Effects of group mindfulness-based cognitive therapy and group cognitive behavioural therapy on symptomatic generalized anxiety disorder: a randomized controlled noninferiority trial.

BACKGROUND: Mindfulness-based cognitive therapy (MBCT) is a promising alternative treatment for generalized anxiety disorder (GAD). The objective of this study was to examine whether the efficacy of group MBCT adapted for treating GAD (MBCT-A) was noninferior to group cognitive behavioural therapy (CBT) designed to treat GAD (CBT-A), which was considered one of first-line treatments for GAD patients. We also explored the efficacy of MBCT-A in symptomatic GAD patients compared with CBT-A for a variety of outcomes of anxiety symptoms, as well as depressive symptoms, overall illness severity, quality of life and mindfulness. METHODS: This was a randomized, controlled, noninferiority trial with two arms involving symptomatic GAD patients. Adult patients with GAD (n = 138) were randomized to MBCT-A or CBT-A in addition to treatment as usual (TAU). The primary outcome was the anxiety response rate assessed at 8 weeks after treatment as measured using the Hamilton Anxiety Scale (HAMA). Secondary outcomes included anxiety remission rates, scores on the HAMA, the state-trait anxiety inventory (STAI), the Hamilton Depression Scale (HAMD), the Severity Subscale of the Clinical Global Impression Scale (CGI-S), and the 12-item Short-Form Health Survey (SF-12), as well as mindfulness, which was measured by the Five Facet Mindfulness Questionnaire (FFMQ). Assessments were performed at baseline, 8 weeks after treatment, and 3 months after treatment. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed for primary analyses. The χ2 test and separate two-way mixed ANOVAs were used for the secondary analyses. RESULTS: ITT and PP analyses showed noninferiority of MBCT-A compared with CBT-A for response rate [ITT rate difference = 7.25% (95% CI: -8.16, 22.65); PP rate difference = 5.85% (95% CI: - 7.83, 19.53)]. The anxiety remission rate, overall illness severity and mindfulness were significantly different between the two groups at 8 weeks. There were no significant differences between the two groups at the 3-month follow-up. No severe adverse events were identified. CONCLUSIONS: Our data indicate that MBCT-A was noninferior to CBT-A in reducing anxiety symptoms in GAD patients. Both interventions appeared to be effective for long-term benefits. TRIAL REGISTRATION: Registered at chictr.org.cn (registration number: ChiCTR1800019150 , registration date: 27/10/2018).

Dual role of polyamines in heart ischemia/reperfusion injury through regulation of mitochondrial permeability transition pore.

Polyamines (putrescine, spermidine, and spermine) are essential polycations that play important roles in various physiological and pathophysiological processes in mammalian cells. The study was to investigate their role in cardioprotection against ischemia/reperfusion (I/R) injury and the underlying mechanism. Isolated hearts from male Sprague-Dawley rats were Langendorff-perfused and cardiac I/R was achieved by 30 min of global ischemia followed by 120 min of reperfusion. Different concentrations of polyamines (0.1, 1, 10, and 15 µmol/L of putrescine, spermidine, and spermine), cyclosporin A (0.2 µmol/L), or atractyloside (20 µmol/L) were given 10 min before the onset of reperfusion. The hemodynamics were monitored; the lactate dehydrogenase (LDH) levels in the coronary effluent were measured spectrophotometrically; infarct size was determined by the 2,3,5-triphenyltetrazolium chloride staining method; and mitochondrial permeability transition pore (MPTP) opening was determined spectrophotometrically by the Ca2+-induced swelling of isolated cardiac mitochondria. The results showed that compared to I/R alone, 0.1 and 1 µmol/L polyamines treatment improved heart function, reduced LDH release, decreased infarct size, and these effects were inhibited by atractyloside (MPTP activator). In isolated mitochondria from normal rats, 0.1 and 1 µmol/L polyamines treatment inhibited MPTP opening. However, 10 and 15 µmol/L polyamines treatment had the opposite effects, and these effects were inhibited by cyclosporin A (MPTP inhibitor). Our findings showed that polyamines may have either protective or damaging effects on hearts suffering from I/R by inhibiting or activating MPTP opening.

The mitochondrial Ca(2+)-activated K(+) channel contributes to cardioprotection by limb remote ischemic preconditioning in rat.

AIMS: To investigate the role of the mitochondrial Ca(2+)-activated K(+) channel in cardioprotection induced by limb remote ischemic preconditioning. MAIN METHODS: Male Sprague-Dawley rats (250-300 g) were randomized into control, ischemia/reperfusion (I/R), remote ischemic preconditioning (RPC), NS1619 (a specific mitochondrial Ca(2+)-activated K(+) channel opener), and RPC+paxilline (a specific mitochondrial Ca(2+)-activated K(+) channel inhibitor) groups. RPC was induced by 4 cycles of 5 min of ligation followed by 5 min of reperfusion of the left femoral artery. Myocardial I/R was achieved by ligation of the left anterior descending coronary artery for 30 min, followed by 120 min of reperfusion. Infarct size was determined by 2,3,5-triphenyltetrazolium chloride staining, the hemodynamics were monitored, and lactate dehydrogenase (LDH) levels in the coronary effluent, manganese superoxide dismutase (Mn-SOD) content in mitochondria and mitochondrial membrane potential were measured spectrophotometrically. The ultrastructure of cardiomyocyte mitochondria was assessed by electron microscopy. KEY FINDINGS: NS1619 (10 µM) improved heart function, decreased infarct size, reduced LDH release, maintained mitochondrial structural integrity and mitochondrial membrane potential, and increased the mitochondrial content of Mn-SOD to the same degree as RPC treatment. However, paxilline (1 µM) eliminated the cardioprotective effect conferred by RPC. SIGNIFICANCE: The mitochondrial Ca(2+)-activated K(+) channel participates in the myocardial protection by limb remote ischemic preconditioning.

[Effect of glucocorticoid on neurokinin A in plasma and lungs of guinea pigs with asthma and molecular mechanism of the effect].

OBJECTIVE: Bronchial asthma is a chronic inflammatory disorder of the airways caused by many complicated elements. Recently, a close attention has been paid to the neurogenic inflammation in airways, which is mediated by sensory neuropeptides secreted by sensory nerve. Neurokinin A (NKA) is an important transmitter of non-cholinergic excitatory nerves in the lung which is an important sensory neuropeptide causing airway neurogenic inflammation. The purpose of this study was to investigate the effect of glucocorticoid (dexamethasone) on neurokinin A in plasma and lungs of guinea pigs with asthma and to explore its molecular mechanism. METHODS: Thirty guinea pigs (1.5 months old and weighed 200 - 225 g) were sensitized by exposure to aerosolized ovalbumin and challenged with the same antigen to establish asthma model. These animals were divided randomly into dexamethasone-treatment group and non-dexamethasone-treatment group (15 guinea pigs in each group). Normal control group animals (n = 15) were treated with normal saline (NS) instead of aerosolized ovalbumin. The guinea pigs in the dexamethasone-treatment group were treated with dexamethasone (5.0 mg/kg, intraperitoneal injection) one day before asthma-inducement, on the day of inducement and 24 h after inducement. The non-dexamethasone-treatment group animals were treated with NS (5.0 mg/kg, intraperitoneal injection) on the same days as the dexamethasone-treatment group was treated. The normal control group animals were treated with NS (5.0 mg/kg, intraperitoneal injection). The contents of NKA in the plasma and lung tissues were detected by ELISA; the expression of NKA mRNA in lung tissues was examined by RT-PCR. RESULTS: (1) The contents of NKA in the plasma (2.20 +/- 0.46 ng/ml), lung tissues (5.02 +/- 2.11 ng/g x protein) and the NKA mRNA expression in the lung tissues (1.10 +/- 0.06) of guinea pigs with induced asthma were significantly higher than those of the normal control group (plasma 0.84 +/- 0.33 ng/ml, lung tissues 2.56 +/- 0.80 ng/g x protein, mRNA 0.30 +/- 0.04; P < 0.001, respectively). (2) The contents of NKA in the plasma, lung tissues and the NKA mRNA expression in the lung tissues of guinea pigs with induced asthma were significantly lower in dexamethasone-treatment group (plasma 0.98 +/- 0.23 ng/ml, lung tissues 2.71 +/- 0.50 ng/g x protein, mRNA 0.35 +/- 0.07) than those in the non-dexamethasone-treatment group (plasma 2.20 +/- 0.46 ng/ml, lung tissues 5.02 +/- 2.11 ng/g x protein, mRNA 1.10 +/- 0.06; P < 0.001, respectively). No significant difference was found between the dexamethasone-treatment group and the normal control group (P > 0.05, respectively). CONCLUSIONS: (1) NKA mRNA expression in the lungs of guinea pigs with asthma was up-regulated and NKA contents were higher in plasma and lungs; (2) Glucocorticoid could significantly decrease the contents of NKA in plasma, lung tissues of guinea pigs with induced asthma; the mechanism of the effect may be related to down-regulation of NKA mRNA expression in lung tissues caused by glucocorticoid.

[Change of neurokinin A plasma level in asthmatic children].

OBJECTIVE: Chronic inflammation of airway in bronchial asthma is caused by many complicated elements. Recently, a close attention has been paid to the neurogenic inflammation in airway which is mediated by sensory neuropeptides secreted by sensory nerve in the lung. Neurokinin A (NKA) is an important sensory neuropeptide leading to neurogenic inflammation in airway. Experimental studies showed that NKA has a close relation to asthma. The purpose of the present study was to investigate the changes of NKA in plasma of asthmatic children and possible relationship between sensory neuropeptides and asthma in children. METHODS: Thirty-five children with bronchial asthma were studied; 16 of the cases were < 3 yrs and 19 were >or= 3 yrs. Eighteen of the cases had severe asthma and 16 had mild asthma. None of the subjects was treated with glucocorticoid within 3 days before the study started; 15 healthy children without history of asthma or family history of asthma were enrolled as control subjects. Plasma was collected from each case during acute attack of asthma and their clinical remission of the asthmatic children. After purifying with SEP-pak C(18), NKA content was detect by enzyme-linked immunosorbent assay (ELISA) as instructed by the manufacturer of the NKA Kit (NKA unit: ng/L). RESULTS: (1) The content of plasma NKA of asthmatic children was significantly higher at the asthma attack (256 +/- 153) than that at their clinical remission stage (70 +/- 66; q = 9.497, P < 0.01) and than that of the normal control group (38 +/- 6; q = 8.599, P < 0.01); no significant difference in plasma NKA was found between the clinical remission stage and the normal control group (q = 1.245, P > 0.05). (2) There was a significant positive correlation between the asthmatic clinical state and the levels of plasma NKA; the contents of plasma NKA at the stage of acute attack in severe asthma (296 +/- 170) were significantly higher than those of the mild asthmatic children (190 +/- 99; q = 3.77, P < 0.05). CONCLUSIONS: The contents of plasma NKA were significantly higher during the asthma attack stage of children, and the higher was the level of NKA, the more severe the attack.; with asthma remission, the contents of plasma NKA decreased to normal; the contents of plasma NKA has a close relation to the asthmatic children.