Sodium ozagrel and atorvastatin for type 2 diabetes patients with lacunar cerebral infarction

Human prostacyclin and thromboxane synthases: Molecular interactions, regulation, and pharmacology

Prostanoids are lipid mediators of the human body that are involved in the inflammation and platelet aggregation. Prostacyclin is a vasodilator and inhibitor of platelet aggregation, and a product of the enzymatic reaction catalyzed by prostacyclin synthase (PTGIS). Thromboxane is a vasoconstrictor and synthesized by thromboxane synthase (TBXAS1). An imbalance of prostanoids can accompany cardio-/cerebrovascular diseases and cancers. PTGIS and TBXAS1 are clinically relevant membrane-bound enzymes of the multigene family of cytochromes P450 (CYPs), also known as CYP8A1 and CYP5A1, respectively. Particular studies of these functional antagonists will contribute to the elucidation of pathogenic mechanisms. The purpose of this work was to analyze the literature landscape over a period of 2020-2024 in the field of biological, pharmacogenomic, and pharmacological features of PTGIS and TBXAS1 as well as to explore the potential of their regulation at the post-transcriptional and post-translational levels using systems biological analysis. The review discusses recent findings on the novel aspects of both synthases established in gene knockout and overexpression experiments, current preclinical pharmacology, and potential ways of gene expression regulation. Identification of protein-protein interactions and post-translational modifications appear to be the main options for modulating PTGIS and TBXAS1 activity. The microsomal CYPs are known to form complexes with each other and direct interactions of CYP2E1 with both synthases can probably lead to modulation of their activity. Progress in the preclinical development of low molecular weight compounds as inhibitors of TBXAS1 is more prospective than PTGIS that is applied as gene therapy biologicals for in vivo production of prostacyclin due to its noticeable anticancer and vasodilator effects.

Effects of glycemic indicators on early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis

BACKGROUND

Stress hyperglycemia (SH) is a common phenomenon that is present in about 50% of patients with acute ischemic stroke (AIS). It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis (IVT).

AIM

To investigate the predictive value of glycemic indicators for early neurological outcomes (ENOs) in patients with AIS treated with IVT.

METHODS

We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, between January 2017 and June 2022. ENO included early neurological improvement (ENI) and early neurological deterioration (END), defined as a decrease or increase in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 24 hours after IVT. We analyzed the associations between glycemic indicators [including admission hyperglycemia (AH), fasting blood glucose (FBG), and SH ratio (SHR)] and ENO in all patients and in subgroups stratified by diabetes mellitus (DM).

RESULTS

A total of 819 patients with AIS treated with IVT were included. Among these, AH was observed in 329 patients (40.2%). Compared with patients without AH, those with AH were more likely to have a higher prevalence of DM (P < 0.001) and hypertension (P = 0.031) and presented with higher admission NIHSS scores (P < 0.001). During the first 24 hours after IVT, END occurred in 208 patients (25.4%) and ENI occurred in 156 patients (19.0%). Multivariate mixed logistic regression analyses indicated that END was independently associated with AH [odds ratio (OR): 1.744, 95% confidence interval (CI): 1.236-2.463; P = 0.002]. Subjects were classified into four groups representing quartiles. Compared with Q1, patients in the higher quartiles of SHR (Q2: OR: 2.306, 95%CI: 1.342-3.960; P = 0.002) (Q3: OR: 2.284, 95%CI: 1.346-3.876; P = 0.002) (Q4: OR: 3.486, 95%CI: 2.088-5.820; P = 0.001) and FBG (Q3: OR: 1.746, 95%CI: 1.045-2.917; P = 0.033) (Q4: OR: 2.436, 95%CI: 1.476-4.022; P = 0.001) had a significantly higher risk of END in the overall population. However, none of the glycemic indicators were found to be associated with ENI in patients with or without DM.

CONCLUSION

Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.

The relationship between HMGB1 and autophagy in the pathogenesis of diabetes and its complications

Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels and has become the third leading threat to human health after cancer and cardiovascular disease. Recent studies have shown that autophagy is closely associated with diabetes. Under normal physiological conditions, autophagy promotes cellular homeostasis, reduces damage to healthy tissues and has bidirectional effects on regulating diabetes. However, under pathological conditions, unregulated autophagy activation leads to cell death and may contribute to the progression of diabetes. Therefore, restoring normal autophagy may be a key strategy to treat diabetes. High-mobility group box 1 protein (HMGB1) is a chromatin protein that is mainly present in the nucleus and can be actively secreted or passively released from necrotic, apoptotic, and inflammatory cells. HMGB1 can induce autophagy by activating various pathways. Studies have shown that HMGB1 plays an important role in insulin resistance and diabetes. In this review, we will introduce the biological and structural characteristics of HMGB1 and summarize the existing knowledge on the relationship between HMGB1, autophagy, diabetes, and diabetic complications. We will also summarize potential therapeutic strategies that may be useful for the prevention and treatment of diabetes and its complications.

Additional Acupuncture Confers a Favorable Long-Term Prognosis for Elderly Hypertensive Patients with Carotid Atherosclerosis after Atorvastatin Treatment

Objective

The purpose of the study is to investigate the clinical efficacy and long-term prognosis of acupuncture (AP) combined with atorvastatin (ATO) in treating senile essential hypertension (EH) complicated with carotid atherosclerosis (CA).

Methods

108 elderly EH patients with CA admitted to our hospital between January 2018 and September 2018 were enrolled into the study, consisting of 67 patients who received treatment of AP with ATO (AP + ATO group) and 41 patients who received treatment of ATO alone (ATO group). Comparative outcomes included clinical efficacy, blood pressure (BP), the levels of blood lipids and inflammatory factors, carotid intima-media thickness (IMT), the number of unstable carotid intima plaques, the carotid plaque area, and the incidence of adverse reactions. All patients were followed up for 3 years to evaluate their quality of life and the recurrence rate of CA.

Results

The AP + ATO group presented a higher efficacy, a declined BP, and lower posttreatment levels of blood lipids and inflammatory factors than the ATO group (P < 0.05). Reductions were observed in IMT, number of plaques, and plaque area in both groups after treatment, with more significant improvements in the AP + ATO group (P < 0.05). No difference was observed in the incidence of adverse reactions between two groups after treatment (P > 0.05). The follow-up analysis demonstrated a higher SF-36 score and a lower recurrence rate of CA in the AP + ATO group than the ATO group (P < 0.05).

Conclusion

The findings suggested that, for elderly EH patients with CA, treatment of AP with ATO offers better clinical efficacy and safety, which not only can decline the BP, but also can reduce blood lipids and plaque formation, and improve quality of life.