Efficacy and safety of venlafaxine hydrochloride combined with tandospirone citrate for patients with vascular depression accompanied by somatic symptoms: An open-labeled randomized control trial.

AIMS: To explore the pharmacological treatment of vascular depression (VaDep) and whether the blood levels of neurotransmitters can reflect the VaDep severity. METHODS: VaDep patients with somatic symptoms were enrolled and randomly received venlafaxine + tandospirone (Combined Group) or venlafaxine (Monotherapy Group). The treatment efficacy was assessed by Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Patient Health Questionnaire-15 (PHQ-15). The levels of blood monoamine neurotransmitters were measured by enzyme-linked immunosorbent assay. RESULTS: Both groups reported a progressive decrease in HAMD, HAMA, and PHQ-15 scores to below the baseline after the respective treatment. Compared with the Monotherapy Group, the Combined Group reported a significant decrease in HAMD score at week 2 and markedly lower HAMA and PHQ-15 scores at weeks 1, 2, 4, and 8. Both groups showed a decrease in the levels of blood monoamine neurotransmitters at weeks 4 and 8 when compared with the baseline. A strong positive association was evident between the plasma 5-HT levels and the HAMD score. CONCLUSION: The combined therapy rapidly acts on VaDep comorbid with anxiety and somatic symptoms and significantly alleviates the anxiety and somatic symptoms. The plasma levels of 5-HT may serve as potential objective candidates in evaluating VaDep severity and the efficacy of the undertaken treatment regimen.

MK8617 inhibits M1 macrophage polarization and inflammation via the HIF-1α/GYS1/UDPG/P2Y14 pathway.

Background: Nonresolving inflammation is a major driver of disease and needs to be taken seriously. Hypoxia-inducible factor (HIF) is closely associated with inflammation. Hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs), as stabilizers of HIF, have recently been reported to have the ability to block inflammation. We used MK8617, a novel HIF-PHI, to study its effect on macrophage inflammation and to explore its possible mechanisms. Methods: Cell viability after MK8617 and lipopolysaccharide (LPS) addition was assessed by Cell Counting Kit-8 (CCK8) to find the appropriate drug concentration. MK8617 pretreated or unpretreated cells were then stimulated with LPS to induce macrophage polarization and inflammation. Inflammatory indicators in cells were assessed by real-time quantitative reverse-transcription polymerase chain reaction (qRT-PCR), western blot (WB) and immunofluorescence (IF). The level of uridine diphosphate glucose (UDPG) in the cell supernatant was measured by ELISA. Purinergic G protein-coupled receptor P2Y14, as well as hypoxia-inducible factor-1α (HIF-1α) and glycogen synthase 1 (GYS1) were detected by qRT-PCR and WB. After UDPG inhibition with glycogen phosphorylase inhibitor (GPI) or knockdown of HIF-1α and GYS1 with lentivirus, P2Y14 and inflammatory indexes of macrophages were detected by qRT-PCR and WB. Results: MK8617 reduced LPS-induced release of pro-inflammatory factors as well as UDPG secretion and P2Y14 expression. UDPG upregulated P2Y14 and inflammatory indicators, while inhibition of UDPG suppressed LPS-induced inflammation. In addition, HIF-1α directly regulated GYS1, which encoded glycogen synthase, an enzyme that mediated the synthesis of glycogen by UDPG, thereby affecting UDPG secretion. Knockdown of HIF-1α and GYS1 disrupted the anti-inflammatory effect of MK8617. Conclusions: Our study demonstrated the role of MK8617 in macrophage inflammation and revealed that its mechanism of action may be related to the HIF-1α/GYS1/UDPG/P2Y14 pathway, providing new therapeutic ideas for the study of inflammation.

Augmentation therapy with tandospirone citrate in vascular depression patients with mild cognitive impairment: A prospective randomized clinical trial.

Cognitive impairment is a prominent clinical manifestation of vascular depression (VaDep). The current study aimed to assess the efficacy of tandospirone citrate in VaDep cases with mild cognitive impairment (VaDep-MCI) as well as the role of plasma monoamine neurotransmitters during the treatment. In this single-blind, randomized controlled study, 116 participants were randomly assigned to the tandospirone (tandospirone citrate-escitalopram) and control (escitalopram) groups. The primary endpoints were changes in cognitive test scores from baseline to Week 8, including the Rey Auditory Verbal Learning Test (RAVLT), Semantic Verbal Fluency (SVF) test, Trail Making Test (TMT), Digital Span Test (DST) and Clock Drawing Test (CDT) scores. Generalized estimating equation models were used to examine repeated measures. The results showed that compared with the changes in the control group from baseline to Week 8, the tandospirone group showed more significant changes in SVF score at Weeks 4 (p < 0.05) and 8 (p < 0.001), and TMT (B-A) score at Week 8 (p < 0.05). RAVLT, DST and DCT scores were relatively stable in both groups during the study period. Moreover, mediation analysis showed that these results were not mediated by the alleviation of depression symptoms. Partial Spearman correlation analysis showed that only plasma 5-hydroxytryptamine (5-HT) was positively correlated with Hamilton Depression Rating Scale score after Bonferroni correction (r = 0.347, p < 0.001). Augmentation therapy with tandospirone citrate improved the executive and language functions of VaDep-MCI patients. Additionally, plasma 5-HT levels may serve as a potential biomarker of VaDep severity. These findings may provide clinical insights into the treatment of vascular depression.

Treadmill exercise exerts a synergistic effect with bone marrow mesenchymal stem cell-derived exosomes on neuronal apoptosis and synaptic-axonal remodeling.

Treadmill exercise and mesenchymal stem cell transplantation are both practical and effective methods for the treatment of cerebral ischemia. However, whether there is a synergistic effect between the two remains unclear. In this study, we established rat models of ischemia/reperfusion injury by occlusion of the middle cerebral artery for 2 hours and reperfusion for 24 hours. Rat models were perfused with bone marrow mesenchymal stem cell-derived exosomes (MSC-exos) via the tail vein and underwent 14 successive days of treadmill exercise. Neurological assessment, histopathology, and immunohistochemistry results revealed decreased neuronal apoptosis and cerebral infarct volume, evident synaptic formation and axonal regeneration, and remarkably recovered neurological function in rats subjected to treadmill exercise and MSC-exos treatment. These effects were superior to those in rats subjected to treadmill exercise or MSC-exos treatment alone. Mechanistically, further investigation revealed that the activation of JNK1/c-Jun signaling pathways regulated neuronal apoptosis and synaptic-axonal remodeling. These findings suggest that treadmill exercise may exhibit a synergistic effect with MSC-exos treatment, which may be related to activation of the JNK1/c-Jun signaling pathway. This study provides novel theoretical evidence for the clinical application of treadmill exercise combined with MSC-exos treatment for ischemic cerebrovascular disease.

Facial emotion perception and recognition deficits in acute ischemic stroke.

BACKGROUND: Facial emotion perception and recognition (FEPR) deficits are the sources of disability, impaired social relationship, and reduced quality of life. Studies of unilateral acute ischemic stroke (AIS) remain controversial about FEPR deficits. METHODS: Clinical and neurocognitive data were collected and analyzed among normal controls (NC) and AIS patients with left brain damage (LBD), right brain damage (RBD), and infratentorial brain damage (IBD). To assess FEPR, all participants completed a localization test (the Southeastern China Brief Affect Recognition Test). Correlation analyses were conducted between the FEPR deficits and cognitive functions. RESULTS: Compared with NC, all three groups of AIS patients reported significant FEPR deficits. Although no statistical difference in FEPR deficits were observed among the LBD, RBD and IBD patients, the deficit patterns were markedly different. FEPR deficits were positively correlated with cognitive impairment. CONCLUSIONS: FEPR deficits may occur in AIS patients and are associated with impaired cognitive functions, where the cerebral hemispheres and the infratentorial brain are jointly involved. Early recognition and early intervention of FEPR deficits in AIS patients are critical for post-stroke rehabilitation, reconstruction of social function and improvement in life quality.

Acupuncture for opioid-induced constipation: Protocol for a systematic review and meta-analysis.

BACKGROUND: Opioid-induced constipation (OIC) is one of the most common complications of analgesic therapy for cancer pain patients who suffer moderate to severe pain. Acupuncture as an effective treatment in constipation has been widely applied. But its efficacy has not been assessed systematically. Thus, the purpose of this study is to provide a protocol to explore the efficacy and safety of acupuncture for OIC. METHODS: Randomized Controlled Trials (RCTs) of acupuncture treatment for OIC in 4 Chinese electronic databases (China National Knowledge Infrastructure, Chinese Biological and Medical Database, China Scientific Journal Database, Wan-Fang Data) and 3 English electronic databases (PubMed, Embase, Cochrane Library) will be searched from their inception to September 31, 2020. RevMan 5.3 software and Stata 14.0 software will be used for meta-analysis, EndNote X9.2 and Cochrane Risk of Bias Tool will be used for literature screening and quality assessment. RESULTS: This study will present an assessment of the efficacy and safety of acupuncture treatment for OIC patients through summarize high-quality clinical evidence. CONCLUSION: The conclusion of our systematic review and meta-analysis may provide evidence of whether acupuncture treatment is beneficial to patients with OIC.INPLASY registration number: INPLASY2020100026.

Association Between Steno-Occlusive Middle Cerebral Artery and Basal Ganglia Perivascular Spaces.

Objectives: Enlarged perivascular spaces in the basal ganglia (BG-EPVS) share common vascular risk factors with atherosclerosis. However, little is known about the relationship between steno-occlusive middle cerebral artery (MCA) and BG-EPVS. In this cross-sectional study, we aimed to test the hypothesis that severe MCA stenosis or occlusion is associated with increased MRI-visible BG-EPVS. Methods: We retrospectively reviewed 112 patients with a steno-occlusive MCA from Fujian Medical University Union Hospital between January 2014 and December 2018. We rated BG-EPVS, white matter hyperintensities (WMH), and lacunes as markers of cerebral small vessel disease (CSVD) on magnetic resonance image (MRI). The severity of steno-occlusive MCA was assessed by computed tomography angiography (CTA) and was classified into moderate (50-69%), severe (70-99%), and occlusion (100%). We evaluated the association of steno-occlusive MCA for >10 BG-EPVS using logistic regression model adjusted for age, gender, hypertension, MR-visible WMH, and lacunes. We also compared the number of BG-EPVS between the affected side and unaffected side in patients with only unilateral steno-occlusive MCA. Results: In multivariable logistic regression analysis, age (OR = 1.07, 95%CI: 1.03-1.13, p = 0.003), hypertension (OR = 2.77, 95%CI: 1.02-7.51, p = 0.046), severe MCA stenosis (OR = 3.65, 95%CI: 1.12-11.87, p = 0.032), or occlusion (OR = 3.67, 95%CI: 1.20-11.27, p = 0.023) were significantly associated with >10 BG-EPVS. The number of BG-EPVS in the affected side was higher than the unaffected side in patients with severe MCA stenosis (12 [9-14] vs. 8 [6-11], p = 0.001) or occlusion (11 [7-14] vs. 8 [5-11], p = 0.028). Conclusions: BG-EPVS were more prevalent in patients with severe MCA atherosclerosis. Our findings suggest a biological link between severe steno-occlusive MCA and increased BG-EPVS. These results need confirmation in prospective studies.

GBX2, as a tumor promoter in lung adenocarcinoma, enhances cells viability, invasion and migration by regulating the AKT/ERK signaling pathway.

BACKGROUND: Increasing evidence shows that gastrulation brain homeobox 2 (GBX2) is involved in multiple cancers. However, whether GBX2 has an effect on the lung adenocarcinoma remains unclear. In the present study, we investigated the functions of GBX2 on lung adenocarcinoma and explored the underlying mechanism. METHODS: Public data were obtained from the TCGA (https://cancergenome.nih.gov) and Oncomine (http://www.oncomine.org) databases. GBX2 expression and its prognostic value were analyzed by bioinformatics methods. Relative mRNA and protein expression levels of GBX2 in lung adenocarcinoma cell lines were evaluated via a quantitative reverse transcriptase polymerase chain reaction and western blotting. Lung adenocarcinoma cell lines LTEP-a-2 and A549, respectively, were selected for gain and loss function of GBX2 assays. Cell viability was detected by CCK8 and clone formation experiments. Cell invasion and migration were assessed by Transwell assays. The effect of GBX2 on the AKT/extracellular signal regulated kinase (ERK) pathway was tested by western blotting. RESULTS: Compared to adjacent tissues, GBX2 expression was up-regulated in lung adenocarcinoma tissues. High expression of GBX2 led to a poor survival and could be seen as an independent predictor for lung adenocarcinoma patients. Furthermore, down-regulation of GBX2 notably restrained the viability, invasion and migration abilities of A549 cells, whereas up-regulation of GBX2 in LTEP-a-2 cells presented the opposite outcomes. Furthermore, western blot indicated that down-regulation of GBX2 decreases the protein levels of phosphorylated (p)-AKT and p-ERK in A549 cells, whereas up-regulation of GBX2 shows the opposite effects in LTEP-a-2 cells. CONCLUSIONS: The results of present study indicate that GBX2 acts a cancer-promoting role to accelerate cell proliferation, invasion and migration partly by modulation of the AKT/ERK pathway in lung adenocarcinoma.

IL-10 produces a dual effect on OGD-induced neuronal apoptosis of cultured cortical neurons via the NF-κB pathway.

As a classic immunoregulatory cytokine, interleukin-10 (IL-10) can provide in vivo and in vitro neuroprotection respectively during cerebral ischemia and after the oxygen-glucose deprivation (OGD)-induced injury. However, its role in cortical neuronal survival at different post-ischemic phases remains unclear. The current study found that IL-10 had distinct effects on the neuronal apoptosis at different OGD stages: at an early stage after OGD, IL-10 promoted the OGD-induced neuronal apoptosis in the cultured primary cortical neurons by activating p65 subunit, which up-regulated Bax expression and down-regulated Bcl-xL expression; at a late OGD stage, however, it attenuated the OGD-induced neuronal apoptosis by activating c-Rel, which up-regulated Bcl-xL expression and down-regulated Bax expression. The early-stage pro-apoptosis and late-stage anti-apoptosis were both partly abolished by PDTC, an NF-κB inhibitor, and promoted by PMA, an NF-κB activator. The optimal anti-apoptotic effect appeared when the cultured neurons were treated with IL-10 at 9-24 h after OGD. Taken together, our findings suggest that IL-10 exerts a dual effect on the survival of the cultured neurons by activating the NF-κB pathway at different stages after OGD injury and that PMA treatment at a late stage can facilitate the IL-10-conferred neuroprotection against OGD-induced neuronal injury.

A controlled study of the efficacy and safety of tandospirone citrate combined with escitalopram in the treatment of vascular depression: A pilot randomized controlled trial at a single-center in China.

Vascular depression can respond poorly to antidepressants. This study aimed to explore the efficacy and safety of tandospirone plus escitalopram for treating vascular depression with anxiety. This pilot randomized controlled trial included consecutive inpatients/outpatients with vascular depression/anxiety at the Department of Neurology, Fujian Medical University Union Hospital, China (January 2014 to December 2016). Among 157 patients screened, 100 were randomly divided into the tandospirone + escitalopram (combination therapy) and escitalopram (monotherapy) groups equally, and then followed for 8 weeks. Efficacy was evaluated using the Hamilton Depression (HAMD), Hamilton Anxiety (HAMA), Clinical Global Impression (CGI) and Mini-Mental State examination (MMSE) scales. Adverse events (AEs) were assessed with the Treatment Emergent Symptom Scale (TESS). HAMD and HAMA scores decreased progressively, showing reductions versus baseline at 1, 2, 4 and 8 weeks in both groups (P < 0.001). HAMD and HAMA scores were lower in the tandospirone + escitalopram group than those in the escitalopram group at 1 and 2 weeks (P < 0.001), but not at 4 and 8 weeks. Improvements in CGI scores (severity, improvement and efficacy indexes) were greater in the tandospirone + escitalopram group than that in the escitalopram group at 1 and 2 weeks (P < 0.01), but not at 4 and 8 weeks. The tandospirone + escitalopram group had higher MMSE scores than that in the escitalopram group at 4 and 8 weeks (P < 0.01). All AEs were mild, and the rates were comparable between groups. Augmentation of escitalopram with tandospirone accelerates the onset of anti-depressive and anxiolytic effects and improves cognitive function in patients with vascular depression and anxiety.

Baseline Signal Reconstruction for Temperature Compensation in Lamb Wave-Based Damage Detection.

Temperature variations have significant effects on propagation of Lamb wave and therefore can severely limit the damage detection for Lamb wave. In order to mitigate the temperature effect, a temperature compensation method based on baseline signal reconstruction is developed for Lamb wave-based damage detection. The method is a reconstruction of a baseline signal at the temperature of current signal. In other words, it compensates the baseline signal to the temperature of current signal. The Hilbert transform is used to compensate the phase of baseline signal. The Orthogonal matching pursuit (OMP) is used to compensate the amplitude of baseline signal. Experiments were conducted on two composite panels to validate the effectiveness of the proposed method. Results show that the proposed method could effectively work for temperature intervals of at least 18 °C with the baseline signal temperature as the center, and can be applied to the actual damage detection.

[Effects of adipose-derived stem cells transplantation on the neuronal apoptosis and the expression of Bcl-2 and caspase-12 in the brain post focal cerebral ischemia in rats].

AIM: To investigate the effects of adipose-derived stem cells (ADSCs) transplantation on neuronal apoptosis in the brain after focal cerebral ischemia in rats. METHODS: 72 male adult Sprague-Dawley rats were randomly divided into 4 groups: Sham-operated group , Middle cerebral artery occlusion (MCAO) group, Vehicle group and ADSC-treated group (n=18). MCAO model was established with the modified Longa's method. One day after right MCAO, 30 µL of cell suspension containing 1×10(6); cells were injected into the lateral ventricle of ADSC-treated group and the same dose of PBS was given to the vehicle group. At 4 d, 7 d and 14 d after MCAO, the apoptosis of neuron was detected by terminal deoxynucleotidyl transferase-mediated DNA nick-end labeling (TUNEL) method and the expression of Bcl-2 and caspase-12 in ischemic region was detected by immunohistochemistry and RT-PCR. RESULTS: TUNEL-positive cells in ischemic region of ADSC-treated group were less than that in MCAO group and Vehicle group at 4 d, 7 d and 14 d post MCAO (P<0.05). Compared with MCAO group and Vehicle group, the expression of Bcl-2 significantly up-regulated while caspase-12 expression significantly decreased in ADSC-treated group at any time point post MCAO (P<0.05). CONCLUSION: The transplantation of ADSCs can reduce neuronal apoptosis of rats with cerebral ischemic injury partly by promoting the expression of Bcl-2 which participates in apoptotic signals after mitochondrial damage and inhibiting the expression of caspase-12 which mediates endoplasmic reticulum (ER) stress-induced apoptosis.

[The effects of adipose-derived stem cell transplantation on the expression of IL-10 and TNF-alpha after cerebral ischaemia in rats].

AIM: To explore the effects of adipose-derived stem cell (ADSC) transplantation on the expression of IL-10 amd TNF-alpha after cerebral ischaemia in Middle cerebral artery occlusion (MCAO) rats. METHODS: 72 male adult Sprague-Dawley rats were randomly divided into 4 groups: sham group, MCAO group, Vehicle group and ADSC group (n=18). Rat's cerebral ischemia model was established by MCAO with Longa's method. ADSC were labeled by DAPI before transplantation. One day after MCAO, 30 microL of cell suspension containing 1 x 10(6); ADSCs were injected into the lateral ventricle of ADSC group and the same dose of PBS was given to the Vehicle group. At day 4, day 7 and day 14 after MCAO, the rats were decapitated to detect the expression of IL-10 and TNF-alpha in ischaemic rat's brain by ELISA, immunohistochemistry and RT-PCR. RESULTS: Compared with sham group, the expression of IL-10 and TNF-alpha significantly up-regulated at 4 d, 7 d of MCAO group(P<0.05). There was no statistical difference of IL-10 and TNF-alpha expression between MCAO and vehicle group ant any time point(P>0.05). Compared with Vehicle group, the expression of IL-10 significantly up-regulated while TNF-alpha expression significantly decreased of ADSC-treated group at any timepoint post MCAO(P<0.05). CONCLUSION: The transplantation of ADSC could up-regulate the expression of IL-10 and down-regulate the expression of TNF-alpha in MCAO rat's brain, which might contribute to its protective role upon cerebral ischaemia.

[Effects of adipose-derived stem cell transplantation on the angiogenesis and the expression of bFGF and VEGF in the brain post focal cerebral ischemia in rats].

AIM: To investigate the effects of adipose-derived stem cell (ADSC) transplantation on the angiogenesis in the brain post focal cerebral ischemia in rats. METHODS: 72 male adult Sprague-Dawley rats were randomly divided into 4 groups: sham-operated group, middle cerebral artery occlusion (MCAO) group, vehicle group and MCAO+ADSC-treated group (n=18). A permenant focal cerebral ischemia model was established with the modified Longa's method. ADSC were labeled by DAPI before transplantation. One day after right MCAO, 30 muL of cell suspension containing 1x10(6) cells were injected into the lateral ventricle of MCAO+ADSC-treated group and the same dose of PBS was given to the vehicle group. On D4, D7 and D14 after MCAO, the rats were killed to detect the regeneration of microvessel and the expression of bFGF and VEGF in ischemic region by immunohistochemistry and RT-PCR. RESULTS: A lot of microvessel proliferate in the injured cortex reached peak in 2 weeks. The microvessel density in the brain tissues of rats treated with ADSC was higher than that in MCAO group and vehicle group (P<0.01). The expression of bFGF and VEGF in the brain tissues of MCAO+ADSC-treated group was higher than that in MCAO group and vehicle group on D4, D7 and D14 post MCAO. CONCLUSION: The transplantation of ADSC can promote the revascularization of cerebral ischemia in rats partly by enhancing bFGF and VEGF synthesis in brain.