PlexinA2 Forward Signaling through Rap1 GTPases Regulates Dentate Gyrus Development and Schizophrenia-like Behaviors

Dentate gyrus (DG) development requires specification of granule cell (GC) progenitors in the hippocampal neuroepithelium, as well as their proliferation and migration into the primordial DG. We identify the Plexin family members Plxna2 and Plxna4 as important regulators of DG development. Distribution of immature GCs is regulated by Sema5A signaling through PlxnA2 and requires a functional PlxnA2 GTPase-activating protein (GAP) domain and Rap1 small GTPases. In adult Plxna2^-/- but not Plxna2-GAP-deficient mice, the dentate GC layer is severely malformed, neurogenesis is compromised, and mossy fibers form aberrant synaptic boutons within CA3. Behavioral studies with Plxna2^-/- mice revealed deficits in associative learning, sociability, and sensorimotor gating-traits commonly observed in neuropsychiatric disorder. Remarkably, while morphological defects are minimal in Plxna2-GAP-deficient brains, defects in fear memory and sensorimotor gating persist. Since allelic variants of human PLXNA2 and RAP1 associate with schizophrenia, our studies identify a biochemical pathway important for brain development and mental health.

[Cross-sectional survey of smoking and smoking cessation behaviors in adults in Jiangxi province, 2013]

Objective: To describe the prevalence of smoking and smoking cessation in adults of Jiangxi province in 2013. Methods: Multi-stage stratified cluster random sampling method was used to select 6 000 individuals aged ≥18 years from 10 chronic and non-communicable disease and risk factor surveillance points of Jiangxi province in 2013. A face-to-face questionnaire survey was carried out to collect information about the risk factors for chronic and non-communicable diseases and 5 997 records were used in final analysis of smoking and smoking cessation. Sample was weighted to represent the adult population of Jiangxi province. The prevalence of different groups were analyzed. Results: The prevalence of current smoking of the sample was 21.53% (1 291/5 997). After complex weighting, the prevalence of smoking was 26.07% in adults in Jiangxi (95%CI:23.48%-28.66%), and it was much higher in men (50.62%, 95%CI: 46.31%-54.94%) than in women(1.46%, 95%CI: 0.57%-2.35%), the difference was statistically significant (P<0.05). The differences in smoking prevalence were significant among different age groups (P=0.029), and the smoking prevalence increased with educational level, but decreased with the worse of self-reported health condition. Most current smokers smoked every day (87.16%, 95%CI: 83.29%-91.03%) and averagely 19.27 (95%CI: 17.69-20.85) cigarettes were smoked daily. The proportion of smokers with average daily consumption ≥20 cigarettes was 64.74% (95%CI: 55.79%-73.70%). The smokers'average age of starting daily smoking was 20.28 (95%CI: 19.74-20.82) years old, which was lower in men [20.11(95%CI: 19.61-20.61) years old] than in women [26.88(95%CI: 24.73-29.03) years old], the difference was statistically significant (P<0.05). Among the male smokers, 27.04%(95%CI:18.91%-35.16%) of male smokers was less than 18 years old when they started daily smoking, and the proportion was 17.46%(95%CI: 0%-37.71%) in female smokers. The smoking cessation rate was 14.80% (95%CI: 10.88%-18.72%) and increased with age, the increase of income level and the worse of self-reported health condition. The successful smoking cessation rate was 10.89%(95%CI: 8.36%-13.42%). Only 32.10%(95%CI: 21.95%-42.25%) of current smokers attempted to quit smoking. The prevalence of passive smoking was 54.71% (95%CI: 44.20%-65.21%). Conclusion: The prevalence of smoking was high in adults in Jiangxi and the proportion of heavy smokers was large. Less smokers quitted smoking and the proportion of current smokers attempting to quit smoking was small. Males and adolescent smokers are targeted populations for tobacco control and special strategy should be taken according to the characteristics of smoking population in Jiangxi.

Evaluation of the Size-Dependent Cytotoxicity of DLC (Diamondlike Carbon) Wear Debris in Arthroplasty Applications

Patients with DLC (diamond like carbon)-coated artificial joints may be exposed to a wide size range of DLC wear debris (DW). In this study, the cytotoxicity of DW of different size ranges (0-0.22, 0.22-0.65, 0.65-1.0, and 1.0-5.0 μm) was evaluated. The microstructure and physical characteristics of DW were investigated by Raman spectroscopy, transmission electron microscopy (TEM), scanning electron microscope (SEM), and dynamic light scattering (DLS). Macrophages, osteoblasts, and fibroblasts were incubated with DW of different size ranges respectively followed by cytotoxicity evaluations of inflammatory cytokines, alkaline phosphatase (ALP) assays, and related signal protein expression analysis. The results showed that, except for the size range of 0-0.22 μm, DW cytotoxicity showed a size-dependent (0.22-5.0 μm) decrease with increasing size. Within the range of 0.22-5.0 μm, DW of larger size resulted in lessened inflammatory response and enhanced osteoblastogenesis and fibrogenesis, with increased viability of cells (macrophages, osteoblasts, and fibroblasts), better morphology, less release of pro-inflammatory factors and more release of anti-inflammatory factors. The results demonstrated that DW sizes below 0.22 μm had less negative effects on cell adhesion and growth because of the BSA (bovine serum albumin) encapsulation effect. These findings provide valuable knowledge about the comprehensive mechanism of promotion of inflammatory response and inhibition of osteoblastogenesis and fibrogenesis induced by DW. In conclusion, an effective system of biocompatibility evaluation for different sizes of DW was derived.

P2X3 receptor-mediated visceral hyperalgesia and neuronal sensitization following exposure to PTSD-like stress in the dorsal root ganglia of rats

BACKGROUND

Patients with posttraumatic stress disorder (PTSD) often share co-morbidity with chronic pain conditions. Recent studies suggest a role of P2X3 receptors and ATP signaling in pain conditions. However, the underlying mechanisms of visceral hyperalgesia following exposure to PTSD-like stress conditions remain unclarified.

METHODS

The behavior and hormones relevant for PTSD were studied. Visceromotor responses (VMR) and the abdominal withdrawal reflexes (AWR) to colorectal distention (CRD) were recorded to determine P2X3-receptor-mediated alteration of hyperalgesia following single-prolonged stress (SPS) exposure. Immunofluorescence, Western blotting, and patch-clamp were used.

KEY RESULTS

The escape latency, adrenocorticotropic hormone and cortisol were increased on days 7-14. Visceromotor responses and AWR was reduced at day 1 in SPS rats but increased to higher levels than in controls after exposure to day 7. Intrathecal administration of the P2X3-receptor antagonist TNP-ATP abolished the CRD response. Based on immunofluorescence and Western blotting analysis, SPS-treated rats exhibited reduced P2X3 expression in dorsal root ganglia (DRG) after day 1 compared with controls. P2X3 expression in DRG was enhanced on day 7 after SPS and the increase of the P2X3 expression was maintained on day 14 and 21 compared with controls. The P2X3-receptor agonist α,β-me ATP (10 μM) induced a fast desensitizing inward current in DRG neurons of both control and SPS-treated rats. The average peak current densities in SPS-treated group were increased 3.6-fold. TNP-ATP (100 nM) markedly blocked all fast α,β-me ATP-induced inward currents in the DRG neurons both in control and SPS-treated rats.

CONCLUSIONS & INFERENCES

The data indicate an important role of P2X3 signaling in visceral hyperalgesia following PTSD-like stress.

[Clinical experience on the employment of the staged step-up approach in the treatment of local complications secondary to severe acute pancreatitis]

Objective: To explore the experience and prognostic factors associated with the employment of the step-up approach in the treatment of local complications secondary to severe acute pancreatitis (SAP). Methods: The clinical data of 279 patients admitted to the Department of Pancreatic and Biliary Surgery, First Affiliated Hospital of Harbin Medical University from January 2011 to December 2015, whose local complications secondary to SAP were treated in a staged step-up framework, were retrospectively analyzed.For patients with documented or suspected infected pancreatic necrosis or gastrointestinal tract obstruction, some non-surgical interventions were initialed with the aim of postponing the timing of surgery to the forth week from the onset of SAP.The first-step intervention was a percutaneous catheter drainage (PCD) under the guidance of ultrasound. A minimal access retroperitoneal pancreatic necrosectomy, representing the second-step intervention, was conducted when PCD had failed. Finally, an open necrosectomy (the third-step intervention) was immediately resorted to when all of previous minimal invasive interventions had failed.Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ² test or Fisher's exact test.A multivariable Logistic regression analytic model was established to figure out the prognostic factors that were independently associated with the requirement of debridement in addition to drainage procedure during the staged step-up framework of patients with local complications secondary to SAP. Results: The initial interventions in this series were performed at 12 d (9-22 d) from the on-set of SAP and 104 cases (37.3%) were cured with ultrasound guided PCD alone.There were 152 cases (54.5%) cured by debridement in addition to PCD with the time interval of 30 d (25 to 44 d) since the on-set of the disease.The overall incidence of postoperative complications was 22.6% (63 cases) and in-hospital mortality was 8.2% (23 cases) in the present series.Multiple organ failures(MOF)(P<0.01, OR=3.15), heterogeneous collections (P<0.01, OR=2.40) and tertiary transfer (P=0.03, OR=1.80) were verified as the prognostic factors that were independently associated with the requirement of debridement in addition to PCD during the staged step-up framework of patients with local complications secondary to SAP. Conclusions: The staged step-up framework is a promising innovation that complies well with the era of minimal invasive surgery and is optimally suitable for the surgical interventions against SAP.MOF, heterogeneous collections and tertiary transfer are the prognostic factors that are independently associated with the requirement of debridement in addition to PCD during the staged step-up framework of patients with local complications secondary to SAP.

Glycemic control and self-monitoring of blood glucose in Chinese patients with type 2 diabetes on insulin: Baseline results from the COMPASS study

AIMS

Self monitoring of blood glucose (SMBG) is not widely utilized in insulin-treated patients with type 2 diabetes. In this analysis, we evaluated the current state of SMBG in Chinese adults with type 2 diabetes treated with insulin.

METHODS

The 2-phase COMPASS study involved 24 centers across 10 provinces and cities in China. In the first phase, a cross sectional survey was carried out in type 2 diabetes patients receiving insulin treatment. The inclusion criteria for the study subjects in the first phase were: type 2 diabetes, insulin treatment for ≥ 3 months, and age ≥ 18 years. Evaluation was made on the status of SMBG and insulin therapy in these patients by a questionnaire.

RESULTS

A total of 2819 patients (age 58.2 ± 10.8 years; 49.6% females; BMI 24.6 ± 3.4 kg/m(2)) with insulin-treated type 2 diabetes were recruited in phase I of this study. The majority of patients (80.4%) were receiving insulin treatment for at least 6 months. At baseline, the mean HbA1c was 8.5 ± 1.9% and 54.6% of patients had an HbA1c above 8%. 50.4% of the cohort had diabetes for at least 10 years, and fewer of these patients achieved HbA1c <7.0% (53 mmol/mol). At baseline, 65.8% of patients reported that daily SMBG frequency was performed on a random basis. 59.2% of patients reported that they occasionally, rarely or never follow their physician's instructions regarding SMBG. Hypoglycemia occurred in over 50% of patients, although in 71.8% of patients this was a rare occurrence.

CONCLUSIONS

There is low utilization of SMBG in Chinese adults with insulin-treated type 2 diabetes, with approximately two-thirds of patients reporting irregular use of SMBG. This is in line with an overall poor level of glycemic control.

Impact of structured self-monitoring of blood glucose on the quality of life of insulin-treated Chinese patients with type 2 diabetes mellitus: Results from the COMPASS study

AIMS

To evaluate the effect of structured self-monitoring of blood glucose (SMBG) regimen on quality of life (QoL) in poorly controlled insulin-treated patients with type 2 diabetes.

METHODS

Phase II of the COMPASS trial was a 6-month, multicenter, prospective, single-arm, interventional study. This study recruited 820 outpatients from 19 clinical sites in China who met the following inclusion criteria: type 2 diabetes, insulin treatment for ≥ 3 months, and age 18-65 years, an HbA1c >8.0% (64 mmol/mol), and willingness to perform SMBG. Subjects were advised to follow a structured SMBG regimen specific to their insulin regimen, and were trained to respond to SMBG readings via lifestyle changes and insulin dose self-adjustment. QoL assessments (SF-36) were performed at baseline and 6 months.

RESULTS

Patients with a mean age of 55.13 ± 9.77 years had an average diabetes duration of 9.83 ± 7.05 years and had been receiving insulin therapy for a mean of 45.4 ± 46.79 months. All QoL parameters were significantly improved following structured SMBG after 6 months, most notably the physical role functioning (p<0.0001) and emotional role functioning (p<0.0001) component scores. Overall, 40.6% of patients rated their overall QoL as 'a bit' or a lot better' after structured SMBG compared with 16.5% prior to the intervention (p<0.0001). SMBG also improved overall feelings of wellbeing, with 39.13% of patients believing that their health was deteriorating prior to SMBG compared with only 14.4% of patients after the intervention (p<0.0001).

CONCLUSIONS

The structured SMBG program in insulin-treated Chinese outpatients with type 2 diabetes significantly improved QoL outcomes. Physical and emotional role functioning are the 2 QoL scales that demonstrate the largest improvement with SMBG.

[Causes analysis of misdiagnosis in patients with familial nasal bleeding]

OBJECTIVE

To analyze the causes of misdiagnosis in patients with familial nasal bleeding and to improve the level of diagnosis and treatment.

METHOD

The clinical characteristics of 7 families with nose blood were analyzed retrospectively and 2 typical cases were reported, including their treatment and misdiagnosis in consulting, out-patient and in-patient.

RESULT

Typical case 1 was misdiagnosed and mistreated for 42 years, misdiagnosed as blood disease so that the patient was biopsied in bone marrow, misdiagnosed as endometriosis so that the patient was performed uterus resection. Typical case 2 was misdiagnosed and mistreated for 17 years, misdiagnosed as upper digestive tract hemorrhage so that the patient was performed endoscopic sleeve ligation, misdiagnosed as inferior turbinate hemangioma so that the patient was performed nasal endoscopic surgery.

CONCLUSION

Neglect of family history and the typical signs are the causes of misdiagnosis. So asking about the family history and checking for the typical signs in patients with nose blood can avoid misdiagnosis.

The effect of treadmill training and N-acetyl-l-cysteine intervention on biogenesis of cytochrome c oxidase (COX)

Mitochondrial biogenesis refers to increased content of mitochondria, which has been shown to be promoted by aerobic exercise. During this process, oxidative stress is considered the essential initiator. Even though some studies have addressed the issue as to whether antioxidants would hamper the effects of exercise on mitochondrial biogenesis, no consensus has been achieved. Therefore, the purpose of the present study was to investigate the effects of exercise and antioxidant intervention on mitochondrial biogenesis, as well as COX biogenesis. Thirty-two clean-grade male ICR mice were randomly assigned to a control group (Con), exercise group (Ex), N-acetyl-l-cysteine group (NAC), or NAC plus exercise group (NEx). The NAC and NEx groups were injected with NAC (0.1 mg/g/2 days) intraperitoneally for 3 weeks, whereas the Con and Ex groups were administered saline for the same period of time. Mice assigned to Ex and NEx groups started exercise training 1 week before drug intervention was initiated. After 1 week of acclimatization, the mice were allowed to run at a speed of 28 m/min for 60 min, 6 days a week. The results showed that exercise training caused an increase in mRNA and protein levels of COXIV, whereas NAC intervention lowered the two so significantly that even exercise training could not reverse the effect of NAC intervention. Our data suggest that even though antioxidant intervention could alleviate oxidative damage caused by exercise, it was not necessarily beneficial for mitochondrial biogenesis.