Tirofiban for Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis: A Systematic Review and Meta-Analysis.

INTRODUCTION: Tirofiban has been used as a rescue when thrombectomy is not successful in endovascular therapy (EVT) for acute ischemic stroke (AIS), but the use of tirofiban after intravenous thrombolysis (IVT) is controversial. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban combined with IVT in AIS compared with not receiving tirofiban. METHODS: The PubMed and Embase databases were searched for all relevant studies published up to August 31, 2021. The safety endpoints included symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and mortality. The efficacy endpoint was the modified Rankin Scale (mRS) score at the 3-month follow-up. RESULTS: Seven articles (1,036 patients) were included. Of these, 444 patients received tirofiban, and 592 patients did not. Meta-analysis showed that tirofiban did not increase the risk of sICH (OR 0.98; 95% CI 0.50-1.93; p = 0.96), any ICH (OR 0.94; 95% CI 0.63-1.39; p = 0.75) or mortality (OR 0.67; 95% CI 0.39-1.15; p = 0.15) and tended to be associated with a favorable functional outcome (OR 1.33; 95% CI 0.99-1.78; p = 0.06) in patients with AIS. Subgroup analysis showed that bridging therapy combined with tirofiban could reduce mortality (OR 0.47; 95% CI 0.23-0.98; p = 0.04). Tirofiban significantly improved the favorable functional outcome in patients with IVT only (non-EVT) (OR 1.98; 95% CI 1.30-3.02; p = 0.002). CONCLUSION: Intravenous tirofiban could be safe for patients with AIS undergoing IVT, regardless of receiving EVT. Intravenous tirofiban may reduce mortality rates for patients undergoing bridging therapy. It also could increase the likelihood of a favorable functional outcome, especially for patients receiving IVT only.

Proportions of Th17 cells and Th17-related cytokines in neuromyelitis optica spectrum disorders patients: A meta-analysis.

BACKGROUND: T helper (Th17) cells play an important role in many autoimmune diseases. In this meta-analysis, we aimed to specify the proportion of Th17 cells and the levels of Th17-related cytokines in neuromyelitis optica spectrum disorders (NMOSD) patients, we did this meta-analysis. METHODS: Using previously reported data from PubMed, EMBASE, and Web of Science and Cochrane, we explored the proportion of Th17 cells in CD4+ T cells in peripheral blood (PB) and the level of Th17-related cytokines, such as interleukin (IL)1ß, IL6, IL17, IL21, IL22, IL23 and transforming growth factor -beta (TGFß), in cerebrospinal fluid (CSF), plasma, and serum in NMOSD patients compared to control group and multiple sclerosis (MS) patients. RESULTS: In total, 38 trials were included for our analysis. Results showed that the proportion of Th17 cells was higher in NMOSD patients than in the control and MS groups. The levels of IL1ß, IL6, IL17 and IL21 in CSF and plasma, and IL6, IL21, IL22, and IL23 in the serum were higher in NMOSD patients than in the control group. The levels of IL6 in CSF and serum and IL17 in plasma and serum were higher in NMOSD patients than in MS patients. CONCLUSION: The proportion of Th17 cells and the levels of Th17-related cytokines was increased in NMOSD patients compared with the control group and MS patients. The results of this meta-analysis indicated that Th17 cells and Th17-associated cytokines may play an essential role in the pathogenesis of NMOSD. PROSPERO registration: CRD42019128785.

Association between bone mineral density and benign paroxysmal positional vertigo: a meta-analysis.

BACKGROUND: The association between bone mineral density (BMD) and benign paroxysmal positional vertigo (BPPV) has been investigated by multiple studies, but the conclusions are controversial. This meta-analysis was conducted to evaluate whether the bone mineral density is associated with BPPV. METHODS: The relevant studies were identified by searching PubMed, EMBASE, Cochrane Library, ScienceDirect, Web of Science database up to June 2018. Statas14.0 software was used for meta-analysis. We used the pooled odds ratio (OR) and 95% confidence interval (CI) to assess the incidence of osteoporosis and osteopenia in patients with BPPV and controls (free of BPPV disease). The standardized mean difference (SMD) and 95% confidence interval (CI) were used to assess the T score in BPPV patients and controls. This meta-analysis has been registered at International Prospective Register of Systematic Reviews (PROSPERO) (number CRD42018082271). RESULTS: A total of 11 studies were eligible for meta-analysis, including 1982 subjects. When compared with the controls, the total incidence of osteoporosis and osteopenia was significantly higher in BPPV patients (OR 3.27, 95% CI 2.66-4.03, p < 0.0001). Further analysis was conducted by separate discussion about the incidence of osteoporosis and osteopenia in BPPV patients, the result of which shows that both the incidence of osteoporosis (OR 3.48, 95% CI 1.86-6.51, p < 0.0001) and the incidence of osteopenia (OR 1.75, 95% CI 1.01-3.04, p < 0.0001) were higher in BPPV patients than that in controls. There was an significant reduction in T scores of BPPV patients (SMD - 0.82, 95% CI -1.18 to - 0.46, p < 0.0001). Publication bias for each analysis was evaluated by Egger's test and Begg's indicating that no publication bias existed. Sensitivity analysis was conducted for each analysis demonstrating that the results were robust. CONCLUSIONS: Our meta-analysis provided stronger evidence that patients with BPPV were associated with a lower T score and a higher risk of osteoporosis and osteopenia. The results demonstrated that lower bone mineral density may be a risk factor for BPPV. However, large-scare, multicenter clinical studies need to be carried out to explore the precise risk of osteoporosis and osteopenia in patients with BPPV in future.

[Effect of Organic Manure Substitution of Synthetic Nitrogen on Crop Yield and N2O Emission in the Winter Wheat-Summer Maize Rotation System].

Controlling agricultural greenhouse gas emissions, such as N2O, is important in mitigating global climate warming. Through monitoring the dynamics of N2O emission fluxes, we investigated the effect of organic nitrogen (N) substitution of synthetic N on N2O emissions and the yield of winter wheat and summer maize in the Guanzhong Plain of Shaanxi Province, China. The study involved six treatments, consisting of no fertilizer (CK), synthetic N, phosphorus (P), and potassium (K) fertilizers alone (NPK), 75% NPK+25% organic N through manure (25%M), 50% NPK+50% organic N (50%M), 25% NPK+75% organic N (75%M), 100% organic N (100%M). The results showed that the peak value of the N2O emission flux appeared after fertilization, rainfall, and irrigation. In the wheat season, the emission flux of N2O varied from -1.33 to 144.2 µg·(m2·h)-1, with the highest peak value in the NPK treatment. In the maize season, the emission flux of N2O varied from 88.2 to 1800.1 µg·(m2·h)-1, and the 50%M treatment showed the highest peak value. The range in the total amount of N2O emissions from the different treatments in the wheat-maize rotation system was 429.8-2632.1 g·hm-2, and the amount for the treatments decreased in order as follows:50%M > 25%M > NPK > 75%M > 100%M > CK. The yields of wheat, maize, or wheat plus maize were significantly higher in the fertilized treatments compared to the CK. Organic substitution treatments significantly increased wheat yield by 26.1% to 50.0% relative to the NPK treatment. While the maize yield in 50%M and 75%M treatments was similar to that in the NPK treatment, the 25%M and 100%M treatments showed significantly lower yields than with the NPK treatment. The total yield of wheat plus maize varied from 9166 to 17496 kg·hm-2, of which total yield was significantly higher with 50%M and 75%M compared to NPK. Overall, the 75%M treatment is the best measure to guarantee crop yield and to reduce N2O emissions in the wheat-maize rotation system based on a one year study in the Guanzhong plain of Shaanxi Province.

REM sleep behavior disorder was associated with Parkinson's disease: a community-based study.

BACKGROUND: Our study was aimed to validate a modified RBD (REM sleep behavior disorder) single question (RBD1Q-C), study the prevalence of probable RBD (pRBD) in a rural community based on RBD1Q-C and investigate the association between pRBD and Parkinson's disease (PD). METHODS: The validation study of RBD1Q-C included 32 Chinese participants (14 idiopathic RBD patients and 18 controls). All participants underwent a polysomnogram (PSG). We then conducted a door-to-door survey to estimate the prevalence of pRBD assessed by RBD1Q-C, and its association with PD among 19614 residents who lived in Malu community of Shanghai, China. RESULTS: RBD1Q-C demonstrated a high sensitivity of 100%, a moderate specificity of 55.6%. The agreement between RBD1Q-C and PSG-based RBD diagnosis was good (k = 0.552). PPV of the RBD1Q-C was 63.6% and NPV was 100%. The prevalence of pRBD in Malu community was 4.9%. In people over 50 years old, presence of pRBD was significantly associated with increased risk of having PD (odds ratio = 2.61, 95% CI: 1.56-4.39). CONCLUSION: RBD1Q-C was shown to be a useful screening tool. Based on the RBD1Q-C, we found that pRBD was not rare in Chinese rural population and associated with odds of PD, calling for more attention from patients, caregivers and physicians.

[The application of in vivo multi-channel recording methods in the studies of the affective pain in rats].

OBJECTIVE: To record the electrical activities of Antirior cingulate cortex (ACC) neurons by in vivo multi-channel recording methods using the model of complete freund's adjuvant (CFA) induced conditioned place avoidance (C-CPA), which has been set up in our previous studies. METHODS: The electrode was self-made and the CPA responses were recorded by in vivo multi-channel recording method. RESULTS: (1) The electrical activities of ACC neurons could be successfully recorded by the self-made electrode. (2) Before or after the injection of CFA, rats were respectively conditioned to the different place. The firing rates of ACC neurons in the CFA-paired place vs that in the non-CFA-paired place was (0.853 ± 1.377) imp/s vs (0.221 ± 0.971) imp/s (P < 0.05, n = 26). (3) The CPA responses in the CFA-paired place vs that in the non-CFA-paired place were (303.55 ± 61.77)s vs (140.32 ± 33.52)s(P < 0.05, n = 6). CONCLUSION: The firing rates of rACC (rostral Anterior Cingulate Cortex) neurons were involved in the occurrence of the affective pain.

Prevalence and Risk Factor of Cognitive Impairment were Different between Urban and Rural Population: A Community-Based Study.

BACKGROUND: China is facing a continuously rising numbers of people with cognitive impairment (CI). OBJECTIVES: To investigate the prevalence and risk factors of CI among elderly people living in rural and urban communities. METHODS: We conducted a face-to-face survey of CI on 7,900 individuals aged 50 years or older meeting inclusion criteria in the Malu (rural community, n = 4,429) and Wuliqiao (urban community, n = 3,471) communities of Shanghai. The Mini-Mental State Examination (MMSE) was used to evaluate the cognitive function. Information on demographic features and potential risk factors for CI was collected during the interview. Multivariate logistic regression was performed to identify risk factors associated with CI. RESULTS: Based on the education modified MMSE score, we identified 329 CI cases in rural community and 227 in urban community. The prevalence of CI was 7.43% in rural population and 6.54% in urban population (p = 0.13). In the urban population, risk of having CI was associated with age (OR = 1.04; 95% CI: 1.01-1.08), lack of physical activities (OR = 2.25; 95% CI: 1.11-4.57), presence of diabetes mellitus (OR = 1.79; 95% CI: 1.04-3.07), and having three or more children (OR = 2.39; 95% CI: 1.27-4.50). In contrast, factors associated with rural populations included female gender (OR = 2.03; 95% CI: 1.08-3.82), age (OR = 1.06; 95% CI: 1.03-1.08), exposure to pesticides (OR = 4.68; 95% CI: 1.27-17.21), history of encephalitis or meningitis (OR = 6.02; 95% CI: 1.92-18.85) and head trauma (OR = 1.89; 95% CI: 1.10-3.24). CONCLUSIONS: Urban rural and populations showed different risk factors for CI, suggesting that different preventive strategies in these areas should be performed.

Plasma epidermal growth factor decreased in the early stage of Parkinson's disease.

Epidermal growth factor (EGF) is a neurotrophic factor that plays an important role in Parkinson's disease (PD). We measured plasma EGF level in PD, essential tremor (ET) and normal controls to investigate whether it changes in PD and whether it is associated with motor and non-motor symptoms of PD. 100 patients with PD, 40 patients with ET as disease control and 76 healthy persons were enrolled in the present study. Motor and non-motor symptoms were assessed by different scales. Plasma EGF levels of three groups were measured by enzyme-linked immunosorbent assay kit. Spearman test and linear logistics regression model were used to test the correlation of EGF with motor and non-motor symptoms of PD. Plasma EGF level was significantly decreased in early PD patients compared with normal control, but not in advanced PD patients. Interestingly, plasma EGF level was significantly increased in advanced PD and total PD patients compared with ET patients, but not in early PD patients. In addition, plasma EGF level was correlated with UPDRS-III scores in PD. Also plasma EGF level was correlated with UPDRS-III scores and NMS scores in early PD. Our results suggested that plasma EGF decreased in the early stage of PD and increased later on in the PD disease course. Also, plasma EGF level was increased significantly in PD compared with ET patients and correlated with motor and non-motor symptoms in early PD.

Evolution of the Karnosky Performance Status throughout life in glioblastoma patients.

Functional independence in glioblastoma (GBM) patients is a key factor in measuring the quality of life. Progression free survival (PFS) and overall survival (OS) have been largely described. However, the evolution over time of the performance status during the patients' life remains understudied. We thus studied the time to loss of functional independence as assessed by a Karnosky Performance Status (KPS) below 70 % in GBM patients. We analysed all GBM patients treated in our institution between 2008 and 2013 and meeting the following criteria: age >18 years, supratentorial location, post-surgical KPS ≥ 70 %, initially treated with concomitant radiotherapy (RT) and Temozolomide. Within the 84 patients studied, the median PFS was 9 months and the median OS was 18.7 months. The median survival time with functional independence (KPS ≥ 70 %) was 14.5 months. On average, the patients spent 73 % of their lifespan with a KPS ≥ 70 %. Surgical resection and low steroid dosage were statistically associated with increased survival time with KPS ≥ 70 % (p = 0.015 and p = 0.03, respectively). Sixty-two (62) patients received one or several lines of chemotherapy at recurrence. Under treatment with Bevacizumab (42 Bev-based regimens), radiological responses were seen in 35 % and improvement in KPS occurred in 24 % whereas no response and rare improvement of KPS (3 %) were seen with other type of chemotherapy (97 non Bev-based regimens). In GBM patients, median survival with KPS ≥ 70 % largely exceeds PFS. Surgical resection and low steroids dosage at RT-onset appeared as good prognosis factors for survival with functional independence.