Current Advances in Endovascular Treatment of Intracranial Atherosclerotic Disease and Future Prospective

Objectives/BackgroundMedical therapy is the first line of treatment for intracranial atherosclerotic disease (ICAD). Percutaneous transluminal angioplasty and stenting (PTAS) are mainly considered for those patients with severe stenosis and recurrent events despite aggressive medical therapy. In this review, we discuss the application of PTAS as a treatment option for ICAD and its future prospect.Materials and MethodsWe did the literature review of the key articles and guidelines to elaborate on the role of PTAS in the management of ICAD based on the current data and expert opinion. We searched PubMed, Google Scholar, and Scopus up to August 2020, and included articles published only in the English language.ResultsSince the publication of the results from SAMMPRIS and VISSIT trials, stenting is no longer recommended for secondary stroke prevention in patients with symptomatic ICAD. However, recent clinical studies on intracranial stenting for a subgroup of ICAD patients have shown promising results, likely due to better patient selection and continued advancement of endovascular techniques.ConclusionThere exists a lack of consensus regarding the best endovascular treatment approach (e.g., angioplasty alone or balloon mounted stent vs. self-expanding stent with or without prior angioplasty) or management of in-stent restenosis. Another area of clinical controversy relates to the ideal use and duration of antiplatelet therapy.     

MIF promoter polymorphism increases peripheral blood expression levels,contributing to increased susceptibility and poor prognosis in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. The etiology and pathogenesis of HCC remain unclear. Macrophage migration inhibitory factor (MIF) plays a critical role in the pathogenesis of hepatocellular carcinoma. The association between MIF polymorphisms and its expression level in HCC has rarely been demonstrated. In the present study, the peripheral blood of 202 patients with HCC (HCC group), 242 patients with chronic hepatitis B (CHB group), 215 patients with liver cirrhosis (LC group) and 227 healthy volunteers (normal group) were collected, DNA was extracted and the target fragment of MIF gene was amplified using PCR. The products were then sequenced, and the expression levels of MIF protein were tested using ELISA. The results showed that the MIF rs755622 polymorphism was associated with an increased susceptibility and metastasis of HCC, and that the genotypes GC and CC were associated with poor prognosis of HCC. Compared with the normal, CHB and LC groups, the expression of MIF in the peripheral blood of the HCC group was significantly increased, and the high expression was associated with to poor prognosis. In the HCC group, MIF protein levels for genotypes GC and CC were increased compared with those of genotype GG. The current study indicated that the MIF rs755622 polymorphism is associated with susceptibility and metastasis of HCC, and that the GC and CC genotypes may be indicators of poor prognosis, which may be ascribed to the MIF rs755622 polymorphism leading to elevated MIF protein expression in peripheral blood.     

Bayes判别在精神分裂症血清蛋白因子水平与认知功能障碍中的预测作用

目的:探讨血清蛋白因子水平与精神分裂症患者临床症状和认知障碍的相关性及对认知障碍缺陷程度的预测作用,为临床评估精神分裂症认知受损严重程度及预后提供辅助方法。方法:选择2017年9月至2019年4月在昆明医科大学第一附院确诊的71例精神分裂症患者作为患者组,以同一医院体检中心的65例健康志愿者作为对照组。使用ELISA方...     

Inhibitory Effects of P2Y12 Receptor Antagonist on PAR1- and PAR4-AP-Induced Platelet Aggregation in Patients with Stroke or TIA

ObjectivesThe inhibitory effects of P2Y12 receptor antagonist on PAR1- and PAR4-activating peptide (AP)-induced platelet aggregation have not been fully elucidated. The present study aimed to investigate the inhibitory effects of P2Y12 receptor antagonist on PAR1- and PAR4-AP-induced platelet aggregation using platelet-rich plasma (PRP) from individuals including patients with stroke or transient ischemic attack (TIA).Materials and MethodsPRP was given to 10 healthy individuals pretreated in vitro with cangrelor, then stimulated with adenosine diphosphate (ADP), PAR4-AP, or PAR1-AP. Moreover, 20 patients were enrolled from 148 consecutive patients with acute ischemic stroke or TIA admitted to our institute between December 2017 and April 2019. PRP obtained from each patient before and >7 days after initiation of clopidogrel was similarly stimulated with these agonists. Platelet aggregation was measured using an automatic coagulation analyzer in all participants.ResultsIn healthy individuals, ADP- and PAR4-AP-induced platelet aggregations were significantly inhibited depending on the cangrelor concentration in vitro, while PAR1-AP-induced platelet aggregation was slightly inhibited. In patients with stroke or TIA, clopidogrel inhibited ADP-induced platelet aggregation at all concentrations, and significantly inhibited PAR4-AP-induced platelet aggregation at 50 µmol/L of PAR4-AP (p<0.05), especially in 5 patients who showed high reactivity to PAR4-AP. PAR1-AP-induced platelet aggregation was also slightly inhibited.ConclusionsWe showed significant inhibitory effects on PAR4-AP-induced platelet aggregation by clopidogrel in patients with stroke or TIA who had high reactivity to PAR4-AP.     

Primary intracranial papillary meningioma: Analysis of factors of prognosis and systematic review

ObjectivePapillary meningioma is rare and displays an aggressive clinical behavior with poor prognosis. Therefore, we performed an extensive literature review to evaluate the adverse factors and treatment strategy of survival.MethodWe performed Ovid, Medline, Embase, Pubmed, Web of Science and Cochrane database queries for articles published between 1938 and 2019 with the search term “WHO grade III meningioma” or “papillary meningioma” and “central nervous system”, “cerebral”, or “intracranial”.ResultsAfter a careful evaluation, a total of 19 studies were included. The entire cohort included the 67 patients, 34 (50.7%) were male and 33 (49.3%) were female with a mean age of 32.6 ± 2.1 years ranging from 4.5 months to 74 years. Gross total resection was achieved in 48 (71.6%) cases, and 29 (51.8%) patients received postoperative radiation. The mean follow-up period was 42.3 ± 4.4 months (range, 2–197 months). Thirty-six (53.7%) patients happened to recurrences, 11 (16.4%) patients happened to extracranial metastasis and 25 (37.3%) patients died. Univariate analysis revealed that the MIB > 5% trended toward a shorter time to recurrence (p = 0.084). Gross total resection was associated with favorable progression-free survival (p = 0.007) and overall survival (p = 0.001). Postoperative radiation was associated with favorable progression-free survival (p = 0.001).ConclusionsGross total resection and adjuvant radiation were recommended as the initial treatment option for patients with papillary meningioma.     

IL-38, a potential therapeutic agent for lupus,inhibits lupus progression

Background

Previous studies reported that IL-38 was abnormally expressed in patients with systemic lupus erythematosus (SLE). However, the involvement of IL-38 in the pathophysiology of SLE remains unknown.

Methods

The therapeutic potential of IL-38 was tested in pristane-treated wild-type (WT) and IL-38^?/? mice. Thus, SLE was induced via pristane in WT and IL-38^?/? mice. Afterwards, the liver, spleen, and kidney of each mouse were obtained. The flow cytometric analysis of the immune cells, serologic expression of inflammatory cytokines and autoantibodies, renal histopathology, and inflammatory signaling were evaluated.

Results

WT mice with pristane-induced lupus exhibited hepatomegaly, splenomegaly, severe kidney damages, increased lymphoproliferation, enhanced lymphoproliferation, and upregulated inflammatory cytokines, such as IL-6, IL-13, IL-17A, MIP-3α, IL-12p70, and IFNγ, and elevated levels of autoantibodies, such as ANA IgG, anti-dsDNA IgG, and total IgG. IL-38^?/? mice whose lupus progressed, had elevated cells of CD14⁺, CD19⁺, CD3⁺, and Th1, upregulated inflammatory cytokines and autoantibodies, and severe pathological changes in kidney. Administration of recombinant murine IL-38 to pristane-treated IL-38^?/? mice improved their renal histopathology, which depended on ERK1/2, JNK1/2, p38, NF-κB p65, and STAT5 signaling pathways.

Conclusion

IL-38 regulates SLE pathogenesis. Furthermore, targeting IL-38 is critical in the treatment of SLE.

     

Incremental Accuracy of Blood Biomarkers for Predicting Clinical Outcomes After Intracerebral Hemorrhage

BackgroundIntracerebral hemorrhage (ICH) is associated with high mortality, morbidity, and recurrence. Studies have reported the accuracy of several blood biomarkers in predicting clinical outcomes; however, their independent contribution in prediction remains to be established.AimTo investigate the incremental accuracy in predicting clinical outcomes in patients with ICH in a north Indian population using blood-based biomarkers.MethodsIn this study, a total of 250 ICH cases were recruited within 72 hours of onset. Baseline clinical and CT scan measurement were recorded. Homocysteine (HCY), C-reactive protein (CRP), matrix metalloproteinase-9 (MMP9), E-selectin (SELE), and P-selectin (SELP) levels were measured through ELISA. Telephonic follow-up was done by using mRS scale at three months.ResultsThe mean age of cohort was 54.9 (SD±12.8) years with 64.8% patients being male. A total of 109 (43.6%) deaths were observed over three months follow-up. Area under the receiver operating characteristics curve-(AUROC) for 90-day mortality were 0.55 (HCY), 0.62 (CRP), 0.57 (MMP9), 0.60 (SELE) and 0.53 (SELP) and for poor outcome at 90-day (mRS: 3-6) were 0.60 (HCY), 0.62 (CRP), 0.54 (MMP9), 0.67 (SELE) and 0.54 (SELP). In multivariable model including age, ICH volume, IVH and GCS at admission, serum SELE (p=0.004) significant for poor outcome with improved AUROC (0.86) and HCY (p=0.04), CRP (p=0.003) & MMP9 (p=0.02) for mortality with least Akaike's Information Criterion-(AIC) (1060.5).ConclusionsOur findings suggest that the serum SELE is a significant predictor of poor outcome and HCY, CRP & MMP9 for Mortality in patients with ICH in the north Indian population.     

Altered expression of circular RNA in primary Sjögren’s syndrome

Clinical Rheumatology - This study evaluated expression of circRNA in primary Sjögren’s syndrome (pSS) patients so as to find novel biomarkers for pSS screening and discussed possible...     

miR-124基于PI3K/Akt通路对脓毒症大鼠肾组织炎症和氧化应激的影响

目的探讨微小RNA-124(miR-124)基于磷脂酰肌醇3激酶(PI3K)/丝氨酸苏氨酸激酶(Akt)通路对脓毒症大鼠肾组织炎症和氧化应激的影响。 方法将72只SD大鼠均分为假手术组(不做任何处理)、模型组(造模成功后不做任何处理)、miR-124-agomir组(miR-124高表达腺病毒载体处理)、agomir-NC组(阴性对照空载体处理)、LY294002组(PI3K/Akt抑制剂处理)、miR-124-agomir+LY294002组(miR-124高表达腺病毒载体和PI3K/Akt抑制剂处理)。除假手术组外,其余各组均采用盲肠结扎穿刺法建立脓毒症肾损伤模型,并于造模成功后按各组相应给药处理。观察各组大鼠行为变化、肾组织炎症细胞浸润现象;检测各组大鼠肾功能指标、肾组织细胞凋亡、肾组织miR-124、PI3K/Akt通路蛋白表达水平、氧化应激相关蛋白、炎症因子及凋亡相关蛋白的表达。 结果与假手术组比较,模型组大鼠肾组织坏死及炎症细胞浸润现象严重,血清肌酐和血尿素氮水平、细胞凋亡率、磷酸化(p)-PI3K/PI3K、p-Akt/Akt、磷酸化核转录因子(p-NF)-κB p65/NF-κB p65、肿瘤坏死因子-α、NF-E2相关因子2(Nrf2)、血红素加氧酶-1(HO-1)、B细胞淋巴瘤2相关X蛋白、Caspase-3表达升高(P＜0.05),miR-124、超氧化物歧化酶、谷胱甘肽过氧化氢酶蛋白表达降低(P＜0.05)。与模型组比较,miR-124-agomir组大鼠肾组织上述指标变化明显改善(P＜0.05);LY294002组大鼠肾组织上述指标变化进一步加重(P＜0.05)。miR-124-agomir+LY294002组大鼠逆转miR-124-agomir组上述指标(P＜0.05)。 结论miR-124通过抑制炎症、氧化应激和细胞凋亡来改善脓毒症大鼠肾损伤进程,其机制可能与激活PI3K/Akt通路,诱导Nrf2/HO-1途径活化有关。