Impact of cerebral collateral flow on stroke outcomes after carotid stenting.

OBJECTIVE: Internal carotid artery stenosis is a main contributor to recurrent ischemic stroke. This study aimed to evaluate associations between recurrent stroke and changes in prestenting flow direction in the primary collaterals or both primary and secondary collaterals, and the potential interaction between extra- and intracranial arteries. METHODS: This longitudinal study recruited stroke patients without intracranial stenosis who underwent right-side carotid stenting between 2011 and 2019. The main study outcome was recurrent stroke. Predictive factors were anterior circulation flow direction change (ACFDC), posterior circulation flow direction change, and reversal of ophthalmic artery/leptomeningeal anastomosis (ROALA) detected by transcranial color-coded duplex (TCCD) before carotid stenting. Patient follow-up was 9 years. Risk factors for recurrent stroke were identified by Kaplan-Meier plot and Cox regression analyses. RESULTS: A total of 234 patients (mean age 70.88 ± 10.3 years, 86.32% male) were included, and 115 had recurrent stroke. Kaplan-Meier plot showed that patients with left ACFDC and ROALA had worse outcomes than those with ACFDC only, while patients with left ACFDC had worse outcome than those with right ACFDC (both p < 0.001). Cox regression analysis showed that recurrent stoke was associated with ACFDC at right (hazard ratio [95% CI]: 20.988 [2.549-172.790], p < 0.01), left (151.441 [20.100-1140.993], p < 0.001), and both sides (144.889 [19.089-1099.710], p < 0.001). INTERPRETATION: Anterior circulation flow direction change is significantly associated with recurrent stroke in patients with unilateral carotid stenosis. Patients with ACFDC and ROALA together have worse outcomes compared to those with ACFDC only. Prestenting TCCD images help provide definitive information to predict outcomes after carotid stenting.

miR-15b-AGO2 play a critical role in HTR8/SVneo invasion and in a model of angiogenesis defects related to inflammation.

INTRODUCTION: microRNAs (miRs) have been shown to play critical roles in the regulation of trophoblast and endothelial cell functions, and one significant finding concerning the miR-15/16 family is that most members of this family are highly expressed in endothelial cells and contribute to functions, such as tube formation. The interaction between trophoblast and endothelial cell play an important role in normal placentation process. Therefore, the aims of this study were to investigate the expression of miR-15b in human placenta and to uncover the potential role of miR-15b as well as its target functional loop in trophoblast and endothelial cells. Whether inflammation could modulate the expression of miR-15b and its down-stream target was further investigated. Additionally, the potential link between miR-15b deregulation and preeclampsia was also explored in the placenta of patients diagnosed with preeclampsia. METHODS: The expression of miR-15b was studied in the placental tissue of a normal pregnancy using in situ hybridization, and the effects of miR-15b on proliferation, invasion, and angiogenesis were further explored in vitro using HTR-8/SVneo and HUVEC cell line models. A Lipopolysaccharides (LPS) treatment model in HTR-8/SVneo cell was utilized to explore the mechanism of how LPS treatment could lead to the activation of miR-15b expression. Western blot was used to detect the expression of proteins related to miR-15b mediated pathway in preeclamptic placentas. RESULTS: miR-15b inhibits trophoblast cell invasion and endothelial cell tube formation by suppressing the expression of Argonaute 2 (AGO2), a major miRNA effecter protein. AGO2 is specifically localized to human placenta cytotrophoblast and endothelial cells, and it plays important roles in trophoblast cell invasion and endothelial cell tube formation. LPS treatment may lead to the overexpression of miR-15b and down-regulation of AGO2, which may be involved in shallow trophoblast cell invasion associated with the pathogenesis of preeclampsia. Chromatin immunoprecipitation assay indicates that increased occupancy of AGO2 to miR-15b promoter is responsible for the increased expression of miR-15b under the condition of LPS treatment. Furthermore, preeclamptic placentas have decreased expression of AGO2, but increased expression of miR-15b and TLR-4 compared to normal controls. DISCUSSION: This is the first report about the function of AGO2 in human trophoblast and endothelial cells in the placenta. The data indicates that the aberrant expression of miR-15b contributes to abnormal placentation by targeting AGO2 mRNA. This study provides insight into the potential role of the miR-15b and AGO2 functional loop in the placentation process.

[Roles of miR-15b in endothelial cell function and their relevance to vascular diseases].

MicroRNAs (miRNAs) are noncoding RNAs with a short length of about 22 nucleotides. As major modulators participating in RNA interference, they affect cellular behaviors by regulating the expression of diverse genes at post-transcriptional levels. miR-15b is a member of the miR-15/16 family, which is broadly expressed in major tissues and specially enriched in the endovascular system of human beings. miR-15/16 affects cellular proliferation, apoptosis, invasion and angiogenesis. In this review, we summarize the role and the underlying mechanism of miR-15b as well as other miR-15/16 family members in different cells, especially in endothelial cells. We focus on the diverse roles of miR-15b in the occurrence, progression and prognosis of vascular diseases, with particular emphasis on preeclampsia, a hypertensive disorder related to endovascular dysfunction in the placenta.

[Expression pattern of congenital chloride diarrhea pathogenic gene Slc26a3 in the reproductive tract of male rodents].

OBJECTIVE: To determine the expression pattern of Slc26a3 gene in reproductive tract of male rodents to clarify whether the expression pattern is related to the subfertility observed in congenital chloride diarrhea (CLD) disease. METHODS: The expression of Slc26a3 in mouse and rat epididymis has been studied with immunohistochemistry and Western blotting. Its developmental expression pattern in rat testis was detected by Western blotting, while both of immunofluorescence and Western blotting were used to localize the expression of Slc26a3 in mouse sperms. The potential change of Slc26a3 expression in CFTR (cystic fibrosis transmembrane conductance regulator) knockout mice and CFTR mutant mice was also detected with Western blotting. RESULTS: The expression level of Slc26a3 gradually decreased along epididymis from its caput to corpus, then to its cauda part. This gradually decreasing expression pattern was also found in rat testis during development. Slc26a3 was localized mainly on the trunk of mouse sperm tail. In the testis and epididymis of CFTR knockout mice and CFTR mutant mice, no significant change of Slc26a3 expression was found. CONCLUSION: Slc26a3 is expressed in male reproductive tract, and its expression pattern is related to the function. Thus, the subfertility observed in CLD disease may be related to the important role of SLC26A3 in acid-base regulation of epididymis.

The strategies to DVI challenges in Typhoon Morakot.

Small village populations in which there is a high amount of kinship can cause complications in cases of disaster victim identification. This problem was highlighted by the loss of life after Typhoon Morakot struck Taiwan where over 500 people from small isolated communities lost their lives. Most of the victims were buried by landslides in the remote mountainous areas of southern Taiwan. Only 146 pieces of human remains were recovered after searching for 4 months. Most of the human remains were received for examination as severely damaged fragments prevented possible identification by morphological features. DNA testing using the traditional duo parent/child or sibling screening by STR data opens the possibility of including not only the actual victim but also false positives. Variable likelihood ratios were obtained when comparing DNA types from human remains to those from potential relatives; however, with the DNA typing of numerous members of the same living family, multiple matches to potential families were avoided. Of the 146 samples obtained and collapsed to 130 victims, they were linked to 124 individuals resulting in their identification when compared to a pool of 588 potential relatives. Six of the human remains could not be linked to any living relative and remain unknown.

Health, financial stresses, and life satisfaction affecting late-life depression among older adults: a nationwide, longitudinal survey in Taiwan.

The purpose of this study was to determine the incidence of depression in late life and to explore associated risk factors among Taiwanese elderly. The analyses were based on nationally representative data from the Survey of Health and Living Status of the Elderly in 1999 and 2003. A total of 1,487 respondents aged 65 years and older who completed the 10-item Center for Epidemiological Survey Depression (CES-D) scale in these two surveys and without depression in 1999 were included in the final analyses. Depression was defined as a CES-D score equal to or greater than 10. The independent variables included sociodemographic characteristics, occurrence of new diseases, social support, perceived health and financial stresses, life satisfaction, and functional condition. The incidence rate of depression over 4 years was 19.7%. Multivariate regression analyses revealed that women who perceived greater health or financial stress and who had greater life dissatisfaction or worsened functional condition were more likely to suffer depression. These findings imply that healthcare programs for older adults should include cognitive and behavioral interventions in order to prevent the development of depression in late life.

The prevalence of subjective frailty and factors associated with frailty in Taiwan.

This study estimated the prevalence of frailty and identified the factors associated with frailty in Taiwan using data from the Survey of Health and Living Status of the Elderly. A nationwide probability sample including 2,238 individuals aged > or =65 years was interviewed in 2003. Based on the Cardiovascular Health Study conducted by Fried, five phenotypes of frailty were selected: poor appetite, exhaustion, low physical activity, poor walking ability, and poor twisting ability of fingers. Participants were classified as nonfrail, prefrail, and frail if they met 0, 1 or 2, and > or =3 criteria. The prevalences of nonfrailty, prefrailty, and frailty were 55.1%, 40.0%, and 4.9%, respectively. The prevalence of frailty increased with age and was greater in women. Frailty was associated with less education, no spouse, disability, higher rates of comorbid chronic diseases, depressive symptoms, and geriatric syndromes. Specific drug use, such as hypnotics, analgesics, herbal drugs, and parenteral fluid supplements was positively associated with frailty. The use of multivitamins, fish oil, and vitamin E was negatively associated with frailty. The prevalence of frailty is lower in Taiwan than in Western countries. Depressive symptoms, geriatric syndromes, and specific medication use are potential fields for frailty prevention in community-dwelling older adults.

Geographical variations in elderly disability in Taiwan.

Inequality in health has long been a topic of discussion. The purpose of this research was to provide estimates of the proportions of elderly who had difficulties in activities of daily living in each of the 23 administrative areas of Taiwan, and to assess if there was geographical disparity in disability across areas. A nationally representative sample of 303,545 subjects was selected for interview. Among the subjects selected for interview, 239,861 completed the survey, a completion rate of about 80%. For the purpose of this research, only those aged 65 years or older were included (N = 114,873) in the analyses. Non-standardized and standardized prevalences of disability were presented for each of the 23 administrative areas in Taiwan, and geographical distribution of elderly disability was plotted. Results show that significant difference in disability prevalence exists among administrative districts, even after adjusting for age and sex structure of the population. Moreover, the extent of gender disparity also varied from one area to another. The western region, in general, had lower disability prevalence than the eastern region. Findings imply that since disability prevalence varied significantly across administrative areas, funding for long-term care should not be allocated based on the number of elderly population in an administrative area. Areas with high prevalence should identify reasons for their high prevalence rates and implement proper interventions.