Human umbilical cord-derived mesenchymal stem cell transplantation supplemented with curcumin improves the outcomes of ischemic stroke via AKT/GSK-3ß/ß-TrCP/Nrf2 axis.

BACKGROUND: Human umbilical cord-derived mesenchymal stem cell (hUC-MSC) engraftment is a promising therapy for acute ischemic stroke (AIS). However, the harsh ischemic microenvironment limits the therapeutic efficacy of hUC-MSC therapy. Curcumin is an anti-inflammatory agent that could improve inflammatory microenvironment. However, whether it enhances the neuroprotective efficacy of hUC-MSC transplantation is still unknown. In the present study, we investigated the therapeutic efficacy and the possible mechanism of combined curcumin and hUC-MSC treatment in AIS. METHODS: Middle cerebral artery occlusion (MCAO) mice and oxygen glucose deprivation (OGD) microglia were administrated hUC-MSCs with or without curcumin. Neurological deficits assessment, brain water content and TTC were used to assess the therapeutic effects of combined treatment. To elucidate the mechanism, MCAO mice and OGD microglia were treated with AKT inhibitor MK2206, GSK3ß activator sodium nitroprusside (SNP), GSK3ß inhibitor TDZD-8 and Nrf2 gene knockout were used. Immunofluorescence, flow cytometric analysis, WB and RT-PCR were used to evaluate the microglia polarization and the expression of typical oxidative mediators, inflammatory cytokines and the AKT/GSK-3ß/ß-TrCP/Nrf2 pathway protein. RESULTS: Compared with the solo hUC-MSC-grafted or curcumin groups, combined curcumin-hUC-MSC therapy significantly improved the functional performance outcomes, diminished the infarct volumes and the cerebral edema. The combined treatment promoted anti-inflammatory microglia polarization via Nrf2 pathway and decreased the expression of ROS, oxidative mediators and pro-inflammatory cytokines, while elevating the expression of the anti-inflammatory cytokines. Nrf2 knockout abolished the antioxidant stress and anti-inflammation effects mediated with combined treatment. Moreover, the combined treatment enhanced the phosphorylation of AKT and GSK3ß, inhibited the ß-TrCP nucleus translocation, accompanied with Nrf2 activation in the nucleus. AKT inhibitor MK2206 activated GSK3ß and ß-TrCP and suppressed Nrf2 phosphorylation in nucleus, whereas MK2206 with the GSK3ß inhibitor TDZD-8 reversed these phenomena. Furthermore, combined treatment followed by GSK3ß inhibition with TDZD-8 restricted ß-TrCP nucleus accumulation, which facilitated Nrf2 expression. CONCLUSIONS: We have demonstrated that combined curcumin-hUC-MSC therapy exerts anti-inflammation and antioxidant stress efficacy mediated by anti-inflammatory microglia polarization via AKT/GSK-3ß/ß-TrCP/Nrf2 axis and an improved neurological function after AIS.

Risk factors associated with the comprehensive needs of cancer caregivers in China.

BACKGROUND: Cancer incidence and mortality rates have been rising in developing countries, especially in Asia. Cancer caregivers face unique challenges which put them at risk for burden, poor quality of life, and burnout. The purpose of this study was to investigate the comprehensive needs and associated factors of cancer caregivers, and explore the correlation with cancer patients. METHODS: In Mainland China, 200 cancer patient-caregiver dyads were chosen and interviewed for a cross-sectional questionnaire survey by convenient sampling method. Cancer caregivers' comprehensive needs were assessed with Comprehensive Needs Assessment Tool in cancer for Caregivers(CNAT-C), including seven domains (health and psychological problems, family and social support, healthcare staffs, information, religious/spiritual support, hospital facilities and services, and practical support). The comprehensive needs assessment tool in cancer for patients (CNAT) was used to assess patients' comprehensive needs. The sociodemographic survey was completed by both cancer patients and caregivers. The mean differences in domain scores for different groups of characteristics were compared by one-way ANOVA or non-parametric analyses, and those factors that had significant differences were selected for the multivariate regression analysis to determine the final influencing factors. The correlation between cancer patients' and caregivers' needs was evaluated by Spearman's correlation analysis. RESULTS: The cancer caregivers' need for healthcare staff (82.60±19.56) was the highest among the seven domains, followed by the need for information (72.17±14.61) and the need for hospital facilities and services (56.44±18.22). The lowest score was the need for religious/spiritual support (28.33±16.05). Caregivers who were younger, highly educated, with high household income, and less than 1 year since diagnosis had higher scores of CNAT-C. Also sociodemographic characteristics were associated with each domain of cancer caregivers' need. Correlations between patients' and caregivers' comprehensive needs were low to moderate (0.013~0.469). CONCLUSION: Cancer caregivers experience high levels of comprehensive needs, which are closely related to their sociological characteristics. The tailored interventions and mobilization of social and health care support may thus provide multiple levels of benefit across cancer trajectories. The patient-caregiver dyad should be regarded as a unit for treatment in cancer care.

Transcriptomic and Functional Analyses of Two Cadmium Hyper-Enriched Duckweed Strains Reveal Putative Cadmium Tolerance Mechanisms.

Cadmium (Cd) is one of the most toxic metals in the environment and exerts deleterious effects on plant growth and production. Duckweed has been reported as a promising candidate for Cd phytoremediation. In this study, the growth, Cd enrichment, and antioxidant enzyme activity of duckweed were investigated. We found that both high-Cd-tolerance duckweed (HCD) and low-Cd-tolerance duckweed (LCD) strains exposed to Cd were hyper-enriched with Cd. To further explore the underlying molecular mechanisms, a genome-wide transcriptome analysis was performed. The results showed that the growth rate, chlorophyll content, and antioxidant enzyme activities of duckweed were significantly affected by Cd stress and differed between the two strains. In the genome-wide transcriptome analysis, the RNA-seq library generated 544,347,670 clean reads, and 1608 and 2045 differentially expressed genes were identified between HCD and LCD, respectively. The antioxidant system was significantly expressed during ribosomal biosynthesis in HCD but not in LCD. Fatty acid metabolism and ethanol production were significantly increased in LCD. Alpha-linolenic acid metabolism likely plays an important role in Cd detoxification in duckweed. These findings contribute to the understanding of Cd tolerance mechanisms in hyperaccumulator plants and lay the foundation for future phytoremediation studies.

A Novel Convolutional Neural Network Model as an Alternative Approach to Bowel Preparation Evaluation Before Colonoscopy in the COVID-19 Era: A Multicenter, Single-Blinded, Randomized Study.

INTRODUCTION: Adequate bowel preparation is key to a successful colonoscopy, which is necessary for detecting adenomas and preventing colorectal cancer. We developed an artificial intelligence (AI) platform using a convolutional neural network (CNN) model (AI-CNN model) to evaluate the quality of bowel preparation before colonoscopy. METHODS: This was a colonoscopist-blinded, randomized study. Enrolled patients were randomized into an experimental group, in which our AI-CNN model was used to evaluate the quality of bowel preparation (AI-CNN group), or a control group, which performed self-evaluation per routine practice (control group). The primary outcome was the consistency (homogeneity) between the results of the 2 methods. The secondary outcomes included the quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS), polyp detection rate, and adenoma detection rate. RESULTS: A total of 1,434 patients were enrolled (AI-CNN, n = 730; control, n = 704). No significant difference was observed between the evaluation results ("pass" or "not pass") of the groups in the adequacy of bowel preparation as represented by BBPS scores. The mean BBPS scores, polyp detection rate, and adenoma detection rate were similar between the groups. These results indicated that the AI-CNN model and routine practice were generally consistent in the evaluation of bowel preparation quality. However, the mean BBPS score of patients with "pass" results were significantly higher in the AI-CNN group than in the control group, indicating that the AI-CNN model may further improve the quality of bowel preparation in patients exhibiting adequate bowel preparation. DISCUSSION: The novel AI-CNN model, which demonstrated comparable outcomes to the routine practice, may serve as an alternative approach for evaluating bowel preparation quality before colonoscopy.

Identification of Foramen Ovale With H-Figure Fluoroscopic Landmark Improves Treatment Outcomes in Idiopathic Trigeminal Neuralgia.

BACKGROUND: Because it is traditionally difficult and time-consuming to identify the foramen ovale (FO) with fluoroscopy, we recently developed the H-figure method to acquire fluoroscopic view of FO with shorter procedure time and less radiation. However, the impact of such an H-figure approach on the clinical outcomes of trigeminal ganglion radiofrequency thermocoagulation (RFT) in treating idiopathic trigeminal neuralgia (ITN) remains unclear. METHODS: In a 12-month follow-up retrospective cohort study, patients with ITN had fluoroscopy-guided RFT of trigeminal ganglion via either classic approach (n = 100) or H-figure approach (n = 136) to identify FO. Data of continuous variables were analyzed with a Shapiro-Wilk test for normality and subsequently with a Mann-Whitney test, and the binary data were analyzed with a χ 2 test. The primary outcome was the facial pain measured by a Visual Analog Scale (VAS) 1 year after the treatment. The secondary outcomes included the quality of the fluoroscopic FO views, the threshold voltage to provoke paresthesia, the procedure time, the number of fluoroscopic images, and the facial numbness VAS. RESULTS: Compared with the classic approach group, the H-figure approach group was associated with better long-term pain relief after the procedure, with significantly fewer patients had pain 3 months (6.6% vs 17.0%, P = .012) and 12 months (21.3% vs 38.0%, P = .005) after the procedure, and among patients who had pain after the procedure, patients in the H-figure group had significantly less pain 6 months after the procedure (VAS median [interquartile range (IQR)]: 3 [2-6] vs 6 [4-7], P < .001). Moreover, compared to the classic approach, the H-figure approach provided better fluoroscopic view of FO, lower threshold voltage to elicit paresthesia (median [IQR]: 0.2 [0.2-0.3] vs 0.4 [0.4-0.5] V, P < .0001), with shorter procedure time (median [IQR]: 7.5 [6.0-9.0] vs 14.0 [10.0-18.0] min, P < .0001), and required fewer fluoroscopic images (median [IQR]: 4.0 [3.0-5.0] vs 8.0 [6.0-10.0], P < .0001). CONCLUSIONS: RFT of the trigeminal ganglion using the H-figure approach is associated with superior longer term clinical pain relief than the classic approach in treating ITN.

Phase unwrapping algorithm for images with local high-density noise.

Due to undersampling and the local phase with local high-density noise, it is still difficult to develop a robust phase unwrapping algorithm. In order to resolve this issue, here, we propose what we believe to be a novel multiple path-following phase unwrapping (MPIPU) algorithm based on the shearing interference principle to recover the undersampling phase (non-noise). By calculating the unwrapping coefficient k, the phase iteration filling algorithm based on least-squares is developed for the high-density noise region in order to reconstruct the three-dimensional surface topography of interferometric synthetic aperture radar (InSAR) data. The proposed algorithm takes advantage of the MPIPU's ability to fill in the missing phase with fitting data and can successfully suppress the error transfer caused by the blocky noise phase iteration process. Several experiments are conducted using both simulated and actual InSAR image data. The experimental findings show that the proposed method can achieve robust phase unwrapping performance on a phase of local high-density noise.

Influence of cadmium and microplastics on physiological responses, ultrastructure and rhizosphere microbial community of duckweed.

The combined contamination of heavy metals and microplastics is widespread in freshwater environments. However, there are few researches on their combined effects on aquatic plants. In this study, the effects of single and combined stress of 0.01 mg L-1 cadmium (Cd), 50 mg L-1 polyethylene and 50 mg L-1 polypropylene for 15 days on the physiological response, ultrastructure and rhizosphere microbial community of duckweed were investigated. The results showed that Cd and microplastics single or combined stress inhibited the growth of duckweed, shortened the root length and decreased the chlorophyll content. Compared with single Cd treatments, the combination of microplastics and Cd increased duckweed growth rate and increased superoxide dismutase activity and malondialdehyde content and reduced chloroplast structural damage, indicating that the combined stress could reduce the toxicity of heavy metals to duckweed. Through the study of rhizosphere microbial diversity, 1381 Operational Taxonomic Unit (OTUs) were identified and rich microbial communities were detected in the duckweed rhizosphere. Among them, the main microbial communities were Proteobacteria, Bacteroidetes, and Cyanobacteria. Compared with Cd single stress, the ACE and chao index of rhizosphere microbial community increased under combined stress, indicating that the diversity and abundance of microbial communities were improved after combined stress treatment. Our study revealed the effects of heavy metals and microplastics on aquatic plants, providing a theoretical basis for duckweed applications in complex water pollution.

Compassion fatigue, burnout and compassion satisfaction among emergency nurses: A path analysis.

AIMS: To verify a hypothesized model of the relationships between compassion fatigue, burnout and compassion satisfaction, as well as their influencing factors and consequences, among emergency nurses. DESIGN: A descriptive, cross-sectional design. METHODS: A hypothesized model was proposed on the basis of the current literature. A convenience sample was conducted of nurses working in the emergency departments of six hospitals in Shanghai, China, from July to September 2020. A total of 445 valid data points were collected using various self-designed and well-validated instruments. Descriptive statistics and correlations were computed, and a path analysis was used to assess model fitness and to investigate direct and indirect effects. RESULTS: The final model reported a desirable fit with significant paths. Compassion satisfaction and compassion fatigue directly and inversely affected burnout, and compassion satisfaction positively influenced compassion fatigue. Perceived social support directly improved compassion satisfaction and protected against compassion fatigue. Compassion satisfaction and compassion fatigue directly affected mental health, and burnout directly influenced physical health. Compassion fatigue, burnout and compassion satisfaction had complicated effects on turnover intention. CONCLUSION: Emergency nurses' compassion satisfaction and compassion fatigue may be two coexisting constructs, and both affect burnout. Perceived social support acts as a protector of the three dimensions, and their effects on health status and turnover intention can be significant and complicated. IMPACT: Emergency nurses may experience high levels of compassion satisfaction and compassion fatigue simultaneously, which can help to explain why compassion fatigue did not directly increase emergency nurses' turnover intention. The direct effects of compassion fatigue and burnout on emergency nurses' health status and working engagement were significantly different. Support from significant others, professional psychological intervention and emergency nursing system reforms are required to tackle emergency nurses' compassion fatigue and burnout and improve their compassion satisfaction.

Duckweed Is a Promising Feedstock of Biofuels: Advantages and Approaches.

With the growing scarcity of traditional sources of energy and the accompanying acute environmental challenges, biofuels based on biomass are favored as the most promising alternative. As one of the core raw materials for biomass energy, research on its production methods and synthesis mechanisms is emerging. In recent years, duckweed has been used as a high-quality new biomass feedstock for its advantages, including fast biomass accumulation, high starch content, high biomass conversion efficiency, and sewage remediation. This study provides a systematic review of the growth characteristics, starch metabolism pathways, and methods to improve starch accumulation in the new energy plant, duckweed. The study also presents a prospect that might be used as a reference for the development of duckweed as a new energy-providing plant.

Theophylline Extracted from Fu Brick Tea Affects the Metabolism of Preadipocytes and Body Fat in Mice as a Pancreatic Lipase Inhibitor.

The dramatic increase in obesity is putting people under increasing pressure. Lipase inhibitors, as a kind of effective anti-obesity drug, have attracted more and more researchers' attention in recent years because of their advantages of acting on the intestinal tract and having no side effects on the central nervous system. In this study, lipase inhibitor Fu Brick Theophylline (FBT) was screened based on enzyme molecular dynamics, and the inhibition mechanism of lipase inhibitors on obesity was analyzed and discussed at the cellular level and animal model level. We found that FBT had high inhibition effects of lipase with an IC50 of 1.02~0.03 µg/mL. Firstly, the laboratory used 3T3-L1 proadipocytes as models, flow cytometry was used to detect the effects of FBT on the cycle, apoptosis and intracellular ROS activity of proadipocytes. To study the contents of triglyceride, total cholesterol, related metabolites and related gene and protein expression in adipocytes. The results showed that FBT could reduce ROS production and inflammatory factor mRNA expression during cell differentiation. Secondly, by establishing the animal model of high-fat feed ob nutritional obese mice, the morphological observation and gene expression analysis of body weight, fat rate, adipocyte and hepatocyte metabolism of FBT obese mice were further discussed. It was proven that FBT can effectively reduce the degree of fatty liver, prevent liver fibrosis and fat accumulation, and improve the damage of mitochondrial membrane structure. This study provides a theoretical basis for the screening and clinical treatment of lipase inhibitors.

Liraglutide regulates lipid metabolism via FGF21- LKB1- AMPK- ACC1 pathway in white adipose tissues and macrophage of type 2 diabetic mice.

Liraglutide (LRG), a glucagon-like peptide 1 analogue (GLP1A), could decrease body mass of type 2 diabetes (T2DM), but the exact molecular mechanism of LRG has not been elucidated. This study was performed to explore whether LRG regulated TG synthesis via secretion of FGF21 and modulating AMP-dependent protein kinase (AMPK) pathway in an autocrine mode. Two-month-old male C57BL/6 mice were fed high-fat diet (HFD) for 4 months followed by injection of 30 mg/kg streptozotocin (STZ) to induce state of T2DM. Then DM mice were given LRG (0.4 mg/kg/d) for 4 months. Body mass, serum lipids and FGF21 levels, related gene expression were analyzed. Lipopolysaccharide (LPS)-induced RAW264.7 cells were treated with palmitic acid and different concentrations of LRG. Then Exendin (9-39), siRNA targeted to liver kinase B1 (LKB1) and Compound C were used to confirm the signaling pathway. LRG decreased adipocyte size, increased secretion of FGF21, and promoted phosphorylation of LKB1, AMPK and Acetyl coenzyme A carboxylase 1 (ACC1) in white adipose tissue (WAT) of DM mice. LRG also increased phosphorylation of fibroblast growth factor receptor 3 (FGFR3), LKB1, AMPK and ACC1 via FGF21 secretion, which ultimately inhibited synthesis of TG in macrophage. In conclusion, FGF21 is induced to be expressed in macrophage by LRG, which then activates LKB1-AMPK-ACC1 pathway in an autocrine manner.

Automatic Measurement of Morphological Traits of Typical Leaf Samples.

It is still a challenging task to automatically measure plants. A novel method for automatic plant measurement based on a hand-held three-dimensional (3D) laser scanner is proposed. The objective of this method is to automatically select typical leaf samples and estimate their morphological traits from different occluded live plants. The method mainly includes data acquisition and processing. Data acquisition is to obtain the high-precision 3D mesh model of the plant that is reconstructed in real-time during data scanning by a hand-held 3D laser scanner (ZGScan 717, made in Zhongguan Automation Technology, Wuhan, China). Data processing mainly includes typical leaf sample extraction and morphological trait estimation based on a multi-level region growing segmentation method using two leaf shape models. Four scale-related traits and six corresponding scale-invariant traits can be automatically estimated. Experiments on four groups of different canopy-occluded plants are conducted. Experiment results show that for plants with different canopy occlusions, 94.02% of typical leaf samples can be scanned well and 87.61% of typical leaf samples can be automatically extracted. The automatically estimated morphological traits are correlated with the manually measured values EF (the modeling efficiency) above 0.8919 for scale-related traits and EF above 0.7434 for scale-invariant traits). It takes an average of 196.37 seconds (186.08 seconds for data scanning, 5.95 seconds for 3D plant model output, and 4.36 seconds for data processing) for a plant measurement. The robustness and low time cost of the proposed method for different canopy-occluded plants show potential applications for real-time plant measurement and high-throughput plant phenotype.

R-YOLO: A Real-Time Text Detector for Natural Scenes with Arbitrary Rotation.

Accurate and efficient text detection in natural scenes is a fundamental yet challenging task in computer vision, especially when dealing with arbitrarily-oriented texts. Most contemporary text detection methods are designed to identify horizontal or approximately horizontal text, which cannot satisfy practical detection requirements for various real-world images such as image streams or videos. To address this lacuna, we propose a novel method called Rotational You Only Look Once (R-YOLO), a robust real-time convolutional neural network (CNN) model to detect arbitrarily-oriented texts in natural image scenes. First, a rotated anchor box with angle information is used as the text bounding box over various orientations. Second, features of various scales are extracted from the input image to determine the probability, confidence, and inclined bounding boxes of the text. Finally, Rotational Distance Intersection over Union Non-Maximum Suppression is used to eliminate redundancy and acquire detection results with the highest accuracy. Experiments on benchmark comparison are conducted upon four popular datasets, i.e., ICDAR2015, ICDAR2013, MSRA-TD500, and ICDAR2017-MLT. The results indicate that the proposed R-YOLO method significantly outperforms state-of-the-art methods in terms of detection efficiency while maintaining high accuracy; for example, the proposed R-YOLO method achieves an F-measure of 82.3% at 62.5 fps with 720 p resolution on the ICDAR2015 dataset.

Persistent Hematuria and Kidney Disease Progression in IgA Nephropathy: A Cohort Study.

RATIONALE & OBJECTIVE: Hematuria is the most typical presentation of immunoglobulin A nephropathy (IgAN); however, its role in disease progression is still controversial. This study aimed to evaluate the association of hematuria and progression of IgAN. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: A cohort of 1,333 patients with IgAN treated at a Chinese referral hospital with a median follow-up of 45 months. PREDICTORS: Microhematuria was evaluated in fresh urine using a fully automated urine particle analyzer (automated method) and urine sediment examination by a skilled examiner (manual method). Hematuria was characterized as a time-varying attribute; namely, average hematuria level was calculated for every 6-month period for each patient during follow-up. Remission was defined as average red blood cell count ≤5/high-power field (manual method) or ≤28 red blood cells/µL (automated method) during the first 6 months of follow-up. OUTCOMES: Composite event of 50% decline in estimated glomerular filtration rate or development of kidney failure. ANALYTICAL APPROACH: Multivariable cause-specific hazards models to analyze the relationship between hematuria and the composite kidney disease progression event. RESULTS: Time-varying hematuria during follow-up was an independent risk factor for the composite kidney disease progression event (HR, 1.46; 95% CI, 1.13-1.87; P = 0.003). Hematuria remission during the 6 months after diagnosis was associated with a significantly lower rate of the composite kidney disease progression event (HR, 0.41; 95% CI, 0.28-0.61; P < 0.001). A significant interaction was detected between remission of proteinuria and remission of hematuria during the first 6 months (P < 0.001). The association between remission of hematuria and kidney disease progression was detectable (HR, 0.46; 95% CI, 0.32-0.68) within the subpopulation with persistent proteinuria (protein excretion > 1.0 g/d during the first 6 months), but not among patients whose proteinuria had remitted (HR, 0.64; 95% CI, 0.31-1.29; P = 0.2). The 2 techniques for hematuria evaluation were strongly and significantly linearly correlated (r = 0.948; P < 0.001), and results using these 2 methods were consistent. LIMITATIONS: A single-center retrospective study. Proportional hazards regression incorporating time-varying covariates may create time-varying confounding. The predictive value of reductions in hematuria was not directly evaluated. CONCLUSIONS: Level of hematuria was independently associated with kidney disease progression, whereas hematuria remission was associated with improved kidney outcomes in IgAN among patients with persistent proteinuria. Additionally, to monitor IgAN progression, automated methods to evaluate hematuria hold promise as a replacement for manual evaluation of urinary sediment.

Inhibition of intracranial hemangioma growth and hemorrhage by TNFSF15.

Hemangioblastoma (HB) is an abnormal intracranial buildup of blood vessels that exhibit a great potential for hemorrhage. Surgical options are limited, and few medications are available for treatment. We show here by immunohistochemical analysis that HB lesions display highly increased levels of VEGF expression and macrophage/microglia infiltration compared with those in normal brain tissues. In the meantime, TNF superfamily 15 (TNFSF15) (also known as vascular endothelial growth inhibitor), an antiangiogenic cytokine, is highly expressed in normal brain blood vessels but diminished in HB lesions. We set up a brain hemangioma model by using mouse bEnd.3 cells of a T antigen-transformed endothelial cell line that produce a large amount of VEGF. When implanted in mouse brains, these cells form lesions that closely resemble the pathologic characteristics of HB. Retroviral infection of bEnd.3 cells with TNFSF15 leads to inhibition of VEGF production and retardation of hemangioma formation. Similar results are obtained when wild-type bEnd.3 cells are implanted in the brains of transgenic mice overexpressing TNFSF15. Additionally, TNFSF15 treatment results in enhanced pericyte coverage of the blood vessels in the lesions together with reduced inflammatory cell infiltration and decreased hemorrhage. These findings indicate that the ability of TNFSF15 to counterbalance the abnormally highly angiogenic and inflammatory potential of the microenvironment of HB is of therapeutic value for the treatment of this disease.-Yang, G.-L., Han, Z., Xiong, J., Wang, S., Wei, H., Qin, T.-T., Xiao, H., Liu, Y., Xu, L.-X., Qi, J.-W., Zhang, Z.-S., Jiang, R., Zhang, J., Li, L.-Y. Inhibition of intracranial hemangioma growth and hemorrhage by TNFSF15.

Assessing the quality of CPR performed by a single lifeguard, two lifeguards and a lifeguard with a bystander after water rescue: a quasi-experimental trial.

BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) could improve survival of drowning victims. The purpose of the study is to assess the impact of fatigue caused by water rescue on subsequent CPR quality and the influence of a bystander's participation on CPR quality in a lifeguard rescue. METHODS: This was a simulated quasi-experimental study with a sample of 14 lifeguards and 13 laypersons. Each lifeguard performed 2 min single-rescuer CPR as baseline measurement. In three separate trials, a single lifeguard swam 50 m to perform a water rescue in a pool and returned with the manikin another 50 m. After each rescue, 10 min of CPR was performed by a single lifeguard, two lifeguards or a lifeguard with a layperson with no CPR training. Paired t-test and repeated analysis of variance were used to analyse CPR quality variables. RESULTS: Baseline CPR quality was adequate for most measures except compression depth and re-expansion. After water rescue, the single lifeguard trial showed no significant differences compared with baseline. CPR score and ventilation score of the single-lifeguard trial was higher than that of the lifeguard-bystander trial (p=0.027, p<0.001). Both the two-lifeguard trial (p=0.025), and lifeguard-bystander trial (p=0.010) had a lower percentage of breaths with correct ventilation volume and higher percentage of breaths with excessive ventilation volume (p=0.007, p=0.011, respectively) than the single-lifeguard trial. No-flow time of the lifeguard-bystander trial was longer than other trials (p<0.001). CONCLUSIONS: Although CPR given by the lifeguard was not optimal, fatigue generated by a water rescue has no impact on the quality of subsequent CPR performed by a trained lifeguard for 10 min. Untrained bystanders assisting in CPR in a drowning event is unlikely to be helpful.

Effects of Hydroxychloroquine on Proteinuria in IgA Nephropathy: A Randomized Controlled Trial.

RATIONALE & OBJECTIVE: Despite optimization of renin-angiotensin-aldosterone system (RAAS) inhibition, patients with immunoglobulin A nephropathy (IgAN) and persistent proteinuria remain at risk for kidney failure. We evaluated the efficacy and safety of hydroxychloroquine (HCQ), an immunomodulator, when added to the treatment regimen of patients with IgAN. STUDY DESIGN: Double-blind, randomized, placebo-controlled, phase 2 clinical trial. SETTING & PARTICIPANTS: Participants had IgAN (proteinuria with protein excretion of 0.75-3.5g/d and estimated glomerular filtration rate>30mL/min/1.73m2) and were receiving optimized RAAS inhibitor therapy. INTERVENTIONS: Patients were randomly assigned 1:1 to receive daily oral HCQ or a placebo for 6 months. OUTCOMES: The primary outcome was percentage change in proteinuria between baseline and 6 months. RESULTS: 60 participants (mean estimated glomerular filtration rate, 53.8mL/min/1.73m2; median urine protein excretion, 1.7g/d) were recruited and randomly assigned to receive HCQ (n=30) or placebo (n=30). Percentage change in proteinuria at 6 months was significantly different between the HCQ group and the placebo group (-48.4% [IQR, -64.2%, -30.5%] vs 10.0% [IQR, -38.7%, 30.6%]; P<0.001, respectively). At 6 months, median proteinuria level was significantly lower in the HCQ group than in the placebo group (0.9 [IQR, 0.6, 1.0] g/d vs 1.9 [IQR, 0.9, 2.6] g/d; P=0.002, respectively). No serious adverse events were recorded during the study in either study group. LIMITATIONS: The short treatment period and lack of postwithdrawal observations limit conclusions about long-term renoprotective efficacy and safety. CONCLUSIONS: HCQ in addition to optimized RAAS inhibition significantly reduced proteinuria in patients with IgAN over 6 months without evidence of adverse events. These findings require confirmation in larger treatment trials. FUNDING: This study was supported by grants from a government entity, the Capital of Clinical Characteristics, and the Applied Research Fund. TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT02942381.

S-type Anion Channels SLAC1 and SLAH3 Function as Essential Negative Regulators of Inward K+ Channels and Stomatal Opening in Arabidopsis.

Drought stress induces stomatal closure and inhibits stomatal opening simultaneously. However, the underlying molecular mechanism is still largely unknown. Here we show that S-type anion channels SLAC1 and SLAH3 mainly inhibit inward K+ (K+in) channel KAT1 by protein-protein interaction, and consequently prevent stomatal opening in Arabidopsis. Voltage-clamp results demonstrated that SLAC1 inhibited KAT1 dramatically, but did not inhibit KAT2. SLAH3 inhibited KAT1 to a weaker degree relative to SLAC1. Both the N terminus and the C terminuses of SLAC1 inhibited KAT1, but the inhibition by the N terminus was stronger. The C terminus was essential for the inhibition of KAT1 by SLAC1. Furthermore, drought stress strongly up-regulated the expression of SLAC1 and SLAH3 in Arabidopsis guard cells, and the over-expression of wild type and truncated SLAC1 dramatically impaired K+in currents of guard cells and light-induced stomatal opening. Additionally, the inhibition of KAT1 by SLAC1 and KC1 only partially overlapped, suggesting that SLAC1 and KC1 inhibited K+in channels using different molecular mechanisms. Taken together, we discovered a novel regulatory mechanism for stomatal movement, in which singling pathways for stomatal closure and opening are directly coupled together by protein-protein interaction between SLAC1/SLAH3 and KAT1 in Arabidopsis.

Discovery of potent anti-inflammatory 4-(4,5,6,7-tetrahydrofuro[3,2-c]pyridin-2-yl) pyrimidin-2-amines for use as Janus kinase inhibitors.

The Janus kinase (JAK) family of tyrosine kinases has been proven to provide targeted immune modulation. Orally available JAK inhibitors have been used for the treatment of immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA). Here, we report the design, synthesis and biological evaluation of 4-(4,5,6,7-tetrahydrofuro[3,2-c]pyridin-2-yl) pyrimidin-2-amino derivatives as JAK inhibitors. Systematic structure-activity relationship studies led to the discovery of compound 7j, which strongly inhibited the four isoforms of JAK kinases. Molecular modeling rationalized the importance of cyanoacetyl and phenylmorpholine moieties. The in vivo investigation indicated that compound 7j possessed favorable pharmacokinetic properties and displayed slightly better anti-inflammatory efficacy than tofacitinib at the same dosage. Accordingly, compound 7j was advanced into preclinical development.

The Associations Between CYP2D6 Metabolizer Status and Pharmacokinetics and Clinical Outcomes of Venlafaxine: A Systematic Review and Meta-Analysis.

BACKGROUND: The association between CYP2D6 metabolizer status and clinical outcomes of venlafaxine was extensively investigated previously, but no widely accepted conclusion has been reached so far. To obtain a more precise estimation of the association, a systematic review by meta-analysis was conducted in the present study. METHODS: The PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Technology of Chongqing, and Wan Fang Database were searched for eligible studies up to August 2018. RESULTS: Fourteen related studies involving 1035 patients were finally included. Significant associations were found among 3 CYP2D6 phenotypes (NM, IM, and PM) and most pharmacokinetic parameters of venlafaxine. However, CYP2D6 phenotypes were not associated with Hamilton Depression Rating Scale response of venlafaxine. In addition, we also found no significant association between CYP2D6 phenotype and overall rate of adverse events. CONCLUSIONS: CYP2D6 metabolizer status had significant influence on venlafaxine pharmacokinetics, but insufficient evidence demonstrated that CYP2D6 metabolizer status was associated with its therapeutic effects and overall rate of adverse events, which provided further evidence regarding the relationship between CYP2D6 metabolizer status and venlafaxine.