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Rajabian A, McCloskey AP, Jamialahmadi T, Moallem SA, Sahebkar A. A review on the efficacy and safety of lipid-lowering drugs in neurodegenerative disease. Rev Neurosci 2023; 34:801-824. [PMID: 37036894 DOI: 10.1515/revneuro-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023]
Abstract
There is a train of thought that lipid therapies may delay or limit the impact of neuronal loss and poor patient outcomes of neurodegenerative diseases (NDDs). A variety of medicines including lipid lowering modifiers (LLMs) are prescribed in NDDs. This paper summarizes the findings of clinical and observational trials including systematic reviews and meta-analyses relating to LLM use in NDDs published in the last 15 years thus providing an up-to-date evidence pool. Three databases were searched PubMed, CINAHL, and Web of Science using key terms relating to the review question. The findings confirm the benefit of LLMs in hyperlipidemic patients with or without cardiovascular risk factors due to their pleotropic effects. In NDDs LLMs are proposed to delay disease onset and slow the rate of progression. Clinical observations show that LLMs protect neurons from α-synuclein, tau, and Aβ toxicity, activation of inflammatory processes, and ultimately oxidative injury. Moreover, current meta-analyses and clinical trials indicated low rates of adverse events with LLMs when used as monotherapy. LLMs appear to have favorable safety and tolerability profiles with few patients stopping treatment due to severe adverse effects. Our collated evidence thus concludes that LLMs have a role in NDDs but further work is needed to understand the exact mechanism of action and reach more robust conclusions on where and when it is appropriate to use LLMs in NDDs in the clinic.
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Affiliation(s)
- Arezoo Rajabian
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alice P McCloskey
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Tannaz Jamialahmadi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Adel Moallem
- Department of Pharmacology and Toxicology, College of Pharmacy, Al-Zahraa University for Women, Karbala, Iraq
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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2
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Kunvariya AD, Dave SA, Modi ZJ, Patel PK, Sagar SR. Exploration of multifaceted molecular mechanism of angiotensin-converting enzyme 2 (ACE2) in pathogenesis of various diseases. Heliyon 2023; 9:e15644. [PMID: 37153428 PMCID: PMC10160752 DOI: 10.1016/j.heliyon.2023.e15644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
Angiotensin converting enzyme 2 (ACE2) is a homolog of ACE (a transmembrane bound dipeptidyl peptidase enzyme). ACE2 converts angiotensinogen to the heptapeptide angiotensin-(1-7). ACE2 and its product, angiotensin-(1-7), have counteracting effects against the adverse actions of other members of renin-angiotensin system (RAS). ACE2 and its principal product, angiotensin-(1-7), were considered an under recognized arm of the RAS. The COVID-19 pandemic brought to light this arm of RAS with special focus on ACE2. Membrane bound ACE2 serves as a receptor for SARS-CoV-2 viral entry through spike proteins. Apart from that, ACE2 is also involved in the pathogenesis of various other diseases like cardiovascular disease, cancer, respiratory diseases, neurodegenerative diseases and infertility. The present review focuses on the molecular mechanism of ACE2 in neurodegenerative diseases, cancer, cardiovascular disease, infertility and respiratory diseases, including SARS-CoV-2. This review summarizes unveiled roles of ACE2 in the pathogenesis of various diseases which further provides intriguing possibilities for the use of ACE2 activators and RAS modulating agents for various diseases.
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Affiliation(s)
- Aditi D. Kunvariya
- Department of Pharmaceutical Chemistry, L.J. Institute of Pharmacy, L J University, Ahmedabad 382 210, India
| | - Shivani A. Dave
- Department of Pharmaceutical Chemistry, L.J. Institute of Pharmacy, L J University, Ahmedabad 382 210, India
| | - Zeal J. Modi
- Department of Pharmaceutical Chemistry, L.J. Institute of Pharmacy, L J University, Ahmedabad 382 210, India
| | - Paresh K. Patel
- Department of Pharmaceutical Chemistry, L.J. Institute of Pharmacy, L J University, Ahmedabad 382 210, India
| | - Sneha R. Sagar
- Department of Pharmaceutical Chemistry, L.J. Institute of Pharmacy, L J University, Ahmedabad 382 210, India
- Corresponding author.
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3
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Khan A, Podlasek A, Somaa F. Virtual reality in post-stroke neurorehabilitation - a systematic review and meta-analysis. Top Stroke Rehabil 2023; 30:53-72. [PMID: 34747351 DOI: 10.1080/10749357.2021.1990468] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stroke is a neurological disorder and one of the leading causes of disability worldwide. The patient may lose the ability to adequately move the extremities, perceive sensations, or ambulate independently. Recent experimental studies have reported the beneficial influence of virtual reality training strategies on improving overall functional abilities for stroke survivors. METHODS Conducted a systematic review of the literature using the following keywords to retrieve the data: stroke, virtual reality, motor deficits, neurorehabilitation, cognitive impairments, and sensory deficits. A random-effect meta-analysis was performed for seven scales - one cognitive (MMSE) and six motor (Fugl-Meyer, Berg Balance Scale, Time up and go, Wolf motor function, 10 m walk, Brunnstrom score). OBJECTIVE To organize and compare all the available data regarding the effectiveness of virtual reality for stroke rehabilitation. RESULTS This literature reviewed 150 studies and included 46 for qualitative and 27 for quantitative analysis. There was no statistically significant difference between groups in MMSE score (MD = 0.24, 95%CI = ((-0.42) -(0.9)), p = .47, I2 = 0%) and Fugl-Meyer score (MD = (-0.38), 95%CI = ((-12.88)-(12.11)), p = .95, I2 = 98%) . The statistical significance was not reached in any of the other outcomes. CONCLUSIONS This review supports that stroke rehabilitation programs incorporating virtual reality are associated with improved functional outcomes, but there is no statistically significant difference compared to standard therapy.
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Affiliation(s)
- Azka Khan
- Faculty of Rehabilitation and Allied Health Sciences Islamabad, Riphah International University, Rawalpindi, Pakistan
| | - Anna Podlasek
- Neuroscience and Vascular Simulation, School of Medicine, Anglia Ruskin University, Chelmsford, Essex, UK.,Nihr Nottingham Brc, University of Nottingham, Nottingham, UK.,Clinical Radiology,Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fahad Somaa
- King Abdulaziz University,Occupational Therapy Department, Faculty of Medical Rehabilitation Sciences, King AbdulAziz University Jeddah, Saudi, Arabia
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4
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Mohseni Afshar Z, Sharma A, Babazadeh A, Alizadeh-Khatir A, Sio TT, Taghizadeh Moghadam MA, Tavakolli Pirzaman A, Mojadad A, Hosseinzadeh R, Barary M, Ebrahimpour S. A review of the potential neurological adverse events of COVID-19 vaccines. Acta Neurol Belg 2023; 123:9-44. [PMID: 36385246 PMCID: PMC9668235 DOI: 10.1007/s13760-022-02137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
Despite the advantages of getting access to the coronavirus disease 2019 (COVID-19) vaccines, their potential ability to induce severe adverse events (AEs) has been a significant concern. Neurological complications are significant among the various adverse events following immunization (AEFI) due to their likely durability and debilitating sequelae. Neurological AEs following COVID-19 vaccination can either exacerbate or induce new-onset neuro-immunologic diseases, such as myasthenia gravis (MG) and Guillain-Barre syndrome (GBS). The more severe spectrum of AEs post-COVID19 vaccines has included seizures, reactivation of the varicella-zoster virus, strokes, GBS, Bell's palsy, transverse myelitis (TM), and acute disseminated encephalomyelitis (ADEM). Here, we discuss each of these neurological adverse effects separately.
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Affiliation(s)
- Zeinab Mohseni Afshar
- grid.412112.50000 0001 2012 5829Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akanksha Sharma
- grid.417468.80000 0000 8875 6339Department of Neurology, Mayo Clinic, Scottsdale, AZ USA
| | - Arefeh Babazadeh
- grid.411495.c0000 0004 0421 4102Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Alizadeh-Khatir
- grid.411495.c0000 0004 0421 4102Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Terence T. Sio
- grid.417468.80000 0000 8875 6339Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ USA
| | | | - Ali Tavakolli Pirzaman
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Ahmadreza Mojadad
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Rezvan Hosseinzadeh
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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5
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Miura Y, Suzuki H. Hypertriglyceridemia and Atherosclerotic Carotid Artery Stenosis. Int J Mol Sci 2022; 23:ijms232416224. [PMID: 36555866 PMCID: PMC9785250 DOI: 10.3390/ijms232416224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Both fasting and non-fasting hypertriglyceridemia have emerged as residual risk factors for atherosclerotic disease. However, it is unclear whether hypertriglyceridemia increases the risks of the progression of carotid artery stenosis. Statins are well known to prevent carotid plaque progression and improve carotid plaque instability. In addition, statin therapy is also known to reduce cerebrovascular events in patients with carotid artery stenosis and to improve clinical outcomes in patients undergoing revascularization procedures. On the other hand, there have been no randomized controlled trials showing that the combination of non-statin lipid-lowering drugs with statins has additional beneficial effects over statin monotherapy to prevent cerebrovascular events and stenosis progression in patients with carotid artery stenosis. In this article, the authors demonstrate the mechanisms of atherosclerosis formation associated with hypertriglyceridemia and the potential role of lipid-lowering drugs on carotid artery stenosis. The authors also review the articles reporting the relationships between hypertriglyceridemia and carotid artery stenosis.
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Affiliation(s)
| | - Hidenori Suzuki
- Correspondence: ; Tel.: +81-59-232-1111; Fax: +81-59-231-5212
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6
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Mardani M, Ganji R, Ghasemi N, Kazemi M, Razavi S. Impact of Intraventricular Human Adipose-Derived Stem Cells Transplantation with Pregnenolone Treatment on Remyelination of Corpus Callosum in A Rat Model of Multiple Sclerosis. CELL JOURNAL 2022; 24. [PMID: 36527347 PMCID: PMC9790074 DOI: 10.22074/cellj.2022.8173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Multiple sclerosis (MS) is known as a nerve tissue disorder, which causes demyelination of central nervous system (CNS) fibers. Cell-based treatment is a novel strategy for the treatment of demyelinating diseases such as MS. Adipose-derived stem cells (ADSCs) have neuroprotective and neuroregenerative effects and pregnenolone as a neurosteroid has remarkable roles in neurogenesis. We intend to examine the impact of intraventricular transplantation of human ADSCs and systemic injection of pregnenolone on the remyelination of a rat model cuprizone-induced demyelination. MATERIALS AND METHODS This experimental study was performed on 36 male Wistar rats that received a regular diet and a cuprizone diet for 3 weeks for M.S. induction. Through lipoaspirate surgery, human-ADSCs (hADSCs) were obtained from a patient. Six groups of rats (n=6): healthy, MS, sham, pregnenolone injection, ADSCs transplantation, and pregnenolone injection/ADSCs transplantation were included in this study. For assessment of remyelination, transmission electron microscopy (TEM), immunohistochemistry staining, real-time reverse transcription-polymerase chain reaction (RT-PCR), and enzyme-linked immunosorbent assay (ELISA) were performed. RESULTS TEM outcomes revealed an increase in the thickness of the fibers myelin in the treatment groups (P<0.05). We also observed a significant upregulation of MBP, PDGFR-α, and MOG after treatment with hADSCs and pregnenolone compared to other study groups (P<0.001). These results were confirmed by immunostaining analysis. Moreover, there was no significant difference between the ADSCs/pregnenolone group and the control group regarding the level of MBP, A2B5, and MOG proteins in ELISA. CONCLUSION Our data implied that the remyelination and cell recovery were more improved by intraventricular ADSCs transplantation and pregnenolone injection after inducing a rat model of MS.
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Affiliation(s)
- Mohammad Mardani
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,P.O.Box: 81746-73461Department of Anatomical SciencesSchool of MedicineIsfahan University of Medical
SciencesIsfahanIran
Emails:,
| | - Raosul Ganji
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazem Ghasemi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Kazemi
- Department of Genetics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Razavi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,P.O.Box: 81746-73461Department of Anatomical SciencesSchool of MedicineIsfahan University of Medical
SciencesIsfahanIran
Emails:,
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7
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Maria E, Das S, Varghese AM, Thangheswaran H, John M. Differentially Expressed Erythrocyte Proteins in Neuromyelitis Optica Spectrum Disorders and Their Functional Annotation Using DAVID Bioinformatics Tool. NEUROCHEM J+ 2022. [DOI: 10.1134/s1819712422040158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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8
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Seyedaghamiri F, Salimi L, Ghaznavi D, Sokullu E, Rahbarghazi R. Exosomes-based therapy of stroke, an emerging approach toward recovery. Cell Commun Signal 2022; 20:110. [PMID: 35869548 PMCID: PMC9308232 DOI: 10.1186/s12964-022-00919-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/11/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractBased on clinical observations, stroke is touted as one of the specific pathological conditions, affecting an individual’s life worldwide. So far, no effective treatment has been introduced to deal with stroke post-complications. Production and release of several neurotrophic factors by different cells exert positive effects on ischemic areas following stroke. As a correlate, basic and clinical studies have focused on the development and discovery of de novo modalities to introduce these factors timely and in appropriate doses into the affected areas. Exosomes (Exo) are non-sized vesicles released from many cells during pathological and physiological conditions and participate in intercellular communication. These particles transfer several arrays of signaling molecules, like several neurotrophic factors into the acceptor cells and induce specific signaling cascades in the favor of cell bioactivity. This review aimed to highlight the emerging role of exosomes as a therapeutic approach in the regeneration of ischemic areas.
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9
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Sabayan B. Primary Prevention of Ischemic Stroke. Semin Neurol 2022; 42:571-582. [PMID: 36395819 DOI: 10.1055/s-0042-1758703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ischemic stroke is by far the most common type of cerebrovascular event and remains a major cause of death and disability globally. Despite advancements in acute stroke care, primary prevention is still the most cost-effective approach in reducing the burden of ischemic stroke. The two main strategies for primary stroke prevention include population-wide versus high-risk group interventions. Interventions such as increasing access to primary care, regulation of salt and sugar contents in processed foods, public education, and campaigns to control cerebrovascular risk factors are examples of population-wide interventions. High-risk group interventions, on the other hand, focus on recognition of individuals at risk and aim to modify risk factors in a timely and multifaceted manner. This article provides an overview on conventional modifiable risk factors for ischemic stroke and highlights the emerging risk factors and approaches for high-risk group identification and treatment.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, HealthPartners Neuroscience Center, St. Paul, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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10
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Borghetti VS, Cintra VP, Ramos JDO, Marques VD, Onofre PT, Santana VAS, Bezerra LFP, Tomaselli PJ, dos Santos ACJ, Sobreira CFDR, Marques W. Misdiagnoses in a Brazilian population with amyotrophic lateral sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:676-680. [PMID: 36254439 PMCID: PMC9685820 DOI: 10.1055/s-0042-1755224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects the upper and lower motor neurons. The correct diagnosis at the onset of the disease is sometimes very difficult, due to the symptoms being very similar to those of other neurological syndromes. OBJECTIVE This study aimed to analyze the initial manifestations, the specialty of the first physician visited due the initial complaint, the misdiagnoses, as well as the unnecessary surgical interventions in a new ALS Brazilian population. METHODS The medical records of 173 patients with typical ALS were reviewed. RESULTS The present study demonstrated that other symptoms, besides weakness, were very frequent as initial presentation of ALS, and orthopedics was the medical specialty most sought by patients at the onset of symptoms. Our frequency of misdiagnoses was 69.7%, and in 7.1% of them, an unnecessary surgical intervention was performed. CONCLUSIONS Amyotrophic lateral sclerosis presents a very large pool of signs and symptoms; therefore, there is an urgent need of increasing the disease awareness to other specialties due to the high frequency of misdiagnoses observed in clinical practice.
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Affiliation(s)
| | - Vívian Pedigone Cintra
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
- Centro Universitário Municipal de Franca, Franca SP, Brazil
| | - Jean de Oliveira Ramos
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Vanessa Daccach Marques
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Patrícia Toscano Onofre
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | | | | | - Pedro José Tomaselli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | | | | | - Wilson Marques
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
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11
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Hupfeld KE, Richmond SB, McGregor HR, Schwartz DL, Luther MN, Beltran NE, Kofman IS, De Dios YE, Riascos RF, Wood SJ, Bloomberg JJ, Mulavara AP, Silbert LC, Iliff JJ, Seidler RD, Piantino J. Longitudinal MRI-visible perivascular space (PVS) changes with long-duration spaceflight. Sci Rep 2022; 12:7238. [PMID: 35513698 PMCID: PMC9072425 DOI: 10.1038/s41598-022-11593-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/20/2022] [Indexed: 01/07/2023] Open
Abstract
Humans are exposed to extreme environmental stressors during spaceflight and return with alterations in brain structure and shifts in intracranial fluids. To date, no studies have evaluated the effects of spaceflight on perivascular spaces (PVSs) within the brain, which are believed to facilitate fluid drainage and brain homeostasis. Here, we examined how the number and morphology of magnetic resonance imaging (MRI)-visible PVSs are affected by spaceflight, including prior spaceflight experience. Fifteen astronauts underwent six T1-weighted 3 T MRI scans, twice prior to launch and four times following their return to Earth after ~ 6-month missions to the International Space Station. White matter MRI-visible PVS number and morphology were calculated using an established, automated segmentation algorithm. We validated our automated segmentation algorithm by comparing algorithm PVS counts with those identified by two trained raters in 50 randomly selected slices from this cohort; the automated algorithm performed similarly to visual ratings (r(48) = 0.77, p < 0.001). In addition, we found high reliability for four of five PVS metrics across the two pre-flight time points and across the four control time points (ICC(3,k) > 0.50). Among the astronaut cohort, we found that novice astronauts showed an increase in total PVS volume from pre- to post-flight, whereas experienced crewmembers did not (p = 0.020), suggesting that experienced astronauts may exhibit holdover effects from prior spaceflight(s). Greater pre-flight PVS load was associated with more prior flight experience (r = 0.60-0.71), though these relationships did not reach statistical significance (p > 0.05). Pre- to post-flight changes in ventricular volume were not significantly associated with changes in PVS characteristics, and the presence of spaceflight associated neuro-ocular syndrome (SANS) was not associated with PVS number or morphology. Together, these findings demonstrate that PVSs can be consistently identified on T1-weighted MRI scans, and that spaceflight is associated with PVS changes. Specifically, prior spaceflight experience may be an important factor in determining PVS characteristics.
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Affiliation(s)
- Kathleen E. Hupfeld
- grid.15276.370000 0004 1936 8091Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd., Gainesville, FL USA
| | - Sutton B. Richmond
- grid.15276.370000 0004 1936 8091Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd., Gainesville, FL USA
| | - Heather R. McGregor
- grid.15276.370000 0004 1936 8091Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd., Gainesville, FL USA
| | - Daniel L. Schwartz
- grid.5288.70000 0000 9758 5690Layton-NIA Oregon Aging and Alzheimer’s Disease Research Center, Department of Neurology, Oregon Health and Science University, Portland, OR USA ,grid.5288.70000 0000 9758 5690Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR USA
| | - Madison N. Luther
- grid.5288.70000 0000 9758 5690Division of Child Neurology, Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR 97239 USA
| | | | | | | | - Roy F. Riascos
- grid.267308.80000 0000 9206 2401Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Scott J. Wood
- grid.419085.10000 0004 0613 2864NASA Johnson Space Center, Houston, TX USA
| | - Jacob J. Bloomberg
- grid.419085.10000 0004 0613 2864NASA Johnson Space Center, Houston, TX USA
| | | | - Lisa C. Silbert
- grid.5288.70000 0000 9758 5690Layton-NIA Oregon Aging and Alzheimer’s Disease Research Center, Department of Neurology, Oregon Health and Science University, Portland, OR USA ,grid.484322.bNeurology, Veteran’s Affairs Portland Health Care System, Portland, OR USA
| | - Jeffrey J. Iliff
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA ,grid.34477.330000000122986657Department of Neurology, University of Washington School of Medicine, Seattle, WA USA ,grid.413919.70000 0004 0420 6540VISN 20 Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA USA
| | - Rachael D. Seidler
- grid.15276.370000 0004 1936 8091Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd., Gainesville, FL USA ,grid.15276.370000 0004 1936 8091Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL USA
| | - Juan Piantino
- grid.5288.70000 0000 9758 5690Division of Child Neurology, Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR 97239 USA
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12
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Proteomics in Multiple Sclerosis: The Perspective of the Clinician. Int J Mol Sci 2022; 23:ijms23095162. [PMID: 35563559 PMCID: PMC9100097 DOI: 10.3390/ijms23095162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 02/08/2023] Open
Abstract
Multiple sclerosis (MS) is the inflammatory demyelinating and neurodegenerative disease of the central nervous system (CNS) that affects approximately 2.8 million people worldwide. In the last decade, a new era was heralded in by a new phenotypic classification, a new diagnostic protocol and the first ever therapeutic guideline, making personalized medicine the aim of MS management. However, despite this great evolution, there are still many aspects of the disease that are unknown and need to be further researched. A hallmark of these research are molecular biomarkers that could help in the diagnosis, differential diagnosis, therapy and prognosis of the disease. Proteomics, a rapidly evolving discipline of molecular biology may fulfill this dire need for the discovery of molecular biomarkers. In this review, we aimed to give a comprehensive summary on the utility of proteomics in the field of MS research. We reviewed the published results of the method in case of the pathogenesis of the disease and for biomarkers of diagnosis, differential diagnosis, conversion of disease courses, disease activity, progression and immunological therapy. We found proteomics to be a highly effective emerging tool that has been providing important findings in the research of MS.
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13
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Exosomes as cell-derivative carriers in the diagnosis and treatment of central nervous system diseases. Drug Deliv Transl Res 2021; 12:1047-1079. [PMID: 34365576 PMCID: PMC8942947 DOI: 10.1007/s13346-021-01026-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 02/08/2023]
Abstract
Exosomes are extracellular vesicles with the diameter ranging from 50 to 100 nm and are found in different body fluids such as blood, cerebrospinal fluid (CSF), urine and saliva. Like in case of various diseases, based on the parent cells, the content of exosomes (protein, mRNA, miRNA, DNA, lipids and metabolites) varies and thus can be utilized as potential biomarker for diagnosis and prognosis of the brain diseases. Furthermore, utilizing the natural potential exosomes to cross the blood–brain barrier and by specifically decorating it with the ligand as per the desired brain sites therapeutics can be delivered to brain parenchyma. This review article conveys the importance of exosomes and their use in the treatment and diagnosis of brain/central nervous system diseases.
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Gamdzyk M, Lenahan C, Tang J, Zhang JH. Role of peroxisome proliferator-activated receptors in stroke prevention and therapy-The best is yet to come? J Neurosci Res 2020; 98:2275-2289. [PMID: 32772463 DOI: 10.1002/jnr.24709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022]
Abstract
Role of peroxisome proliferator-activated receptors (PPARs) in the pathophysiology of stroke and protective effects of PPAR ligands have been widely investigated in the last 20 years. Activation of all three PPAR isoforms, but especially PPAR-γ, was documented to limit postischemic injury in the numerous in vivo, as well as in in vitro studies. PPARs have been demonstrated to act on multiple mechanisms and were shown to activate multiple protective pathways related to inflammation, apoptosis, BBB protection, neurogenesis, and oxidative stress. The aim of this review was to summarize two decades of PPAR research in stroke with emphasis on in vivo animal studies. We focus on each PPAR receptor separately and detail their implication in stroke. This review also discusses recent clinical efforts in the field and the epidemiological data with regard to role of PPAR polymorphisms in susceptibility to stroke, and tries to draw conclusions and describe future perspectives.
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Affiliation(s)
- Marcin Gamdzyk
- Department of Physiology and Pharmacology, Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Cameron Lenahan
- Department of Physiology and Pharmacology, Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jiping Tang
- Department of Physiology and Pharmacology, Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - John H Zhang
- Department of Physiology and Pharmacology, Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Department of Anesthesiology, Neurosurgery and Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Low total cholesterol and high density lipoprotein are independent predictors of poor outcomes following aneurysmal subarachnoid hemorrhage: A preliminary report. Clin Neurol Neurosurg 2020; 197:106062. [PMID: 32688095 DOI: 10.1016/j.clineuro.2020.106062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) is devastating, with delayed cerebral ischemia (DCI) significantly contributing to the high morbidity and mortality rates. Cholesterol has been studied as a measure of nutritional status in other neurological pathologies, but reports examining cholesterol's effects on aSAH outcomes are sparse. This study aimed to elucidate the effect of low total cholesterol (TC) and high density lipoprotein (HDL) on mortality and DCI following aSAH. METHODS We performed a retrospective cohort study at a quaternary academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography and had TC measured on admission. Primary outcomes were mortality and DCI. Secondary outcome was radiographic vasospasm. Univariate and multivariate logistic regressions were performed. RESULTS There were 75 aSAH patients, with an average age of 58.7 ± 1.7 (range: 14-89) and Hunt & Hess score of 2.8 ± 0.1, included for analysis. Those with a low TC < 160 mg/dL had 3 times increased odds of DCI (OR = 3.4; 95 %CI: 1.3-9.0; p = 0.0175) and a nearly 5 times increased odds of death (OR = 4.9; 95 %CI: 1.1-18.3; p = 0.0339). Low HDL < 40 mg/dL was associated with 12 times increased odds of DCI (OR = 12.3; 95 %CI: 2.7-56.4; p = 0.0003) but no significant differences in death (p = 0.2205). In multivariate analysis, low TC was an independent risk factor for increased mortality (OR = 5.6; 95 %CI: 1.2-27.6; p = 0.0335) while low HDL was associated with increased risk for DCI (OR = 17.9; 95 %CI: 3.1-104.4; p = 0.0013). There was no effect of TC or HDL on radiographic vasospasm. CONCLUSIONS Low TC and HDL are independent predictors of increased mortality and DCI, respectively, following aSAH. Low TC and HDL may be markers of poor overall health, in addition to having some pathophysiological effect on cerebral vasculature. These results may have practical implications for the improvement of aSAH prognostication and management.
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Zadeh FJ, Ghasemi Y, Bagheri S, Maleknia M, Davari N, Rezaeeyan H. Do exosomes play role in cardiovascular disease development in hematological malignancy? Mol Biol Rep 2020; 47:5487-5493. [PMID: 32319009 DOI: 10.1007/s11033-020-05453-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
Exosomes play a role in the pathogenesis and treatment of malignancies as a double-edged sword. Recently, researchers discussed about two new roles, cardiomyocyte function impairment and cardiovascular disease (CVD) genesis. Data were collected from PUBMED at various time points up to the 2019 academic year. The related key words are listed as following; "Arsenic trioxide", "acute promyelocytic leukemia" and "cardio toxicity" and "molecular pathway" and "biomarker". This study has shown that exosomes secreted substances stimulate angiogenesis and cardiomyocytes repairment; cited process depended on the kinds of released substances. Generally, exosomes may involve in the pathogenesis of CVD; although CVD can prevented by identifying the pathways that induce angiogenesis.
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Affiliation(s)
- Fatemeh Javaherforoosh Zadeh
- Department of Cardiac Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Yasmin Ghasemi
- Department of Cardiovascular Disease, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Saeede Bagheri
- High Institute for Education and Research in Transfusion Medicine, Tehran, Iran
| | - Mohsen Maleknia
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nader Davari
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hadi Rezaeeyan
- High Institute for Education and Research in Transfusion Medicine, Tehran, Iran.
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Cano Porras D, Siemonsma P, Inzelberg R, Zeilig G, Plotnik M. Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review. Neurology 2018; 90:1017-1025. [PMID: 29720544 DOI: 10.1212/wnl.0000000000005603] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Virtual reality (VR) has emerged as a therapeutic tool facilitating motor learning for balance and gait rehabilitation. The evidence, however, has not yet resulted in standardized guidelines. The aim of this study was to systematically review the application of VR-based rehabilitation of balance and gait in 6 neurologic cohorts, describing methodologic quality, intervention programs, and reported efficacy. METHODS This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. VR-based treatments of Parkinson disease, multiple sclerosis, acute and chronic poststroke, traumatic brain injury, and cerebral palsy were researched in PubMed and Scopus, including earliest available records. Therapeutic validity (CONTENT scale) and risk of bias in randomized controlled trials (RCT) (Cochrane Collaboration tool) and non-RCT (Newcastle-Ottawa scale) were assessed. RESULTS Ninety-seven articles were included, 68 published in 2013 or later. VR improved balance and gait in all cohorts, especially when combined with conventional rehabilitation. Most studies presented poor methodologic quality, lacked a clear rationale for intervention programs, and did not utilize motor learning principles meticulously. RCTs with more robust methodologic designs were widely recommended. CONCLUSION Our results suggest that VR-based rehabilitation is developing rapidly, has the potential to improve balance and gait in neurologic patients, and brings additional benefits when combined with conventional rehabilitation. This systematic review provides detailed information for developing theory-driven protocols that may assist overcoming the observed lack of argued choices for intervention programs and motor learning implementation and serves as a reference for the design and planning of personalized VR-based treatments. REGISTRATION PROSPERO CRD42016042051.
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Affiliation(s)
- Desiderio Cano Porras
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
| | - Petra Siemonsma
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
| | - Rivka Inzelberg
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
| | - Gabriel Zeilig
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
| | - Meir Plotnik
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands.
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McKay KA, Tremlett H, Fisk JD, Zhang T, Patten SB, Kastrukoff L, Campbell T, Marrie RA. Psychiatric comorbidity is associated with disability progression in multiple sclerosis. Neurology 2018. [PMID: 29523642 DOI: 10.1212/wnl.0000000000005302] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Emerging evidence suggests that comorbidity may influence disability outcomes in multiple sclerosis (MS); we investigated the association between psychiatric comorbidity and MS disability progression in a large multiclinic population. METHODS This retrospective cohort study accessed prospectively collected information from linked clinical and population-based health administrative databases in the Canadian provinces of British Columbia and Nova Scotia. Persons with MS who had depression, anxiety, or bipolar disorder were identified using validated algorithms using physician and hospital visits. Multivariable linear regression models fitted using an identity link with generalized estimating equations were used to determine the association between psychiatric comorbidity and disability using all available Expanded Disability Status Scale (EDSS) scores. RESULTS A total of 2,312 incident cases of adult-onset MS were followed for a mean of 10.5 years, during which time 35.8% met criteria for a mood or anxiety disorder. The presence of a mood or anxiety disorder was associated with a higher EDSS score (β coefficient = 0.28, p = 0.0002, adjusted for disease duration and course, age, sex, socioeconomic status, physical comorbidity count, and disease-modifying therapy exposure). Findings were statistically significant among women (β coefficient = 0.31, p = 0.0004), but not men (β coefficient 0.22, p = 0.17). CONCLUSION Presence of psychiatric comorbidities, which were common in our incident MS cohort, increased the severity of subsequent neurologic disability. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.
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Affiliation(s)
- Kyla A McKay
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Tingting Zhang
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lorne Kastrukoff
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Trudy Campbell
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Department of Medicine (K.A.M., H.T., L.K.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., T.C.) and School of Nursing, Faculty of Health Professions (T.C.), Dalhousie University, Halifax, Canada; Department of Health Services, Policy & Practice (T.Z.), Brown University School of Public Health, Providence, RI; Departments of Psychiatry and Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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Goldman MD, Koenig S, Engel C, McCartney CR, Sohn MW. Glucocorticoid-associated blood glucose response and MS relapse recovery. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e378. [PMID: 28761902 PMCID: PMC5515601 DOI: 10.1212/nxi.0000000000000378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the relationship between MS relapse recovery and blood glucose (BG) response to IV methylprednisolone (IVMP) treatment. METHODS We retrospectively identified 36 patients with MS admitted for IVMP treatment of acute relapse who had adequate data to characterize BG response, relapse severity, and recovery. The relationship between glucocorticoid-associated nonfasting BG (NFBG) and relapse recovery was assessed. RESULTS Highest recorded nonfasting BG (maximum NFBG [maxNFBG]) values were significantly higher in patients with MS without relapse recovery compared with those with recovery (271 ± 68 vs 209 ± 48 mg/dL, respectively; p = 0.0045). After adjusting for relapse severity, MS patients with maxNFBG below the group median were 6 times (OR = 6.01; 95% CI, 1.08-33.40; p = 0.040) more likely to experience relapse recovery than those with maxNFBG above the group median. In a multiple regression model adjusting for age, sex, and relapse severity, a 1-mg/dL increase in the maxNFBG was associated with 4.5% decrease in the probability of recovery (OR = 0.955; 95% CI, 0.928-0.983; p = 0.002). CONCLUSIONS These findings suggest that higher glucocorticoid-associated NFBG values in acutely relapsing patients with MS are associated with diminished probability of recovery. This relationship could reflect steroid-associated hyperglycemia and/or insulin resistance, defects in non-steroid-associated (e.g., prerelapse) glucose metabolism, or both. This study included only those admitted for an MS relapse, and it is this subset of patients for whom these findings may be most relevant. A prospective study to evaluate glucose regulation and MS relapse recovery in a broader outpatient MS population is under way.
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Affiliation(s)
- Myla D Goldman
- Department of Neurology (M.D.G.), Division of Endocrinology and Metabolism, Department of Medicine (C.R.M.), and Department of Public Health Sciences (M.-W.S.), University of Virginia School of Medicine, Charlottesville; University of Maryland School of Medicine (S.K.), Baltimore; and University of Virginia College of Arts and Sciences (C.E.), Charlottesville
| | - Scott Koenig
- Department of Neurology (M.D.G.), Division of Endocrinology and Metabolism, Department of Medicine (C.R.M.), and Department of Public Health Sciences (M.-W.S.), University of Virginia School of Medicine, Charlottesville; University of Maryland School of Medicine (S.K.), Baltimore; and University of Virginia College of Arts and Sciences (C.E.), Charlottesville
| | - Casey Engel
- Department of Neurology (M.D.G.), Division of Endocrinology and Metabolism, Department of Medicine (C.R.M.), and Department of Public Health Sciences (M.-W.S.), University of Virginia School of Medicine, Charlottesville; University of Maryland School of Medicine (S.K.), Baltimore; and University of Virginia College of Arts and Sciences (C.E.), Charlottesville
| | - Christopher R McCartney
- Department of Neurology (M.D.G.), Division of Endocrinology and Metabolism, Department of Medicine (C.R.M.), and Department of Public Health Sciences (M.-W.S.), University of Virginia School of Medicine, Charlottesville; University of Maryland School of Medicine (S.K.), Baltimore; and University of Virginia College of Arts and Sciences (C.E.), Charlottesville
| | - Min-Woong Sohn
- Department of Neurology (M.D.G.), Division of Endocrinology and Metabolism, Department of Medicine (C.R.M.), and Department of Public Health Sciences (M.-W.S.), University of Virginia School of Medicine, Charlottesville; University of Maryland School of Medicine (S.K.), Baltimore; and University of Virginia College of Arts and Sciences (C.E.), Charlottesville
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Neuhaus W, Krämer T, Neuhoff A, Gölz C, Thal SC, Förster CY. Multifaceted Mechanisms of WY-14643 to Stabilize the Blood-Brain Barrier in a Model of Traumatic Brain Injury. Front Mol Neurosci 2017; 10:149. [PMID: 28603485 PMCID: PMC5445138 DOI: 10.3389/fnmol.2017.00149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/03/2017] [Indexed: 12/27/2022] Open
Abstract
The blood-brain barrier (BBB) is damaged during ischemic insults such as traumatic brain injury or stroke. This contributes to vasogenic edema formation and deteriorate disease outcomes. Enormous efforts are pursued to understand underlying mechanisms of ischemic insults and develop novel therapeutic strategies. In the present study the effects of PPARα agonist WY-14643 were investigated to prevent BBB breakdown and reduce edema formation. WY-14643 inhibited barrier damage in a mouse BBB in vitro model of traumatic brain injury based on oxygen/glucose deprivation in a concentration dependent manner. This was linked to changes of the localization of tight junction proteins. Furthermore, WY-14643 altered phosphorylation of kinases ERK1/2, p38, and SAPK/JNK and was able to inhibit proteosomal activity. Moreover, addition of WY-14643 upregulated PAI-1 leading to decreased t-PA activity. Mouse in vivo experiments showed significantly decreased edema formation in a controlled cortical impact model of traumatic brain injury after WY-14643 application, which was not found in PAI-1 knockout mice. Generally, data suggested that WY-14643 induced cellular responses which were dependent as well as independent from PPARα mediated transcription. In conclusion, novel mechanisms of a PPARα agonist were elucidated to attenuate BBB breakdown during traumatic brain injury in vitro.
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Affiliation(s)
- Winfried Neuhaus
- Competence Unit Molecular Diagnostics, Competence Center Health and Bioresources, AIT Austrian Institute of Technology (AIT) GmbHVienna, Austria
| | - Tobias Krämer
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University of MainzMainz, Germany
| | - Anja Neuhoff
- Department of Anesthesia and Critical Care, Center of Operative Medicine, University Hospital WürzburgWürzburg, Germany
| | - Christina Gölz
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University of MainzMainz, Germany
| | - Serge C Thal
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University of MainzMainz, Germany
| | - Carola Y Förster
- Department of Anesthesia and Critical Care, Center of Operative Medicine, University Hospital WürzburgWürzburg, Germany
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Haussmann R, Bauer M, Donix M. [Evidence-based treatment of psychosis associated with Parkinson's disease]. DER NERVENARZT 2017; 87:543-51. [PMID: 26643499 DOI: 10.1007/s00115-015-4438-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Psychotic symptoms in Parkinson's disease are frequent phenomena and are often associated with an immense burden for caregivers, increased risk of nursing home placement and mortality. Treatment of psychotic disorders associated with Parkinson's disease often poses a therapeutic dilemma and necessitates a differentiated risk-benefit assessment as both the reduction of antiparkinsonian drugs and use of antipsychotic drugs can result in deterioration of motor functions. This article gives an overview of relevant clinical aspects and highlights the pharmacological evidence-based treatment options.
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Affiliation(s)
- R Haussmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - M Bauer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Donix
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Effects of a combined aerobic and resistance exercise program in people with multiple sclerosis: a pilot study. SPORT SCIENCES FOR HEALTH 2016. [DOI: 10.1007/s11332-016-0310-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pallebage-Gamarallage M, Takechi R, Lam V, Elahy M, Mamo J. Pharmacological modulation of dietary lipid-induced cerebral capillary dysfunction: Considerations for reducing risk for Alzheimer's disease. Crit Rev Clin Lab Sci 2015; 53:166-83. [PMID: 26678521 DOI: 10.3109/10408363.2015.1115820] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An increasing body of evidence suggests that cerebrovascular dysfunction and microvessel disease precede the evolution of hallmark pathological features that characterise Alzheimer's disease (AD), consistent with a causal association for onset or progression. Recent studies, principally in genetically unmanipulated animal models, suggest that chronic ingestion of diets enriched in saturated fats and cholesterol may compromise blood-brain barrier (BBB) integrity resulting in inappropriate blood-to-brain extravasation of plasma proteins, including lipid macromolecules that may be enriched in amyloid-β (Aβ). Brain parenchymal retention of blood proteins and lipoprotein bound Aβ is associated with heightened neurovascular inflammation, altered redox homeostasis and nitric oxide (NO) metabolism. Therefore, it is a reasonable proposition that lipid-lowering agents may positively modulate BBB integrity and by extension attenuate risk or progression of AD. In addition to their robust lipid lowering properties, reported beneficial effects of lipid-lowering agents were attributed to their pleiotropic properties via modulation of inflammation, oxidative stress, NO and Aβ metabolism. The review is a contemporary consideration of a complex body of literature intended to synthesise focussed consideration of mechanisms central to regulation of BBB function and integrity. Emphasis is given to dietary fat driven significant epidemiological evidence consistent with heightened risk amongst populations consuming greater amounts of saturated fats and cholesterol. In addition, potential neurovascular benefits associated with the use of hypolipidemic statins, probucol and fenofibrate are also presented in the context of lipid-lowering and pleiotropic properties.
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Affiliation(s)
- Menuka Pallebage-Gamarallage
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
| | - Ryusuke Takechi
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
| | - Virginie Lam
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
| | - Mina Elahy
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
| | - John Mamo
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
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Sando KR, Knight M. Nonstatin therapies for management of dyslipidemia: a review. Clin Ther 2015; 37:2153-79. [PMID: 26412799 DOI: 10.1016/j.clinthera.2015.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/29/2015] [Accepted: 09/01/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Recently published cholesterol treatment guidelines emphasize the use of statins as the preferred treatment strategy for both primary and secondary prevention of CVD. However, the optimal treatment strategy for patients who cannot tolerate statin therapy or those who need additional lipid-lowering therapy is unclear in light of recent evidence that demonstrates a lack of improved cardiovascular outcomes with combination therapy. The purpose of this review is to summarize and interpret evidence that evaluates nonstatin drug classes in reducing cardiovascular outcomes, to provide recommendations for use of nonstatin therapies in clinical practice, and to review emerging nonstatin therapies for management of dyslipidemia. METHODS Relevant articles were identified through searches of PubMed, International Pharmaceutical Abstracts, and the Cochrane Database of Systematic Reviews by using the terms niacin, omega-3 fatty acids (FAs), clofibrate, fibrate, fenofibrate, fenofibric acid, gemfibrozil, cholestyramine, colestipol, colesevelam, ezetimibe, proprotein convertase subtilisin/kexin 9 (PCSK9), cholesteryl ester transfer protein (CETP), and cardiovascular outcomes. Only English language, human clinical trials, meta-analyses, and systematic reviews were included. Additional references were identified from citations of published articles. FINDINGS Niacin may reduce cardiovascular events as monotherapy; however, recent trials in combination with statins have failed to show a benefit. Trials with omega-3 FAs have failed to demonstrate significant reductions in cardiovascular outcomes. Fibrates may improve cardiovascular outcomes as monotherapy; however, trials in combination with statins have failed to show a benefit, except in those with elevated triglycerides (>200 mg/dL) or low HDL-C (<40 mg/dL). There is a lack of data that evaluates bile acid sequestrant in combination with statin therapy on reducing cardiovascular events. Ezetimibe-statin combination therapy can reduce cardiovascular outcomes in those with chronic kidney disease and following vascular surgery or acute coronary syndrome. Long-term effects of emerging nonstatin therapies (CETP and PCSK9 inhibitors) are currently being evaluated in ongoing Phase III trials. IMPLICATIONS Nonstatin therapies have a limited role in reducing cardiovascular events in those maintained on guideline-directed statin therapy. In certain clinical situations, such as patients who are unable to tolerate statin therapy or recommended intensities of statin therapy, those with persistent severe elevations in triglycerides, or patients with high cardiovascular risk, some nonstatin therapies may be useful in reducing cardiovascular events. Future research is needed to evaluate the role of nonstatin therapies in those who are unable to tolerate guideline-directed statin doses.
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Affiliation(s)
- Karen R Sando
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, Florida.
| | - Michelle Knight
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, Florida
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Alternativas terapéuticas al manejo farmacológico con estatinas en adultos con dislipidemia. Revisión sistemática de la literatura y recomendaciones generales. REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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The Expression and Significance of the Plasma Let-7 Family in Anti-N-methyl-D-aspartate Receptor Encephalitis. J Mol Neurosci 2015; 56:531-9. [PMID: 25603816 DOI: 10.1007/s12031-015-0489-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/01/2015] [Indexed: 01/09/2023]
Abstract
The study aimed to investigate the expression and significance of the plasma let-7 family in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Blood samples from 5 anti-NMDAR encephalitis patients and 5 negative controls were collected for microarray analysis. Blood samples from10 anti-NMDAR encephalitis patients, 10 anti-NMDAR encephalitis patients whose physical conditions have improved after 3 months of immunotherapy, 20 virus (meningitis) encephalitis patients, 20 tuberculosis (meningitis) encephalitis patients, 10 purulent (meningitis) encephalitis patients, 20 cerebral cysticercosis patients, 20 ischemic stroke patients, 20 intracerebral hemorrhage patients, 15 neuromyelitis optica patients, 15 multiple sclerosis patients, 15 moyamoya disease patients, and 20 negative controls were collected for real-time quantitative PCR (qRT-PCR) analysis. The expression levels of let-7a, let-7b, let-7d, and let-7f were significantly down-regulated in anti-NMDAR encephalitis compared with the negative controls (NC). The expression levels of let-7a, let-7d, and let-7f were significantly down-regulated in other nervous system diseases compared with the NC group while the expression level of let-7b was statistically insignificant in other nervous system diseases compared with the NC group. In addition, there was no significant dysregulation of let-7b in the anti-NMDAR encephalitis treatment group compared with the NC. Let-7b may be a potential diagnostic marker and an indicator that reflected the molecular mechanism of anti-NMDAR encephalitis.
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Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:3754-832. [PMID: 25355838 PMCID: PMC5020564 DOI: 10.1161/str.0000000000000046] [Citation(s) in RCA: 989] [Impact Index Per Article: 98.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.
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Jackman M, Novak I, Lannin N. Effectiveness of functional hand splinting and the cognitive orientation to occupational performance (CO-OP) approach in children with cerebral palsy and brain injury: two randomised controlled trial protocols. BMC Neurol 2014; 14:144. [PMID: 25023385 PMCID: PMC4107752 DOI: 10.1186/1471-2377-14-144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) and brain injury (BI) are common conditions that have devastating effects on a child's ability to use their hands. Hand splinting and task-specific training are two interventions that are often used to address deficits in upper limb skills, both in isolation or concurrently. The aim of this paper is to describe the method to be used to conduct two randomised controlled trials (RCT) investigating (a) the immediate effect of functional hand splints, and (b) the effect of functional hand splints used concurrently with task-specific training compared to functional hand splints alone, and to task-specific training alone in children with CP and BI. The Cognitive Orientation to Occupational Performance (CO-OP) approach will be the task-specific training approach used. METHODS/DESIGN Two concurrent trials; a two group, parallel design, RCT with a sample size of 30 participants (15 per group); and a three group, parallel design, assessor blinded, RCT with a sample size of 45 participants (15 per group). INCLUSION CRITERIA age 4-15 years; diagnosis of CP or BI; Manual Abilities Classification System (MACS) level I - IV; hand function goals; impaired hand function; the cognitive, language and behavioural ability to participate in CO-OP. Participants will be randomly allocated to one of 3 groups; (1) functional hand splint only (n=15); (2) functional hand splint combined with task-specific training (n=15); (3) task-specific training only (n=15). Allocation concealment will be achieved using sequentially numbered, sealed opaque envelopes opened by an off-site officer after baseline measures. Treatment will be provided for a period of 2 weeks, with outcome measures taken at baseline, 1 hour after randomisation, 2 weeks and 10 weeks. The functional hand splint will be a wrist cock-up splint (+/- thumb support or supination strap). Task-specific training will involve 10 sessions of CO-OP provided in a group of 2-4 children. Primary outcome measures will be the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scale (GAS). Analysis will be conducted on an intention-to-treat basis. DISCUSSION This paper outlines the protocol for two randomised controlled trials investigating functional hand splints and CO-OP for children with CP and BI.
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Affiliation(s)
- Michelle Jackman
- University of Notre Dame, School of Medicine, Sydney, Australia
- Department of Occupational Therapy, John Hunter Children’s Hospital, Locked Bag 1, HRMC, Newcastle, NSW 3210, Australia
| | - Iona Novak
- University of Notre Dame, School of Medicine, Sydney, Australia
- Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - Natasha Lannin
- Department of Occupational Therapy, La Trobe University, Faculty of Health Sciences, Melbourne, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
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Valanti E, Tsompanidis A, Sanoudou D. Pharmacogenomics in the development and characterization of atheroprotective drugs. Methods Mol Biol 2014; 1175:259-300. [PMID: 25150873 DOI: 10.1007/978-1-4939-0956-8_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Atherosclerosis is the main cause of cardiovascular disease (CVD) and can lead to stroke, myocardial infarction, and death. The clinically available atheroprotective drugs aim mainly at reducing the levels of circulating low-density lipoprotein (LDL), increasing high-density lipoprotein (HDL), and attenuating inflammation. However, the cardiovascular risk remains high, along with morbidity, mortality, and incidence of adverse drug events. Pharmacogenomics is increasingly contributing towards the characterization of existing atheroprotective drugs, the evaluation of novel ones, and the identification of promising, unexplored therapeutic targets, at the global molecular pathway level. This chapter presents highlights of pharmacogenomics investigations and discoveries that have contributed towards the elucidation of pharmacological atheroprotection, while opening the way to new therapeutic approaches.
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Affiliation(s)
- Efi Valanti
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
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Mao PJ, Zhang C, Tang L, Xian YQ, Li YS, Wang WD, Zhu XH, Qiu HL, He J, Zhou YH. Effect of calcium or vitamin D supplementation on vascular outcomes: a meta-analysis of randomized controlled trials. Int J Cardiol 2013; 169:106-11. [PMID: 24035175 DOI: 10.1016/j.ijcard.2013.08.055] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/07/2013] [Accepted: 08/18/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Whether calcium or vitamin D supplementation reduces serious vascular outcomes in older people remains unclear. We conducted a meta-analysis based on randomized controlled trials to evaluate the effect of calcium or vitamin D supplementation on the risk of major cardiovascular outcomes. METHODS We performed electronic searches in PubMed, Embase, and the Cochrane Library to identify relevant randomized controlled trials. Odds ratios (ORs) were used to measure the effect of calcium or vitamin D supplementation on the risk of major vascular outcomes with a random-effect model. RESULTS Of the 1643 identified studies, we included 11 trials reporting data on 50,252 individuals. These studies reported 2685 major cardiovascular events, 1097 events of myocardial infarction, and 1350 events of stroke. Calcium or vitamin D supplementation did not have an effect on major cardiovascular events (OR, 1.03; 95% confidence interval [CI]: 0.94-1.12; P=0.54), myocardial infarction (OR, 1.08; 95% CI: 0.96-1.22; P=0.21), or stroke (OR, 1.01; 95% CI: 0.91-1.13; P=0.80) when compared to the effect with a placebo. Subgroup analysis indicated that calcium supplementation alone might play an important role in increasing the risk of major cardiovascular events, myocardial infarction, and stroke, but this difference could not be identified as statistically significant. Furthermore, males seem to experience more harmful effects with supplements of calcium or vitamin D than the effects experienced by females. CONCLUSIONS Calcium supplementation might increase the risk of major cardiovascular events, myocardial infarction, and stroke compared to the risk with a placebo.
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Affiliation(s)
- Pei-Juan Mao
- Department of VIP Special Clinic, Shanghai Seventh People's Hospital, Shanghai, China
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