Microglia in epilepsy.

Epilepsy is one of most common chronic neurological disorders, and the antiseizure medications developed by targeting neurocentric mechanisms have not effectively reduced the proportion of patients with drug-resistant epilepsy. Further exploration of the cellular or molecular mechanism of epilepsy is expected to provide new options for treatment. Recently, more and more researches focus on brain network components other than neurons, among which microglia have attracted much attention for their diverse biological functions. As the resident immune cells of the central nervous system, microglia have highly plastic transcription, morphology and functional characteristics, which can change dynamically in a context-dependent manner during the progression of epilepsy. In the pathogenesis of epilepsy, highly reactive microglia interact with other components in the epileptogenic network by performing crucial functions such as secretion of soluble factors and phagocytosis, thus continuously reshaping the landscape of the epileptic brain microenvironment. Indeed, microglia appear to be both pro-epileptic and anti-epileptic under the different spatiotemporal contexts of disease, rendering interventions targeting microglia biologically complex and challenging. This comprehensive review critically summarizes the pathophysiological role of microglia in epileptic brain homeostasis alterations and explores potential therapeutic or modulatory targets for epilepsy targeting microglia.

Efficacy of delayed 18F-FDG hybrid PET/MRI for epileptic focus identification: a prospective cohort study.

OBJECTIVE: We sought to investigate the contribution of delayed 18F-FDG imaging data to epileptogenic zone (EZ) identification using a hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) system. METHODS: Forty-one patients with epilepsy underwent a brain dual time point 18F-FDG PET/MRI examination. All early imaging was acquired at approximately 40 min. Late imaging was classified as short delay (150.1 ± 20.2 min) or long delay (247.8 ± 24.6 min). Visual evaluation and scoring of 18F-FDG uptake at dual time points were performed. An SUVmean asymmetry index (AI) was calculated representing the difference in uptake between the EZ and the contralateral side. The EZ location was defined by a multidisciplinary team based on findings on video electroencephalography, 18F-FDG, and MRI. EZ location was classified as extratemporal lobe epilepsy (extra-TLE) or temporal lobe epilepsy (TLE). MRI findings were classified as positive if there were signal/structural abnormalities, or negative. AI of dual time points was compared between MRI-positive and MRI-negative, between extra-TLE and TLE, and between short delay and long delay of the late imaging time point. RESULTS: The AI at the delayed time points was increased by a mean of 3.7 over the early time point in all patients (P < 0.01). The biggest AIs were found in the MRI-positive group. The ΔAI between two imaging points were 3.71 ± 3.50 and 4.67 ± 7.94 for MRI-positive and MRI-negative; 4.52 ± 6.70 and 2.51 ± 2.42 for extra-TLE and TLE; and 4.24 ± 6.52 and 3.46 ± 2.90 for short delay and long delay groups, respectively. There were more patients with increased AI at the delayed time with MRI-positive (95.8%, 23/24), with extra-TLE (96.8%, 30/31), and with short delay time (93.7%, 30/32). Two observers who had no knowledge of the images chose 85.4% and 82.9% of the delay-time point images as the more obvious asymmetry from all images. The kappa value between the two observers was 0.66 with good agreement. CONCLUSION: Delayed 18F-FDG PET imaging can be used to better identify EZs with relatively greater metabolic asymmetry between the EZ and contralateral regions.

The High-Sensitivity C-Reactive Protein to Prealbumin Ratio Predicts Adverse Cardiovascular Events after ST-Elevation Myocardial Infarction.

BACKGROUND: This study evaluated the association of the high-sensitivity C-reactive protein to prealbumin ratio (CPR) with adverse cardiovascular events after ST-elevation myocardial infarction (STEMI) in patients undergoing primary percutaneous coronary intervention (PCI). METHODS: The study included 682 patients who presented with STEMI and were treated with primary PCI. Patients were divided into 2 groups: high CPR (CPR ≥0.02) and low CPR (CPR <0.02). The primary endpoint of the study was the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular mortality or admission due to recurrent AMI or heart failure. Multivariate Cox regression models were used to assess the prognostic value of CPR on MACE in patients with STEMI. RESULTS: During a median follow-up of 18 months, the accumulated incidence rate of MACE was significantly higher in the high-CPR group than in the low-CPR group (38.7% versus 12.0%, P < .01). Multivariate analysis revealed that CPR was an independent predictor for increased risk of MACE (hazard ratio = 3.27, 95% confidence interval [CI] 2.14 to 4.49, P < .01). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve for predicting the diagnosis of MACE was higher for CPR (0.82, 95% CI 0.77 to 0.87) than hs-CRP (0.70, 95% CI 0.65 to 0.75). CONCLUSION: CPR was independently associated with MACE and can be used for risk stratification in patients with STEMI.

A PRRT2 variant in a Chinese family with paroxysmal kinesigenic dyskinesia and benign familial infantile seizures results in loss of interaction with STX1B.

OBJECTIVE: To identify the causative gene of autosomal dominant paroxysmal kinesigenic dyskinesia and benign familial infantile seizures (PKD/BFIS) in a large Chinese family and explore the potential pathogenic mechanism of a PRRT2 (proline-rich transmembrane protein 2) variant. METHODS: Genetic testing was performed via whole exome sequencing. Western blotting and immunofluorescence were used to analyze the protein expression level and subcellular localization of the PRRT2 mutant in HeLa cells and N2A cells. Coimmunoprecipitation was conducted to investigate the interaction of the PRRT2 mutant with syntaxin 1B (STX1B). RESULTS: In a large Chinese family with autosomal dominant PKD/BFIS showing wide phenotypic heterogeneity, including patients suffering from PKD, BFIS, or epilepsy and asymptomatic variant carriers, a c.621dupA variant in PRRT2 was identified in the proband and was shown to cosegregate with the phenotype in this family. This variant results in premature termination at codon 224, producing a truncated protein (p.Ser208Ilefs*17) in which the two conserved hydrophobic segments and the cytoplasmic loop are missing. Both the expression and subcellular localization of PRRT2 are strongly affected by the c.621dupA variant. In addition, we found that PRRT2 directly interacts with STX1B, a SNARE protein critical for neurotransmitter release, whereas the truncated variant p.Ser208Ilefs*17 lacking the helix-loop-helix domain fails to bind to STX1B. SIGNIFICANCE: Our findings identified a PRRT2 variant in a family with PKD/BFIS and confirmed STX1B as a new binding partner of PRRT2, which suggested that the loss of the interaction between PRRT2 and STX1B may contribute to the pathogenesis of PKD/BFIS.

Impacts of Inflammatory Cytokines Variants on Systemic Inflammatory Profile and COVID-19 Severity.

BACKGROUND: Cytokine storm is known to impact the prognosis of coronavirus disease 2019 (COVID-19), since pro-inflammatory cytokine variants are associated with cytokine storm. It is tempting to speculate that pro-inflammatory cytokines variants may impact COVID-19 outcomes by modulating cytokine storm. Here, we verified this hypothesis via a comprehensive analysis. METHODS: PubMed, Cochrane Library, Central, CINAHL, and ClinicalTrials.gov were searched until December 15, 2023. Case-control or cohort studies that investigated the impacts of rs1800795 or rs1800629 on COVID-19 susceptibility, severity, mortality, IL-6, TNF-α, or CRP levels were included after an anonymous review by two independent reviewers and consultations of disagreement by a third independent reviewer. RESULTS: 47 studies (8305 COVID-19 individuals and 17,846 non-COVID-19 individuals) were analyzed. The rs1800629 A allele (adenine at the -308 position of the promoter was encoded by the A allele) was associated with higher levels of tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP). In contrast, the rs1800795 C allele (cytosine at the -174 position of the promoter was encoded by the C allele) was linked to higher levels of interleukin-6 (IL-6) and CRP. In addition, the A allele of rs1800629 increased the severity and mortality of COVID-19. However, the C allele of rs1800795 only increased COVID-19 susceptibility. CONCLUSIONS: rs1800629 and rs1800795 variants of pro-inflammatory cytokines have significant impacts on systemic inflammatory profile and COVID-19 clinical outcomes. rs1800629 may serve as a genetic marker for severe COVID-19.

White blood cell counts can predict 4-year cardiovascular disease risk in patients with stable coronary heart disease: a prospective cohort study.

Background: The prevalence of cardiovascular disease has increased sharply in the Asian population, and evaluation of the risk of cardiovascular events with stable coronary heart disease remains challenging. The role of white blood cell (WBC) count in assisting clinical decision-making in this setting is still unclear. Objectives: This study sought to evaluate the prognostic meaning of WBC count among patients with stable coronary heart disease. Methods: This study included Asian participants (n = 1,933) from the prospective STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial, which involved 15,828 patients with stable coronary heart disease with 3-5 years of follow-up on optimal secondary preventive treatment. WBC count was measured at baseline. Associations between WBC count and cardiovascular outcomes were evaluated by Cox regression analyses with multivariable adjustments. Hematologic emergencies in patients may introduce potential bias. Results: In the lower WBC count quartiles, patients had lower-risk clinical profiles. Higher WBC counts were associated with greater event probabilities for cardiovascular death, major cardiovascular events, or all-cause death. In Cox regression models, WBC counts were an independent predictor of major adverse cardiovascular events (OR = 2.445, 95% CI 1.427-4.190, P = 0.001) for the primary outcomes. For the secondary outcomes, including the composite of all-cause death, cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure, WBC counts were significantly predictive of events with similar magnitude (OR = 1.716, 95% CI 1.169-2.521, P = 0.006). Conclusions: In patients with stable coronary heart disease, higher WBC counts were associated with a heightened risk for the primary or secondary outcomes. Registration: https://clinicaltrials.gov/; Unique identifier NCT00799903.

Gene mutations in comorbidity of epilepsy and arrhythmia.

Epilepsy is one of the most common neurological disorders, and sudden unexpected death in epilepsy (SUDEP) is the most severe outcome of refractory epilepsy. Arrhythmia is one of the heterogeneous factors in the pathophysiological mechanism of SUDEP with a high incidence in patients with refractory epilepsy, increasing the risk of premature death. The gene co-expressed in the brain and heart is supposed to be the genetic basis between epilepsy and arrhythmia, among which the gene encoding ion channel contributes to the prevalence of "cardiocerebral channelopathy" theory. Nevertheless, this theory could only explain the molecular mechanism of comorbid arrhythmia in part of patients with epilepsy (PWE). Therefore, we summarized the mutant genes that can induce comorbidity of epilepsy and arrhythmia and the possible corresponding treatments. These variants involved the genes encoding sodium, potassium, calcium and HCN channels, as well as some non-ion channel coding genes such as CHD4, PKP2, FHF1, GNB5, and mitochondrial genes. The relationship between genotype and clinical phenotype was not simple linear. Indeed, genes co-expressed in the brain and heart could independently induce epilepsy and/or arrhythmia. Mutant genes in brain could affect cardiac rhythm through central or peripheral regulation, while in the heart it could also affect cerebral electrical activity by changing the hemodynamics or internal environment. Analysis of mutations in comorbidity of epilepsy and arrhythmia could refine and expand the theory of "cardiocerebral channelopathy" and provide new insights for risk stratification of premature death and corresponding precision therapy in PWE.

Retracted: Overexpression of αCP2, a translational repressor of GAP-43, inhibited axon outgrowth during development in Xenopus laevis.

The 3'-untranslated regions (3'-UTRs) of growth-associated protein 43 (GAP-43), which is crucial for neural development and axonal regeneration, are highly conserved among vertebrates. Previous studies in mammals have identified one U-rich cis element within GAP-43 3'-UTR and several trans factors that regulate its mRNA stability. However, much less is known in lower vertebrates. The Xenopus GAP-43 3'-UTR, despite its high similarity with those in higher vertebrates, contains unique CU-rich sequences, suggesting the existence of novel cis elements and trans factors. In current study, we isolated four proteins bound to GAP-43 3'-UTR from juvenile frog brain using affinity purification. Mass spectrometry identified Hu antigen D (HuD) and poly(C) binding protein 2 (αCP2) as the proteins forming 48- and 44-kDa ribonucleoprotein complexes, respectively. We validated the association between αCP2 and GAP-43 3'-UTR in vivo. After confirming the post-transcriptional effects of αCP2 on GAP-43 expression, we demonstrated that αCP2 directly inhibited the translation of GAP-43 gene, without affecting its mRNA stability. αCP2 overexpression led to decreased level of GAP-43 protein and significantly inhibited axonal outgrowth in primarily cultured neurons. Our study therefore provided insights on novel functions of αCP2 in vertebrate nervous system during development and new mechanisms of post-transcriptional regulation for GAP-43 gene.

KLF2 alleviates endothelial cell injury and inhibits the formation of THP­1 macrophage­derived foam cells by activating Nrf2 and enhancing autophagy.

Atherosclerosis (AS) is an important cause of common vascular diseases. The present study aimed to investigate whether Krüppel like transcription factor 2 (KLF2) could protect against endothelial cell injury and promote cholesterol excretion from foam cells through autophagy. An in vitro AS model was established by the induction of oxidized low-density lipoprotein (ox-LDL) for human umbilical vein endothelial cells (HUVECs). Phorbol-12-myristate-13-acetate (PMA)-induced THP-1 monocytes were differentiated into macrophages which were transformed to foam cells by ox-LDL incubation. The expression of KLF2, adhesion factors, cholesterol efflux regulatory proteins and autophagy-associated proteins in HUVECs or/and THP-1 monocytes was detected by reverse transcription-quantitative PCR and western blot analysis. HUVECs viability, levels of inflammatory factors, formation of foam cells and cholesterol efflux were respectively analyzed by CCK-8 assay, ELISA and Oil Red O staining. KLF2 expression was decreased in ox-LDL-induced HUVECs. KLF2 overexpression attenuated ox-LDL-induced endothelial cell injury, as evidenced by increased cell viability and decreased levels of TNF-α, IL-6, IL-1ß, intercellular adhesion molecule 1, vascular cell adhesion molecule-1 and E-selectin. In addition, KLF2 overexpression inhibited the formation of THP-1 macrophage-derived foam cells and promoted lipid efflux. ox-LDL induced decreased KLF2 expression in THP-1 macrophage derived foam cells and KLF2 overexpression activated Nrf2 expression and enhanced autophagy. In conclusion, KLF2 alleviated endothelial cell injury and inhibited the formation of THP-1 macrophage-derived foam cells by activating Nrf2 and enhancing autophagy.

lncNALT knockdown ameliorates hypertensive retinopathy via PTEN/PI3K/AKT pathway.

This study aimed to explore the role of the long non-coding RNA NOTCH1-associated lncRNA in T cell acute lymphoblastic leukemia (lncNALT) in the pathogenesis of hypertensive retinopathy (HR). LncNALT expression levels were determined using reverse transcription-quantitative polymerase chain reaction. The effects of lncNALT knockdown on the viability, proliferation, migration, and invasion of human retinal microvascular endothelial cells (RMECs) were determined via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide, 5-ethynyl-2'-deoxyuridine staining, and Transwell assays. Protein expression levels were determined using western blotting. We found that lncNALT expression levels were increased in RMECs treated with hydrogen peroxide (H2O2), while the knockdown of lncNALT rescued the viability, proliferation, migration, and invasion of RMECs treated with H2O2. Moreover, lncNALT interacted with ELAV like RNA binding protein 1 to affect the phosphatase and tensin homolog (PTEN) expression. Knockdown of lncNALT enhanced the viability, proliferation, migration, and invasion of RMECs via the PTEN/phosphoinositide 3-kinase (PI3K)/serine-threonine kinase (AKT) pathway. Taken together, knockdown of lncNALT enhanced the viability, proliferation, migration, and invasion of RMECs via the PTEN/PI3K/AKT pathway, suggesting that lncNALT could be a potential therapeutic target for patients with HR.

lncNALT interacts with HuR to increase the stability and expression levels of the PTENlncNALT regulates HR via the PTEN/PI3K/AKT pathwaylncNALT may be a potential diagnostic biomarker for HR.

Efficacy comparison of oxcarbazepine and levetiracetam monotherapy among patients with newly diagnosed focal epilepsy in China: A multicenter, open-label, randomized study.

AIMS: This multicenter, open-label, randomized study (Registration No. ChiCTR-OCH-14004528) aimed to compare the efficacy and effects of oxcarbazepine (OXC) with levetiracetam (LEV) as monotherapies on patient quality of life and mental health for patients with newly diagnosed focal epilepsy from China. METHODS: Patients with newly diagnosed focal epilepsy who had experienced 2 or more unprovoked seizures at greater than a 24-h interval during the previous year were recruited. Participants were randomly assigned to the OXC group or LEV group. Efficacy, safety, quality of life, and mental health were evaluated over 12-week and 24-week periods. RESULTS: In total, we recruited 271 newly diagnosed patients from 23 centers. Forty-four patients were excluded before treatment for reasons. The rate of seizure freedom of OXC was significantly superior to that of LEV at 12 weeks and 24 weeks (p < 0.05). The quality of life (except for the seizure worry subsection) and anxiety scale scores also showed significant differences from before to after treatment in the OXC and LEV groups. CONCLUSIONS: OXC monotherapy may be more effective than LEV monotherapy in patients with newly diagnosed focal epilepsy. Both OXC and LEV could improve the quality of life and anxiety state in adult patients with focal epilepsy.

Correlation study on expression of GST-π protein in brain tissue and peripheral blood of epilepsy rats induced by pilocarpine.

Previous studies have suggested that glutathione-S-transferase π (GST-π) over-expression in the brain tissue is associated with refractory epilepsy. However, whether the change in GST-π level in the peripheral blood is in line with that in brain tissue remains unknown. This study examined the correlation between GST-π in brain tissue and that in peripheral blood in rat models of pilocarpine-induced refractory epilepsy. The animals were divided into drug-resistant group and drug-responsive group according to the response to anti-epileptic drugs. GST-π expression in brain tissue was immunohistochemically determined, while the expression of GST-π in peripheral blood was analyzed by Western blotting. In the hippocampus and cortex, GST-π was mainly found in the cytoplasm and membrane of neurons, and the GST-π expression level was higher in drug-resistant group than in the drug-responsive group and saline control group (P<0.05). Moreover, there was no significant difference between responders and saline control animals (P>0.05). The change in expression of GST-π in peripheral blood showed the same pattern as that in brain tissues, suggesting GST-π might contribute to drug resistance in epilepsy. Importantly, the GST-π over-expression in peripheral blood could be used as a marker for resistance to anti-epileptic agents.

Endothelial nitric oxide synthase polymorphism and venous thromboembolism: A meta-analysis of 9 studies involving 3993 subjects.

BACKGROUND: Endothelial nitric oxide synthase (eNOS) polymorphism may influence the risk of venous thromboembolism (VTE). However, data from published studies with low statistical power are inconclusive. The present meta-analysis aimed to assess the relationship between eNOS polymorphism and the risk of VTE. METHOD: Case-control studies evaluating the association between the eNOS polymorphism and VTE were searched in PubMed, Embase, Web of Science, Google Scholar, Wanfang, Chinese National Knowledge Infrastructure (CNKI), the Chongqing VIP Chinese Science and Technology Periodical Database (VIP), and Chinese Biomedical Literature Database (CBM). RESULTS: A total of 1588 cases and 2405 controls from 9 studies were included in the analysis. The results showed that eNOS G894T polymorphism was related to VTE susceptibility and the difference was statistically significant [T vs G: OR = 1.41, 95% CI (1.13, 1.75), P = 0.002; TT + GG vs TG: OR = 0.71, 95% CI (0.60, 0.84), P = 0.000; TT + TG vs GG: OR = 1.45, 95% CI (1.23, 1.70), P = 0.000]. Additionally, eNOS Intron 4 VNTR polymorphism was related to VTE susceptibility and the difference was statistically significant [4b4b vs 4a4a + 4a4b: OR = 2.77, 95% CI (1.01, 7.61), P = 0.048]. CONCLUSION: ENOS G894T and eNOS Intron 4 VNTR polymorphisms were associated with VTE susceptibility, especially in Asian populations. However, multicenter studies with larger samples should be conducted to further clarify this association and verify our findings.

Correlation of Seizure Increase and COVID-19 Outbreak in Adult Patients with Epilepsy: Findings and Suggestions from a Nationwide Multi-centre Survey in China.

OBJECTIVES: To investigate the impact of the COVID-19 outbreak on the behaviours, mental health and seizure control of adult patients with epilepsy (PWE) and to identify the correlation of seizure increase and the COVID-19 outbreak to guide the medical care of individuals with epilepsy during a public health crisis. METHODS: This study was conducted at 28 centres from February 2020 to April 2020. Participants filled out a 62-item online survey including sociodemographic, COVID-19-related, epilepsy-related and psychological variables and were divided into two groups based on whether their seizure frequency increased during the COVID-19 pandemic. Chi-square tests and t-tests were used to test differences in significant characteristics. Multiple logistic regression analyses were used to identify risk factors for seizure worsening. RESULTS: A total of 1,237 adult PWE were enrolled for analysis. Of this sample, 31 (8.33%) patients experienced an increase in seizures during the pandemic. Multivariate logistic regression suggested that feeling nervous about the pandemic (P < 0.05), poor quality of life (P = 0.001), drug reduction/withdrawal (P = 0.032), moderate anxiety during the COVID-19 outbreak (P = 0.046) and non-seizure free before the COVID-19 outbreak (P < 0.05) were independently related to seizure increase during the pandemic. CONCLUSIONS: During the COVID-19 pandemic, PWE with poor quality of life and mental status, as well as AED reduction/withdrawal, were more likely to experience seizure increase. This observation highlights the importance of early identification of the population at high risk of seizure worsening and implementation of preventive strategies during the pandemic.

MicroR-26b Targets High Mobility Group, AT-hook 2 to Ameliorate Myocardial Infarction-induced Fibrosis by Suppression of Cardiac Fibroblasts Activation.

BACKGROUND: Myocardial Fibrosis (MF) is an important physiological change after myocardial infarction (MI). MicroRNA-26b (MiR-26b) has a certain inhibitory effect on pulmonary fibrosis. However, the role of miR-26b in MI-induced MF rats and underlying molecular mechanisms remain unknown. METHODS: Forty male Sprague Dawley (SD) rats weighing 200-250 g were divided into four groups (n=10): Sham group, MF group, MF + negative control (NC) agomir group and MF + miR-26b agomir group. Cardiac fibroblasts were isolated from cardiac tissue. Fibrosis levels were detected by MASSON staining, while the expression of related genes was detected by RT-qPCR, Western blotting and Immunohistochemistry, respectively. TargetScan and dual-luciferase reporter assay were utilized to predict the relationship between miR-26b and high mobility group, AT-hook 2 (HMGA2). RESULTS: The study found the expression of miR-26b to be down-regulated in the myocardium of MF rats (P<0.01). miR-26b overexpression in vitro significantly reduced the survival rate of cardiac fibroblasts and inhibited the expression of the fibrillar-associated protein (α-SMA alphasmooth muscle actin (α-SMA) and collagen I) (P<0.01). TargetScan indicated that HMGA2 was one of the target genes of miR-26b; dual-luciferase reporter assay further confirmed the targeted regulatory relationship (P<0.01). Moreover, miR-26b overexpression significantly reduced the expression of HMGA2 (P<0.01). Notably, HMGA2 overexpression reversed the inhibitory effect of miR-26b overexpression on cardiac fibroblast viability and the expression of α-SMA and collagen I (P<0.01). Animal experiments further indicated that miR-26b overexpression inhibited MIinduced rat MF by inhibiting the expression of HMGA2 (P<0.05, P<0.01). CONCLUSION: In short, these findings indicate that miR-26b targets HMGA2 to ameliorate MI-induced fibrosis by suppression of cardiac fibroblasts activation.

[Comparison of amiodarone plus irbesartan regimen versus amiodarone alone on maintaining sinus rhythm in rheumatic heart disease patients with persistent atrial fibrillation post valve replacement and cardioversion].

OBJECTIVE: To compare the efficacy of combined amiodarone and irbesartan use versus amiodarone alone on maintaining sinus rhythm in rheumatic heart disease patients with persistent atrial fibrillation (AF) post valve replacement and cardioversion. METHODS: Patients were randomly divided into amiodarone group (A, n = 31) and amiodarone plus irbesartan group (AI, n = 32) and all patients received Warfarin (INR 2.0 - 3.0). For patients in group A, intravenous amiodarone (600 mg/d) was applied for 10 days and oral amiodarone (200 mg, b.i.d.) was given on the 7th day for 3 days. For patients in group AI, irbesartan (150 mg/d) was added on top of amiodarone at the study begin. Electric cardioversion was performed for patients still with AF on day 10. Amiodarone (200 mg, b.i.d. for 1 week, then 200 mg, q.d. till study end) with or without irbesartan (150 mg/d) was continued thereafter. Patients were followed up for 12 months after sinus rhythm recovery. The primary end points are first recurrence of symptomatic and asymptomatic AF. RESULTS: Twelve months post therapy, number of patients on sinus rhythm was significantly higher (68.7% vs. 41.9%, P<0.05) and left atrium diameter (LAD) was significantly smaller [(48.6 +/- 4.6) mm vs. (51.5 +/- 4.2) mm, P<0.05] in group AI than those in group A. LAD (OR 1.242) and use of irbesartan (OR 0.226) are associated with the AF recurrence. CONCLUSION: Combined amiodarone and irbesartan use is superior to amiodarone alone for maintaining sinus rhythm in rheumatic heart disease patients with persistent AF post valve replacement and cardioversion.

Genetic association between plasminogen activator inhibitor-1 rs1799889 polymorphism and venous thromboembolism: Evidence from a comprehensive meta-analysis.

BACKGROUND: Association between plasminogen activator inhibitor-1 (PAI-1) rs1799889 polymorphism and venous thromboembolism (VTE) were explored by many previous studies, yet the findings of these studies were conflicting. HYPOTHESIS: PAI-1 rs1799889 polymorphism may serve as a genetic marker of VTE. We aimed to better clarify the relationship between PAI-1 rs1799889 polymorphism and VTE in a larger combined population by performing a meta-analysis. METHODS: Literatures were searched in Pubmed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI). We used Review Manager to combine the results of individual studies. RESULTS: Forty-eight studies involving 14 806 participants were eligible for inclusion. Combined results revealed that PAI-1 rs1799889 polymorphism was significantly associated with VTE in Caucasians (dominant comparison: odds ratio [OR] 1.20, 95% confidence interval [CI] 1.09-1.32; recessive comparison: OR 0.84, 95% CI 0.76-0.94; allele comparison: OR 1.08, 95% CI 1.02-1.15) and East Asians (dominant comparison: OR 1.60, 95% CI 1.17-2.19; allele comparison: OR 1.53, 95% CI 1.21-1.93). Further analyses obtained similar significant associations in these with deep vein thrombosis (DVT) and these with Factor V Leiden mutation. CONCLUSIONS: Our findings supported that PAI-1 rs1799889 polymorphism may serve as one of the predisposing factors of VTE in both Caucasians and East Asians, especially in these with DVT and these with Factor V Leiden mutation.

Increased expression of the P2X7 receptor in temporal lobe epilepsy: Animal models and clinical evidence.

Previous studies have indicated that the adenosine triphosphate­sensitive homomeric P2X7 receptor (P2X7R) plays an important role and exhibits therapeutic potential in a number of brain disorders, including temporal lobe epilepsy (TLE). The aim of the present study was to assess the expression of P2X7R, glutamate (GLU) and glial fibrillary acidic protein (GFAP) in the temporal neocortex and hippocampus of rats with lithium­pilocarpine­induced epilepsy as well as in patients with intractable TLE. The results demonstrated that the levels of P2X7R, GLU and GFAP were significantly upregulated in rats with spontaneous recurrent seizures, whereas they were reduced in rats that were treated with brilliant blue G (BBG), a P2X7R antagonist. To the best of our knowledge, the present study is also the first to demonstrate that P2X7R expression was elevated in patients with intractable TLE. These findings suggest that P2X7R plays a key role in the development of TLE and that BBG treatment may be a promising therapeutic strategy for TLE.

Prognostic value of serum uric acid in patients with acute heart failure: A meta-analysis.

BACKGROUND: Conflicting results have been reported on the prognostic significance of serum uric acid (SUA) in patients with acute heart failure (AHF). This meta-analysis aimed to determine the prognostic significance of SUA level in patients with AHF. METHODS: We made a comprehensive literature search in Pubmed and Embase databases from inception to April 6, 2018. All available observational studies or post hoc analysis of randomized controlled trial that evaluated the prognostic value of SUA level in patients with AHF were eligible. Outcome of interests were all-cause mortality and the combined endpoint of death or readmission. Prognostic values of SUA level were summarized as higher vs lower SUA category or per 1 mg/ml SUA rise. RESULTS: Ten studies involving 12,854 AHF patients were identified and analyzed. AHF patients with the highest SUA level had an increased risk of all-cause mortality (risk ratio [RR] 1.43; 95% confidence intervals [CI] 1.31-1.56) and combined endpoint of death or readmission (RR 1.68; 95% CI 1.33-2.13) after adjusting potential variables. In addition, per 1 mg/ml SUA rise significantly increased by 11% and 12% higher risk all-cause mortality and combined endpoint of death or readmission, respectively. A leave out 1 study sensitivity analysis confirmed the reliability of the pooling effect sizes. CONCLUSION: This meta-analysis indicates that elevated SUA level independently predicts all-cause mortality and the combined endpoint of death or readmission in AHF patients. Measurement of SUA level may improve risk stratification of adverse outcomes in these patients.

Rapid inhibition of the glutamate-induced increase of intracellular free calcium by magnesium in rat hippocampal neurons.

By using Fura-2/AM, the effects of magnesium (Mg2+) on the glutamate-induced increase of intracellular free calcium ([Ca2+]i) in the cultured hippocampal neurons and the features were investigated by integrated photoelectric detecting system. The experiments were designed to three groups (The drug was spit to the cells for 20 s): Group A receiving 1 x 10(-5) mol/L glutamate; Group B receiving 1 x 10(-5) mol/L glutamate and 1 x 10(-5) mol/L Mg2+ simultaneously; Group C receiving 1 x 10(-5) mol/L glutamate again after [Ca2+]i in group B back to the baseline. The results showed that in group A, [Ca2+]i was obviously increased. In group B, the changes in [Ca+] i and the peak value were significantly decreased. Moreover, the elevation of Phase 1 was slowed down and Phase 2 was shortened to some extent, and the plateau phase between them was relatively prolonged. In group C, calcium oscillation similar to that in group A occurred, but both the Phase 1 and Phase 2 were shortened and the delta[Ca2+]i was slightly decreased. It was suggested that Mg2+ could quickly inhibit the rise of [Ca2+]i induced by glutamate in the cultured hippocampal neurons in rats.