March 2017 to August 2017 at the Institutes of Biology and Medical Sciences of Soochow University, hematoxylin and eosin (HE) staining was used to quantitatively analyze the composition of thrombus in 58 cases with acute ischemic stroke. The differences in components of thrombus with different TOAST classifications were compared, meanwhile, clinical data such as surgical process and prognosis were also analyzed. Results: (1) Baseline data: the age of arteriosclerosis was significantly lower than that of cardiogenic (P<0.05). There was statistically significant differences in onset to admission between the two types of stroke of other undetermined etiology (SUE) and Cardioembolism (CE) (P<0.05). (2) Histological composition of thrombus: there were no significant differences in fibrin and red blood cells (RBC) between the two types of SUE and CE thrombus (P>0.05). There were more RBC in LAA thrombus and more fibrin in CE thrombus (P<0.05). (3) Intraoperative data: the time of admission to recanalization of type LAA was longer than that of type CE (P<0.05). (4) Prognosis: there was no significant difference in the good prognosis between the two types of SUE and CE (P>0.05). It is the same between the types of LAA and CE (P>0.05). Conclusions: LAA thrombus contains more RBC, and cardiogenic thrombus contains more fibrin. Cryptogenic thrombus has the same composition with cardioembolism. The results may help to choose appropriate recanalization technique in different TOAST stroke and have guiding significance for the secondary prevention of SUE stroke.

Multiple biomarkers and arrhythmia outcome following catheter ablation of atrial fibrillation: The Guangzhou Atrial Fibrillation Project

BACKGROUND

Biomarkers have been related to the arrhythmia recurrence following catheter ablation (CA) of atrial fibrillation (AF). We hypothesized that concurrent measurement of several biomarkers would additively improve their predictive value.

METHODS

One thousand four hundred and ten consecutive AF patients (68% male; 57.2 ± 11.6 years) undergoing CA were enrolled. Baseline characteristics, serum B type brain natriuretic peptide (BNP) and high sensitivity C reactive protein (hsCRP), estimated glomerular filtration rate (eGFR), ablation parameters, arrhythmia data at discharge, 1, 3, 6, and then every 6 months post CA were collected. Follow-up ended when arrhythmia recurred or until 31st December 2016.

RESULTS

Three hundred and sixty-five (25.9%) patients had arrhythmia recurrence post-CA during a mean follow-up of 20.7 ± 8.8 months. BNP, hsCRP, and eGFR levels and their cut-off values of 237.45 pg/mL, 1.6 mg/dL, and 82.5 mL/min/1.73 m2 were good predictors for AF recurrence (all P < 0.01). On multivariate analysis, increasing BNP and hsCRP, decreasing eGFR, gender, and early recurrence (ER) were independent predictors of AF recurrence (all P < 0.01). Compared to BNP alone, BNP plus eGFR or both eGFR and CRP showed incrementally better predictive values (ROC comparisons, all P < 0.01). Similar findings were evident in the subgroups of patients with paroxysmal or nonparoxysmal AF.

CONCLUSION

Measurement of BNP, CRP, and eGFR were incrementally additive to clinical risk factors in a cumulative manner to improve prediction of arrhythmia recurrence post-CA of AF. The implications of poor arrhythmia outcome in AF patients with multiple abnormal biomarkers pre-CA procedure may help with patient selection and inform the likelihood of success or the need of more complicated CA procedure(s).

Using the MB-LATER score for predicting arrhythmia outcome after catheter ablation for atrial fibrillation: The Guangzhou atrial fibrillation project

INTRODUCTION

Several clinical scoring systems have been derived to predict the arrhythmia outcome of catheter ablation (CA) for atrial fibrillation (AF) but which is better is not clear. Simple clinical risk scores (that any clinician can use in the everyday clinic) can help assess the likelihood of recurrence of AF following CA and the simple MB-LATER score has recently been described. We compare the predictive ability of seven existing clinical scoring systems (HATCH, CHADS₂ , CHA₂ DS₂ -VASc, BASE-AF₂ , APPLE, CAAP-AF, and MB-LATER) in a Chinese cohort of AF patients undergoing CA.

METHODS AND RESULTS

1410 patients (mean age 57.2 ± 11.6 years; 68% male) with AF undergoing CA during 2011-2015 were enrolled in final analysis. Symptoms, 12 lead ECG and Holter ECGs were recorded before discharge, and at 1, 3, 6 months, and every 6 months thereafter to detect the arrhythmia relapse. During a mean 20.7 ± 8.8-month follow-up, recurrence occurred in 365 patients(25.9%). All tested scores were predictors of AF recurrence with areas under the curve (AUCs) of 0.58, 0.57, 0.57, 0.75, 0.74, 0.71, and 0.73 respectively (all P < 0.01). Compared to all other scores, the MB-LATER score showed improved reclassification (NRI range 30%-82.6%, P < 0.01) and discrimination indexes (IDI range 2.6%-18.6%, all P < 0.01) in predicting AF recurrence.

CONCLUSION

Based on net reclassification and discrimination analysis, the MB-LATER score performed best for predicting AF recurrent postablation, in a large "all comers" Chinese cohort. This simple clinical risk score (that any clinician can use in the everyday clinic) can help assess the likelihood of recurrence of AF following catheter ablation.

[Research progress of amphiregulin and its role in airway inflammatory disease]

Amphiregulin is a member of epidermal growth factor family, and is also one of the ligand of epidermal growth factor receptor, it participates in many physiological and pathological process by combining with EGFR. Researches have proved that AREG participates in asthma and airway inflammatory diseases caused by smoking and PM 2.5, and AREG plays an important role in the process of airway remodeling and inflammation. This paper mainly reviews the expression and function of AREG, and focus on it's research status in airway inflammatory disease.

A U-shaped relationship of body mass index on atrial fibrillation recurrence post ablation: A report from the Guangzhou atrial fibrillation ablation registry

Background

Obesity or overweight is related to worse outcomes in patients with atrial fibrillation (AF) following catheter ablation (CA). The role of being underweight in relation to recurrent arrhythmias post AF ablation is less certain. We conducted a retrospective study to investigate the association of body mass index (BMI) with arrhythmia outcomes in AF patients undergoing CA.

Methods

In a cohort of 1410 AF patients (mean age 57.2 ± 11.6 years; 68% male) undergoing single CA, the association between BMI and AF ablation outcome was analyzed using BMI as a continuous variable and by four BMI categories (<18.5 kg/m², 18.5-24 kg/m², 25-29 kg/m², and ≥ 30 kg/m²).

Result

We observed a positive association between a cut off value of BMI and risk of AF recurrence post AF ablation. BMI ≥26.36 kg/m² was related to more AF recurrence (c-statistic 0.55, 95%CI 0.51–0.58; P < 0.01) with 50% increased risk of AF recurrence (HR 1.50, 95% CI 1.22–1.86; P < 0.01). Recurrence rates in the four BMI categories were 33.3%, 23.2%, 27.2 and 41.8%, respectively (P < 0.01).

Kaplan-Meier analysis showed that BMI categories of <18.5 kg/m² and ≥ 30 kg/m² were all associated with more AF recurrence (P = 0.01). Both underweight (HR 1.85, 95%CI 1.12–3.08; P = 0.02) and obesity (HR 1.78, 95%CI 1.17–2.72; P = 0.01) significantly increased the risk of AF recurrence in a Cox proportional hazard model.

Conclusion

BMI had good predictive value for AF ablation outcomes with a cut off value of ≥26.36 kg/m². Apart from being obese/overweight, being underweight might also be a risk factor for AF recurrence post ablation.

Case report of familial sudden cardiac death caused by a DSG2 p.F531C mutation as genetic background when carrying with heterozygous KCNE5 p.D92E/E93X mutation

Background

Sudden cardiac death (SCD) induced by malignant ventricular tachycardia (MVT) among young adults with right ventricular cardiomyopathy/dysplasia (ARVC/D) is a devastating event. Parts of ARVC/D patients have a mutation in genes encoding components of cardiac desmosomes, such as desmoglein-2 (DSG2), plakophilin-2 and desmoplakin.

Case presentation

Here we report a potentially pathogenic mutation in the DSG2 gene, which was identified in a family with ARVC/D using Whole Exome Sequencing (WES) and Sanger Sequencing. In all, Patient III:1 with ARVC/D carried the compound heterozygous mutations of DSG2 p.F531C and KCNE5 p.D92E/E93X, which were both inherited from her mother (II:2), who died of SCD. Carriers of DSG2p.F531C showed various phenotypes, such as ARVC/D, SCD, MVT and dilated cardiomyopathy. For III:1, there were significant low-voltage regions in the inferior-apical, inferior-lateral wall of the right ventricular epicardium and outflow tracts of the right ventricle. Under the guidance of a three-dimensional mapping system, MVT was successfully ablated with an epicardial–endocardial approach targeting for late, double or fragmental potentials after implantable cardioverter-defibrillator (ICD) electrical storms. No VT recurrence was observed during the one year of follow-up.

Conclusions

When coexisting with heterozygous KCNE5 p.D92E/E93X, heterozygous DSG2 p.F531C as a genetic background was found to predispose to ARVC/D, SCD and MVT, which were successfully ablated using an epicardial–endocardial approach.

Electronic supplementary material

The online version of this article (10.1186/s12881-018-0580-2) contains supplementary material, which is available to authorized users.

The clinical effects of gonadotropin-releasing hormone agonists for the treatment of children patients with central precocious puberty

OBJECTIVE

We explored the clinical effect of gonadotropin-releasing hormone agonists for the treatment of children patients with central precocious puberty.

PATIENTS AND METHODS

From March 2012 to October 2015, 100 cases of children patients with central precocious puberty were enrolled in this study. Intramuscular injection of acetic acid triptorelin (50 to 100 pLg/kg) was made once every 4 weeks, and the treatment lasted for 4 months. Patients' bone age/height differentials (DBA/DCA), bone age (BA), growth velocity (GV) and predicted adult height (PAH) were determined before and after treatment (after 6, 12, 24, 36 months). Differences before and after treatment were analyzed. DBA/DCA, BA and PAH values 6, 12, 24, 36 months after treatment were significantly different compared with those before treatment.

RESULTS

Sexual development symptoms in children patients were significantly improved 4 months after treatment (p<0.05). All patients completed the treatment, without any adverse drug reaction or severe complication. After one course of treatment (4 months), patients' uterus and ovarian volumes shrank, FSH level peaked, and LH level was reduced, compared to those before treatment.

CONCLUSIONS

Acetate acid triptorelin is safe and reliable for treating central precocious puberty. We achieved the excellent clinical curative effect and were able to delay the growth rate in children patients. The predicted height and final height were improved.

The effect of enriched environment across ages: A study of anhedonia and BDNF gene induction

Enriched environment treatment (EET) is a potential intervention for depression by inducing brain-derived neurotrophic factor (BDNF). However, its age dependency remains unclear. We recently found that EET during early-life development (ED) was effective in increasing exploratory activity and anti-despair behavior, particularly in promoter IV-driven BDNF deficient mice (KIV), with the largest BDNF protein induction in the hippocampus and frontal cortex. Here, we further determined age dependency of EET effects on anhedonia and promoter-specific BDNF transcription, by using the sucrose preference test and qRT-PCR. Wild-type (WT) and KIV mice received 2 months of EET during ED, young-adulthood and old-adulthood (0-2, 2-4 and 12-14 months, respectively). All KIV groups showed reduced sucrose preference, which EET equally reversed regardless of age. EET increased hippocampal BDNF mRNA levels for all ages and genotypes, but increased frontal cortex BDNF mRNA levels only in ED KIV and old WT mice. Transcription by promoters I and IV was age-dependent in the hippocampus of WT mice: more effective induction of exon IV or I during ED or old-adulthood, respectively. Transcription by almost all 9 promoters was age-specific in the frontal cortex, mostly observed in ED KIV mice. After discontinuance of EET, the EET effects on anti-anhedonia and BDNF transcription in both regions persisted only in ED KIV mice. These results suggested that EET was equally effective in reversing anhedonia and inducing hippocampal BDNF transcription, but was more effective during ED in inducing frontal cortex BDNF transcription and for lasting anti-anhedonic and BDNF effects particularly in promoter IV-BDNF deficiency.

[Association of α-actinin-3 gene polymorphism and muscle strength of postmenopausal women]

Objective: To explore the association between α-actinin-3 (ACTN3) polymorphism and muscle strength in postmenopausal women. Methods: Five hundred and ninety-eight postmenopausal women with an average of (62.9±7.0) years old in Dongcheng District of Beijing were included. The ACTN3 polymorphism including rs540874, rs618838 and rs2229456 were genotyped by Sequenom Mass Array to explore their associations with muscle strength. One hundred and sixty-three of them were trained with regular Tai chi movement while 271 were administered with elemental calcium 600 mg/d combined with Vitamin D 800 U/d or calcitriol 0.25 μg/d for 2 years. Association between changes of muscle strength and ACTN3 polymorphism were analyzed. Results: The rs540874 genotypes were found to be significantly associated with chair stand test[GG (9.02±3.85) s vs GA (9.27±4.14) s vs AA (9.68±5.00) s, P=0.015]. Right grip strength in women with G allele were likely to be higher compared with A allele, but it was not statistically significant (P=0.056). Multiple linear regression showed that the chair stand test of AA genotype was statistically longer than that of GG and GA genotype (β=2.639, 95% CI: 1.632-4.646, P=0.010). The associations between rs618838, rs2229456 genotypes and muscle strength of both lower and upper limbs were not significant (all P>0.05). In addition, muscle strength of lower limbs of patients with rs540874 genotyped with G allele, rs618838 genotyped with C allele and rs2229456 genotyped with A allele increased significantly after enhanced exercise and vitamin D supplementation (all P<0.05). Conclusions: The rs540874 polymorphism of ACTN3 gene was associated with the muscle function of lower limb in postmenopausal women. The improvement of muscle strength after intervention were possibly correlated with rs540874, rs618838 and rs2229456 polymorphisms.

Non-Dirac Chern insulators with large band gaps and spin-polarized edge states

Based on first-principles calculations and k·p models, we demonstrate that PbC/MnSe heterostructures are a non-Dirac type of Chern insulator with very large band gaps (244 meV) and exotically half-metallic edge states, providing the possibilities of realizing very robust, completely spin polarized, and dissipationless spintronic devices from the heterostructures. The achieved extraordinarily large nontrivial band gap can be ascribed to the contribution of the non-Dirac type electrons (composed of px and py) and the very strong atomic spin-orbit coupling (SOC) interaction of the heavy Pb element in the system. Surprisingly, the band structures are found to be sensitive to the different exchange and correlation functionals adopted in the first-principles calculations. Chern insulators with various mechanisms are acquired from them. These discoveries show that the predicted nontrivial topology in PbC/MnSe heterostructures is robust and can be observed in experiments at high temperatures. The system has great potential to have attractive applications in future spintronics.

Comparative Analysis of Diffusional Kurtosis Imaging, Diffusion Tensor Imaging, and Diffusion-Weighted Imaging in Grading and Assessing Cellular Proliferation of Meningiomas

BACKGROUND AND PURPOSE

An accurate evaluation of the World Health Organization grade and cellular proliferation is particularly important in meningiomas. Our aim was to prospectively evaluate and compare diffusional kurtosis imaging, DTI, and DWI metrics in determining the grade and cellular proliferation of meningiomas.

MATERIALS AND METHODS

Ninety-six consecutive patients with histopathologically confirmed meningiomas were included in this study. Mean kurtosis, radial kurtosis, axial kurtosis, fractional anisotropy, mean diffusivity, and ADC were semiautomatically obtained in the solid components of tumors. Each normalized diffusion value was compared between high-grade meningiomas and low-grade meningiomas using the Mann-Whitney U test. Receiver operating characteristic, multiple logistic regression, and Pearson correlation analysis were used for statistical evaluations.

RESULTS

Diffusional kurtosis imaging metrics (mean kurtosis, radial kurtosis, and axial kurtosis) were significantly higher in high-grade meningiomas than in low-grade meningiomas (P ≤ .001). Mean diffusivity and ADC were significantly lower in high-grade meningiomas than in low-grade meningiomas (P = .003 and .002). Mean kurtosis had significantly greater area the under curve values than mean diffusivity and fractional anisotropy in differentiating high-grade meningiomas from low-grade meningiomas (P = .038 and .002). Mean kurtosis was the only variable that could be used to independently differentiate high-grade meningiomas and low-grade meningiomas (P < .001). Significant correlations were found between the Ki-67 labeling index and kurtosis metrics (P < .001), as well as for mean diffusivity and ADC (P = .004, and .007).

CONCLUSIONS

Compared with other diffusion metrics, mean kurtosis may serve as an optimal parameter for evaluating and predicting the meningioma grade. Moreover, diffusion metrics may potentially reflect cellular proliferation.

Comparative cytotoxicity and apoptotic pathways induced by nanosilver in human liver HepG2 and L02 cells

Silver nanoparticles are used in many commercial products in daily life. Exposure to nanosilver has hepatotoxic effects in animals. This study investigated the cytotoxicity associated with polyvinylpyrrolidone-coated nanosilver (23.44 ± 4.92 nm in diameter) exposure in the human hepatoma cell line (HepG2) and normal hepatic cell line (L02), and the molecular mechanisms induced by nanosilver in HepG2 cells. Nanosilver, in doses of 20-160 μg mL^-1 for 24 and 48 h, reduced cell viability in a dose- and time-dependent manner and induced cell membrane leakage and mitochondria injury in both cell lines; these effects were more pronounced in HepG2 cells than in L02 cells. Intracellular oxidative stress was documented by reactive oxygen species (ROS) being generated in HepG2 cells but not in L02 cells, an effect possibly due to differential uptake of nanosilver by cancer cells and normal cells. In HepG2 cells, apoptosis was documented by finding that ROS triggered a decrease in mitochondrial membrane potential, an increase in cytochrome c release, activation of caspase 3 and caspase 9, and a decrease in the ratio of Bcl-2/Bax. Furthermore, nanosilver activated the Fas death receptor pathway by downregulation of nuclear factor-κB and activation of caspase 8 and caspase 3. These results suggest that apoptosis induced by nanosilver in HepG2 cells is mediated via a mitochondria-dependent pathway and the Fas death receptor pathway. These findings provide toxicological and mechanistic information that can help in assessing the effects of nanosilver in biological systems, including the potential for anticancer activities.

Human dental pulp stromal cell conditioned medium alters endothelial cell behavior

Background

Angiogenesis is of utmost importance for tissue regeneration and repair. Human dental pulp stromal cells (hDPSCs) possess angiogenic potential, as they secrete paracrine factors that may alter the host microenvironment. However, more insight into how hDPSCs guide endothelial cells (ECs) in a paracrine fashion is yet to be obtained. Therefore, the current study aimed to investigate the effect(s) of conditioned medium derived from hDPSCs (hDPSC-CM) on EC behavior in vitro.

Methods

hDPSCs were harvested from third molars scheduled for surgical removal under informed consent. The angiogenic profile of hDPSC-CM was identified using human angiogenesis antibody array and enzyme-linked immunosorbent assay (ELISA). Using real-time reverse transcription-polymerase chain reaction (RT-PCR) and ELISA, the mRNA and protein expression level of specific angiogenic biomarkers was determined in human umbilical vein endothelial cells (HUVECs) exposed to hDPSC-CM. The effect of hDPSC-CM on HUVEC attachment, proliferation and migration was evaluated by crystal violet staining, MTT, transwell migration along with real-time cell monitoring assays (xCELLigence; ACEA Biosciences, Inc.). A Matrigel assay was included to examine the influence of hDPSC-CM on HUVEC network formation. Endothelial growth medium (EGM-2) and EGM-2 supplemented with hDPSC-CM served as experimental groups, whereas endothelial basal medium (EBM-2) was set as negative control.

Results

A wide range of proangiogenic and antiangiogenic factors, including vascular endothelial growth factor, tissue inhibitor of metalloproteinase protein 1, plasminogen activator inhibitor (serpin E1), urokinase plasminogen activator and stromal cell-derived factor 1, was abundantly detected in hDPSC-CM by protein profiling array and ELISA. hDPSC-CM significantly accelerated the adhesion phases, from sedimentation to attachment and spreading, the proliferation rate and migration of HUVECs as shown in both endpoint assays and real-time cell analysis recordings. Furthermore, Matrigel assay demonstrated that hDPSC-CM stimulated tubulogenesis, affecting angiogenic parameters such as the number of nodes, meshes and total tube length.

Conclusions

The sustained proangiogenic and promaturation effects of hDPSC-CM shown in this in vitro study strongly suggest that the trophic factors released by hDPSCs are able to trigger pronounced angiogenic responses, even beyond EGM-2 considered as an optimal culture condition for ECs.

Relationship between spicy flavor, spicy food intake frequency, and general obesity in a rural adult Chinese population: The RuralDiab study

BACKGROUND AND AIMS

The purpose of this study was to explore the association between spicy flavor, spicy food frequency, and general obesity in Chinese rural adults.

METHODS AND RESULTS

A total of 15,683 subjects (5907 males, 9776 females) aged 35-74 years from the RuralDiab Study were recruited for this cross-sectional study. Analysis of covariance was used to determine the differences of participant characteristics across body mass index (BMI) categories. Logistic regression yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for obesity associated with the level of spicy flavor and frequency of spicy food intake. A meta-analysis was conducted to validate the result of the cross-sectional study. The crude and standardized prevalence of obesity were 16.78% and 17.57%, respectively. Compared with No spicy flavor, the adjusted ORs (95% CIs) of Mild, Middle, and Heavy spicy flavor for obesity were 1.232 (1.117-1.359), 1.463 (1.290-1.659), and 1.591 (1.293-1.958), respectively (P_trend < 0.001). Similarly, compared with no spicy food consumption, the adjusted ORs (95% CIs) of 1 or 2 days/week, 3-5 days/week, and 6 or 7 days/week were 1.097 (0.735-1.639), 1.294 (0.932-1.796), and 1.250 (1.025-1.525), respectively (P_trend = 0.026). The point estimate and 95% CI of mean BMI difference between the spicy food consuming group and spicy food non-consuming group was 0.37 (95% CI: 0.30-0.44) in the meta-analysis.

CONCLUSION

The data indicated that spicy flavor and spicy food frequency were positively associated with general obesity in Chinese rural populations.