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Biard K, De Koninck J, Douglass AB. Creation of a shortened version of the Sleep Disorders Questionnaire (SDQ). PLoS One 2024; 19:e0288216. [PMID: 38319900 PMCID: PMC10846718 DOI: 10.1371/journal.pone.0288216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
The 176-item Sleep Disorders Questionnaire (SDQ) was initially developed using canonical discriminant function analysis on 4 groups of sleep disorder patients, but it was never studied by factor analysis in its entirety. Several authors have criticized 2 of its subscales as being confounded with each other, and its narcolepsy scale as substantially over-diagnosing narcolepsy. This study describes its first exploratory factor analysis (EFA), the intent of which was to reassess item membership on the 4 existing subscales and to derive new scales to improve differential diagnosis between patient groups. It was also hoped that EFA could reduce the total number of questions, to increase speed of completion. The EFA was performed on the anonymized SDQ results from a retrospective review of the charts of 2131 persons from 7 sleep disorders clinics and research centers. Factors were assessed via scree plots and eigenvalues. The EFA identified four main factors: insomnia, daytime sleepiness, substance use, and sleep-disordered breathing. The insomnia factor had 3 subfactors: psychological symptoms of insomnia, subjective description of insomnia, and insomnia due to periodic limb movements. The sleepiness factor had two subfactors: daytime sleepiness and neurological symptoms of narcolepsy. The novel substance use factor was homogeneous, as was the sleep-disordered breathing factor. Importantly, the EFA reassigned items from the original SDQ's NAR, PSY, and PLM subscales to five of the new subscales. The Sleep Apnea (SA) subscale emerged mostly unchanged. The 7 resulting factors comprised only 66 items of the original 176-item SDQ. These results have allowed the creation of a new shorter questionnaire, to be called the SDQ-2. External validation of the SDQ-2 is currently underway. It will likely prove to be a superior differential diagnostic instrument for sleep disorders clinics, compared to the original SDQ.
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Affiliation(s)
- Kathleen Biard
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph De Koninck
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Institute of Mental Health Research at the Royal Ottawa Mental Health Center, Ottawa, Ontario, Canada
| | - Alan B. Douglass
- University of Ottawa Institute of Mental Health Research at the Royal Ottawa Mental Health Center, Ottawa, Ontario, Canada
- Psychiatry Department, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Van Dusen RA, Abernethy K, Chaudhary N, Paudyal V, Kurmi O. Association of the COVID-19 pandemic on stroke admissions and treatment globally: a systematic review. BMJ Open 2023; 13:e062734. [PMID: 36931673 PMCID: PMC10030289 DOI: 10.1136/bmjopen-2022-062734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted insufficiencies and gaps within healthcare systems globally. In most countries, including high-income countries, healthcare facilities were over-run and occupied with too few resources beyond capacity. We carried out a systematic review with a primary aim to identify the influence of the COVID-19 pandemic on the presentation and treatment of stroke globally in populations≥65 years of age. DESIGN A systematic review was completed. In total, 38 papers were included following full-text screening. DATA SOURCES PubMed, MEDLINE and Embase. ELIGIBILITY CRITERIA Eligible studies included observational and real-world evidence publications with a population who have experienced stroke treatment during the COVID-19 pandemic. Exclusion criteria included studies comparing the effect of the COVID-19 infection on stroke treatment and outcomes. DATA EXTRACTION AND SYNTHESIS Primary outcome measures extracted were the number of admissions, treatment times and patient outcome. Secondary outcomes were severity on admission, population risk factors and destination on discharge. No meta-analysis was performed. RESULTS This review demonstrated that 84% of studies reported decreased admissions rates during the COVID-19 pandemic. However, among those admitted, on average, had higher severity of stroke. Additionally, in-hospital stroke treatment pathways were affected by the implementation of COVID-19 protocols, which resulted in increased treatment times in 60% of studies and increased in-hospital mortality in 82% of studies by 100% on average. The prevalence of stroke subtype (ischaemic or haemorrhagic) and primary treatment methods (thrombectomy or thrombolysis) did not vary due to the COVID-19 pandemic. CONCLUSIONS During the COVID-19 pandemic, many populations hesitated to seek medical attention, decreasing hospital admissions for less severe strokes and increasing hospitalisation of more severe cases and mortality. The effect of the pandemic on society and healthcare systems needs to be addressed to improve stroke treatment pathways and prepare for potential future epidemics. PROSPERO REGISTRATION NUMBER CRD42021248564.
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Affiliation(s)
| | - Kiera Abernethy
- Physical and environmenal science, University of Toronto, Toronto, Ontario, Canada
| | | | - Vibhu Paudyal
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Om Kurmi
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty Centre for Intelligent Healthcare, Coventry University, Coventry, UK
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Nexus Institute of Research and Innovation, Lalitpur, Nepal
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Ye F, Liang J, Wang T, Wu X, Li J, Lan K, Sheng W. Bioinformatic Analysis of Co-Expressed Differentially Expressed Genes and Potential Targets for Intracerebral and Subarachnoid Hemorrhage. World Neurosurg 2022; 159:e442-e452. [PMID: 34990842 DOI: 10.1016/j.wneu.2021.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are serious subtypes of hemorrhagic stroke that affect adults and have a high risk of morbidity and mortality; both share certain identical risk factors and clinical features. Recent studies have shown that secondary brain injury (SBI) following ICH and SAH is more life-threatening and lacks effective therapeutic strategies. The aim of this study is to understand the molecular pathogenesis of ICH- or SAH-induced SBI and provide insights to the potential therapeutic options. METHODS The original gene expression profile data of tissue microarray studies (GSE24265, GSE13353) was downloaded from the Gene Expression Omnibus (GEO) database. We identified the differentially expressed genes (DEGs) for each disease and co-DEGs between ICH and SAH. The functional enrichment analyses were then analyzed and a protein-protein interaction (PPI) network was constructed to strictly select hub genes via the maximal clique centrality (MCC) method. Additionally, immune infiltration analyses were used to identify the common differently distributed cells in both diseases. Finally, potential target microRNAs (miRNAs) and related targeted drugs were predicted for further studies. The animal model microarrays were used for external validation. RESULTS A total of 614 ICH-DEGs, 1272 SAH-DEGs, and 158 co-DEGs were identified in our study. The co-DEGs were significantly enriched in cytotoxicity and inflammation pathways. The top 10 hub genes (CCL20, CXCL1, CXCL3, CXCL8, CXCL16, CXCR2, CXCR4, CCR7, PF4, and PPBP) were then filtered through the PPI networks. Moreover, nTreg, Th17, and dendritic cells and monocytes and macrophages were identified as the common differentially distributed immune cells between ICH and SAH. Additionally, the target miRNAs (e.g., miR-21-5p, miR-590-5p, miR-6834-3p) and related drugs (e.g., ABX-IL8, HUMAX-IL8, Rivanicline) of hub genes were predicted. CONCLUSIONS This study identified a variety of key genes and their respective molecular functions involved in both ICH and SAH for better understanding of the cytotoxic and inflammatory pathogenesis of SBI. The predicted targeted miRNAs and related drugs of hub genes not only provide insights into the novel therapeutic strategies but also aid in future studies and drug discovery.
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Affiliation(s)
- Fei Ye
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Liang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianzhu Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoxin Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaoxing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kai Lan
- Department of Anesthesiology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China; Department of Anesthesiology, PLA 32268 Troops, Dali, China
| | - Wenli Sheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Iyengar SS, Mohan JC, Ray S, Rao MS, Khan MY, Patted URH, Gaurav K. Effect of Amlodipine in Stroke and Myocardial infarction: A Systematic Review and Meta-analysis. Cardiol Ther 2021; 10:429-444. [PMID: 34480745 PMCID: PMC8555097 DOI: 10.1007/s40119-021-00239-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Hypertension is a progressive cardiovascular condition arising from complex aetiologies. Progression is strongly associated with functional and structural abnormalities that lead to multi-organ dysfunction. Stroke and myocardial infarction are two of the major complications of hypertension in India. Various anti-hypertensive drugs, such as calcium channel blockers (CCBs), beta-blockers, diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have been the medications of choice for disease management and are known to be effective in reducing the complications of hypertension. CCBs, such as amlodipine, are also currently being used and proven to be effective, although their beneficial effects in the management of complications of hypertension like stroke and myocardial infarction (MI) have yet to be proven. Therefore, the aim of this systematic review was to evaluate the effect of amlodipine on stroke and MI in hypertensive patients. METHODS A systematic search of English electronic databases was performed for studies with sufficient statistical power that were published between 2000 andl 30 August 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A total of 676 papers were screened, and 13 were found eligible to be included in the meta-analysis. Studies that included patients who suffered from MI or stroke and were under amlodipine treatment were included in the analysis. The odds ratio and the risk ratio of amlodipine compared to active control/placebo were noted from the studies and statistically analyzed. RESULTS Amlodipine had a significant effect in reducing stroke and MI in hypertensive patients. Similar to results published in reports, this systematic review proved that the hazard ratio for amlodipine was < 1 for stroke (0.69-1.04) and MI (0.77-0.98), showing that amlodipine accounted for better prevention of stroke and MI. CONCLUSION In the pooled analysis of data from 12 randomised controlled trials and one double-blinded cohort study measuring the effect of CCBs, we found that the CCB amlodipine reduced the risk of stroke and MI in hypertensive patients. Superior results for amlodipine were found in ten of the 13 studies included in this meta-analysis.
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Affiliation(s)
| | - Jagdish Chander Mohan
- Institute of Heart and Vascular Diseases, Jaipur Golden Hospital, Sector 3, Rohini, Delhi, India
| | - Saumitra Ray
- Amri Hospital, Kolkata, West Bengal, India
- Woodland Hospital, Kolkata, West Bengal, India
| | | | - Mohammed Yunus Khan
- Medical Affairs, Dr Reddy's Laboratories Ltd., Ameerpet, Hyderabad, Telangana, India.
| | - Usha Rani H Patted
- Medical Affairs, Dr Reddy's Laboratories Ltd., Ameerpet, Hyderabad, Telangana, India
| | - Kumar Gaurav
- Medical Affairs, Dr Reddy's Laboratories Ltd., Ameerpet, Hyderabad, Telangana, India
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Paz Landim M, Cosenso-Martin LN, Polegati Santos A, Roma Uyemura JR, Barufi Fernandes L, da Silva Lopes V, Yugar-Toledo JC, Vilela-Martin JF. Predictive Factors for Target Organ Injuries in Hypertensive Individuals. Integr Blood Press Control 2021; 14:113-121. [PMID: 34429649 PMCID: PMC8374840 DOI: 10.2147/ibpc.s324151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 01/13/2023] Open
Abstract
Background The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors (CV). Ambulatory blood pressure monitoring (ABPM) is important in monitoring hypertension and assessing the risk of TOD. Objective To evaluate the relationship between blood pressure (BP) and clinical and biochemical parameters in the development of TOD in hypertensive patients. Methods This was a retrospective cohort study with 162 hypertensive patients followed for an average period of 13 years. The TOD investigated were left ventricular hypertrophy (LVH), microalbuminuria, coronary artery disease (CAD) and stroke. Blood pressure was assessed by ABPM and LVH using echocardiogram and electrocardiogram, respectively. Biochemical-metabolic tests and 24-hour microalbuminuria were performed at baseline and follow-up. The P-value <0.05 was considered significant. Results The average age was 69±11.8 years, with a predominance of women (64.8%), white ethnicity (79.6%) and diabetics (78.4%). ABPM showed a significant reduction in BP values during follow-up, although without association with TOD (microalbuminuria, stroke, and CAD), except for LVH that showed a correlation with sleep BP ≥120/70 mmHg (P=0.044). The most frequent TODs were LVH (29.6%), microalbuminuria (26.5%), CAD (19.8%) and stroke (17.3%). In the follow-up, there was an association between LVH and diabetes; microalbuminuria was associated with diabetes and triglycerides; stroke was associated with HDL-cholesterol (HDL-c), microalbuminuria and carotid disease. CAD showed a relationship with age and HDL-c. Conclusion Predictive factors for TOD are age, microalbuminuria, diabetes, HDL-c, triglycerides and carotid disease. Nocturnal BP is correlated with LVH. The absence of a relationship between ABPM and other TODs can be explained by the use of effective drugs, improvement of metabolic and blood pressure parameters.
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Affiliation(s)
- Manoel Paz Landim
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Luciana Neves Cosenso-Martin
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Aleandra Polegati Santos
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Jessica Rodrigues Roma Uyemura
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Leticia Barufi Fernandes
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Valquiria da Silva Lopes
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Jose Fernando Vilela-Martin
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
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Ramis MR, Sarubbo F, Moranta D, Tejada S, Lladó J, Miralles A, Esteban S. Neurochemical and Cognitive Beneficial Effects of Moderate Physical Activity and Catechin in Aged Rats. Antioxidants (Basel) 2021; 10:antiox10040621. [PMID: 33921628 PMCID: PMC8072822 DOI: 10.3390/antiox10040621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022] Open
Abstract
A healthy aging process is a requirement for good life quality. A relationship between physical activity, the consumption of antioxidants and brain health has been stablished via the activation of pathways that reduce the harmful effects of oxidative stress, by inducing enzymes such as SIRT1, which is a protector of brain function. We analyzed the cognitive and neurochemical effects of applying physical exercise in elderly rats, alone or in combination with the antioxidant catechin. Several tests of spatial and episodic memory and motor coordination were evaluated. In addition, brain monoaminergic neurotransmitters and SIRT1 protein levels were assessed in the brains of the same rats. The results show that physical activity by itself improved age-related memory and learning deficits, correlating with the restoration of brain monoaminergic neurotransmitters and SIRT1 protein levels in the hippocampus. The administration of the antioxidant catechin along with the exercise program enhanced further the monoaminergic pathways, but not the other parameters studied. These results agree with previous reports revealing a neuroprotective effect of physical activity, probably based on its ability to improve the redox status of the brain, demonstrating that exercise at an advanced age, combined with the consumption of antioxidants, could produce favorable effects in terms of brain health.
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Affiliation(s)
- Margarita R. Ramis
- Laboratory of Neurophysiology, Biology Department, University of Balearic Islands (UIB), Ctra. Valldemossa Km 7.5, E-07122 Palma de Mallorca, Spain; (M.R.R.); (F.S.); (D.M.); (S.T.); (A.M.)
| | - Fiorella Sarubbo
- Laboratory of Neurophysiology, Biology Department, University of Balearic Islands (UIB), Ctra. Valldemossa Km 7.5, E-07122 Palma de Mallorca, Spain; (M.R.R.); (F.S.); (D.M.); (S.T.); (A.M.)
- Research Unit, University Hospital Son Llàtzer, Crta. Manacor Km 4, 07198 Palma, Spain
| | - David Moranta
- Laboratory of Neurophysiology, Biology Department, University of Balearic Islands (UIB), Ctra. Valldemossa Km 7.5, E-07122 Palma de Mallorca, Spain; (M.R.R.); (F.S.); (D.M.); (S.T.); (A.M.)
| | - Silvia Tejada
- Laboratory of Neurophysiology, Biology Department, University of Balearic Islands (UIB), Ctra. Valldemossa Km 7.5, E-07122 Palma de Mallorca, Spain; (M.R.R.); (F.S.); (D.M.); (S.T.); (A.M.)
- CIBERON (Physiopathology of Obesity and Nutrition), 28029 Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
| | - Jerònia Lladó
- Department of Biology and University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma, Spain;
| | - Antoni Miralles
- Laboratory of Neurophysiology, Biology Department, University of Balearic Islands (UIB), Ctra. Valldemossa Km 7.5, E-07122 Palma de Mallorca, Spain; (M.R.R.); (F.S.); (D.M.); (S.T.); (A.M.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
| | - Susana Esteban
- Laboratory of Neurophysiology, Biology Department, University of Balearic Islands (UIB), Ctra. Valldemossa Km 7.5, E-07122 Palma de Mallorca, Spain; (M.R.R.); (F.S.); (D.M.); (S.T.); (A.M.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Correspondence: ; Tel.: +34-971-173-145
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Obembe OO, Usman TO, Raji Y. Hepatoprotective effects of Quassia amara stem bark against cadmium-induced toxicity in male Wistar rats. J Basic Clin Physiol Pharmacol 2021; 32:1131-1136. [PMID: 33544994 DOI: 10.1515/jbcpp-2020-0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/08/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The liver is one of the primary biorepositories of cadmium (Cd) and it has been implicated in the pathogenesis of hepatic diseases. Quassia amara stem bark has been reputed to have strong antimalarial, antimicrobial, antiulcerative and amoebicidal properties. This study aims to determine the effects of Q. amara on Cd-induced hepatotoxicity and lipid profile in male Wistar rats. METHODS The animals were divided into three groups of five animals each. Group 1 served as control while group 2 received Cd (5 mg/kg) for 4 weeks. Prior to Cd treatment, group 3 was treated with Q. amara extract (200 mg/kg) for 2 weeks and received the Q. amara and Cd simultaneously for 4 weeks. RESULTS Cadmium caused significant increase in serum total cholesterol and low-density lipoprotein (LDL) as well as increased hepatic malondialdehyde (MDA) when compared with the control group. On the other hand, Cd caused a decrease in serum high-density lipoprotein (HDL) and hepatic superoxide dismutase (SOD) when compared with control. However, treatment with Q. amara prevented Cd-induced changes in the lipid profile, augmented Cd-induced decline in SOD and also ameliorated the Cd-induced increase in MDA. Catalase level was however comparable across the groups. CONCLUSIONS Q. amara ameliorated the Cd-induced damage to liver by preventing dyslipidemia and oxidative damage in the hepatic tissue.
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Affiliation(s)
- Olawale O Obembe
- Department of Physiology, College of Health Sciences, Osun State University, Osogbo Nigeria
| | - Taofeek O Usman
- Department of Physiology, College of Health Sciences, Osun State University, Osogbo Nigeria
| | - Yinusa Raji
- Department of Physiology, College of Medicine, University of Ibadan, Ibadan Nigeria
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Yu Y, Hu L, Huang X, Zhou W, Bao H, Cheng X. BMI modifies the association between serum HDL cholesterol and stroke in a hypertensive population without atrial fibrillation. J Endocrinol Invest 2021; 44:173-181. [PMID: 32406023 DOI: 10.1007/s40618-020-01288-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Both high-density lipoprotein cholesterol (HDL-C) and body mass index (BMI) have an impact on the prevalence of stroke. However, it is unclear whether BMI can modify the relationship between HDL-C and stroke. Therefore, we aimed to assess the effect of the BMI on the association between HDL-C and stroke in a hypertensive population without atrial fibrillation (AF). METHODS We analyzed data of 10,925 hypertensive patients without AF from the Chinese Hypertension Registry Study. BMI was categorized as < 24 and ≥ 24 kg/m2. Multivariate logistic regression and smooth curve fitting (penalized spline method) were used to analyze the association between HDL-C and stroke in different BMI groups. Subgroup analysis and interaction tests were used to explore the effect of other variables on this relationship. RESULTS The results showed a negative association between HDL-C and stroke in the BMI < 24 kg/m2 group, but HDL-C was not associated with stroke in the BMI ≥ 24 kg/m2 group. In the BMI < 24 kg/m2 group, each 1 mmol/L increase in HDL-C was associated with a 50% decreased risk of stroke [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.38-0.66]. No significant relationship between HDL-C and stroke was observed in the BMI ≥ 24 kg/m2 group (OR 0.73, 95% CI 0.49-1.10). There was a significant interaction between BMI and HDL-C in regard to the prevalence of stroke in the hypertensive population without AF (PInteraction = 0.027). CONCLUSIONS We found an inverse association between HDL-C and stroke only in the BMI < 24 kg/m2 group. The finding suggested that BMI could modify the association between HDL-C and stroke in hypertensive populations without AF.
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Affiliation(s)
- Y Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi, China
| | - L Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi, China
| | - X Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi, China
| | - W Zhou
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - H Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi, China.
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - X Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi, China.
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Machine learning provides evidence that stroke risk is not linear: The non-linear Framingham stroke risk score. PLoS One 2020; 15:e0232414. [PMID: 32437368 PMCID: PMC7241753 DOI: 10.1371/journal.pone.0232414] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
Current stroke risk assessment tools presume the impact of risk factors is linear and cumulative. However, both novel risk factors and their interplay influencing stroke incidence are difficult to reveal using traditional additive models. The goal of this study was to improve upon the established Revised Framingham Stroke Risk Score and design an interactive Non-Linear Stroke Risk Score. Leveraging machine learning algorithms, our work aimed at increasing the accuracy of event prediction and uncovering new relationships in an interpretable fashion. A two-phase approach was used to create our stroke risk prediction score. First, clinical examinations of the Framingham offspring cohort were utilized as the training dataset for the predictive model. Optimal Classification Trees were used to develop a tree-based model to predict 10-year risk of stroke. Unlike classical methods, this algorithm adaptively changes the splits on the independent variables, introducing non-linear interactions among them. Second, the model was validated with a multi-ethnicity cohort from the Boston Medical Center. Our stroke risk score suggests a key dichotomy between patients with history of cardiovascular disease and the rest of the population. While it agrees with known findings, it also identified 23 unique stroke risk profiles and highlighted new non-linear relationships; such as the role of T-wave abnormality on electrocardiography and hematocrit levels in a patient’s risk profile. Our results suggested that the non-linear approach significantly improves upon the baseline in the c-statistic (training 87.43% (CI 0.85–0.90) vs. 73.74% (CI 0.70–0.76); validation 75.29% (CI 0.74–0.76) vs 65.93% (CI 0.64–0.67), even in multi-ethnicity populations. The clinical implications of the new risk score include prioritization of risk factor modification and personalized care at the patient level with improved targeting of interventions for stroke prevention.
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Wang XY, Liu FC, Yang XL, Li JX, Cao J, Lu XF, Huang JF, Li Y, Chen JC, Zhao LC, Shen C, Hu DS, Zhao YX, Yu L, Liu XQ, Wu XP, Gu DF. Association of cardiovascular diseases with milk intake among general Chinese adults. Chin Med J (Engl) 2020; 133:1144-1154. [PMID: 32433046 PMCID: PMC7249710 DOI: 10.1097/cm9.0000000000000786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The association of milk intake with cardiovascular disease (CVD) and cause-specific mortality remained controversial and evidence among the Chinese population was limited. We aimed to study the relationship between milk intake and CVDs among general Chinese adults. METHODS A total of 104,957 participants received questionnaire survey. Results of physical examination such as anthropometric measurements and biochemical tests during 2007 to 2008, demographic data and their information on milk intake were collected through standardized questionnaires. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) of CVD incidence, cause-specific mortality and all-cause mortality related to milk intake. Restricted cubic splines (RCSs) were applied to examine dose-response associations. RESULTS Among the 91,757 participants with a median follow-up period of 5.8 years, we documented 3877 CVD cases and 4091 all-cause deaths. Compared with participants who never consumed milk, the multivariate-adjusted HRs (95% CIs) of CVD incidence for 1 to 150 g/day, 151 to 299 g/day, and ≥300 g/day were 0.94 (0.86-1.03) (P > 0.05), 0.77 (0.66-0.89) (P < 0.05), and 0.59 (0.40-0.89) (P < 0.05), respectively; each 100 g increase of daily milk intake was associated with 11% lower risk of CVD incidence (HR, 0.89; 95% CI: 0.85-0.94; P < 0.001), and 11% lower risk of CVD mortality (HR, 0.89; 95% CI: 0.82-0.97; P = 0.008) after adjustment for age, sex, residential area, geographic region, education level, family history of CVD, smoking, alcohol drinking, physical activity level, body mass index, and healthy diet status (ideal or not). RCS analyses also showed a linear dose-response relationship with CVD (P for overall significance of the curve <0.001; P for non-linearity = 0.979; P for linearity <0.001) and stroke (P for overall significance of the curve = 0.010; P for non-linearity = 0.998; P for linearity = 0.002) incidence, and CVD mortality (P for overall significance of the curve = 0.045; P for non-linearity = 0.768; P for linearity = 0.014) within the current range of daily milk intake. CONCLUSIONS Daily milk intake was associated with lower risk of CVD incidence and mortality in a linear inverse relationship. The findings provide new evidence for dietary recommendations in CVD prevention among Chinese adults and people with similar dietary pattern in other countries.
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Affiliation(s)
- Xin-Yan Wang
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fang-Chao Liu
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xue-Li Yang
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jian-Xin Li
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jie Cao
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiang-Feng Lu
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jian-Feng Huang
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Li
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ji-Chun Chen
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lian-Cheng Zhao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Dong-Sheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong 518071, China
| | - Ying-Xin Zhao
- Shandong First Medical University, Jinan, Shandong 271000, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, Fujian 350004, China
| | - Xiao-Qing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, Guangdong 510080, China
| | - Xian-Ping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
| | - Dong-Feng Gu
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong 518055, China
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11
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Ohno K, Fujita Y, Ohno Y, Takeshima T, Maki K. The factors related to decreases in masticatory performance and masticatory function until swallowing using gummy jelly in subjects aged 20-79 years. J Oral Rehabil 2020; 47:851-861. [PMID: 32270885 PMCID: PMC7318595 DOI: 10.1111/joor.12975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/25/2022]
Abstract
Background There is growing international interest in the prevention of decreased oral function for managing oral health in older people. Objective The aims of the present study were to identify factors related to decreases in masticatory performance and masticatory function until swallowing in subjects aged 20‐79 years old. Methods A total of 152 subjects, ranging in age from 20 to 79 years, were divided into six groups according to their chronological age: 20‐29, 30‐39, 40‐49, 50‐59, 60‐69 and 70‐79 years. Grip strength, maximum occlusal force, maximum tongue pressure, masticatory performance and swallowing threshold were measured in all subjects. Masticatory performance and swallowing threshold were determined according to the concentration of dissolved glucose obtained from gummy jellies; decreased masticatory performance and decreased swallowing threshold were defined as glucose concentrations in the lowest 20th percentile. A multivariate binary logistic regression analysis was used to identify factors associated with decreased masticatory performance and decreased swallowing threshold. A self‐administered lifestyle questionnaire was also completed. Results Logistic regression analyses revealed that factors related to decreased masticatory performance included use of more than one kind of medicine for treating chronic diseases and removable denture use, while factors related to decreased swallowing threshold included eating between meals once or more per day, poorer mental health and decreased saliva flow. Conclusions Different factors are related to decreased masticatory performance and decreased swallowing threshold, although both of these phenomena are closely associated with general health status.
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Affiliation(s)
- Keitaro Ohno
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion, Kyushu Dental University, Kitakyushu City, Japan
| | - Yuko Fujita
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion, Kyushu Dental University, Kitakyushu City, Japan
| | - Yoma Ohno
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion, Kyushu Dental University, Kitakyushu City, Japan
| | - Tomohiro Takeshima
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion, Kyushu Dental University, Kitakyushu City, Japan
| | - Kenshi Maki
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion, Kyushu Dental University, Kitakyushu City, Japan
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12
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Falck RS, Best JR, Davis JC, Eng JJ, Middleton LE, Hall PA, Liu-Ambrose T. Sleep and cognitive function in chronic stroke: a comparative cross-sectional study. Sleep 2019; 42:5364812. [DOI: 10.1093/sleep/zsz040] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/10/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ryan S Falck
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - John R Best
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Jennifer C Davis
- University of British Columbia-Okanagan Campus, Faculty of Management, Kelowna, BC, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Neurorehabilitation Research Program, GFS Rehabilitation Centre, Vancouver, BC, Canada
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Peter A Hall
- University of Waterloo, School of Public Health and Health Systems, Waterloo, ON, Canada
| | - Teresa Liu-Ambrose
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
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13
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Zou Y, Gong P, Zhao W, Zhang J, Wu X, Xin C, Xiong Z, Li Z, Wu X, Wan Q, Li X, Chen J. Quantitative iTRAQ-based proteomic analysis of piperine protected cerebral ischemia/reperfusion injury in rat brain. Neurochem Int 2018; 124:51-61. [PMID: 30579855 DOI: 10.1016/j.neuint.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/26/2018] [Accepted: 12/20/2018] [Indexed: 01/15/2023]
Abstract
Piperine is the key bioactive factor in black pepper, and has been reported to alleviate cerebral ischemic injury. However, the mechanisms underlying its neuroprotective effects following cerebral ischemia remain unclear. In this study, rats were administered vehicle (dimethyl sulfoxide) or piperine, 20 mg/kg, daily for 14 days before focal cerebral artery occlusion. After occlusion for 2 h followed by reperfusion for 24 h. Histological examinations were used to assess whether piperine has a neuroprotective effect in the rat model of cerebral ischemia/reperfusion injury. The levels of proteins in the ischemic penumbra were evaluated by isobaric tags for relative and absolute quantitation-based proteomics. A total of 3687 proteins were identified, including 23 proteins that were highly significantly differentially expressed between the control and piperine groups. The proteomic findings were verified by immunofluorescence and western blot analysis. Interestingly, piperine administration downregulated a number of critical factors in the complement and coagulation cascades, including complement component 3, fibrinogen gamma chain, alpha-2-macroglobulin, and serpin family A member 1. Collectively, our findings suggest that the neuroprotective effects of piperine following cerebral ischemia/reperfusion injury are related to the regulation of the complement and coagulation cascades.
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Affiliation(s)
- Yichun Zou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Pian Gong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Wenyuan Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Xiaolin Wu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Can Xin
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Zhongwei Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Xiaohui Wu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Qi Wan
- Institute of Neuroregeneration and Neurorehabilitation of Qingdao University, Qingdao, Shandong, 266071, China
| | - Xiang Li
- Queensland Brain Institute of the University of Queensland, St Lucia, Queensland, Australia
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China; Department of Neurosurgery, Tongji Hospital of Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Hancock AM, Frostig RD. Hypertension prevents a sensory stimulation-based collateral therapeutic from protecting the cortex from impending ischemic stroke damage in a spontaneously hypersensitive rat model. PLoS One 2018; 13:e0206291. [PMID: 30352082 PMCID: PMC6198990 DOI: 10.1371/journal.pone.0206291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 10/10/2018] [Indexed: 12/02/2022] Open
Abstract
Assessing potential stroke treatments in the presence of risk factors can improve screening of treatments prior to clinical trials and is important in testing the efficacy of treatments in different patient populations. Here, we test our noninvasive, nonpharmacological sensory stimulation treatment in the presence of the main risk factor for ischemic stroke, hypertension. Utilizing functional imaging, blood flow imaging, and histology, we assessed spontaneously hypertensive rats (SHRs) pre- and post-permanent middle cerebral artery occlusion (pMCAO). Experimental groups included a treatment SHR group (sensory-stimulated group), control untreated SHR group (no sensory stimulation), and a treated (sensory-stimulated) Wistar-Kyoto normotensive group. Unlike our previous studies, which showed sensory-based complete protection from impending ischemic cortical stroke damage in rats as seen in the treated Wistar-Kyoto group, we found that SHRs at 24hr post-pMCAO lacked evoked cortical activation, had a significant reduction in blood flow within the MCA, and sustained very large infarcts regardless of whether they received stimulation treatment. If translatable, this work highlights a potential need for a combined treatment plan when delivering sensory stimulation treatment in this patient population.
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Affiliation(s)
- Aneeka M. Hancock
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, California, United States of America
| | - Ron D. Frostig
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, California, United States of America
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, California, United States of America
- Department of Biomedical Engineering, University of California Irvine, Irvine, California, United States of America
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15
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Abbasian S, Rastegar MM M. Is the Intensity or Duration of Treadmill Training Important for Stroke Patients? A Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 27:32-43. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/20/2017] [Accepted: 09/29/2017] [Indexed: 11/26/2022] Open
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16
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Aoyama N, Suzuki JI, Kumagai H, Ikeda Y, Akazawa H, Komuro I, Minabe M, Izumi Y, Isobe M. Specific periodontopathic bacterial infection affects hypertension in male cardiovascular disease patients. Heart Vessels 2017; 33:198-204. [DOI: 10.1007/s00380-017-1042-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/09/2017] [Indexed: 12/20/2022]
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17
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Fallah-Moshkani R, Saadatnia M, Shakeri F, Keshteli AH, Saneei P, Larijani B, Esmaillzadeh A. A case-control study on egg consumption and risk of stroke among Iranian population. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:28. [PMID: 28583161 PMCID: PMC5460545 DOI: 10.1186/s41043-017-0104-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/24/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Most available data that linked intake of egg to risk of stroke came from western countries, with conflicting findings. We aimed to examine the association between egg consumption and risk of stroke among Iranian adults. METHODS In a hospital-based case-control study, 195 stroke patients, hospitalized in Alzahra University Hospital, were selected as cases and 195 control subjects, from patients hospitalized in other wards with no history of cerebrovascular diseases or neurologic disorders, were recruited. A validated 168-item food frequency questionnaire (FFQ) was used to assess participants' usual dietary intake, including egg consumption, over the previous year. Other required information was gathered by the use of questionnaires. RESULTS Consumption of eggs was associated with lower odds of stroke, such that after adjustment for potential confounders, those in the highest category of egg intake (>2 eggs/week) were 77% lower odds to have stroke, compared with those with the lowest category of egg intake (<1 egg/week) (OR 0.23; 95% CI 0.11-0.45). Further controlling for body mass index strengthened the association (OR 0.20; 95% CI 0.09-0.41). CONCLUSIONS We found evidence indicating that high intake of eggs (>2 eggs/week) during the past 1 year was associated with a lower risk of stroke. Further prospective studies are required to confirm these findings.
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Affiliation(s)
- Roohallah Fallah-Moshkani
- Students' Research Committee, Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Saadatnia
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forough Shakeri
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ammar Hassanzadeh Keshteli
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Parvane Saneei
- Students' Research Committee, Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, PO Box 14155-6117, Tehran, Iran.
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18
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Silva CI, Novais PC, Rodrigues AR, Carvalho CA, Colli BO, Carlotti Jr. CG, Tirapelli LF, Tirapelli DP. Expression of NMDA receptor and microRNA-219 in rats submitted to cerebral ischemia associated with alcoholism. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:30-35. [DOI: 10.1590/0004-282x20160188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Abstract
ABSTRACT Alcohol consumption aggravates injuries caused by ischemia. Many molecular mechanisms are involved in the pathophysiology of cerebral ischemia, including neurotransmitter expression, which is regulated by microRNAs. Objective: To evaluate the microRNA-219 and NMDA expression in brain tissue and blood of animals subjected to cerebral ischemia associated with alcoholism. Methods: Fifty Wistar rats were divided into groups: control, sham, ischemic, alcoholic, and ischemic plus alcoholic. The expression of microRNA-219 and NMDA were analyzed by real-time PCR. Results: When compared to the control group, the microRNA-219 in brain tissue was less expressed in the ischemic, alcoholic, and ischemic plus alcoholic groups. In the blood, this microRNA had lower expression in alcoholic and ischemic plus alcoholic groups. In the brain tissue the NMDA gene expression was greater in the ischemic, alcoholic, and ischemic plus alcoholic groups. Conclusion: A possible modulation of NMDA by microRNA-219 was observed with an inverse correlation between them.
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19
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Hemorrhagic transformation of acute ischemic stroke is limited in hypertensive patients with cardiac hypertrophy. Int J Cardiol 2016; 219:362-6. [DOI: 10.1016/j.ijcard.2016.06.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/18/2016] [Indexed: 12/18/2022]
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20
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Xiong J, Wu Z, Chen C, Wei Y, Guo W. Association between diabetes and prevalence and growth rate of abdominal aortic aneurysms: A meta-analysis. Int J Cardiol 2016; 221:484-95. [PMID: 27414727 DOI: 10.1016/j.ijcard.2016.07.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/28/2016] [Accepted: 07/04/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although the prevalence of abdominal aortic aneurysm (AAA) was lower in diabetes, the relationship between diabetes and AAA prevalence remains unclear. In this meta-analysis, we sought to clarify the effect of diabetes on prevalence and growth rate (GR) of AAA. METHODS We searched PubMed, Web of Science, Scopus and Cochrane databases. Articles reporting the AAA prevalence in diabetic patients and diabetic effects in GR of AAA were included. RESULTS Forty-nine studies on AAA prevalence in diabetics and thirteen studies on effect of diabetes in GR of AAA were included for meta-analysis. A strongly negative association was found between diabetes and AAA prevalence in population based screening (odds ratio [OR]adjusted: 0.66; 95% confidence interval [CI]: 0.58-0.75) and prospective studies (ORadjusted: 0.52; 95% CI: 0.43-0.63), but not in case-control studies (ORadjusted: 0.48; 95% CI: 0.20-1.15). Similar association was found in North American (ORadjusted: 0.62; 95% CI 0.54-0.71) and European (ORadjusted: 0.45; 95% CI 0.33-0.62) studies. The strongly negative association remained consistent after stratification by time of data collection (up to -1995 [ORadjusted: 0.65; 95% CI: 0.53-0.80], 1996-2005 [ORadjusted: 0.61; 95% CI: 0.47-0.78], 2006 and beyond- [ORadjusted: 0.67; 95% CI: 0.53-0.85], and data collection time >10years [ORadjusted: OR: 0.44; 95% CI 0.34-0.58]). The annual mean diabetic effect on AAA GR was -0.60mm/y (95% CI: -0.76 - -0.43). CONCLUSION Diabetes was strongly and negatively associated with AAA prevalence regardless of study type, geography and time of data collection, as well as negative impact of diabetes on GR of AAA.
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Affiliation(s)
- Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, PR China.
| | - Zhongyin Wu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, PR China
| | - Chen Chen
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Yingqi Wei
- Beijing Center for Diseases Prevention and Control, Beijing, PR China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, PR China
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Aygul R, Kotan D, Demirbas F, Ulvi H, Deniz O. Plasma Oxidants and Antioxidants in Acute Ischaemic Stroke. J Int Med Res 2016; 34:413-8. [PMID: 16989498 DOI: 10.1177/147323000603400411] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Plasma levels of the oxidants xanthine oxidase, nitric oxide and malondialdehyde and the antioxidants superoxide dismutase, glutathione peroxidase and glutathione reductase, together with total superoxide scavenger activity and non-enzymatic superoxide scavenger activity, were determined in 19 patients with acute ischaemic stroke and 20 controls. Compared with controls, superoxide dismutase, total superoxide scavenger activity, glutathione peroxidase and glutathione reductase activities were significantly lower, and nitric oxide and malondialdehyde levels significantly higher, in acute stroke patients. Xanthine oxidase showed a slight but non-significant increase in stroke patients compared with controls. There was no significant difference in non-enzymatic superoxide scavenger activity between the two groups. There was a positive correlation between glutathione reductase levels and Glasgow Coma Scale scores, and a negative correlation between malondialdehyde levels and non-enzymatic superoxide scavenger activity. These findings suggest that oxidative stress in patients with acute ischaemic stroke may be the result of an imbalance in oxidant/antioxidant homeostasis.
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Affiliation(s)
- R Aygul
- Department of Neurology, Medical Faculty, Atatürk University, Erzurum, Turkey
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Yau JA, Karaye KM, Okeahialam BN. Profile of Cardiovascular Risk Factors in Nigerians with Stroke. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/wjcs.2016.610020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Li M, Feng B, Wang L, Guo S, Zhang P, Gong J, Zhang Y, Zheng A, Li H. Tollip is a critical mediator of cerebral ischaemia-reperfusion injury. J Pathol 2015; 237:249-62. [PMID: 26011492 DOI: 10.1002/path.4565] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/11/2015] [Accepted: 05/20/2015] [Indexed: 01/11/2023]
Abstract
Toll-like receptor (TLR) signalling plays an important role in regulating cerebral ischaemia-reperfusion (I/R) injury. Toll-interacting protein (Tollip) is an endogenous negative modulator of TLR signalling that is involved in several inflammatory diseases. Our previous study showed that Tollip inhibits overload-induced cardiac remodelling. However, the role of Tollip in neurological disease remains unknown. In the present study, we proposed that Tollip might contribute to the progression of stroke and confirmed this hypothesis. We found that Tollip expression was significantly increased in I/R-challenged brain tissue of humans, mice and rats in vivo and in primary neurons subjected to oxygen and glucose deprivation in vitro, indicating the involvement of Tollip in I/R injury. Next, using genetic approaches, we revealed that Tollip deficiency protects mice against I/R injury by attenuating neuronal apoptosis and inflammation, as demonstrated by the decreased expression of pro-apoptotic and pro-inflammatory genes and the increased expression of anti-apoptotic genes. By contrast, neuron-specific Tollip over-expression exerted the opposite effect. Mechanistically, the detrimental effects of Tollip on neuronal apoptosis and inflammation following I/R injury were largely mediated by the suppression of Akt signalling. Additionally, to further support our findings, a Tollip knockout rat strain was generated via CRISPR-Cas9-mediated gene inactivation. The Tollip-deficient rats were also protected from I/R injury, based on dramatic decreases in neuronal apoptosis and ischaemic inflammation through Akt activation. Taken together, our findings demonstrate that Tollip acts as a novel modulator of I/R injury by promoting neuronal apoptosis and ischaemic inflammation, which are largely mediated by suppression of Akt signalling.
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Affiliation(s)
- Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, People's Republic of China
| | - Bin Feng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lang Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, People's Republic of China
| | - Sen Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, People's Republic of China
| | - Peng Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, People's Republic of China
| | - Jun Gong
- Department of Cardiology, Renmin Hospital of Wuhan University, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, People's Republic of China.,College of Life Sciences, Wuhan University, People's Republic of China
| | - Yan Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, People's Republic of China
| | - Ankang Zheng
- Department of Cardiology, Renmin Hospital of Wuhan University, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, People's Republic of China
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, People's Republic of China.,Cardiovascular Research Institute, Wuhan University, People's Republic of China
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Abstract
PURPOSE This study investigated the physiological responses of stroke survivors to a 16-week program of moderate aerobic and anaerobic exercise. METHOD Forty participants who were a minimum of 6 months post stroke underwent physiological testing over the course of 2 days that included a maximal VO(2) stress test, a Biodex strength assessment, and a blood lipid panel. The participants were then randomly assigned to two groups, an aerobic training only (ATO) group and an aerobic and strength training (A&ST) group. Both groups were then required to exercise aerobically for 20 minutes for 3 days a week at a moderate intensity for 16 weeks. Only the A&ST group was required to do a series of eight strength-training activities as part of their exercise protocol. Once the 16-week protocol was completed, all tests were repeated. These results were compared to the pretest data. RESULTS Statistically significant changes in VO(2max) were noted in the A&ST group, while positive but not significant changes were noted in the ATO group. Both groups saw significant increases in knee flexion but not in knee extension. The A&ST group showed significant increases in both shoulder flexion and extension, while the ATO group only had significant increases in shoulder extension. CONCLUSION We concluded that aerobic exercise produced positive metabolic changes in both groups, but only the A&ST group had statistically significant changes. Both groups demonstrated significant changes in functional strength, but the A&ST group experienced larger increases, likely due to the strength component of their training protocol.
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Affiliation(s)
- Mitchell Carr
- Galvin Center for Health and Fitness, Rehabilitation Institute of Chicago, Illinois, USA
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25
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A lovastatin-elicited genetic program inhibits M2 macrophage polarization and enhances T cell infiltration into spontaneous mouse mammary tumors. Oncotarget 2014; 4:2288-301. [PMID: 24317954 PMCID: PMC3926827 DOI: 10.18632/oncotarget.1376] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Beyond their ability to inhibit cholesterol biosynthesis, the statins have pleiotropic effects that include anti-inflammatory and immunomodulatory activities. Statins could have clinical utility, alone or in combination with other chemotherapeutics, in the treatment of cancer. The mechanisms that underlie the anti-tumor activity of the statins are nonetheless poorly defined. No studies have analyzed how they alter the tumor-associated leukocyte infiltrate, a central factor that influences tumor stroma and cancer evolution. Here we used HER2/neu transgenic (Tg-neu) mice to analyze the effect of lovastatin (Lov) on the inflammatory reaction of spontaneous mammary tumors. Lov treatment of tumor-bearing Tg-neu mice did not alter growth of established tumors, but significantly reduced the number of new oncogenic lesions in these mice. Moreover, Lov inhibited the growth of newly implanted Tg-neu tumors in immunocompetent but not in immunodeficient mice. We found that Lov enhanced tumor infiltration by effector T cells, and reduced the number of immunosuppressive and pro-angiogenic M2-like tumor-associated macrophages (TAM). Concomitantly, the drug improved the structure and function of the tumor vasculature, measured as enhanced tumor oxygenation and penetration of cytotoxic drugs. Microarray analysis identified a Lov-elicited genetic program in Tg-neu tumors that might explain these effects; we observed Lov-induced downregulation of placental growth factor, which triggers aberrant angiogenesis and M2-like TAM polarization. Our results identify a role for lovastatin in the shaping and re-education of the inflammatory infiltrate in tumors, with functional consequences in angiogenesis and antitumor immunity.
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26
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Macedo Paizan ML, Vilela-Martin JF. Is there an association between periodontitis and hypertension? Curr Cardiol Rev 2014; 10:355-61. [PMID: 24739001 PMCID: PMC4101200 DOI: 10.2174/1573403x10666140416094901] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 03/29/2014] [Accepted: 04/14/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases are the leading cause of deaths. Also, cardiovascular risk factors start the atherosclerotic process, which leads to cardiovascular diseases. Nowadays, periodontal disease can also be considered another cardiovascular risk factor. It involves inflammatory, immunological and humoral activities, which induce the production of proinflammatory cytokines and the destruction of the epithelium. This allows the entry of endotoxins and exotoxins in the bloodstream, which may contribute to atherogenesis and thromboembolic events. There is also direct invasion of the vessel wall by oral pathogens, triggering an inflammatory response that produces endothelial dysfunction. In hypertension, changes in microcirculation can cause ischemia in the periodontium, which favors periodontal disease. Moreover, endothelial dysfunction promotes the formation of atherosclerotic plaque and the development of lesions in target organs. Periodontitis has also been associated with insulin resistance and a higher risk for the metabolic syndrome, which is characterized by oxidative stress. This seems to act as a common link to explain the relationship between each component of the metabolic syndrome (including hypertension) and periodontitis. This article will discuss clinical and experimental evidence, as well as possible pathophysiologic mechanisms and links involved in the relationship among periodontal disease, hypertension and cardiovascular disease.
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Blood-brain barrier Na transporters in ischemic stroke. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2014; 71:113-46. [PMID: 25307215 DOI: 10.1016/bs.apha.2014.06.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Blood-brain barrier (BBB) endothelial cells form a barrier that is highly restrictive to passage of solutes between blood and brain. Many BBB transport mechanisms have been described that mediate transcellular movement of solutes across the barrier either into or out of the brain. One class of BBB transporters that is all too often overlooked is that of the ion transporters. The BBB has a rich array of ion transporters and channels that carry Na, K, Cl, HCO3, Ca, and other ions. Many of these are asymmetrically distributed between the luminal and abluminal membranes, giving BBB endothelial cells the ability to perform vectorial transport of ions across the barrier between blood and brain. In this manner, the BBB performs the important function of regulating the volume and composition of brain interstitial fluid. Through functional coupling of luminal and abluminal transporters and channels, the BBB carries Na, Cl, and other ions from blood into brain, producing up to 30% of brain interstitial fluid in healthy brain. During ischemic stroke cerebral edema forms by processes involving increased activity of BBB luminal Na transporters, resulting in "hypersecretion" of Na, Cl, and water into the brain interstitium. This review discusses the roles of luminal BBB Na transporters in edema formation in stroke, with an emphasis on Na-K-Cl cotransport and Na/H exchange. Evidence that these transporters provide effective therapeutic targets for reduction of edema in stroke is also discussed, as are recent findings regarding signaling pathways responsible for ischemia stimulation of the BBB Na transporters.
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Yuen N, Lam TI, Wallace BK, Klug NR, Anderson SE, O'Donnell ME. Ischemic factor-induced increases in cerebral microvascular endothelial cell Na/H exchange activity and abundance: evidence for involvement of ERK1/2 MAP kinase. Am J Physiol Cell Physiol 2014; 306:C931-42. [PMID: 24647544 DOI: 10.1152/ajpcell.00021.2013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Brain edema forms rapidly in the early hours of ischemic stroke by increased secretion of Na, Cl, and water into the brain across an intact blood-brain barrier (BBB), together with swelling of astrocytes as they take up the ions and water crossing the BBB. Our previous studies provide evidence that luminal BBB Na-K-Cl cotransport (NKCC) and Na/H exchange (NHE) participate in ischemia-induced edema formation. NKCC1 and two NHE isoforms, NHE1 and NHE2, reside predominantly at the luminal BBB membrane. NKCC and NHE activities of cerebral microvascular endothelial cells (CMEC) are rapidly stimulated by the ischemic factors hypoxia, aglycemia, and AVP, and inhibition of NKCC and NHE activities by bumetanide and HOE642, respectively, reduces brain Na uptake and edema in the rat middle cerebral artery occlusion model of stroke. The present study was conducted to further explore BBB NHE responses to ischemia. We examined whether ischemic factor-stimulated NHE activity is sustained over several hours, when the majority of edema forms during stroke. We also examined whether ischemic factors alter NHE1 and/or NHE2 protein abundance. Finally, we conducted initial studies of ERK1/2 MAP kinase involvement in BBB NHE and NKCC responses to ischemic factors. We found that hypoxia, aglycemia, and AVP increase CMEC NHE activity through 5 h and that NHE1, but not NHE2, abundance is increased by 1- to 5-h exposures to these factors. Furthermore, we found that these factors rapidly increase BBB ERK1/2 activity and that ERK1/2 inhibition reduces or abolishes ischemic factor stimulation of NKCC and NHE activities.
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Affiliation(s)
- Natalie Yuen
- Department of Physiology and Membrane Biology, University of California, Davis, California
| | - Tina I Lam
- Department of Physiology and Membrane Biology, University of California, Davis, California
| | - Breanna K Wallace
- Department of Physiology and Membrane Biology, University of California, Davis, California
| | - Nicholas R Klug
- Department of Physiology and Membrane Biology, University of California, Davis, California
| | - Steven E Anderson
- Department of Physiology and Membrane Biology, University of California, Davis, California
| | - Martha E O'Donnell
- Department of Physiology and Membrane Biology, University of California, Davis, California
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Xiang M, Wang L, Guo S, Lu YY, Lei H, Jiang DS, Zhang Y, Liu Y, Zhou Y, Zhang XD, Li H. Interferon regulatory factor 8 protects against cerebral ischaemic-reperfusion injury. J Neurochem 2014; 129:988-1001. [PMID: 24528256 DOI: 10.1111/jnc.12682] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Mei Xiang
- Department of Cardiology; Renmin Hospital of Wuhan University; Wuhan China
- Cardiovascular Research Institute of Wuhan University; Wuhan China
| | - Lang Wang
- Department of Cardiology; Renmin Hospital of Wuhan University; Wuhan China
- Cardiovascular Research Institute of Wuhan University; Wuhan China
| | - Sen Guo
- Department of Cardiology; Renmin Hospital of Wuhan University; Wuhan China
- Cardiovascular Research Institute of Wuhan University; Wuhan China
| | - Yan-Yun Lu
- Department of Cardiology; Renmin Hospital of Wuhan University; Wuhan China
- Cardiovascular Research Institute of Wuhan University; Wuhan China
| | - Hao Lei
- Wuhan Center for Magnetic Resonance; State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics; Wuhan Institute of Physics and Mathematics; Chinese Academy of Sciences; Wuhan China
| | - Ding-Sheng Jiang
- Department of Cardiology; Renmin Hospital of Wuhan University; Wuhan China
- Cardiovascular Research Institute of Wuhan University; Wuhan China
| | - Yan Zhang
- Department of Cardiology; Renmin Hospital of Wuhan University; Wuhan China
- Cardiovascular Research Institute of Wuhan University; Wuhan China
| | - Yi Liu
- College of Life Sciences; Wuhan University; Wuhan China
| | - Yan Zhou
- College of Life Sciences; Wuhan University; Wuhan China
| | | | - Hongliang Li
- Department of Cardiology; Renmin Hospital of Wuhan University; Wuhan China
- Cardiovascular Research Institute of Wuhan University; Wuhan China
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30
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Liang W, Lee AH, Binns CW. Tea drinking, diet and ischemic stroke prevention in China: a future perspective. Expert Rev Cardiovasc Ther 2014; 7:1447-54. [DOI: 10.1586/erc.09.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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31
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Flaster M, Morales-Vidal S, Schneck MJ, Biller J. Statins in hemorrhagic stroke. Expert Rev Neurother 2014; 11:1141-9. [DOI: 10.1586/ern.11.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Katz BS, Flemming KD. Antithrombotic selection and risk factor management in ischemic stroke and transient ischemic attack. Neurosurg Focus 2014; 36:E10. [PMID: 24380476 DOI: 10.3171/2013.10.focus13402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In addition to appropriate antithrombotic therapy, the identification and treatment of modifiable ischemic stroke risk factors can reduce the likelihood of recurrent stroke. Neurosurgeons should be knowledgeable of the specific risk factors and general recommendations for ischemic stroke, as they may play a significant role in the management options for patients with intracranial and extracranial atherosclerotic disease. The authors of this article review the indications for and selection of antithrombotics in patients with cerebral ischemia. In addition, the identification and secondary prevention of select risk factors are discussed.
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Affiliation(s)
- Brian S Katz
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
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33
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Wang L, Chen CM, Liao WC, Hsiao CY. Evaluating a community-based stroke nursing education and rehabilitation programme for patients with mild stroke. Int J Nurs Pract 2013; 19:249-56. [PMID: 23730856 DOI: 10.1111/ijn.12064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study evaluated whether mild stroke patients who received a community-based stroke nursing intervention had better stroke knowledge, behaviour and self-efficacy than those who were exposed to traditional education programmes. The intervention group consisted of sixty five stroke patients randomly selected from seven communities who received three 2-hour stroke interventions per week for 8 weeks. The normal care group consisted of sixty two stroke patients randomly selected from a medical centre who received a general stroke education programme. The stroke patients in two groups were assessed at baseline, after intervention and at the 6-month follow-up. At the 6-month follow-up, the intervention group demonstrated an improvement in the knowledge of stroke risk factors compared with the normal care group. Three months after education, the intervention group exhibited changes in the knowledge of stroke, social participation and self-efficacy compared with those at baseline. Also, self-efficacy was correlated with the knowledge of stroke risk factors after intervention and at the 6-month follow-up; self-efficacy was correlated with social participation after the 6-month follow-up. A community-based stroke nursing intervention might have effects on changes in the knowledge of stroke risk factors, social participation and self-efficacy.
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Affiliation(s)
- Lee Wang
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan.
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34
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Radák Z, Silye G, Bartha C, Jakus J, Stefanovits-Bányai É, Atalay M, Marton O, Koltai E. The effects of cocoa supplementation, caloric restriction, and regular exercise, on oxidative stress markers of brain and memory in the rat model. Food Chem Toxicol 2013; 61:36-41. [DOI: 10.1016/j.fct.2013.01.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
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Motani AS, Luo J, Liang L, Mihalic JT, Chen X, Tang L, Li L, Jaen J, Chen JL, Dai K. Evaluation of AMG 076, a potent and selective MCHR1 antagonist, in rodent and primate obesity models. Pharmacol Res Perspect 2013; 1:e00003. [PMID: 25505557 PMCID: PMC4184568 DOI: 10.1002/prp2.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/02/2013] [Accepted: 07/04/2013] [Indexed: 02/06/2023] Open
Abstract
Melanin-concentrating hormone (MCH) regulates food intake through activation of the receptor, MCHR1. We have identified AMG 076 as an orally bioavailable potent and selective small molecule antagonist of MCHR1. In mouse models of obesity, AMG 076 caused a reduction in body weight gain in wild-type (MCHR1+/+) but not in knockout (MCHR1−/−) mice. The body weight reduction was associated with decreases in food intake and increases in energy expenditure. Importantly, we show that these MCHR1-dependent effects of AMG 076 were also reflected in improved metabolic phenotypes, increased glucose tolerance and insulin sensitivity. Preliminary data on effects of AMG 076 in obese cynomolgus monkeys are also presented.
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Mindin is a critical mediator of ischemic brain injury in an experimental stroke model. Exp Neurol 2013; 247:506-16. [DOI: 10.1016/j.expneurol.2013.01.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 12/14/2012] [Accepted: 01/18/2013] [Indexed: 11/23/2022]
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37
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Ma R, Wang C, Zhao X, Xu M, Lv Y, Wei M, Cai Y, Zhang Z, Wang L, Zhang W, Huang Y, Li Y, Li H, Wang Y. A survey on compliance with secondary stroke prevention guidelines and follow up for the inpatients with atherosclerotic cerebral infarction/transient ischemic attack. Neurol Res 2013; 30:383-8. [DOI: 10.1179/174313208x300404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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38
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Choi-Kwon S, Kim JS. Lifestyle factors and risk of stroke in Seoul, south Korea. J Stroke Cerebrovasc Dis 2013; 7:414-20. [PMID: 17895120 DOI: 10.1016/s1052-3057(98)80125-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/1997] [Accepted: 05/06/1998] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND PURPOSE The importance of stroke risk factors, especially lifestyle associated ones, may differ among different ethnic groups. The purpose of the present study is to elucidate the risk factors for stroke in Seoul, Korea. SUBJECTS AND METHODS Three-hundred four stroke patients and 249 age-matched controls were studied. Patients were divided into those with cerebral infarction (CI) and intracerebral hemorrhage (ICH). Using a structured interview, we assessed risk factors for stroke including lifestyle-associated factors: hypertension (HT); diabetes mellitus (DM); cigarette smoking; alcohol drinking; sodium intake; salt taste preference; physical activity and exercise; consumption of vegetables, fat, fish and fruits; body mass index; total body fat; and skinfold thickness of triceps, subscapular, and abdomen. The results were compared between patients and controls, and between CI and ICH. RESULTS There were 232 CI and 72 ICH. Multivariate logistic regression analyses revealed the following independent risk factors; for CI in men, HT, DM, high sodium intake, low intake of vegetables, and excessive abdominal skinfold thickness; for ICH in men, HT, heavy alcohol drinking, high sodium intake, excessive abdominal skinfold thickness, and low fat consumption; for CI in women, excessive abdominal skinfold thickness, and low fat consumption; for CI in women, HT, high sodium intake, excessive abdominal skinfold thickness, decreased triceps skinfold thickness, and lack of recent physical exercise. On subgroup comparison, DM was found to be a discriminant risk factor favoring CI (v ICH) in women. CONCLUSION Our results showed that in Seoul, Korea, HT is the strongest risk factor for CI and ICH, and high sodium intake, lack of exercise, and central body fat deposition are relatively important factors related to stroke, whereas factors such as cigarette smoking, hypercholesterolemia, and body mass index are not. Low consumption of fat and heavy alcohol drinking appear to be related to the occurrence of ICH. Risk factors for stroke may differ among different ethnic groups and guidelines for stroke prevention should be based on a correct understanding of them.
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Affiliation(s)
- S Choi-Kwon
- Department of Nursing, Dankook University, Cheon-An (S.C.-K.), South Korea; Department of Neurology, University of Ulsan, Asan Medical Center, Seoul (J.S.K.), South Korea
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Hamakawa M, Ishida A, Tamakoshi K, Shimada H, Nakashima H, Noguchi T, Toyokuni S, Ishida K. Repeated short-term daily exercise ameliorates oxidative cerebral damage and the resultant motor dysfunction after transient ischemia in rats. J Clin Biochem Nutr 2013; 53:8-14. [PMID: 23874064 PMCID: PMC3705152 DOI: 10.3164/jcbn.12-72] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 12/13/2012] [Indexed: 12/18/2022] Open
Abstract
Long-term exercise prior to brain ischemia enhances the activities of antioxidant enzymes and leads to a significant reduction in brain damage and neurological deficits in rats subjected to transient middle cerebral artery occlusion. However, it has not been established whether relatively short-term exercise generates similar results following middle cerebral artery occlusion. We aimed to determine whether short-term exercise could reduce oxidative damage and prevent sensori-motor dysfunction. Male Wistar rats were subjected to perform daily exercise on a treadmill for 30 min at a speed of 15 m/min for 3 weeks, followed by a 90-min middle cerebral artery occlusion. Animals were assessed after middle cerebral artery occlusion for neurological deficits and sensori-motor function. Brain tissues were processed to evaluate infarct volume and oxidative damage. Oxidative stress was assessed using immunohistochemistry for 4-hydroxy-2-nonenal-modified proteins and 8-hydroxy-2'-deoxyguanosine. Antioxidant enzymes were evaluated using immunohistochemistry for thioredoxin and activity assay for superoxide dismutase. Exercise for 3 weeks decreased the severity of paralysis and impairment in forelimb motor coordination. Furthermore, exercise had effect on superoxide dismutase and reduced the infarct volume and the number of cells immunopositive for 4-hydroxy-2-nonenal-modified proteins and 8-hydroxy-2'-deoxyguanosine. Our results suggest that pre-conditioning treadmill exercise for 3 weeks is useful for ameliorating ischemia-induced brain injury.
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Affiliation(s)
- Michiru Hamakawa
- Department of Physical Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan ; Okinawa Rehabilitation Center Hospital, 2-15-1 Hiyagon, Okinawa, Okinawa 904-2173, Japan
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40
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Wang L, Lu Y, Guan H, Jiang D, Guan Y, Zhang X, Nakano H, Zhou Y, Zhang Y, Yang L, Li H. Tumor necrosis factor receptor-associated factor 5 is an essential mediator of ischemic brain infarction. J Neurochem 2013; 126:400-14. [PMID: 23413803 DOI: 10.1111/jnc.12207] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 01/20/2013] [Accepted: 02/14/2013] [Indexed: 12/22/2022]
Abstract
Tumor necrosis factor receptor-associated factor 5 (TRAF5) is an adaptor protein of the tumor necrosis factor (TNF) receptor superfamily and the interleukin-1 receptor/Toll-like receptor superfamily and plays important roles in regulating multiple signaling pathways. This study was conducted to investigate the role of TRAF5 in the context of brain ischemia/reperfusion (I/R) injury. Transient occlusion of the middle cerebral artery was performed on TRAF5 knockout mice (KO), neuron-specific TRAF5 transgene (TG), and the appropriate controls. Compared with the WT mice, the TRAF5 KO mice showed lower infarct volumes and better outcomes in the neurological tests. A low neuronal apoptosis level, an attenuated blood-brain barrier (BBB) disruption and an inhibited inflammatory response were exhibited in TRAF5 KO mice. TRAF5 TG mice exhibited an opposite phenotype. Moreover, the Akt/FoxO1 signaling pathway was enhanced in the ischemic brains of the TRAF5 KO mice. These results provide the first demonstration that TRAF5 is a critical mediator of I/R injury in an experimental stroke model. The Akt /FoxO1 signaling pathway probably plays an important role in the biological function of TRAF5 in this model.
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Affiliation(s)
- Lang Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, PR China
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Cadilhac DA, Kilkenny MF, Johnson R, Wilkinson B, Amatya B, Lalor E. The Know Your Numbers (KYN) program 2008 to 2010: impact on knowledge and health promotion behavior among participants. Int J Stroke 2013; 10:110-6. [PMID: 23490310 DOI: 10.1111/ijs.12018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/19/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Since 2007, the National Stroke Foundation in Australia has undertaken a community-based 'Know Your Numbers' program on blood pressure and other stroke risk factors. AIMS The aims of this study are to assess, in a sample of registrants participating in a three-month follow-up survey, retention of knowledge of risk factors and health conditions associated with hypertension, and whether those who were advised to see their doctor sought treatment or performed other health promotion actions. METHODS Various organizations (mainly pharmacies) were recruited to offer a 'free' standardized blood pressure check and educational resources for one-week/year between 2008 and 2010. Data collection was done thru registration log and detailed questionnaires for a sample of registrants at baseline and three-months. Descriptive statistics were used for comparison of baseline and three-month data. RESULTS There were 59 817 registrants over three-years. A total of 2044/2283 (90%) registrants completed a baseline survey (66% female, 50% aged >55 years); 43% had blood pressure ≥140/90 mmHg whereby 32% were unaware of their blood pressure status. Follow-up surveys were obtained from 510/805 (63%) baseline participants who provided consent. At three-months, improved knowledge was found for 9 of 11 risk factors for hypertension (e.g. lack of exercise baseline 73%; three-months 85%, P < 0·001). Knowledge for all the health conditions assessed that are associated with hypertension improved (e.g. stroke baseline 72%; three-months 87%, P < 0·001, heart attack baseline 69%; three-months 84%, P < 0·001). All respondents reported at least one health promotion action. Among 141/510 advised to visit their doctor, 114 (81%) did. CONCLUSION Know Your Numbers is a successful health promotion program and encourages people to be reviewed by their doctor.
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Affiliation(s)
- Dominique A Cadilhac
- Department of Medicine, Monash University, Stroke and Ageing Research Centre, Clayton, Vic., Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia; The University of Melbourne, Heidelberg, Vic., Australia
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Chen KI, Erh MH, Su NW, Liu WH, Chou CC, Cheng KC. Soyfoods and soybean products: from traditional use to modern applications. Appl Microbiol Biotechnol 2012; 96:9-22. [PMID: 22872103 DOI: 10.1007/s00253-012-4330-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 07/19/2012] [Accepted: 07/21/2012] [Indexed: 01/12/2023]
Abstract
Soybean products (soyfoods), reported as potential functional foods, are implicated in several health-enhancing properties, such as easing the symptoms of postmenopausal women, reducing the risk of osteoporosis, preventing cardiovascular disease, and antimutagenic effects. Isoflavone, for example, is one of the most important compounds abundantly found in soybean, mainly accounting for the health-enhancing properties as mentioned earlier. However, most biological activities of isoflavones are mainly attributed to their aglycone forms. It has also been demonstrated that isoflavone aglycones are absorbed faster and in greater amount than their glycosides in human intestines. Fortunately, deglycosylation of isoflavones can be achieved during fermentation process by several strains such as lactic acid bacteria, basidiomycetes, filamentous fungus, and Bacillus subtilis with their β-glucosidase activity. This article presents an overview of soybean's chemistry, application, state-of-the-art advances in soybean fermentation processing and products as well as their applications in food and pharmaceutical industries. Different compounds, such as isoflavone, dietary fibers, and proteins which exhibit significant bioactivities, are summarized. The roles of different microorganisms in bioconversion and enhancement of bioactivities of fermented soybean are also discussed.
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Affiliation(s)
- Kuan-I Chen
- Graduate Institute of Food Science and Technology, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, Taiwan
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Steiner B, Witte V, Flöel A. [Lifestyle and cognition: what do we know from the aging and neurodegenerative brain?]. DER NERVENARZT 2012; 82:1566-77. [PMID: 21842331 DOI: 10.1007/s00115-011-3353-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Epidemiological studies demonstrated positive effects of continuous physical activity and balanced diet on cardiovascular fitness. In chronic neurodegenerative disorders, e.g. Parkinson's disease and Alzheimer's disease, physical activity has become a successful supportive symptomatic therapy. However, it has become evident that physical activity not only improves motor symptoms but also has high impact on cognition in both (elderly) healthy brain and neurodegenerative alterations in the CNS. Nutrition also has been reported to exert positive effects on brain function.Animal studies indicate an increased endogenous plasticity as the underlying mechanism in terms of activation of neuronal precursor cells in different brain areas, leading to improved brain function.First experimental studies in humans also show that physical activity and balanced nutrition increase the release of neurotrophic factors in the brain, increase the volume of grey matter in learning- and memory-associated brain regions and improve cognitive function. This phenomenon opens up noninvasive causal therapeutic options in neurodegenerative disorders and during aging-associated cognitive decline by inducing changes in lifestyle. This option could provide a socioeconomically and ethically reasonable treatment for neurodegenerative disorders.The presented article summarizes the current knowledge from animal experiments and studies in humans. It provides an overview of potential cellular and molecular candidate mechanisms and discusses novel translational clinical studies and first clinical applications.
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Affiliation(s)
- B Steiner
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Deutschland.
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Iijima K, Iimuro S, Shinozaki T, Ohashi Y, Sakurai T, Umegaki H, Araki A, Ouchi Y, Ito H. Lower physical activity is a strong predictor of cardiovascular events in elderly patients with type 2 diabetes mellitus beyond traditional risk factors: The Japanese elderly diabetes intervention trial. Geriatr Gerontol Int 2012; 12 Suppl 1:77-87. [DOI: 10.1111/j.1447-0594.2011.00815.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wallace BK, Jelks KA, O'Donnell ME. Ischemia-induced stimulation of cerebral microvascular endothelial cell Na-K-Cl cotransport involves p38 and JNK MAP kinases. Am J Physiol Cell Physiol 2012; 302:C505-17. [PMID: 22049209 PMCID: PMC3287160 DOI: 10.1152/ajpcell.00261.2011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 10/28/2011] [Indexed: 11/22/2022]
Abstract
Previous studies have provided evidence that, in the early hours of ischemic stroke, a luminal membrane blood-brain barrier (BBB) Na-K-Cl cotransporter (NKCC) participates in ischemia-induced cerebral edema formation. Inhibition of BBB NKCC activity by intravenous bumetanide significantly reduces edema and infarct in the rat permanent middle cerebral artery occlusion model of ischemic stroke. We demonstrated previously that the BBB cotransporter is stimulated by hypoxia, aglycemia, and AVP, factors present during cerebral ischemia. However, the underlying mechanisms have not been known. Ischemic conditions have been shown to activate p38 and JNK MAP kinases (MAPKs) in brain, and the p38 and JNK inhibitors SB-239063 and SP-600125, respectively, have been found to reduce brain damage following middle cerebral artery occlusion and subarachnoid hemorrhage, respectively. The present study was conducted to determine whether one or both of these MAPKs participates in ischemic factor stimulation of BBB NKCC activity. Cultured cerebral microvascular endothelial cell NKCC activity was evaluated as bumetanide-sensitive (86)Rb influx. Activities of p38 and JNK were assessed by Western blot and immunofluorescence methods using antibodies that detect total vs. phosphorylated (activated) p38 or JNK. We report that p38 and JNK are present in cultured cerebral microvascular endothelial cells and in BBB endothelial cells in situ and that hypoxia (7% O(2) and 2% O(2)), aglycemia, AVP, and O(2)-glucose deprivation (5- to 120-min exposures) all rapidly activate p38 and JNK in the cells. We also provide evidence that SB-239063 and SP-600125 reduce or abolish ischemic factor stimulation of BBB NKCC activity. These findings support the hypothesis that ischemic factor stimulation of the BBB NKCC involves activation of p38 and JNK MAPKs.
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Affiliation(s)
- Breanna K Wallace
- Dept. of Physiology and Membrane Biology, School of Medicine, Univ. of California, Davis, CA 95616, USA
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Eames S, Hoffmann T, Worrall L, Read S. Stroke patients' awareness of risk and readiness to change behaviors. Top Stroke Rehabil 2011; 18:481-9. [PMID: 22082699 DOI: 10.1310/tsr1805-481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Behavior change is an important component of secondary stroke prevention. The transtheoretical model, which describes behavior change as occurring through a series of stages, may be a useful way of assessing patients' readiness to change behavior. The model has been successfully applied to other chronic conditions and argues that people progressing "forward" through the stages are more likely to successfully change their behavior. The aim of this study was to describe stroke patients' readiness to change behaviors for stroke-related risk factors using this model, in the absence of a behavior modification intervention. METHOD Patients (n = 27) from an acute stroke ward of a major metropolitan hospital in Brisbane, Australia, were interviewed prior to and at 3 months following hospital discharge regarding their awareness of stroke risk factors and their readiness to change stroke risk-related behaviors. RESULTS At both points in time, 30% of patients could not spontaneously nominate one or more stroke risk factors. Despite a trend of "forward" progression in stages of change between the 2 interviews for behaviors relating to hypertension, heart disease, and high cholesterol, there were no statistically significant changes over time for any of the behaviors. Patients' readiness to change stroke risk-related behaviors differed for each risk factor. CONCLUSION Acknowledging that patients' readiness to change may differ for each risk factor may promote more effective facilitation of stroke secondary prevention behaviors.
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Affiliation(s)
- Sally Eames
- Brighton Health Campus & Services, Brisbane, Australia
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Lee LK, Bateman BT, Wang S, Schumacher HC, Pile-Spellman J, Saposnik G. Trends in the Hospitalization of Ischemic Stroke in the United States, 1998–2007. Int J Stroke 2011; 7:195-201. [DOI: 10.1111/j.1747-4949.2011.00700.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The late 1990s/early 2000s was a time of change in both the prevention and acute care of ischemic stroke, with primary prevention driven by increased utilization of antihypertensive, antiplatelet, anticoagulation, and lipid-lowering agents. Aim To examine whether ischemic stroke hospitalization rates and outcomes in the United States have changed. Method We retrospectively identified 894 169 hospitalizations with a primary diagnosis of ischemic stroke from 1 January 1998 through to 31 December 2007 in the Nationwide Inpatient Sample, the largest all-payer healthcare database in the United States. Annual, national case estimates were combined with US Census data to derive age-adjusted and age-specific population hospitalization rates. Temporal trends were tested using linear regression. Results From 1998 through 2007, there were an estimated 4 382 336 ischemic stroke hospitalizations in the United States. Overall, the age-adjusted rate of ischemic stroke hospitalization decreased from 184 to 128 per 100 000 ( P #< 0.0001). Age-specific rates decreased among those 55+ years old ( P #< 0.0001), but increased among those 25–34 and 35–44 years old ( P #< 0.001 and P #< 0.0001, respectively). Rates among those <25 and 45–54 years old were unchanged. In-hospital mortality decreased from 7.0% (standard error 0.1) to 5.4% (standard error 0.1) ( P #< 0.0001). Case proportion at the highest quintile of hospitals by annual caseload increased from 54.0% (standard error 2.1) to 61.8% (standard error 2.0) ( P #< 0.0001). Mean adjusted hospitalization costs increased from $9273 (standard deviation 199) to $10 524 (standard deviation 77) ( P #< 0.0001). Conclusion In 1998 through to 2007, the overall rate of ischemic stroke hospitalization in the United States decreased. However, rates among young adults increased. In-hospital mortality rates decreased over the study period.
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Affiliation(s)
- Leslie K. Lee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Brian T. Bateman
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Shuang Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - H. Christian Schumacher
- Saul R. Korey Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John Pile-Spellman
- Division of Interventional Neuroradiology, Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Gustavo Saposnik
- Stroke Research Unit, St. Michael's Hospital and Institute of Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
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Spectrum of cardiovascular diseases inAsian-American racial/ethnic subgroups. Ann Epidemiol 2011; 21:608-14. [PMID: 21737048 DOI: 10.1016/j.annepidem.2011.04.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 04/25/2011] [Accepted: 04/26/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the prevalence of coronary heart disease (CHD), stroke, and peripheral vascular disease (PVD) across Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and non-Hispanic white (NHW) subjects in a mixed-payer, outpatient health care organization in California. METHODS Electronic health records from 2007 to 2010 were examined for 94,423 Asian and NHW patients. Age-adjusted prevalence rates of CHD, stroke, and PVD, defined by physician International Classification of Diseases, Version 9, codes, were directly standardized to the NHW population. Age-adjusted odds ratios were calculated by the use of logistic regression for each Asian subgroup, by sex, compared with NHWs. RESULTS The range of age-adjusted prevalence rates were: CHD (1.7%-5.2%), stroke (0.3%-1.8%), and PVD (0.9%-3.4%). The adjusted odds ratios of CHD were significantly higher for Filipino women (1.66; 95% confidence interval; 1.13-2.43) and men (1.47, 1.05-2.06) and Asian Indian men (1.77, 1.43-2.21), and significantly lower for Chinese women (0.72, 0.55-0.94) and men (0.78, 0.65-0.93), compared with NHWs. The odds of stroke were significantly greater for Filipino women (2.02, 1.22-3.34). The odds of PVD were generally lower for all Asian subgroups. CONCLUSION There is considerable heterogeneity across Asian subgroups for prevalent CHD, stroke, and PVD. Future research should disaggregate Asian subgroups and cardiovascular outcomes to inform targeted prevention and treatment efforts.
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Katsargyris A, Klonaris C, Tsiodras S, Bastounis E, Giannopoulos A, Theocharis S. Statin treatment is associated with reduced toll-like receptor 4 immunohistochemical expression on carotid atherosclerotic plaques: a novel effect of statins. Vascular 2011; 19:320-6. [PMID: 21903856 DOI: 10.1258/vasc.2011.oa0306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Toll-like receptor 4 (TLR4) has been recently implicated in inflammatory pathways involved in carotid plaque destabilization. Given that statins have plaque stabilization and inflammation reduction effects, we investigated whether TLR4 expression on carotid atherosclerotic plaques correlates with statin intake. Carotid atherosclerotic plaques were obtained on 140 patients (preoperative statin intake, n = 70). TLR4 immunohistochemical expression was investigated in endothelial cells (ECs), macrophages (MACs) and smooth muscle cells (SMCs) of carotid atheroma. TLR4 positivity, over-expression and intensity of immunostaining were compared in statin versus no-statin users. The results of this study showed that statin users had a significantly lower expression of TLR4 in ECs (P = 0.02, 0.001, 0.006 for TLR4 positivity, increased intensity and over-expression, respectively). Similarly, TLR4 positivity was less pronounced in carotid plaque MACs of statin users (P = 0.03). No carotid specimen with increased EC TLR4 intensity or over-expression was observed among statin users. The prevalence of any cerebrovascular accident was 61.4% in the 'no statin' versus 18.6% in the 'statin' group (odds ratio for statin use: 0.14, 95% CI: 0.07-0.31, P < 0.001). In conclusion, statin treatment is associated with attenuated TLR4 expression on human carotid atherosclerotic plaques and a reduced risk of carotid-related cerebrovascular events. TLR4 may potentially mediate statins' plaque stabilization effects. Further investigation is necessary.
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Affiliation(s)
- Athanasios Katsargyris
- st Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Goudi, Athens, Greece.
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Wallace BK, Foroutan S, O'Donnell ME. Ischemia-induced stimulation of Na-K-Cl cotransport in cerebral microvascular endothelial cells involves AMP kinase. Am J Physiol Cell Physiol 2011; 301:C316-26. [PMID: 21562306 PMCID: PMC3154550 DOI: 10.1152/ajpcell.00517.2010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/09/2011] [Indexed: 11/22/2022]
Abstract
Increased blood-brain barrier (BBB) Na-K-Cl cotransporter activity appears to contribute to cerebral edema formation during ischemic stroke. We have shown previously that inhibition of BBB Na-K-Cl cotransporter activity reduces edema and infarct in the rat middle cerebral artery occlusion (MCAO) model of ischemic stroke. We have also shown that the BBB cotransporter is stimulated by the ischemic factors hypoxia, aglycemia, and arginine vasopressin (AVP), although the mechanisms responsible are not well understood. AMP-activated protein kinase (AMPK), a key mediator of cell responses to stress, can be activated by a variety of stresses, including ischemia, hypoxia, and aglycemia. Previous studies have shown that the AMPK inhibitor Compound C significantly reduces infarct in mouse MCAO. The present study was conducted to evaluate the possibility that AMPK participates in ischemic factor-induced stimulation of the BBB Na-K-Cl cotransporter. Cerebral microvascular endothelial cells (CMEC) were assessed for Na-K-Cl cotransporter activity as bumetanide-sensitive (86)Rb influx. AMPK activity was assessed by Western blot analysis and immunofluorescence methods using antibodies that detect total versus phosphorylated (activated) AMPK. We found that hypoxia (7% and 2% O(2)), aglycemia, AVP, and oxygen-glucose deprivation (5- to 120-min exposures) increase activation of AMPK. We also found that Compound C inhibition of AMPK reduces hypoxia-, aglycemia-, and AVP-induced stimulation of CMEC Na-K-Cl cotransporter activity. Confocal immunofluorescence of perfusion-fixed rat brain slices revealed the presence of AMPK, both total and phosphorylated kinase, in BBB in situ of both control and ischemic brain. These findings suggest that ischemic factor stimulation of the BBB Na-K-Cl cotransporter involves activation of AMPK.
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Affiliation(s)
- Breanna K Wallace
- Department of Physiology and Membrane Biology, University of California, Davis, CA 95616, USA
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