Decreased risk of acute myocardial infarction in stroke patients receiving acupuncture treatment: a nationwide matched retrospective cohort study.

BACKGROUND: Whether acupuncture protects stroke patients from acute myocardial infarction (AMI) has not been studied previously. The purpose of this study was to investigate the risk of AMI among stroke patients receiving acupuncture treatment. METHODS: Taiwan's National Health Insurance Research Database was used to conduct a retrospective cohort study of 23475 stroke patients aged 40-79 years receiving acupuncture treatment and 46950 propensity score-matched stroke patients not receiving acupuncture treatment who served as controls from 2000 to 2004. Both stroke cohorts were followed until the end of 2009 and were adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) for new-onset AMI in multivariate Cox proportional hazard models. RESULTS: Stroke patients who received acupuncture treatment (9.2 per 1000 person-years) exhibited a lower incidence of AMI compared with those who did not receive acupuncture treatment (10.8 per 1000 person-years), with an HR of 0.86 (95 % CI, 0.80-0.93) after adjusting for age, sex, low income, coexisting medical conditions and medications. The relationship between acupuncture treatment and AMI risk was investigated in female stroke patients (HR, 0.85; 95 % CI, 0.76-0.95), male stroke patients (HR, 0.87; 95 % CI, 0.80-0.95), patients from 50 to 59 years of age (HR, 0.75; 95 % CI, 0.63-0.90), patients from 60 to 69 years of age (HR, 0.85; 95 % CI, 0.75-0.95), patients suffering from ischemic stroke (HR, 0.87; 95 % CI, 0.79-0.95), and patients suffering from hemorrhagic stroke (HR, 0.62; 95 % CI, 0.44-0.88). CONCLUSIONS: We raised the possibility that acupuncture may be effective in lowering the risk of AMI in stroke patients aged 50-69 in this study, which was limited by a lack of information regarding stroke severity and acupuncture points. Our results suggest that prospective randomized trials are needed to establish the efficacy of acupuncture in preventing AMI.

Reduced risk of stroke in patients with cardiac arrhythmia receiving traditional Chinese medicine: A nationwide matched retrospective cohort study.

OBJECTIVE: Patients with cardiac arrhythmia were more likely to develop stroke than general population. The therapeutic effect of traditional Chinese medicine (TCM) on the risk of stroke in patients with cardiac arrhythmia was unknown. The aim of this study is to investigate the risk of stroke in patients with cardiac arrhythmia receiving TCM. METHODS: From the one million cohort of the Taiwan's National Health Insurance Research Database, we identified cohort of cardiac arrhythmia included 2029 patients who received TCM treatment in 2000-2004. The matching methods with propensity score was used to select 2029 appropriate control cohort for comparison. Incident events of stroke were identified during the follow-up period at the end of 2010. Cox proportional hazard model was used to calculate adjusted hazard ratios and 95% confidence intervals of stroke associated with TCM treatment. RESULTS: During the follow-up period, patients with cardiac arrhythmia who underwent TCM treatment (11.4 per 1000 person-years) had a lower incidence of new-onset stroke than those without TCM treatment (17.7 per 1000 person-years), with an HR of 0.62 (95% CI=0.50-0.78). The association between TCM treatment and decreased new-onset stroke was both significant in women and men. The young patients aged 45-54 years who received TCM had the lowest risk of stroke (HR=0.48, 95% CI=0.27-0.87). CONCLUSIONS: Receiving TCM treatment was associated with a lower risk of stroke in patients with cardiac arrhythmia. However, this study was limited by lack of information regarding lifestyles, biochemical profiles, the dose of herbal medicine, and acupuncture points used in treatments.

Wogonin induced apoptosis in human nasopharyngeal carcinoma cells by targeting GSK-3ß and ΔNp63.

PURPOSE: Wogonin, a plant flavonoid, has antitumor activity in various cancers. Dysregulation of GSK-3ß has been implicated in tumorigenesis and cancer progression. In this study, we investigated the antitumor activity and the mechanistic action of wogonin in human nasopharyngeal carcinoma (NPC) cells. METHODS: The effects of wogonin on the cell survival and apoptosis in NPC cells were investigated by MTS assay, flow cytometry, and PARP cleavage assays. Pharmacological inhibitors (BIO, LiCl, and OA), or small interfering RNA (siRNA) were used to address the expression status of GSK-3ß and the anticancer effect of ΔNp63 in NPC cells. RESULTS: Wogonin was shown to induce dose-dependent cell apoptosis due to the induction of sub-G1-phase cells, PARP cleavage, and downregulation of ΔNp63, a survival factor in NPC cells. Strikingly, the apoptotic effect of wogonin involved GSK-3ß inactivation via prominent inhibition of phosphorylation at Tyr216 and slightly increment of phosphorylation at Ser9, while there is no change in total GSK-3ß proteins. Dysregulation of GSK-3ß caused cell apoptosis was confirmed by pharmacological inhibitors (lithium chloroid, LiCl, and 6-bro-moindirubin-3-oxime, BIO). Administration of okadaic acid (OA, a protein phosphatase inhibitor) that significantly inactivated GSK-3ß also induced ΔNp63 downregulation and apoptosis. Targeted silencing of ΔNp63 repressed the phosphorylation of GSK-3ß at Tyr216 and sensitized NPC cells to wogonin-induced apoptosis. Furthermore, GSK-3ß or PP2A inhibitors enhanced wogonin-induced apoptosis via activation of caspase 3/7. CONCLUSION: These results indicate that GSK-3ß, as well as ΔNp63, are novel targets for wogonin action and suggest that wogonin might provide a potential therapeutic option in NPC. Further in vitro and in vivo studies will help to clarify the therapeutic role of wogonin in NPC.