Is Nuclear Factor Erythroid 2-Related Factor 2 a Target for the Intervention of Cytokine Storms?

The term "cytokine storm" describes an acute pathophysiologic state of the immune system characterized by a burst of cytokine release, systemic inflammatory response, and multiple organ failure, which are crucial determinants of many disease outcomes. In light of the complexity of cytokine storms, specific strategies are needed to prevent and alleviate their occurrence and deterioration. Nuclear factor erythroid 2-related factor 2 (NRF2) is a CNC-basic region-leucine zipper protein that serves as a master transcription factor in maintaining cellular redox homeostasis by orchestrating the expression of many antioxidant and phase II detoxification enzymes. Given that inflammatory response is intertwined with oxidative stress, it is reasonable to assume that NRF2 activation limits inflammation and thus cytokine storms. As NRF2 can mitigate inflammation at many levels, it has emerged as a potential target to prevent and treat cytokine storms. In this review, we summarized the cytokine storms caused by different etiologies and the rationale of interventions, focusing mainly on NRF2 as a potential therapeutic target.

NIHSS-the Alberta Stroke Program Early CT Score mismatch in guiding thrombolysis in patients with acute ischemic stroke.

OBJECTIVE: This study investigates the mismatch between the National Institutes of Health Stroke Scale (NIHSS) score and the computed tomography (CT) findings measured by the Alberta Stroke Program Early CT Score (ASPECTS) for predicting the functional outcome and safety of intravenous thrombolysis (IVT) treatment in patients with acute ischemic stroke (AIS). METHODS: This prospective observational study includes patients with AIS who underwent CT imaging within 4.5 h of the onset of symptoms. Patients were divided into the NIHSS-ASPECTS mismatch (NAM)-positive and NAM-negative groups (group P and N, respectively). The clinical outcome was assessed using the Modified Rankin Scale (mRS). Safety outcomes included progression, symptomatic intracerebral hemorrhage (sICH), intracerebral hemorrhage (ICH), adverse events, clinical adverse events, and mortality. RESULTS: A total of 208 patients were enrolled in the study. In group P, IVT treatment was associated with a good functional outcome at 3 months (p = 0.005) and 1 year (p = 0.001). A higher percentage of patients with favorable mRS (0-2) (p = 0.01) and excellent mRS (0-1) (p = 0.011) functional outcomes was obtained at 1 year in group P with IVT treatment. Group N did not benefit from the same treatment (p = 0.352 and p = 0.480 at 3 months and 1 year, respectively). There were no statistically significant differences in sICH, ICH, mortality rates, or other risks between the IVT and conventional treatment groups. CONCLUSION: IVT treatment is associated with a good functional outcome in patients with NAM, without increasing the risks of sICH, ICH, mortality, or other negative outcomes. NAM promises to be an easily obtained indicator for guiding the treatment decisions of AIS.

Effect of platelet count on long-term prognosis of cerebral infarction.

OBJECTIVE: This study aimed to analyze the correlation between platelet (PLT) count and the modified Rankin scale (mRS) in patients with cerebral infarction (CI) at the later stage of rehabilitation, which can be used to guide the secondary prevention strategy of CI. METHODS: A total of 180 CI patients were divided into three groups according to PLT count: low PLT group (<125×109/L), medium PLT group (126- 225×109/L) and high PLT group (>226×109/L). The mRS was evaluated after three months and one year, respectively, and the difference in long-term prognosis between groups was analyzed. The mRS is an ordered scale coded from 0 (no symptoms at all) through 5 (severe disability) 6 (death). RESULTS: Finally, a total of 99 patients had complete data. The results of the multiple comparisons among the three groups were as follows: the analysis of variance of the mRS at three months after onset yielded F = 6.714 and P = 0.002, and the difference was statistically significant. The mRS was lowest in the medium PLT group (2.09±1.465), and neurological function recovery was the best. After one year, the mRS for the medium PLT group was the lowest (1.49±1.523), with F = 6.860 and P = 0.002. The repeated measures analysis of variance revealed that the effect of continuous rehabilitation was significant in the interval from three months to one year after onset (F = 35.528, P < 0.001). This was very significant, especially for patients taking aspirin (F = 50.908, P < 0.001). However, for patients who did not take aspirin, the effect of continuous rehabilitation was not obvious during the nine months, and the difference between the results of two mRS measurements was not statistically significant (F = 1.089, P = 0.308). CONCLUSIONS: Patients with a PLT count of 126- 225×109/L had the lowest mRS between three months and one year after onset, but had the best recovery of nerve function. Patients who persisted in taking aspirin continued to significantly recover during the 9-month period, from three months to one year after onset. Aspirin is not only a secondary preventive drug, but also an important drug to promote the rehabilitation of CI patients.

Organizing Health Data Standards Based on Knowledge Map.

To facilitate easy use of health data standards, we collected health data standards and parsed them into more fine-grained knowledge units. Reference and inclusion relations among these standards were constructed into knowledge map. Until now there are 156 standards collected and 4796 reference relations linked within those standards. Besides, an interface was built to enable users to easily get one standard's main information without referring to numerous PDF documents.

TBench: A Collaborative Work Platform for Multilingual Terminology Editing and Development.

Terminology facilitates consistent use and semantic integration of heterogeneous, multimodal data within and across domains. This paper presents TBench (Termilology Workbench) for multilingual terminology editing and development within a distributed environment. TBench is a web-service Java tool consisting of two main functionalities that are knowledge construction (i.e.extended model based on ISO25964, batch reusing and constructing multilingual concept hierarchy and relationships) and collaborative control in order to achieve custom extensions, reuse, multilingual alignment, integration and refactoring.

Top-Level Design of a Normalized Chinese Clinical Terminology: An Integrated Application of National and International Data Standards and Terminologies.

This work describes the design and building of a Chinese clinical terminology (called CCTS). The terminology is similar to an ontology, and will promote the use of Chinese clinical data, such as indexing, retrieval and exchange. The terminology is a TOPL concept framework, which integrates hierarchical structures of Chinese and interenational reference terminology standards for health. Our framework includes 14 subtrees, 2286 classes and 65 relationships.

Accelerated bony defect healing based on chitosan thermosensitive hydrogel scaffolds embedded with chitosan nanoparticles for the delivery of BMP2 plasmid DNA.

Regeneration of alveolar bone is among the main purposes of periodontal treatment. However, it is a challenge for both dentists and patients. An injectable chitosan-based thermosensitive hydrogel scaffold (CS/CSn-GP) was successfully designed and prepared with the incorporation of bone morphogenetic protein-2 plasmid DNA (pDNA-BMP2)-loaded chitosan nanoparticles (CS/CSn(pDNA-BMP2)-GP) in this study. The aim of this study was to evaluate the regenerative effect of this scaffold on the endogenous repair of alveolar bone. Thermosensitive properties, SEM scans and in vivo inflammatory reactions and degradation were evaluated. The CS/CSn-GP solution was initially injected into the muscle pouches of rats, where it changed into a gel, resulting in non-specific inflammation. It effectively enhanced new bone formation in rat calvarial defects and enhanced bony defect healing in beagle dogs. All results indicated that the CS/CSn(pDNA-BMP2)-GP complex system is a potential candidate as a targeted, multi-effect scaffold for the endogenous repair of alveolar bone. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 265-273, 2017.