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1.
Neurosci Lett ; 715: 134611, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31698026

RESUMO

Continuous theta burst stimulation (cTBS) has been widely recognized as a therapeutic treatment for ischemic stroke, but the underlying mechanism is still elusive. Here, we investigated the protective effects of cTBS in the posterior parietal cortex during the chronic phase of stroke in the photothrombotic ischemic model. Infarction volume and neuron excitability in the peri-infarct area were assessed using immunohistochemistry and whole-cell patch-clamp. Spatial cognitive function was measured using the Morris water maze. Gamma-Amino butyric acid (GABA) interneurons were responsive to cTBS, and cTBS induced elevated phasic inhibition rather than tonic inhibition. Given that GABA-A-mediated phasic inhibition was elevated during the chronic phase of ischemic stroke for 30 days and was beneficial for stroke recovery, we investigated the therapeutic potential of cTBS in promoting functional recovery and found that the elevated phasic inhibition by cTBS improved spatial cognitive function in the photothrombotic stroke mouse model with induction in the posterior parietal cortex. Our study indicates the mechanism by which cTBS may modify the excitability of the brain cortex and provides novel insight into the potential of cTBS to protect against neuronal dysfunction in ischemic stroke.

2.
Brain Res ; 1726: 146488, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586625

RESUMO

Acute ischemic stroke is a leading cause of disability with limited therapeutic options. Continuous theta burst stimulation (cTBS) has recently been shown to be a promising noninvasive therapeutic strategy for neuroprotection in ischemic stroke patients. Here, we investigated the protective effects of cTBS following acute infarction using a photothrombotic stroke (PTS) model in the right posterior parietal cortex (PPC) of C57BL/6 mice. Treatment with cTBS resulted in a reduction in the volume of the infarct region and significantly increased vascular diameter and blood flow velocity in peri-infarct region, as well as decreased the numbers of calcium binding adapter molecule 1 (Iba-1)-positive microglia and glial fibrillary acidic protein (GFAP)-positive astrocytes. Moreover, the number of CD16/32 positive microglia was decreased, whereas the number of CD206 positive microglia was increased. In addition, performance in a water maze task was significantly improved. These results indicated that cTBS protected against PPC infarct region, leading to an improvement in spatial cognitive function, possibly as a result of changes to cerebral microvascular function and inflammatory responses.

3.
Biomed Res Int ; 2019: 9276097, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281847

RESUMO

Background: The hyperhomocysteinemia was with high prevalence and has been considered as a risk factor for cardiovascular disease in hemodialysis patients. These patients also experienced a high risk of muscle wasting caused by the comorbidity, malnutrition, and low physical activity. We investigated the associations of homocysteinemia with muscle mass, muscle function in elderly hemodialysis patients. Methods: A clinical cross-sectional study was conducted on 138 hemodialysis patients aged 65 years and above in seven hospital-based hemodialysis centers in Taiwan. The data on anthropometry, laboratory, and 3-day dietary intake was examined. The skeletal muscle mass (SMM) was measured by the bioelectrical impedance analysis; the SMM was adjusted by height or weight as SMMHt2 (kg/m2) and SMMWt (%). Muscle function was defined as handgrip strength (HGS) (kg) measured by handgrip dynamometer. Statistical analyses were conducted using simple regression and multivariable stepwise regression analysis. Results: In the total sample, 74.6 % of hemodialysis patients were hyperhomocysteinemia (≥ 15 µmol/L). The means of SMMHt2, SMMWt, arm lean mass, hand grip strength, and muscle quality were 8.7 ± 1.2, 37.7 ± 5.6, 1.7 ± 0.5, 21.1 ± 7.4, and 10.0 ± 3.0, respectively. The multivariable stepwise regression analysis showed that homocysteinemia level was significantly inversely associated with SMMWt (B-coeff. = -0.03, p = 0.02) in hemodialysis patients above 65 years old, but not with muscle function. Conclusions: Hyperhomocysteinemia is common and associated with decreased muscle mass in the elderly hemodialysis patients. Future studies are suggested to explore the impact of the homocysteine-lowering therapy on muscle decline.


Assuntos
Hiper-Homocisteinemia/etiologia , Hiper-Homocisteinemia/fisiopatologia , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Diálise Renal/efeitos adversos , Idoso , Feminino , Humanos , Modelos Lineares , Masculino , Tamanho do Órgão
4.
Nutrients ; 11(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31234433

RESUMO

A valid diet quality assessment scale has not been investigated in hemodialysis patients. We aimed to adapt and validate the alternative healthy eating index in hemodialysis patients (AHEI-HD), and investigate its associations with all-cause mortality. A prospective study was conducted on 370 hemodialysis patients from seven hospital-based dialysis centers. Dietary data (using three independent 24-hour dietary records), clinical and laboratory parameters were collected. The construct and criterion validity of original AHEI-2010 with 11 items and the AHEI-HD with 16 items were examined. Both scales showed reasonable item-scale correlations and satisfactory discriminant validity. The AHEI-HD demonstrated a weaker correlation with energy intake compared with AHEI-2010. Principle component analysis yielded the plateau scree plot line in AHEI-HD but not in AHEI-2010. In comparison with patients in lowest diet quality (tertile 1), those in highest diet quality (tertile 3) had significantly lower risk for death, with a hazard ratio (HR) and 95% confidence intervals (95%CI) of HR: 0.40; 95%CI: 0.18 - 0.90; p = 0.028, as measured by AHEI-2010, and HR: 0.37; 95%CI: 0.17-0.82; p = 0.014 as measured by AHEI-HD, respectively. In conclusion, AHEI-HD was shown to have greater advantages than AHEI-2010. AHEI-HD was suggested for assessments of diet quality in hemodialysis patients.


Assuntos
Registros de Dieta , Diálise Renal , Insuficiência Renal Crônica/terapia , Idoso , /mortalidade , Ingestão de Energia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Nutritivo , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Proteção , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/fisiopatologia , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Taiwan , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Medicine (Baltimore) ; 98(12): e14930, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30896655

RESUMO

Hemodialysis patients are at the high risk for morbidity and mortality. Evaluation and management of body composition and biochemical values are important to improve dialysis outcomes. We aimed to examine the effects of the mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, and dialysis adequacy on the mortality.A prospective cohort study was conducted on 375 patients from 7 hospital-based dialysis centers. At baseline between September 2013 and April 2017, we assessed patients' characteristics using chart review, body composition using the bioelectrical impedance analysis, and biochemical parameters using available laboratory tests. Patients were followed-up for all-cause mortality until April 2018. Kaplan-Meier Curves with Log-rank test, and Cox proportional hazards models were used to analyze the effects of assessed factors on the mortality.During the median of follow-up time of 1.4 (1.0-3.2) years, 47 (12.5%) patients died. In the multivariate analysis, mid-arm circumference (hazard ratio, HR, 0.90; 95% confidence interval, 95%CI, 0.82-0.99; P = .036), body fat mass (HR, 0.95; 95%CI, 0.91-1.00; P = .031), percent body fat (HR, 0.96; 95%CI, 0.92-0.99; P = .024), serum creatinine (HR, 0.81; 95%CI, 0.68-0.96; P = .015), and eKt/V (HR, 0.07; 95%CI, 0.01-0.33; P = .001) reduced the mortality risk. Inflammation (HR, 2.90; 95%CI, 1.59-5.27; P < .001), hyperglycemia (HR, 2.16; 95%CI, 1.06-4.40; P = .033), and low serum uric acid (HR, 2.22; 95%CI, 1.15-4.31; P = .018) increased the death risk.In hemodialysis patients, the higher values of the mid-arm circumference, body fat, serum creatinine, uric acid, and dialysis adequacy were associated with lower mortality, whereas, inflammation and hyperglycemia associated with higher mortality.


Assuntos
Glicemia , Pesos e Medidas Corporais , Mediadores da Inflamação/metabolismo , Falência Renal Crônica/mortalidade , Estado Nutricional , Fatores Etários , Idoso , Comorbidade , Creatinina/sangue , Impedância Elétrica , Exercício , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Diálise Renal/métodos , Fatores Sexuais
6.
BMC Nephrol ; 19(1): 236, 2018 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-30231860

RESUMO

BACKGROUND: Metabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients. METHODS: A cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and < 60 years, respectively. MetS was defined by the American Association of Clinical Endocrinologists (AACE-MetS), and Harmonizing Metabolic Syndrome (HMetS). Logistic regression models were utilized for examining the association between EI and MetS. Age, gender, physical activity, hemodialysis vintage, Charlson comorbidity index, high sensitive C-reactive protein, and interdialytic weight gains were adjusted in the multivariate analysis. RESULTS: The prevalence of inadequate EI, AACE-MetS, and HMetS were 60.5%, 63.2%, and 53.9%, respectively. Inadequate EI was related to higher proportion of metabolic abnormalities and MetS (p <  0.05). Results of the multivariate analysis shows that inadequate EI was significantly linked with higher prevalence of impaired fasting glucose (OR = 2.42, p <  0.01), overweight/obese (OR = 6.70, p <  0.001), elevated waist circumference (OR = 8.17, p <  0.001), AACE-MetS (OR = 2.26, p <  0.01), and HMetS (OR = 3.52, p <  0.01). In subgroup anslysis, inadequate EI strongly associated with AACE-MetS in groups of non-hypertension (OR = 4.09, p = 0.004), and non-cardiovascular diseases (OR = 2.59, p = 0.012), and with HMetS in all sub-groups of hypertension (OR = 2.59~ 5.33, p <  0.05), diabetic group (OR = 8.33, p = 0.003), and non-cardiovascular diseases (OR = 3.79, p <  0.001). CONCLUSIONS: Inadequate EI and MetS prevalence was high. Energy intake strongly determined MetS in different groups of hemodialysis patients.


Assuntos
Ingestão de Energia/fisiologia , Unidades Hospitalares de Hemodiálise/tendências , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/metabolismo , Diálise Renal/tendências , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/terapia , Pessoa de Meia-Idade , Prevalência , Autorrelato
7.
PLoS One ; 13(3): e0193742, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29538427

RESUMO

Dietary energy intake strongly linked to dialysis outcomes. We aimed to explore the optimal cut-off point of energy intake (EI) for identification of metabolic syndrome (MetS) in hemodialysis patients. The cross-sectional data of 243 hemodialysis patients from multi-dialysis centers in Taiwan was used. The dietary intake was assessed by using the three-day dietary questionnaire, and a 24-hour dietary recall, clinical and biochemical data were also evaluated. The MetS was diagnosed by the Harmonized Metabolic Syndrome criteria. The receiver operating characteristic (ROC) curve was to depict the optimal cut-off value of EI for the diagnosis of MetS. The logistic regression was also used to explore the association between inadequate EI and MetS. The optimal cut-off points of EI for identifying the MetS were 26.7 kcal/kg/day for patients aged less than 60 years, or with non-diabetes, and 26.2 kcal/kg/day for patients aged 60 years and above, or with diabetes, respectively. The likelihood of the MetS increased with lower percentiles of energy intake in hemodialysis patients. In the multivariate analysis, the inadequate dietary energy intake strongly determined 3.24 folds of the MetS. The assessment of dietary EI can help healthcare providers detecting patients who are at risk of metabolic syndrome.


Assuntos
Ingestão de Energia , Síndrome Metabólica/diagnóstico , Fatores Etários , Idoso , Área Sob a Curva , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Curva ROC , Diálise Renal , Fatores Sexuais
8.
Anesthesiology ; 127(3): 534-547, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28617705

RESUMO

BACKGROUND: Liver X receptors, including α and ß isoforms, are ligand-activated transcription factors. Whether liver X receptor α plays a role in neuropathic pain is unknown. METHODS: A spared nerve injury model was established in adult male rats and mice. Von Frey tests were performed to evaluate the neuropathic pain behavior; Western blot and immunohistochemistry were performed to understand the underlying mechanisms. RESULTS: Intrathecal injection of a specific liver X receptor agonist T0901317 or GW3965 could either prevent the development of mechanical allodynia or alleviate the established mechanical allodynia, both in rats and wild-type mice. GW3965 could inhibit the activation of glial cells and the expression of tumor necrosis factor-α (mean ± SD: 196 ± 48 vs. 119 ± 57; n = 6; P < 0.01) and interleukin 1ß (mean ± SD: 215 ± 69 vs. 158 ± 74; n = 6; P < 0.01) and increase the expression of interleukin 10 in the spinal dorsal horn. All of the above effects of GW3965 could be abolished by liver X receptor α mutation. Moreover, more glial cells were activated, and more interleukin 1ß was released in the spinal dorsal horn in liver X receptor α knockout mice than in wild-type mice after spared nerve injury. Aminoglutethimide, a neurosteroid synthesis inhibitor, blocked the inhibitory effect of T0901317 on mechanical allodynia, on the activation of glial cells, and on the expression of cytokines. CONCLUSIONS: Activation of liver X receptor α inhibits mechanical allodynia by inhibiting the activation of glial cells and rebalancing cytokines in the spinal dorsal horn via neurosteroids.


Assuntos
Hiperalgesia/prevenção & controle , Inflamação/prevenção & controle , Receptores X do Fígado/metabolismo , Neuralgia/prevenção & controle , Corno Dorsal da Medula Espinal/fisiopatologia , Animais , Western Blotting , Citocinas , Modelos Animais de Doenças , Imuno-Histoquímica , Interleucina-1beta/metabolismo , Masculino , Camundongos , Camundongos Knockout , Neuroglia/metabolismo , Ratos , Ratos Sprague-Dawley
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