ASCOD phenotyping of acute vertebrobasilar artery occlusion treated by mechanical thrombectomy: insight from the PERSIST registry.

OBJECTIVE: Determining the underlying etiology of acute vertebrobasilar artery occlusion (VBAO) is crucial for selecting an appropriate treatment approach. The authors aimed to investigate the distribution of etiology and the association with functional outcomes in patients with acute VBAO who underwent endovascular treatment in which atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection (ASCOD) phenotyping was used. METHODS: A retrospective study was conducted at 21 centers in China, involving patients with VBAO who received endovascular treatment within 24 hours of the estimated occlusion time. In the ASCOD phenotyping, each phenotype is graded based on the following categories: 1, likely to be causal; 2, uncertain if causal; and 3, unlikely to be causal. The authors defined a single possible cause as a cause graded 1 in a single domain, and multiple possible causes were graded 1 or 2 regardless of overlap. The primary outcome was unfavorable outcome (modified Rankin Scale [mRS] score of 3-6) at 90 days. The secondary outcomes included shift of mRS score at 90 days, 90-day mortality, successful reperfusion, and National Institutes of Health Stroke Scale score at 24 hours. Multivariable regression analysis was used to assess the association between etiological subtypes and functional outcomes. Multivariate competing-risk regression analysis was performed to analyze the association between etiological subtypes and the risk of recurrent stroke. RESULTS: A total of 577 patients were included in this study. Of these, 521 (90%) had a single possible cause. The most common etiology was A1 (382 cases, 73%), followed by C1 (111 cases, 21%) and O1 (28 cases, 5%-in this study the other causes and dissection subtypes were categorized under the umbrella term of "O" causes). Similar patterns were observed in the multiple possible causes. In the baseline characteristics of the cohort, as rescue therapy, stenting was more frequently used in patients in the A1 group than in the C1 group (53.2% vs 41.7%; p < 0.01). The proportion of atherosclerosis-type etiology increased when the occlusion was located more proximally (p < 0.01). Compared to the A1 group, patients in the C1 group had a lower incidence of unfavorable outcome (OR 0.42, 95% CI 0.24-0.73), which was less likely to shift to a worse mRS score (OR 0.60, 95% CI 0.39-0.91). The O1 subtype was not associated with unfavorable outcome (OR 1.35, 95% CI 0.46-4.01), whereas patients with the O1 subtype were more likely to shift to worse mRS score (OR 2.39, 95% CI 1.09-5.25) and to have a higher 90-day mortality rate (OR 2.60, 95% CI 1.07-6.31). Furthermore, there was no significant association between single etiological subtypes and stroke recurrence within 1 year. CONCLUSIONS: The most common etiology in patients with VBAO was atherosclerosis, followed by cardiac pathology and other. Compared to the A1 subgroup, the C1 subgroup showed better functional outcomes, whereas the O1 subgroup showed worse outcomes. Additionally, there was no statistically significant difference in the recurrence risk.

Adsorption removal of tetracycline from aqueous solution by anaerobic granular sludge: equilibrium and kinetic studies.

High concentration animal wastewater is often contaminated by tetracycline and an upflow anaerobic sludge bioreactor (UASB) with granular sludge is often used to treat the wastewater. The investigation of the adsorption process of tetracycline on anaerobic granular sludge during anaerobic digestion of animal wastewater will increase the understanding of antibiotics behavior in the UASB reactor. In this study, the effects of initial pH, humic acid concentration, and temperature on the removal of tetracycline by anaerobic granular sludge from aqueous solution were investigated using the batch adsorption technique in 100 mL flasks with 75 mL of work volume. The results show that the highest removal efficiency of 93.0% was achieved around pH 3.0 and the removal efficiency at the neutral pH range (pH 6.0-8.0) is about 91.5%. The thermodynamic analysis indicates that the adsorption is a spontaneous and endothermic process. The adsorption kinetics followed the pseudo-second-order equation. The adsorption isotherms analysis indicates that the Langmuir model is better than the Freundlich model for the description of the adsorption process and confirms the result of thermodynamics analysis. The maximum adsorption capacities were 2.984, 4.108 and 4.618 mg/g at 25, 35 and 45 °C, respectively. These results provide useful information for understanding the fate and transformation of tetracycline in a UASB digestion system and improving the management of tetracycline contaminated animal wastewater.

Obesity and Poststroke Fatigue: A 2-Year Longitudinal Study.

INTRODUCTION: Obesity is associated with fatigue in many diseases, but the correlation between obesity and poststroke fatigue (PSF) is unclear. The study aimed to investigate the relationship between body mass index (BMI) and the occurrence of and recovery from PSF. METHODS: Within 3 days of the onset of ischemic stroke, patients were consecutively recruited. We assessed PSF at admission and at 6, 12, and 24 months with the Fatigue Severity Scale (FSS). Multivariable logistic regression and restricted cubic spline function were used to explore the relationships between baseline BMI and the risk of PSF at different time points. The correlation between baseline BMI and the dynamic changes in the natural logarithm transformation of the FSS (lnFSS) score during the follow-up period was analyzed by the piecewise linear mixed-effects model. RESULTS: A total of 1026 stroke patients were included. Multivariable analyses indicated that obesity was associated with a decreased risk of early PSF (fatigue diagnosed at baseline) [odds ratio (OR) 0.61, 95% confidence interval (CI) 0.41-0.93] but an increased risk of late PSF (fatigue diagnosed 6 months after the index stroke) (OR 1.63, 95% CI 1.06-2.50 for 6 months; OR 1.87, 95% CI 1.18-2.96 for 12 months; OR 2.11, 95% CI 1.28-3.49 for 24 months). Longitudinal analyses indicated that in the late stage of fatigue, the higher the BMI category, the slower the rate of decrease was for the FSS score. CONCLUSION: Obese patients are less likely to develop fatigue in the acute stage of ischemic stroke. However, they are more prone to late fatigue and exhibit a slower decline in the FSS score in the long term.

Effect of the Early Administration of Selective Serotonin Reuptake Inhibitors on the Time Course of Poststroke Fatigue: A 2-Year Longitudinal Study.

BACKGROUND: Poststroke fatigue (PSF) is a dynamic process over time. Current evidence for interventions for PSF is limited. Our study investigated the effects of selective serotonin reuptake inhibitors (SSRIs) on the time course of PSF. METHODS: The patients with acute ischaemic stroke were enrolled in this study. All patients were scored with the Fatigue Severity Scale (FSS) at baseline and 6, 12, and 24 months after the index stroke. The time course of PSF was classified as non-PSF, incident PSF, recovered PSF and persistent PSF according to the PSF status at baseline and the 24-month follow-up. Multivariate logistic regression analysis and generalized mixed model were applied to explore the relationships between SSRIs and the time course of PSF. RESULTS: Eight hundred forty-seven patients were analyzed in this study. No significant association between SSRIs and the time course of PSF was observed in all patients (p = 0.076). The subgroup analyses indicated that SSRI antidepressants reduced the risk of incident PSF [Odds Ratio (OR) 0.23; 95% confidence interval (CI) 0.05-0.96, p = 0.044] and persistent PSF (OR 0.28; 95% CI 0.09-0.90, p = 0.033) in the PSD subgroup, but not in the non-PSD group. In the longitudinal analysis, generalized logistical mixed-effect models indicated that early administration of SSRIs reduced the risk (OR 0.955; 95% CI 0.928-0.984, p = 0.002) and severity (ß = -0.018, p = 0.041) of PSF in the PSD subgroup. CONCLUSION: No relationship was identified between the use of SSRIs and the time course of PSF in all patients. However, these drugs might be effective in PSF patients with depression.

Influence of procedure time on outcome and hemorrhagic transformation in stroke patients undergoing thrombectomy.

BACKGROUND AND PURPOSE: Data on procedure time (PT) for mechanical thrombectomy (MT) are scarce. Moreover, the relationship among PT, postprocedural hemorrhagic transformation (HT), and functional outcomes in MT patients remains unclear. We investigated whether postprocedural HT mediated the relationship between PT and functional outcomes in patients with stent-retriever thrombectomy. METHODS: We retrospectively analyzed consecutive patients who underwent MT at two comprehensive stroke centers. PT was defined as the time from puncture to first successful recanalization or to abortion of the procedure if successful recanalization was not achieved. A favorable outcome was defined as a 90-day modified Rankin Scale score of 0-2. HT was classified using the European Cooperative Acute Stroke Study definition. RESULTS: Among 283 patients (mean age, 67.2 ± 11.9 years; male, 53.7%), 124 (43.8%) patients had a favorable outcome and 27 (9.5%) patients experienced symptomatic intracranial hemorrhage (sICH). Whether in the overall cohort or in the successful recanalization cohort, extended PT was an independent predictor for a poor outcome (per 30 min: OR 1.433, 95% CI 1.062-1.865, p = 0.019; OR 1.522, 95% CI 1.062-2.159, p = 0.020, respectively) and sICH (per 30 min: OR 1.391, 95% CI 1.030-1.865, p = 0.029; OR 1.716, 95% CI 1.161-2.648, p = 0.009, respectively). Moreover, postprocedural HT might partially explain the worse function outcomes in patients with an extended PT (the regression coefficient was changed by 28.2% and 28.1%, respectively). CONCLUSIONS: The PT is an independent predictor for 90-day outcomes in stent-retriever thrombectomy patients. Postprocedural HT was partially responsible for the worse outcome in patients who experienced a longer PT.

[Anaerobic digestion of animal manure contaminated by tetracyclines].

Anaerobic digestion of pig manure spiked with tetracycline (TC) and chlortetracycline (CTC) and the degradation of the two antibiotics during the anaerobic digestion at 35 degrees C were investigated. The results indicate that propionate was the main volatile fatty acid produced during the anaerobic digestion followed by acetate. Compared with the CTC addition, TC + CTC addition showed obvious inhibitory effect on the hydrolysis and acidification of easily digestible organic components of pig manure. The cumulative methane production of TC, CTC, TC + CTC and CK2 during anaerobic digestion was 386.4 mL, 406.0 mL, 412.1 mL and 464.6 mL, respectively. Degradation of TC and CTC followed the first-order kinetic equation. The half-life of TC and CTC was 14-18 days and 10 days, respectively. After the treatment of 45-day anaerobic digestion, the degradation efficiency of TC was 88.6%-91.6% with 97.7%-98.2% of CTC. Therefore, anaerobic digestion shows the benefit on the management of animal manures contaminated by tetracyclines.

Characterization of organic matter degradation during composting of manure-straw mixtures spiked with tetracyclines.

The objective of this study was to investigate humification and mineralization of manure-straw mixtures contaminated by tetracyclines during composting. Hen manure, pig manure and rice straw were used as the raw materials. The manure-straw mixtures were spiked with tetracycline, chlortetracycline, and oxytetracycline at the concentration of 60 mg/kg dry matter. The results show that tetracyclines had no obvious influence on the composting process and more than 93% of the tetracyclines was decreased during a 45-day composting. The Fourier transform infrared (FTIR) spectra indicated that easily biodegradable components such as aliphatic substrates, carbohydrates and polysaccharides were decomposed and the contents of aromatic components relatively rose during the composting. The X-ray diffraction (XRD) spectra confirmed the natural formation of struvite, the degradation of easily biodegradable components, and the mineralization of organic matter during the composting. Therefore, FTIR and XRD analysis can be useful tools for monitoring the composting process.

[The effects of tetrandrine on activity of collagenase derived from human hypertrophic scar].

OBJECTIVE: To observe the effect of tetrandrine on activity of collagenase derived from human hypertrophic scar for the sake of clarifying the mechanism as tetrandrine acting on scar. METHODS: The experimental concentration was controlled below that of cell proliferation inhibited, SDS-PAGE electrophoresis was adopted to separate collagenase from extracellular matrix, and then activated by trypsin analyzed the activity of collagenase with density scanning apparatus. At the same time quantity of extracellular collagen was measured using improved chloraseptine T oxidizing assay, moreover analyzed correlation between activity of collagenase and quantity of extracellular collagen. RESULTS: In the concentration below the lever of inhibiting fibroblast proliferation, the total activity of collagenase could be significantly increased by tetrandrine with dosage-dependence associated with quantity of extracellular collagen reduced, which was much greater than that of triamcinolone. CONCLUSION: Increasing activity of collagenase on degradation of collagen even in a lower concentration was one of the mechanisms of tetrandrine treating hypertrophic scar.