Are beta blockers effective in preventing stroke-associated infections? - a systematic review and meta-analysis.

BACKGROUND: Excessive sympathoexcitation could lead to stroke associated infection. Inhibiting sympathetic excitation may reduce the infection risk after stroke. Thus, the present study aimed to determine the protective effect of beta blockers on stroke associated infection through systematic review and meta-analysis. METHODS: A systematic search of multiple databases were performed up to February 2022. The included studies required beta blockers therapy in stroke patients and assessed the incidence of stroke-associated infections. Outcomes of interest included infections, pneumonia, urinary tract infection and sepsis. Random-effects model was used for analysis. Heterogeneity was evaluated using I2 statistics and publication bias was evaluated by the funnel plot. RESULT: A total of 83 potentially relevant publications was identified in the initial search. Six studies met the inclusion criteria for meta-analysis. The risk of bias in the included articles satisfies the quality requirement of meta-analysis. No significant associations between beta blockers therapy and the prevention of stroke associated infection, stroke associated pneumonia and septicemia were found, However, subgroup analyses revealed an association between beta blockers treatment and the increased risk of post-stroke urinary tract infection or stroke associated pneumonia in some stroke patients (OR = 1.69 [1.33, 2.14], P < 0.0001; OR = 1.85 [1.51, 2.26], P < 0.0001). CONCLUSION: Due to the lack of robust evidence, this meta-analysis may not support the preventive effect of beta blockers on stroke associated infection. But beta blockers treatment may be associated with development of post-stroke urinary tract infection and stroke associated pneumonia in some stroke patients.

Attachment Styles, Self-Esteem, Flexible Goal Adjustment, and Intimate Relationship Satisfaction in Women: A Moderated Mediation Model.

The present study aimed to examine the psychological mechanism underlying the relationship between attachment style and intimate relationship satisfaction in women. For this purpose, a cross-sectional research design was employed in which 233 women (Mage = 28.16 years) who were currently in a romantic relationship completed a questionnaire that assessed attachment style, relationship satisfaction, self-esteem, and flexible goal adjustment (FGA). The results showed that both high attachment anxiety and high attachment avoidance were associated with low relationship satisfaction. Self-esteem mediated the relationship between attachment insecurity and relationship satisfaction. Moreover, the mediation effect of self-esteem was moderated by FGA, such that only in women with high FGA was self-esteem a significant mediator in the relationship between an insecure attachment style and relationship satisfaction. The results have implications for enhancing women's relationship satisfaction.

Efficacy and Safety of Endovascular Treatment for Acute Large-Vessel Ischemic Stroke Beyond 6 h After Symptom Onset: A Meta-Analysis.

Background: There is considerable evidence on the benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) within 6 h after symptom onset. However, uncertainties remain regarding EVT efficacy beyond 6 h after symptom onset. We undertook a meta-analysis to assess the efficacy and safety of EVT in patients with AIS >6 h after symptom onset. Methods: We searched PubMed, EMBASE, and Chinese Biomedical through July 2019. We included studies involving early (≤6 h) vs. delayed (>6 h) EVT in selected patients with AIS, based on radiological evaluation criteria. Functional independence, successful recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) rates were assessed. Results: Eight articles, with 3,265 patients who had undergone early EVT and 1,078 patients who had received delayed EVT, were included in the meta-analysis. Patients treated with early EVT showed a similar proportion of functional independence at 90 days [odds ratio (OR) = 1.14, 95% confidence interval (CI) = 0.926-1.397, P = 0.219; I 2 = 36.2%, P = 0.128] as those treated with delayed EVT. Delayed EVT was also associated with no significant difference in mortality (OR = 1.015, 95% CI = 0.852-1.209; P = 0.871; I 2 = 0.0%, P = 0.527), successful recanalization (OR = 1.255, 95% CI = 0.923-1.705; P = 0.147; I 2 = 60.5%, P = 0.009), and sICH (OR = 0.976, 95% CI = 0.737-1.293; P = 0.871; I 2 = 0.0%, P = 0.742) rates compared with early EVT. Conclusions: Among selected patients with AIS, delayed EVT showed comparable outcomes in functional independence, recanalization, mortality, and sICH rates compared with early EVT.

External quality assessment of automated hematology analyzer performance using fresh human blood samples in Shanghai.

We set out to assess the performance and degree of agreement for the different automated hematology analyzers (AHAs) currently used within the Shanghai region. Analyzers from 5 different manufacturers were represented within the 114 hospitals that participated in this project: Abbott, ABX, Beckman Coulter, Nihon Kohden, and Sysmex. We determined the results obtained on 115 hematology analyzers in the 114 different hospitals for hemoglobin (HGB), red blood cell count (RBC), white blood cell count (WBC), hematocrit (HCT), and platelet count (PLT) from fresh anticoagulated blood samples from healthy donors. The maximum coefficients of variation (CV%) among instruments of the 3 main manufacturers (Abbott, Beckman Coulter, and Sysmex) for RBC, HGB, HCT, WBC, and PLT were 3.2%, 3.8%, 3.6%, 9.3%, and 10.8%, respectively. The maximum deviations observed among these parameters from the 5 major instrument groups were 0.74% (RBC), 2.24% (HGB), 6.37% (HCT), 6.97% (WBC), and 21.06% (PLT). Implementation of the regular, local external quality assessment program in the Shanghai region using fresh blood samples has resulted in a reduction of CV% values for the major clinically important CBC parameters (RBC, HGB, HCT, WBC, and PLT) within the instrument groups over time. An important result was that the CBC parameter CVs were also well within established US Clinical Laboratory Improvement Amendments of 1988 guidelines for AHA performance. Combined with a comprehensive education program, the Shanghai external fresh blood quality assessment program has resulted in closer agreement among the various AHA manufacturers, with only very small differences for RBC, HGB, HCT, WBC, and PLT counts. The success of this program has given us increased confidence in the comparability of results and subsequent patient management using the various types of AHAs currently in use in the hospitals within the Shanghai region.