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Guan X, Zhu S, Song J, Liu K, Liu M, Xie L, Wang Y, Wu J, Xu X, Pang T. Microglial CMPK2 promotes neuroinflammation and brain injury after ischemic stroke. Cell Rep Med 2024; 5:101522. [PMID: 38701781 PMCID: PMC11148565 DOI: 10.1016/j.xcrm.2024.101522] [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: 10/29/2023] [Revised: 02/08/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024]
Abstract
Neuroinflammation plays a significant role in ischemic injury, which can be promoted by oxidized mitochondrial DNA (Ox-mtDNA). Cytidine/uridine monophosphate kinase 2 (CMPK2) regulates mtDNA replication, but its role in neuroinflammation and ischemic injury remains unknown. Here, we report that CMPK2 expression is upregulated in monocytes/macrophages and microglia post-stroke in humans and mice, respectively. Microglia/macrophage CMPK2 knockdown using the Cre recombination-dependent adeno-associated virus suppresses the inflammatory responses in the brain, reduces infarcts, and improves neurological outcomes in ischemic CX3CR1Cre/ERT2 mice. Mechanistically, CMPK2 knockdown limits newly synthesized mtDNA and Ox-mtDNA formation and subsequently blocks NLRP3 inflammasome activation in microglia/macrophages. Nordihydroguaiaretic acid (NDGA), as a CMPK2 inhibitor, is discovered to reduce neuroinflammation and ischemic injury in mice and prevent the inflammatory responses in primary human monocytes from ischemic patients. Thus, these findings identify CMPK2 as a promising therapeutic target for ischemic stroke and other brain disorders associated with neuroinflammation.
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Affiliation(s)
- Xin Guan
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing 210009, P.R. China
| | - Sitong Zhu
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing 210009, P.R. China
| | - Jinqian Song
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing 210009, P.R. China
| | - Kui Liu
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing 210009, P.R. China
| | - Mei Liu
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, P.R. China
| | - Luyang Xie
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing 210009, P.R. China
| | - Yifang Wang
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, P.R. China
| | - Jin Wu
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, P.R. China.
| | - Xiaojun Xu
- Department of Pharmacy, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Center for Innovative Traditional Chinese Medicine Target and New Drug Research, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang Province 322000, P.R. China.
| | - Tao Pang
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing 210009, P.R. China; State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing 210023, P.R. China.
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2
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Zhao J, Zhu R, He F, Wu M, Wu Y, Meng X, Liu X. Neuroprotective effects of galectin‑1 on cerebral ischemia/reperfusion injury by regulating oxidative stress. Exp Ther Med 2024; 27:154. [PMID: 38476925 PMCID: PMC10928996 DOI: 10.3892/etm.2024.12442] [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: 10/06/2023] [Accepted: 01/19/2024] [Indexed: 03/14/2024] Open
Abstract
Oxidative stress contributes to the pathology of cerebral ischemia/reperfusion (I/R) injury. Galectin-1 has shown an anti-oxidative stress effect. The present study investigated whether this anti-oxidative stress effect can account for the neuroprotective actions of galectin-1 induced by cerebral I/R injury. A cerebral I/R injury model was created in C57Bl/6 mice by transient occlusion of the middle cerebral artery, after which the mice were treated with galectin-1 for 3 days. Infarct volumes were measured. A rotarod test and neurological deficit score assessment was performed to evaluate the neurological deficits. Oxidative stress was evaluated by measuring the levels of reactive oxygen species (ROS) and lipid peroxidation malondialdehyde (MDA), while the anti-oxidative stress status was assessed by measuring molecules such as catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidation enzyme (GSH-Px) in the ischemic cerebral hemisphere of mice. The inflammatory cytokines, including Interleukin 1 (IL-1), IL-6 and tumor necrosis factor alpha (TNF-α) were measured, and the expression of microglia was evaluated by immunohistochemistry in the ischemic cerebral hemisphere of mice. Galectin-1 treatment ameliorated neurological deficits and reduced infarct volumes in the mice model with cerebral I/R injury. Moreover, it was demonstrated that galectin-1 can significantly alleviate cerebral I/R injury in the ischemic cerebral hemisphere by decreasing the production of ROS and MDA, but increasing the production of CAT, SOD and GSH-Px. Galectin-1 treatment decreased microglia expression, and IL-1, IL-6 and TNF-α levels in the ischemic cerebral hemisphere of mice. Galectin-1 could improve the outcome of cerebral I/R injury by alleviating oxidative stress. Moreover, the neuroprotective effect of galectin-1 in cerebral ischemia could be related to its anti-oxidative stress effect.
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Affiliation(s)
- Jie Zhao
- Department of Neurology, Beijing Geriatric Hospital, Beijing 100095, P.R. China
| | - Rui Zhu
- Department of Neurology, Beijing Geriatric Hospital, Beijing 100095, P.R. China
| | - Feifei He
- Department of Neurology, Beijing Geriatric Hospital, Beijing 100095, P.R. China
| | - Miao Wu
- Department of Neurology, Beijing Geriatric Hospital, Beijing 100095, P.R. China
| | - Yufu Wu
- Department of Neurology, Beijing Geriatric Hospital, Beijing 100095, P.R. China
| | - Xiangjun Meng
- Department of Neurology, Liaoyuan City Central Hospital, Liaoyuan, Jilin 136200, P.R. China
| | - Xiaohong Liu
- Department of Neurology, Beijing Geriatric Hospital, Beijing 100095, P.R. China
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Geng X, Du X, Wang W, Zhang C, Liu X, Qu Y, Zhao M, Li W, Zhang M, Tu K, Li YQ. Confined Cascade Metabolic Reprogramming Nanoreactor for Targeted Alcohol Detoxification and Alcoholic Liver Injury Management. ACS NANO 2023; 17:7443-7455. [PMID: 37057958 DOI: 10.1021/acsnano.2c12075] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Alcoholic liver injury (ALI) is the leading cause of serious liver disease, whereas current treatments are mostly supportive and unable to metabolize alcohol directly. Here we report a metabolic reprogramming strategy for targeted alcohol detoxification and ALI management based on a confined cascade nanoreactor. The nanoreactor (named AA@mMOF) is designed by assembling natural enzymes of alcohol oxidase (AOx) and aldehyde dehydrogenase (ALDH) in the cavity of a mesoporous metal organic framework (mMOF) nanozyme with intrinsic catalase (CAT)-like activity. By conducting confined AOx/CAT/ALDH cascade reactions, AA@mMOF enables self-accelerated alcohol degradation (>0.5 mg·mL-1·h-1) with negligible aldehyde diffusion and accumulation, reprogramming alcohol metabolism and allowing high-efficiency detoxification. Administered to high-dose alcohol-intoxicated mice, AA@mMOF shows surprising liver targeting and accumulation performance and dramatically reduces blood alcohol concentration and rapidly reverses unconsciousness and acute liver injury to afford targeted alcoholism treatment. Moreover, AA@mMOF dramatically alleviates fat accumulation and oxidative stress in the liver of chronic alcoholism mice to block and reverse the progression of ALI. By conducting confined AOx/CAT/ALDH cascade reactions for high-efficiency alcohol metabolism reprogramming, AA@mMOF nanoreactor offers a powerful modality for targeted alcohol detoxification and ALI management. The proposed confined cascade metabolic reprogramming strategy provides a paradigm shift for the treatment of metabolic diseases.
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Affiliation(s)
- Xudong Geng
- Institute of Advanced Interdisciplinary Science, School of Physics, Shandong University, Jinan 250100, China
| | - Xuancheng Du
- Institute of Advanced Interdisciplinary Science, School of Physics, Shandong University, Jinan 250100, China
| | - Weijie Wang
- Institute of Advanced Interdisciplinary Science, School of Physics, Shandong University, Jinan 250100, China
| | - Chengmei Zhang
- Laboratory Animal Center of Shandong University, Jinan 250012, China
| | - Xiangdong Liu
- Institute of Advanced Interdisciplinary Science, School of Physics, Shandong University, Jinan 250100, China
| | - Yuanyuan Qu
- Institute of Advanced Interdisciplinary Science, School of Physics, Shandong University, Jinan 250100, China
| | - Mingwen Zhao
- Institute of Advanced Interdisciplinary Science, School of Physics, Shandong University, Jinan 250100, China
| | - Weifeng Li
- Institute of Advanced Interdisciplinary Science, School of Physics, Shandong University, Jinan 250100, China
| | - Mingzhen Zhang
- School of Basic Medical Sciences, Xi'an Key Laboratory of Immune Related Diseases, Xi'an Jiaotong University, Xi'an 710061, China
| | - Kangsheng Tu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yong-Qiang Li
- Institute of Advanced Interdisciplinary Science, School of Physics, Shandong University, Jinan 250100, China
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Kamal FZ, Lefter R, Jaber H, Balmus IM, Ciobica A, Iordache AC. The Role of Potential Oxidative Biomarkers in the Prognosis of Acute Ischemic Stroke and the Exploration of Antioxidants as Possible Preventive and Treatment Options. Int J Mol Sci 2023; 24:ijms24076389. [PMID: 37047362 PMCID: PMC10094154 DOI: 10.3390/ijms24076389] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Ischemic strokes occur when the blood supply to a part of the brain is interrupted or reduced due to arterial blockage, and it often leads to damage to brain cells or death. According to a myriad of experimental studies, oxidative stress is an important pathophysiological mechanism of ischemic stroke. In this narrative review, we aimed to identify how the alterations of oxidative stress biomarkers could suggest a severity-reflecting diagnosis of ischemic stroke and how these interactions may provide new molecular targets for neuroprotective therapies. We performed an eligibility criteria-based search on three main scientific databases. We found that patients with acute ischemic stroke are characterized by increased oxidative stress markers levels, such as the total antioxidant capacity, F2-isoprostanes, hydroxynonenal, total and perchloric acid oxygen radical absorbance capacity (ORACTOT and ORACPCA), malondialdehyde (MDA), myeloperoxidase, and urinary 8-oxo-7,8-dihydro-2′-deoxyguanosine. Thus, acute ischemic stroke is causing significant oxidative stress and associated molecular and cellular damage. The assessment of these molecular markers could be useful in diagnosing ischemic stroke, finding its causes, predicting its severity and outcomes, reducing its impact on the cellular structures of the brain, and guiding preventive treatment towards antioxidant-based therapy as novel therapeutic alternatives.
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Siotto M, Germanotta M, Santoro M, Canali R, Pascali S, Insalaco S, Cipollini V, Papadopoulou D, Antonacci E, Aprile I. Oxidative Stress Status in Post Stroke Patients: Sex Differences. Healthcare (Basel) 2022; 10:healthcare10050869. [PMID: 35628006 PMCID: PMC9140331 DOI: 10.3390/healthcare10050869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
After a cerebral stroke insult, there is an overproduction of Reactive Oxygen Species (ROS), which overcome the antioxidant defenses, causing further tissues damage. The status of oxidative stress in stroke patients over time, particularly in those undergoing rehabilitation treatments, has been poorly investigated. We analyzed the oxidative stress status in 61 subacute stroke patients (33 females and 28 males) admitted to our rehabilitation center by measuring, in serum: hydroperoxides levels (d-ROMs), antioxidant activity (BAP test), and the relative antioxidant capacity (OSI index). We also analyzed patients for glucose levels and lipid profile. In addition, we analyzed the correlation between oxidative stress status biomarkers and motor deficits, disability, and pain. Almost all patients showed high or very high levels of d-ROMs, while BAP levels were apparently in the reference range of normality. Females had lower BAP values (females: 2478 ± 379; males: 2765 ± 590; p = 0.034) and lower OSI index (females: 5.7 ± 1.9; males: 6.8 ± 1.9; p = 0.043). Moreover, in the male group, the correlation with motor impairment and disability showed a worsened motor performance when oxidative stress is higher. Female group, on the other hand, had an unexpected different trend of correlation, probably due to an unbalanced systemic oxidative stress. Further research is needed to see if sex differences in oxidative stress status in subacute stroke patients persist after rehabilitation.
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Affiliation(s)
- Mariacristina Siotto
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
- Correspondence: ; Tel.: +39-0633086552
| | - Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
| | - Massimo Santoro
- Energy and Sustainable Economic Development, Division of Health Protection Technologies ENEA-Italian National Agency for New Technologies, 00123 Rome, Italy;
| | - Raffaella Canali
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
| | - Simona Pascali
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
| | - Sabina Insalaco
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
| | - Valeria Cipollini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
| | - Dionysia Papadopoulou
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
| | - Erika Antonacci
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (M.G.); (R.C.); (S.P.); (S.I.); (V.C.); (D.P.); (E.A.); (I.A.)
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Huang CY, Chiang WC, Yeh YC, Fan SC, Yang WH, Kuo HC, Li PC. Effects of virtual reality-based motor control training on inflammation, oxidative stress, neuroplasticity and upper limb motor function in patients with chronic stroke: a randomized controlled trial. BMC Neurol 2022; 22:21. [PMID: 35016629 PMCID: PMC8751278 DOI: 10.1186/s12883-021-02547-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immersive virtual reality (VR)-based motor control training (VRT) is an innovative approach to improve motor function in patients with stroke. Currently, outcome measures for immersive VRT mainly focus on motor function. However, serum biomarkers help detect precise and subtle physiological changes. Therefore, this study aimed to identify the effects of immersive VRT on inflammation, oxidative stress, neuroplasticity and upper limb motor function in stroke patients. METHODS Thirty patients with chronic stroke were randomized to the VRT or conventional occupational therapy (COT) groups. Serum biomarkers including interleukin 6 (IL-6), intracellular adhesion molecule 1 (ICAM-1), heme oxygenase 1 (HO-1), 8-hydroxy-2-deoxyguanosine (8-OHdG), and brain-derived neurotrophic factor (BDNF) were assessed to reflect inflammation, oxidative stress and neuroplasticity. Clinical assessments including active range of motion of the upper limb and the Fugl-Meyer Assessment for upper extremity (FMA-UE) were also used. Two-way mixed analyses of variance (ANOVAs) were used to examine the effects of the intervention (VRT and COT) and time on serum biomarkers and upper limb motor function. RESULTS We found significant time effects in serum IL-6 (p = 0.010), HO-1 (p = 0.002), 8-OHdG (p = 0.045), and all items/subscales of the clinical assessments (ps < 0.05), except FMA-UE-Coordination/Speed (p = 0.055). However, significant group effects existed only in items of the AROM-Elbow Extension (p = 0.007) and AROM-Forearm Pronation (p = 0.048). Moreover, significant interactions between time and group existed in item/subscales of FMA-UE-Shoulder/Elbow/Forearm (p = 0.004), FMA-UE-Total score (p = 0.008), and AROM-Shoulder Flexion (p = 0.001). CONCLUSION This was the first study to combine the effectiveness of immersive VRT using serum biomarkers as outcome measures. Our study demonstrated promising results that support the further application of commercial and immersive VR technologies in patients with chronic stroke.
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Affiliation(s)
- Chien-Yu Huang
- Department of Occupational Therapy, I-Shou University, Yanchao Dist., Kaohsiung, 824, Taiwan, R.O.C.,School of Occupational Therapy, National Taiwan University, Zhongzheng Dist., Taipei, 100, Taiwan, R.O.C
| | - Wei-Chi Chiang
- Department of Occupational Therapy, I-Shou University, Yanchao Dist., Kaohsiung, 824, Taiwan, R.O.C
| | - Ya-Chin Yeh
- Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, 741, Taiwan, R.O.C.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan, R.O.C
| | - Shih-Chen Fan
- Department of Occupational Therapy, I-Shou University, Yanchao Dist., Kaohsiung, 824, Taiwan, R.O.C
| | - Wan-Hsien Yang
- Tan-Chi International Technology Co., Ltd, 824, Kaohsiung, Taiwan, R.O.C
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 824, Taiwan R.O.C
| | - Ping-Chia Li
- Department of Occupational Therapy, I-Shou University, Yanchao Dist., Kaohsiung, 824, Taiwan, R.O.C..
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Kuwashiro T, Tanabe K, Hayashi C, Mizoguchi T, Mori K, Jinnouchi J, Yasaka M, Okada Y. Oxidized Albumin and Cartilage Acidic Protein-1 as Blood Biomarkers to Predict Ischemic Stroke Outcomes. Front Neurol 2021; 12:686555. [PMID: 34917008 PMCID: PMC8670551 DOI: 10.3389/fneur.2021.686555] [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: 03/27/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background: There is high demand for blood biomarkers that reflect the therapeutic response or predict the outcomes of patients with acute ischemic stroke (AIS); however, few biomarkers have been evidentially verified to date. This study evaluated two proteins, oxidized albumin (OxHSA) and cartilage acidic protein-1 (CRTAC1), as potential prognostic markers of AIS. Methods: The ratio of OxHSA to normal albumin (%OxHSA) and the level of CRTAC1 in the sera of 74 AIS patients were analyzed on admission (day 0), and at 1 and 7 days after admission. AIS patients were divided into two groups according to their modified Rankin Scale (mRS) at 3 months after discharge: the low-mRS (mRS < 2) group included 48 patients and the high-mRS (mRS ≥ 2) group included 26 patients. The differences in %OxHSA and CRTAC1 between the two groups on days 0, 1, and 7 were evaluated. Results: The mean %OxHSA values of the high-mRS group on days 0, 1, and 7 were significantly higher than those of the low-mRS group (p < 0.05). The CRTAC1 levels continuously increased from day 0 to day 7, and those of the high-mRS group were significantly higher than those of the low-mRS group on day 7 (p < 0.05). Conclusions: These results suggest that higher %OxHSA and CRTAC1 are associated with poor outcomes in AIS patients. An index that combines %OxHSA and CRTAC1 can accurately predict the outcomes of AIS patients.
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Affiliation(s)
- Takahiro Kuwashiro
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Kazuhiro Tanabe
- Medical Solution Promotion Department, Medical Solution Segment, LSI Medience Corporation, Tokyo, Japan.,Kyushu Pro Search Limited Liability Partnership, Fukuoka, Japan
| | - Chihiro Hayashi
- Medical Solution Promotion Department, Medical Solution Segment, LSI Medience Corporation, Tokyo, Japan
| | - Tadataka Mizoguchi
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Kota Mori
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Juro Jinnouchi
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
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8
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Garcia-Rodriguez N, Rodriguez S, Tejada PI, Miranda-Artieda ZM, Ridao N, Buxó X, Pérez-Mesquida ME, Beseler MR, Salom JB, Pérez LM, Inzitari M, Otero-Villaverde S, Martin-Mourelle R, Molleda M, Quintana M, Olivé-Gadea M, Penalba A, Rosell A. Functional Recovery and Serum Angiogenin Changes According to Intensity of Rehabilitation Therapy After Stroke. Front Neurol 2021; 12:767484. [PMID: 34899582 PMCID: PMC8655101 DOI: 10.3389/fneur.2021.767484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Rehabilitation is still the only treatment available to improve functional status after the acute phase of stroke. Most clinical guidelines highlight the need to design rehabilitation treatments considering starting time, intensity, and frequency, according to the tolerance of the patient. However, there are no homogeneous protocols and the biological effects are under investigation. Objective: To investigate the impact of rehabilitation intensity (hours) after stroke on functional improvement and serum angiogenin (ANG) in a 6-month follow-up study. Methods: A prospective, observational, longitudinal, and multicenter study with three cohorts: strokes in intensive rehabilitation therapy (IRT, minimum 15 h/week) vs. conventional therapy (NO-IRT, <15 h/week), and controls subjects (without known neurological, malignant, or inflammatory diseases). A total of seven centers participated, with functional evaluations and blood sampling during follow-up. The final cohort includes 62 strokes and 43 controls with demographic, clinical, blood samples, and exhaustive functional monitoring. Results: The median (IQR) number of weekly hours of therapy was different: IRT 15 (15–16) vs. NO-IRT 7.5 (5–9), p < 0.01, with progressive and significant improvements in both groups. However, IRT patients showed earlier improvements (within 1 month) on several scales (CAHAI, FMA, and FAC; p < 0.001) and the earliest community ambulation achievements (0.89 m/s at 3 months). There was a significant difference in ANG temporal profile between the IRT and NO-IRT groups (p < 0.01). Additionally, ANG was elevated at 1 month only in the IRT group (p < 0.05) whereas it decreased in the NO-IRT group (p < 0.05). Conclusions: Our results suggest an association of rehabilitation intensity with early functional improvements, and connect the rehabilitation process with blood biomarkers.
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Affiliation(s)
- Nicolás Garcia-Rodriguez
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Barcelona, Spain
| | - Susana Rodriguez
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Natalia Ridao
- Servei de Medicina Física i Rehabilitació, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Xavi Buxó
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Maria Rosario Beseler
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan B Salom
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe-Universitat de Valencia, Valencia, Spain.,Departamento de Fisiología, Universidad de Valencia, Valencia, Spain
| | - Laura M Pérez
- RE-FiT Barcelona Research Group, Vall d'Hebron Institute of Research, Parc Sanitari Pere Virgili, Barcelona, Spain.,Parc Sanitari Pere Virgili, Area of Intermediate Care, Barcelona, Spain
| | - Marco Inzitari
- RE-FiT Barcelona Research Group, Vall d'Hebron Institute of Research, Parc Sanitari Pere Virgili, Barcelona, Spain.,Universitat Oberta de Catalunya, Barcelona, Spain
| | | | | | | | - Manuel Quintana
- Epilepsy Research Group and Epilepsy Unit, Vall d'Hebron Research Institute and Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rosell
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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9
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Gbotolorun SC, Ezeife CC, Ogunlade B. Prenatal exposure of bonny light crude oil induces embryotoxicity, impaired cognitive functions and cortico-hippocampal neurodegeneration on fetal outcomes of pregnant sprague-dawley rats. Drug Chem Toxicol 2021; 45:1978-1985. [PMID: 33719803 DOI: 10.1080/01480545.2021.1894721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The low Sulfur level, heavy metals and easy production rate of Bonny Light Crude Oil (BLCO) makes it one of Nigeria's most explored oil. This study investigated the memory impairments, embryotoxicity and cortico-hippocampal neurodegeneration induced by prenatal exposure to BLCO of pregnant Sprague-Dawley (S-D) rats. Twenty pregnant rats were divided into 4 groups (A-D) of 5 rats each. Group A received normal saline as placebo. Group B-D received oral doses of BLCO at 0.73 ml/kg, 2 ml/kg and 3.8 ml/kg on pregnancy day 8-12.5 respectively. The pregnant rats were allowed to litter and nurse their pups. At 6 weeks postnatal life, twelve (12) selected young rats (n = 12) were accessed for behavioral study (Y-maze) and then sacrificed for biochemical and histological analysis. The results showed spontaneous abortion, still births and significantly reduced number of live births in the high dose group of BLCO compared to control. Length of gestation was significantly increased in the high dose group when compared to the control. CAT levels reduced significantly with concomitant increase in 8-OHdG among BLCO treated groups compared to control. Spontaneous alteration and number of arm entries decreased in the BLCO groups in comparison to control. Histological observation showed reduced cellular size, chromatolysis and presence of extracellular senile plaques in the prefrontal cortex and mild histological changes in the hippocampus architecture in the BLCO treated groups compared to the control. BLCO is capable of inducing embryotoxicity, impair cognition and cortico-hippocampal neurodegeneration.
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Affiliation(s)
- S C Gbotolorun
- Anatomy Department, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Nigeria
| | - C C Ezeife
- Anatomy Department, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Nigeria
| | - B Ogunlade
- Anatomy Department, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Nigeria.,Human Anatomy Department, Federal University of Technology Akure, Akure, Nigeria
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10
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Syafrita Y, Amir D, Susanti R, Fadhilah I. Relationship of brain-derived neurotrophic factor, malondialdehyde, and 8-Hydroxy 2-Deoxyguanosine with post-ischemic stroke depression. Dement Neuropsychol 2020; 14:41-46. [PMID: 32206197 PMCID: PMC7077855 DOI: 10.1590/1980-57642020dn14-010007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/21/2019] [Indexed: 12/22/2022] Open
Abstract
A few studies have shown that serum brain-derived neurotrophic factor (BDNF) level in post-stroke depression is highly correlated with memory and neuropsychiatric disturbances. OBJECTIVE This study aimed to elucidate the relationship of serum BDNF, malondialdehyde (MDA), and 8-Hydroxy 2-Deoxyguanosine (8-OhdG) levels in acute stroke cases with one-month post-stroke depression. METHODS An observational study was conducted of 72 post-ischemic stroke patients in the Neurology ward of the Dr. M. Djamil Hospital, Padang, West Sumatra, Indonesia. Acute stroke (< 48 hours) serum BDNF, MDA, and 8-OhdG levels were measured using ELISA. Based on observations using the Hamilton Depression Rating Scale conducted one month after stroke, respondents were divided into two groups: with and without depression. The mean serum level was analyzed using the t-test and Mann-Whitney test, while differences in basic characteristics were analyzed using the Chi-square test. Multivariate analysis was conducted to determine the most significant factor associated with post-stroke depression. The error rate was set at 5%. RESULTS BDNF levels in acute stroke were significantly lower in the depression group than in the non-depression group (p < 0.05). MDA and 8-OhdG levels in acute stroke were higher in the depression group (p < 0.05). BDNF level during acute stroke was negatively correlated with post-stroke depression, while, conversely, acute stroke MDA and 8-OhdG levels were positively correlated with depression. CONCLUSION BDNF had a negative correlation, while MDA and 8-OhdG had a positive correlation, with depression one-month post-stroke. 8-OhdG was the most influential factor in post-stroke depression.
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Affiliation(s)
- Yuliarni Syafrita
- Neurology Department, Faculty of Medicine, Andalas University,
Indonesia
| | - Darwin Amir
- Hospital, Perintis Kemerdekaan Street, Padang, West Sumatra,
Indonesia
| | - Restu Susanti
- Neurology Department, Faculty of Medicine, Andalas University,
Indonesia
| | - I Fadhilah
- Neurology Department, Faculty of Medicine, Andalas University,
Indonesia
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11
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Oxaliplatin-Fluoropyrimidine Combination (XELOX) Therapy Does Not Affect Plasma Amino Acid Levels and Plasma Markers of Oxidative Stress in Colorectal Cancer Surgery Patients: A Pilot Study. Nutrients 2019; 11:nu11112667. [PMID: 31694176 PMCID: PMC6893861 DOI: 10.3390/nu11112667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/25/2019] [Accepted: 10/31/2019] [Indexed: 12/31/2022] Open
Abstract
Chemotherapy for colorectal cancer may lower muscle protein synthesis and increase oxidative stress. We hypothesize that chemotherapy may worsen plasma amino acids (AAs) and markers of oxidative stress (MOS). Therefore, this study aimed to document plasma AAs and MOS before, during and after chemotherapy in colorectal cancer (CRC) surgery patients. Fourteen normal-weight CRC patients were enrolled one month after surgery and scheduled for oxaliplatin-fluoropyrimidine combination (XELOX) therapy. Venous blood samples for AA and MOS (malondialdehyde, MDA; 8-hydroxy-2’-deoxyguanosine, 8-OHdG) measurements were drawn in fasting patients before each oxaliplatin infusion at initiation (A), 1 month (B) and 3 months (C) of the therapy, and after XELOX had finished (6 months, D). The results showed that during XELOX therapy (from phase B to phase D), in comparison to baseline (phase A), the branched chain amino acid/essential amino acid ratio, branched chain amino acids expressed as a percentage of total AAs, and arginine expressed as a percentage of total AAs significantly decreased (p = 0.017, p = 0.028, p = 0.028, respectively). Plasma levels of MOS did not change significantly. This study indicates that XELOX therapy does not affect plasma AA levels or worsen oxidative stress.
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12
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The Healing of Oxidative Injuries with Trehalose in UVB-Irradiated Rabbit Corneas. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:1857086. [PMID: 31641422 PMCID: PMC6770344 DOI: 10.1155/2019/1857086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/25/2019] [Accepted: 08/20/2019] [Indexed: 11/17/2022]
Abstract
Our previous research revealed that trehalose, a nonreducing disaccharide of glucose and an important stress responsive factor, proved to have anti-inflammatory, antiapoptotic, and particularly antioxidant properties in UVB-irradiated corneas. Trehalose reduced oxidative stress in corneas induced by UVB irradiation, by means of a decrease in the antioxidant/prooxidant imbalance in the corneal epithelium. In this study, we demonstrate that trehalose of 3% or 6% concentration in eye drops directly decreases oxidative stress in UVB-irradiated corneas, by removing the excessive amount of reactive oxygen species (ROS). Trehalose drops applied on corneas during UVB irradiation once daily for four days resulted in a reduction or even absence of the oxidative stress, DNA damage, and peroxynitrite formation (detected by nitrotyrosine residues), seen in buffer-treated corneas. Furthermore, trehalose treatment applied curatively after repeated irradiation for the subsequent fourteen days led to the renewal of corneal transparency and significant suppression or even absence of neovascularization. This was in contrast to buffer-treated irradiated corneas, where the intracorneal inflammation was developed and the untransparent corneas were vascularized. In conclusion, the treatment of UVB-irradiated corneas with trehalose eye drops removed the excessive amount of ROS in the corneal epithelium, leading to the suppression of oxidative stress and favorable corneal healing. The 6% trehalose showed a higher intensive antioxidant effect.
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13
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Flynn D, Eaton LH, Langford DJ, Ieronimakis N, McQuinn H, Burney RO, Holmes SL, Doorenbos AZ. A SMART design to determine the optimal treatment of chronic pain among military personnel. Contemp Clin Trials 2018; 73:68-74. [PMID: 30145267 PMCID: PMC6234001 DOI: 10.1016/j.cct.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 12/18/2022]
Abstract
Chronic pain is a leading cause of disability among active duty service members in the U.S. armed forces. Standard rehabilitative care and complementary and integrative health therapies are used for chronic pain rehabilitation. However, the optimal sequence and duration of these therapies has yet to be determined. This article describes a sequential multiple assignment randomized trial (SMART) protocol being used to identify the optimal components and sequence of standard rehabilitative care and complementary and integrative health therapies for reducing pain impact and improving other patient outcomes. Active duty service members referred to Madigan Army Medical Center for treatment of chronic pain are being recruited to the Determinants of the Optimal Dose and Sequence of Functional Restoration and Integrative Therapies study. Study participants are randomized to either standard rehabilitative care (physical and occupational therapy and psychoeducation) or complementary and integrative health therapies (chiropractic, acupuncture, yoga and psychoeducation). Those participants who do not respond to the first 3 weeks of treatment are randomized to receive an additional 3 weeks of either (1) the alternative treatment or (2) the first-stage treatment plus the alternative treatment. This study will also determine factors associated with treatment response that can support clinical decision making, such as baseline fitness, pain catastrophizing, kinesiophobia, post-traumatic stress, pain self-efficacy, and biological indicators. The information gained from this research will be applicable to all integrative chronic pain rehabilitation programs throughout the U.S. Department of Defense and the U.S. Department of Veterans Affairs, and the broader rehabilitation community.
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Affiliation(s)
- Diane Flynn
- Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Linda H Eaton
- School of Nursing & Health Studies, University of Washington Bothell, Box 358531, Bothell, WA 98011, USA.
| | - Dale J Langford
- School of Medicine, University of Washington Seattle, Box 356340, Seattle, WA 98195, USA.
| | - Nicholas Ieronimakis
- Madigan Army Medical Center, Department of Clinical Investigations, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Honor McQuinn
- Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Richard O Burney
- Madigan Army Medical Center, Department of Clinical Investigations, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Samuel L Holmes
- Madigan Army Medical Center, Department of Pain Management, 9040 Jackson Ave, Tacoma, WA 98431, USA.
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave, Chicago, IL 60612, USA.
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Gabriel-Salazar M, Morancho A, Rodriguez S, Buxó X, García-Rodríguez N, Colell G, Fernandez A, Giralt D, Bustamante A, Montaner J, Rosell A. Importance of Angiogenin and Endothelial Progenitor Cells After Rehabilitation Both in Ischemic Stroke Patients and in a Mouse Model of Cerebral Ischemia. Front Neurol 2018; 9:508. [PMID: 30008694 PMCID: PMC6034071 DOI: 10.3389/fneur.2018.00508] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Rehabilitation therapy is the only available treatment for stroke survivors presenting neurological deficits; however, the underlying molecules and mechanisms associated with functional/motor improvement during rehabilitation are poorly understood. Objective: Our aim is to study the modulation of angiogenin and endothelial progenitor cells (EPCs) as repair-associated factors in a cohort of stroke patients and mouse models of rehabilitation after cerebral ischemia. Methods: The clinical study included 18 ischemic strokes admitted to an intensive rehabilitation therapy (IRT) unit, 18 non-ischemic controls and brain samples from three deceased patients. Angiogenin and EPCs were measured in blood obtained before and up to 6 months after IRT together with an extensive evaluation of the motor/functional status. In parallel, C57BL/6 mice underwent middle cerebral artery occlusion, and the pasta matrix reaching-task or treadmill exercises were used as rehabilitation models. Angiogenin RNA expression was measured after 2 or 12 days of treatment together with cell counts from EPCs cultures. Results: Brain angiogenin was identified in both human and mouse tissue, whereas serum levels increased after 1 month of IRT in association with motor/functional improvement. EPC populations were increased after stroke and remained elevated during follow-up after IRT. The mouse model of rehabilitation by the task-specific pasta matrix exercise increased the number of EPCs at 2 days and increased angiogenin expression after 12 days of rehabilitation. Conclusions: Angiogenin and EPCs are modulated by rehabilitation after cerebral ischemia, suggesting that both angiogenin and EPCs could serve as biomarkers of improvement during rehabilitation or future therapeutic targets.
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Affiliation(s)
- Marina Gabriel-Salazar
- Neurovascular Research Laboratory and Neurology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Morancho
- Neurovascular Research Laboratory and Neurology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Rodriguez
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Barcelona, Spain
| | - Xavi Buxó
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Guillem Colell
- Neurovascular Research Laboratory and Neurology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Fernandez
- Neurovascular Research Laboratory and Neurology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory and Neurology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory and Neurology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory and Neurology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rosell
- Neurovascular Research Laboratory and Neurology Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Semprini M, Laffranchi M, Sanguineti V, Avanzino L, De Icco R, De Michieli L, Chiappalone M. Technological Approaches for Neurorehabilitation: From Robotic Devices to Brain Stimulation and Beyond. Front Neurol 2018; 9:212. [PMID: 29686644 PMCID: PMC5900382 DOI: 10.3389/fneur.2018.00212] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/16/2018] [Indexed: 12/30/2022] Open
Abstract
Neurological diseases causing motor/cognitive impairments are among the most common causes of adult-onset disability. More than one billion of people are affected worldwide, and this number is expected to increase in upcoming years, because of the rapidly aging population. The frequent lack of complete recovery makes it desirable to develop novel neurorehabilitative treatments, suited to the patients, and better targeting the specific disability. To date, rehabilitation therapy can be aided by the technological support of robotic-based therapy, non-invasive brain stimulation, and neural interfaces. In this perspective, we will review the above methods by referring to the most recent advances in each field. Then, we propose and discuss current and future approaches based on the combination of the above. As pointed out in the recent literature, by combining traditional rehabilitation techniques with neuromodulation, biofeedback recordings and/or novel robotic and wearable assistive devices, several studies have proven it is possible to sensibly improve the amount of recovery with respect to traditional treatments. We will then discuss the possible applied research directions to maximize the outcome of a neurorehabilitation therapy, which should include the personalization of the therapy based on patient and clinician needs and preferences.
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Affiliation(s)
| | | | - Vittorio Sanguineti
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, Genova, Italy
| | - Laura Avanzino
- Section of Human Physiology, Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy
| | - Roberto De Icco
- Department of Neurology and Neurorehabilitation, Istituto Neurologico Nazionale C. Mondino, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Liu Z, Cai Y, He J. High serum levels of 8-OHdG are an independent predictor of post-stroke depression in Chinese stroke survivors. Neuropsychiatr Dis Treat 2018; 14:587-596. [PMID: 29497302 PMCID: PMC5822852 DOI: 10.2147/ndt.s155144] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Although previous studies have investigated oxidative stress biomarkers in association with depression in non-stroke subjects, the association between oxidative deoxyribonucleic acid damage and post-stroke depression (PSD) remains unelucidated. PATIENTS AND METHODS Two hundred forty-one first-ever ischemic stroke patients were consecutively recruited within the first 24 h of stroke onset and were followed up at 1 month. Serum 8-hydroxy-2'-deoxyguanosine (8-OHdG) and catalase (CAT) levels were measured within 24 h of admission using a commercially available enzyme-linked immunosorbent assay. The 17-item Hamilton Depression Scale was used to evaluate depressive symptoms. Diagnosis of PSD was made in line with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for depression. RESULTS Serum levels of 8-OHdG (P<0.001) and CAT (P=0.025) increased in depressed patients at admission. A positive correlation was found between the 8-OHdG and CAT levels in both the total stroke patients (r=0.320, P<0.001) and the depressed patients (r=0.300, P=0.012). The 8-OHdG levels were positively correlated with the 17-item Hamilton Depression Scale scores (r=0.129, P=0.046) in depressed patients. Multivariate analyses found that 8-OHdG levels ≥200.0 ng/L were independently associated with PSD (odds ratio, 7.477; 95% CI, 3.342-16.289, P<0.001) after adjusting for possible relevant confounders. CONCLUSION Higher serum 8-OHdG levels at admission were found to be correlated with PSD 1 month after stroke.
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Affiliation(s)
- Zhihua Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Cai
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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17
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Oxidative stress and DNA damage after cerebral ischemia: Potential therapeutic targets to repair the genome and improve stroke recovery. Neuropharmacology 2017; 134:208-217. [PMID: 29128308 DOI: 10.1016/j.neuropharm.2017.11.011] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/02/2017] [Accepted: 11/05/2017] [Indexed: 12/12/2022]
Abstract
The past two decades have witnessed remarkable advances in oxidative stress research, particularly in the context of ischemic brain injury. Oxidative stress in ischemic tissues compromises the integrity of the genome, resulting in DNA lesions, cell death in neurons, glial cells, and vascular cells, and impairments in neurological recovery after stroke. As DNA is particularly vulnerable to oxidative attack, cells have evolved the ability to induce multiple DNA repair mechanisms, including base excision repair (BER), nucleotide excision repair (NER) and non-homogenous endpoint jointing (NHEJ). Defective DNA repair is tightly correlated with worse neurological outcomes after stroke, whereas upregulation of DNA repair enzymes, such as APE1, OGG1, and XRCC1, improves long-term functional recovery following stroke. Indeed, DNA damage and repair are now known to play critical roles in fundamental aspects of stroke recovery, such as neurogenesis, white matter recovery, and neurovascular unit remodeling. Several DNA repair enzymes are essential for comprehensive neural repair mechanisms after stroke, including Polβ and NEIL3 for neurogenesis, APE1 for white matter repair, Gadd45b for axonal regeneration, and DNA-PKs for neurovascular remodeling. This review discusses the emerging role of DNA damage and repair in functional recovery after stroke and highlights the contribution of DNA repair to regenerative elements after stroke. This article is part of the Special Issue entitled 'Cerebral Ischemia'.
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18
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Liu Z, Zhu Z, Zhao J, Ren W, Cai Y, Wang Q, Luan X, Zhao K, He J. Malondialdehyde: A novel predictive biomarker for post-stroke depression. J Affect Disord 2017; 220:95-101. [PMID: 28600933 DOI: 10.1016/j.jad.2017.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 03/29/2017] [Accepted: 05/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is evidence that stroke is accompanied by oxidative stress. However, the links between oxidative stress and depression in stroke patients are poorly understood. This study examines whether post-stroke depression (PSD) is associated with oxidative stress. METHODS Overall, 216 acute stroke patients were consecutively recruited and followed up for 1 month. Blood specimens were collected within 24h after admission and measured for the following oxidative stress biomarkers: malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX). All enrolled patients were divided into the PSD group or the non-PSD group according to an assessment of clinical depression. One hundred normal control subjects were also recruited. RESULTS There was a positive correlation between serum MDA levels and HAMD scores in stroke patients (r=0.536, p<0.001). Based on the Receiver-operating characteristic (ROC) curve, the optimal cutoff value of serum MDA levels as an indicator for an auxiliary diagnosis of PSD was projected to be 2.898 nmol/ml, which yielded a sensitivity of 77.9% and a specificity of 81.1%, with an area under the curve of 0.883 (95% CI, 0.836-0.929). Elevated MDA (≥2.898 nmol/ml) was an independent predictive marker of PSD (odds ratio OR=24.295; 95% CI, 9.461-62.388; p<0.001, adjusted for relevant confounders). LIMITATIONS We excluded patients with severe aphasia or with serious conditions. In addition, the information for dietary intake was not recorded, which may influence oxidative stress levels. CONCLUSION Our study demonstrated that an elevated serum MDA level at admission was positively associated with an increased risk of developing depression after acute stroke, especially minor stroke.
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Affiliation(s)
- Zhihua Liu
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zhuoying Zhu
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jiyun Zhao
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Wenwei Ren
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yan Cai
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qiongzhang Wang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaoqian Luan
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Kai Zhao
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jincai He
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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Yeh TT, Hsieh YW, Wu CY, Wang JS, Lin KC, Chen CL. A Preliminary Investigation of the Association of Sleep With Inflammation and Oxidative Stress Biomarkers and Functional Outcomes After Stroke Rehabilitation. Sci Rep 2017; 7:8634. [PMID: 28819157 PMCID: PMC5561026 DOI: 10.1038/s41598-017-08931-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/19/2017] [Indexed: 11/09/2022] Open
Abstract
This study examined the association of sleep with inflammation and oxidative stress biomarkers, and with functional outcomes, after stroke rehabilitation. The rehabilitation effects on biomarkers and functional outcomes were also evaluated. Twenty subacute stroke survivors received 4 weeks of upper limb rehabilitation. Baseline inflammatory (i.e., soluble intercellular adhesion molecule-1, sICAM-1) and oxidative stress biomarkers (i.e., glutathione peroxidase, GPx and malondialdehyde, MDA) were assessed, as were sleep outcomes. Positive correlations were observed between baseline level of sICAM-1 and number of awakenings at post-treatment (ρ = 0.51, p < 0.05) as well as between baseline level of MDA and post-performance time of the Wolf Motor Function Test (WMFT-time) (ρ = 0.46, p < 0.05). In addition, MDA levels were significantly decreased, and functional outcomes of the modified Rankin Scale (mRS), functional ability scale of the WMFT, and Stroke Impact Scale (SIS-total, and SIS-physical function) were improved after the rehabilitation. This pilot study emphasizes the relationship among biomarkers, sleep, and functional outcomes after stroke rehabilitation. Oxidative stress markers may be useful predictors of functional outcomes in subacute stroke survivors.
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Affiliation(s)
- Ting-Ting Yeh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fuxing St., Guishan Dist., Taoyuan City, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fuxing St., Guishan Dist., Taoyuan City, Taiwan
| | - Jong-Shyan Wang
- Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Graduate Institute of Rehabilitation Science, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan.
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 7 Chung Shan South Rd., Taipei, Taiwan.
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fuxing St., Guishan Dist., Taoyuan City, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, 259 Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
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Recuperating Lung Decoction Attenuates the Oxidative Stress State of Chronic Obstructive Pulmonary Disease by Inhibiting the MAPK/AP-1 Signal Pathway and Regulating γ-GCS. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:9264914. [PMID: 28408945 PMCID: PMC5376952 DOI: 10.1155/2017/9264914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/08/2017] [Accepted: 02/26/2017] [Indexed: 11/18/2022]
Abstract
Purpose/Objective. To evaluate the effects of Recuperating Lung Decoction (RLD) on the indices of oxidative stress in a rat model of COPD and detect the indices of the MAPK/AP-1/γ-GCS signal pathway for a further survey of the possible targeting site of RLD. Methods/Materials. The rats of COPD were treated with RLD. The protein levels of glutathione (GSH), oxidized glutathione (GSSG), 8-hydroxy-2-deoxyguanosine (8-OHdG), and 4-hydroxynonenal (4-HNE) were measured. In addition, the levels of key signaling molecules (extracellular signal-regulated kinases [ERK], the c-jun N-terminal kinase [JNKs signal pathway], and p38 MAP kinase [p38MAPK], AP-1 proteins [C-fos, C-jun], and γ-glutamyl-cysteine synthetase [γ-GCS-h]) of the MAPK/AP-1/γ-GCS-h signal pathway were assessed. Results. After treatment, the protein level of GSH and the ratio of GSH/GSSG were increased and the amounts of 8-OHdG and 4-HNE were decreased significantly in lung tissues when compared with the nontreated COPD group. Further results showed that the RLD could effectively inhibit the MAPK pathway by inactivation of p38MAPK and ERK and could also downregulate the AP-1 and the γ-GCS-h genes expressions in both protein and mRNA levels. Conclusion. RLD might improve the state of oxidative stress by downregulation of the expression of γ-GCS-h gene by inhibition of the MAPK/AP-1 pathway, thereafter enhancing the ability of antioxidation in COPD.
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Ma F, Rodriguez S, Buxo X, Morancho A, Riba-Llena I, Carrera A, Bustamante A, Giralt D, Montaner J, Martinez C, Bori I, Rosell A. Plasma Matrix Metalloproteinases in Patients With Stroke During Intensive Rehabilitation Therapy. Arch Phys Med Rehabil 2016; 97:1832-1840. [PMID: 27373742 DOI: 10.1016/j.apmr.2016.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 05/26/2016] [Accepted: 06/08/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study plasma levels of matrix metalloproteinases (MMPs) as potential markers of recovery during intensive rehabilitation therapy (IRT) after stroke. DESIGN Prospective and descriptive 3-month follow-up study. SETTING Rehabilitation unit and research center. PARTICIPANTS Patients with first-ever ischemic stroke (n=15) enrolled to IRT (≥3h/d and 5d/wk) and healthy volunteers (n=15) (N=30). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome was to measure plasma MMP3, MMP12, and MMP13 levels and evaluate potential associations with motor/functional scales using a battery of tests (National Institutes of Health Stroke Scale, modified Rankin scale, Barthel Index, Fugl-Meyer Assessment, Functional Ambulation Categories, Medical Research Council scale, Chedoke Arm and Hand Activity Inventory, and the 10-m walk test) before IRT and at 1- and 3-month follow-ups. The secondary outcome was to evaluate the use of these MMPs as biomarkers as predictors of patient's outcome. RESULTS MMP levels remained stable during the study period and were similar to those in the healthy volunteer group. However, baseline MMP12 and MMP13 levels were strongly associated with stroke severity and were found to be elevated in those patients with the poorest outcomes. Interestingly, plasma MMP3 was independent of baseline stroke characteristics but was found to be increased in patients with better motor/functional recovery and in patients with larger improvements during rehabilitation. CONCLUSIONS MMPs might act as biologic markers of recovery during rehabilitation therapy related to their roles in both injury and tissue remodeling. Future confirmatory investigations in multicenter studies are warranted by our data.
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Affiliation(s)
- Feifei Ma
- Neurovascular Research Laboratory and Neuroscience Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Rodriguez
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavi Buxo
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Morancho
- Neurovascular Research Laboratory and Neuroscience Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Iolanda Riba-Llena
- Neurovascular Research Laboratory and Neuroscience Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Carrera
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory and Neuroscience Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory and Neuroscience Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory and Neuroscience Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Martinez
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Immaculada Bori
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rosell
- Neurovascular Research Laboratory and Neuroscience Department, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Graczyk H, Lewinski N, Zhao J, Sauvain JJ, Suarez G, Wild P, Danuser B, Riediker M. Increase in oxidative stress levels following welding fume inhalation: a controlled human exposure study. Part Fibre Toxicol 2016; 13:31. [PMID: 27286820 PMCID: PMC4901438 DOI: 10.1186/s12989-016-0143-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/03/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Tungsten inert gas (TIG) welding represents one of the most widely used metal joining processes in industry. It has been shown to generate a large majority of particles at the nanoscale and to have low mass emission rates when compared to other types of welding. Despite evidence that TIG fume particles may produce reactive oxygen species (ROS), limited data is available for the time course changes of particle-associated oxidative stress in exposed TIG welders. METHODS Twenty non-smoking male welding apprentices were exposed to TIG welding fumes for 60 min under controlled, well-ventilated settings. Exhaled breathe condensate (EBC), blood and urine were collected before exposure, immediately after exposure, 1 h and 3 h post exposure. Volunteers participated in a control day to account for oxidative stress fluctuations due to circadian rhythm. Biological liquids were assessed for total reducing capacity, hydrogen peroxide (H2O2), malondialdehyde (MDA), and 8-hydroxy-2'-deoxyguanosine (8-OHdG) concentrations at each time point. A linear mixed model was used to assess within day and between day differences. RESULTS Significant increases in the measured biomarkers were found at 3 h post exposure. At 3 h post exposure, we found a 24 % increase in plasma-H2O2 concentrations ([95%CI: 4 % to 46 %], p = 0.01); a 91 % increase in urinary-H2O2 ([2 % to 258 %], p = 0.04); a 14 % increase in plasma-8-OHdG ([0 % to 31 %], p = 0.049); and a 45 % increase in urinary-8-OHdG ([3 % to 105 %], p = 0.03). Doubling particle number concentration (PNC) exposure was associated with a 22 % increase of plasma-8-OHdG at 3 h post exposure (p = 0.01). CONCLUSION A 60-min exposure to TIG welding fume in a controlled, well-ventilated setting induced acute oxidative stress at 3 h post exposure in healthy, non-smoking apprentice welders not chronically exposed to welding fumes. As mass concentration of TIG welding fume particles is very low when compared to other types of welding, it is recommended that additional exposure metrics such as PNC are considered for occupational risk assessments. Our findings highlight the importance of increasing awareness of TIG welding fume toxicity, especially given the realities of welding workplaces that may lack ventilation; and beliefs among interviewed welders that TIG represents a cleaner and safer welding process.
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Affiliation(s)
- Halshka Graczyk
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, CH-1066, Switzerland
| | - Nastassja Lewinski
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, CH-1066, Switzerland.,Department of Chemical and Life Science Engineering, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Jiayuan Zhao
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, CH-1066, Switzerland.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA, 02115, USA
| | - Jean-Jacques Sauvain
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, CH-1066, Switzerland
| | - Guillaume Suarez
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, CH-1066, Switzerland
| | - Pascal Wild
- Department of Scientific Management, National Institute for Research and Security, INRS, Vandoeuvre, 54500, France
| | - Brigitta Danuser
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, CH-1066, Switzerland
| | - Michael Riediker
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, CH-1066, Switzerland. .,SAFENANO, IOM Singapore, Singapore, 048622, Singapore.
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Chen CY, Yu CC, Chen CL. Nocturnal periodic limb movements decrease antioxidant capacity in post-stroke women. Acta Neurol Scand 2016; 133:245-52. [PMID: 26033278 DOI: 10.1111/ane.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Considerable evidence suggests that periodic limb movements during sleep (PLMS) are associated with cardiovascular risk and poor stroke outcome. However, the pathogenesis for this association in stroke patients remains largely unknown. MATERIALS AND METHODS This cross-sectional study enrolled 112 consecutive patients who were admitted to rehabilitation ward due to ischemic stroke. Polysomnography and laboratory tests for oxidative stress and inflammatory biomarkers including C-reactive protein, interleukin 6, total antioxidant capacity (TAC), and urinary 8-hydroxy-2-deoxyguanosine were conducted. RESULTS Patients were stratified into three categories according to their PLMS index. Patients in the PLMS index ≥15 group were significantly older (P = 0.011), presented a significantly higher National Institute of Health Stroke Scale at stroke onset (P = 0.032), and lower Barthel index (P = 0.035) than patients in the PLMS index <5 group. The level of TAC differed significantly (P = 0.018) among the three groups. Multivariate linear regression analyses show that the PLMS index was negatively and independently correlated with TAC (P = 0.024) in women. Besides, multivariate logistic regression analyses also reveal that patients with a PLMS index ≥15 compared with the referent PLMS index <5 had a 7.58-fold increased relative hazard for stroke recurrence (odds ratio 7.58, [1.31-43.88], P = 0.024). CONCLUSIONS This study suggests that PLMS was independently associated with decreased antioxidant capacity in women with ischemic stroke.
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Affiliation(s)
- C.-Y. Chen
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital; Keelung Taiwan
- School of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - C.-C. Yu
- School of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Division of Pulmonary, Critical Care and Sleep Medicine; Department of Internal Medicine; Chang Gung Memorial Hospital; Keelung Taiwan
| | - C.-L. Chen
- Department of Physical Medicine and Rehabilitation; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Graduate Institute of Early Intervention; College of Medicine; Chang Gung University; Taoyuan Taiwan
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