Gram-Scale Total Synthesis of Carbazomycins A-D through Late-Stage Regioselective Demethylation of Aryl Methyl Ethers.

Gram-scale total synthesis of carbazomycins A-D is described. The total synthesis of carbazomycin A was achieved in 44% overall yield over six steps from symmetrical 5-chloro-1,2,3-trimethoxybenzene. The key aryne-mediated carbazole formation and methylation steps provided the multiply substituted carbazole. The regioselective demethylation of the trimethoxycarbazole was performed using boron trichloride. Thereafter, the phenolic hydroxy group was converted into the methyl group to provide carbazomycin A. Subsequent installation of the methoxy group realized the total synthesis of carbazomycin D. Regioselective demethylation was performed using 1-dodecanethiol, effecting the conversions of carbazomycins A and D into carbazomycins B and C, respectively.

Total Synthesis of Carbazomycins E and F.

Total synthesis of carbazomycins E and F was achieved by double functionalization of an aryne intermediate generated from a 2-aminobiphenyl derivative. The tethered amino group underwent nucleophilic addition to the aryne intermediate to construct the carbazole skeleton. The resulting carbanion was formylated to give the multiply substituted carbazole. This formyl group caused several problems. For example, it was difficult to perform regioselective demethylation of the methoxy group proximal to the formyl group without protecting the carbazole nitrogen. In addition, the formyl group was unexpectedly reduced to give a methoxymethyl group under heating conditions with copper iodide and sodium methoxide. Oxidation of this compound in the presence of water was effective for obtaining the formylated carbazole, leading to the first total synthesis of carbazomycin F.

Highly Enantioselective Synthesis of Polycyclic Dihydroisoquinolinones via NHC-Catalyzed [4 + 2] Annulations.

The NHC-catalyzed enantioselective [4 + 2] annulation of 9H-fluorene-1-carbaldenydes with cyclic imines was successfully developed. A series of optically enriched polycyclic dihydroisoquinolinones were synthesized in moderate to excellent yields with good to excellent enantioselectivities. In addition, this efficient method could also be amenable to the synthesis of spirocyclic compounds by using isatin-derived ketimines as the electrophiles.

Antimicrobial resistance characteristics and phylogenetic relationships of pleuromutilin-resistant Enterococcus isolates from different environmental samples along a laying hen production chain.

Antimicrobial resistance in the laying hen production industry has become a serious public health problem. The antimicrobial resistance and phylogenetic relationships of the common conditional pathogen Enterococcus along the laying hen production chain have not been systematically clarified. 105 Enterococcus isolates were obtained from 115 environmental samples (air, dust, feces, flies, sewage, and soil) collected along the laying hen production chain (breeding chicken, chick, young chicken, and commercial laying hen). These Enterococcus isolates exhibited resistance to some clinically relevant antibiotics, such as tetracycline (92.4%), streptomycin (92.4%), and erythromycin (91.4%), and all strains had multidrug resistance phenotypes. Whole genome sequencing characterized 29 acquired antibiotic resistance genes (ARGs) that conferred resistance to 11 classes of antibiotics in 51 pleuromutilin-resistant Enterococcus isolates, and lsa(E), which mediates resistance to pleuromutilins, always co-occurred with lnu(B). Alignments with the Mobile Genetic Elements database identified four transposons (Tn554, Tn558, Tn6261, and Tn6674) with several ARGs (erm(A), ant(9)-la, fex(A), and optrA) that mediated resistance to many clinically important antibiotics. Moreover, we identified two new transposons that carried ARGs in the Tn554 family designated as Tn7508 and Tn7492. A complementary approach based on conventional multi-locus sequence typing and whole genome single nucleotide polymorphism analysis showed that phylogenetically related pleuromutilin-resistant Enterococcus isolates were widely distributed in various environments on different production farms. Our results indicate that environmental contamination by antimicrobial-resistant Enterococcus requires greater attention, and they highlight the risk of pleuromutilin-resistant Enterococcus and ARGs disseminating along the laying hen production chain, thereby warranting effective disinfection.

Metformin treatment and acute ischemic stroke outcomes in patients with type 2 diabetes: a retrospective cohort study.

BACKGROUND AND PURPOSE: Preclinical studies have shown that metformin has neuroprotective actions in stroke. However, the optimal treatment timing and duration remain unknown. Herein, we examined the efficacy of metformin treatment on prognosis in acute ischemic stroke (AIS) patients, and assessed the optimal treatment timing and duration. METHODS: AIS patients with type 2 diabetes mellitus were retrospectively enrolled. Patients were grouped into those who never received metformin (MET - group), those who received metformin continuously before stroke and after admission (pre-stroke + /post-stroke + group), those who only received metformin before stroke onset (pre-stroke + /post-stroke - group), and those who only received metformin after admission (pre-stroke - /post-stroke + group). The all MET + group represents the sum of the three metformin treatment groups. The efficacy outcome was the 90-day modified Rankin Scale (mRS) score. RESULTS: In total, 309 eligible patients were included (MET - [N = 130], pre-stroke + /post-stroke + [N = 94], pre-stroke + /post-stroke - [N = 30], pre-stroke - /post-stroke + [N = 55]; all MET + [N = 179]). The all MET + group had a trend toward a lower 90-day mRS score compared with that in the MET - group (1 [0-2] vs 1 [0-3], unadjusted odds ratio [OR] = 0.652, P = 0.041; adjusted OR = 0.752, P = 0.218). In the three metformin treatment groups, only the pre-stroke + /post-stroke + group had a significantly lower 90-day mRS score (1 [0-1] vs 1 [0-3], adjusted OR = 0.497, 95%CI = 0.289-0.854; P = 0.011) and higher proportion of mRS score 0-1 (78.7% vs. 61.5%, adjusted OR = 2.278, 95%CI = 1.108-4.680; P = 0.025) than the MET - group. CONCLUSION: AIS patients with type 2 diabetes mellitus who receive continuous metformin treatment before stroke onset and after admission have improved functional outcome at 90 days.

Exploring the abundance and influencing factors of antimicrobial resistance genes in manure plasmidome from swine farms.

Plasmids play a critical role in the dissemination of antimicrobial resistance genes (ARGs), however, a systematical understanding of ARGs originated from plasmids in swine production is currently lacking. Herein, quantitative polymerase chain reaction was applied to determine the prevalence of ten ARGs and the class1 integron gene intI1 of plasmid source in swine manure from 44 farms in Sichuan, Hubei and Hebei provinces, China. All assayed ARGs were observed in plasmid DNA samples, and the average absolute abundance of aac(6')-Ib-cr, blaNDM, blaCTX-M, optrA, ermB, floR, mcr-1, qnrS, tetM, sul1 and intI1 were 7.09, 2.90, 4.67, 6.62, 7.55, 7.14, 4.08, 4.85, 7.16, 7.11 and 8.07 of 10 log copies/gram, respectively. IntI1 showed a high correlation (r > 0.8, P < 0.01) with the abundance of aac(6')-Ib-cr and sul1 in swine manure. Moreover, the farm scale (i.e., herd population) and geographical location were not found to be critical factors influencing the absolute abundance of ARGs of plasmid DNA in swine farms. However, the concentrations of florfenicol, Cu, Zn, Fe, total phosphorus (TP) and total potassium (TK) demonstrated a significant correlation with the abundance of several ARGs. Particularly, Cu and Zn had high correlations with optrA and blaCTX-M, respectively. Our results demonstrated that antibiotics, heavy metals and environmental nutrients are likely jointly contributing to the long-term persistence of ARGs in swine production. This study provides insights into the abundance and influencing factors of ARGs from swine manure, which is of significance for assessing and reducing the public health risks in livestock production.

Host miR-4301 promotes rotavirus replication via PPP1R3D in Caco-2 cells.

To investigate the role of miR-4301 in rotavirus (RV)-infected Caco-2 cells. In this experiment, RNAs of RV-infected Caco-2 cells were extracted, and the high-throughput second-generation sequencing was performed to detect the expression profiles of host microRNAs (miRNAs). Synthetic miRNA mimics and inhibitors were examined (quantitative polymerase chain reaction [qPCR], crystalline violet, immunofluorescence and electron microscopy) to evaluate the effect on RV replication. Target genes of miR-4301 were predicted by software analysis. The expression of target genes was evaluated by qPCR and Western blot after transfected with miRNA inhibitor/mimic, and crystalline violet and qPCR were used to detect the downregulation effects of target genes on RV replication. By transfecting miRNA inhibitors/mimics and detecting downstream target genes, the mechanism of miRNA affecting RV replication was analyzed. There were 78 known miRNAs with significant differential expression, including 39 upregulated miRNAs and 39 downregulated miRNAs. The results showed that miR-4301 exerted a key role in enhancing RV replication. PPP1R3D protein which can inhibit RV replication was predicted as the target gene of miR-4301 by software analysis. While upregulating miR-4301 by RV, the expression of PPP1R3D and glycogen synthase (GS) is suppressed. For the first time, the effect of miR-4301 on RV infection, and its influence on GS was investigated. Specifically, RV inhibits host cell glycogen synthesis to utilize the host intracellular glucose for promoting its own replication.

"Snapshot" Trapping of Multiple Transient Azolyllithiums in Batch.

Invited for the cover of this issue is Kentaro Okano and co-workers at Kobe University. The image depicts that the 'dancing' transient organolithiums in the 'halogen dance' are successfully trapped in a batch reactor as if their individual snapshots were taken. Read the full text of the article at 10.1002/chem.202101256.

"Snapshot" Trapping of Multiple Transient Azolyllithiums in Batch.

Recent developments in flow microreactor technology have allowed the use of transient organolithium compounds that cannot be realized in a batch reactor. However, trapping the transient aryllithiums in a "halogen dance" is still challenging. Herein is reported the trapping of such short-lived azolyllithiums in a batch reactor by developing a finely tuned in situ zincation using zinc halide diamine complexes. The reaction rate is controlled by the appropriate choice of diamine ligand. The reaction is operationally simple and can be performed at 0 °C with high reproducibility on a multigram scale. This method was applicable to a wide range of brominated azoles allowing deprotonative functionalization, which was used for the concise divergent syntheses of both constitutional isomers of biologically active azoles.

Hydrogel-Mediated Mineralization Generates Oriented Crystalline Films Comprising Granular-Rhombohedral Heterogeneous Structures.

Gel-mediated crystallization is a common system to produce self-organized materials, which is fundamental to the development of bottom-up approaches to functional complex materials. Mineralization in hydrogel matrices nevertheless remains empirical in the generation of crystallization products with tailored heterogeneous structures. We demonstrate that the employment of the hydrogels with proper cationic diffusivity can trigger the consecutive growth of oriented, granular-rhombohedral heterogeneous structures. The controllable morphogenesis leads to continuous calcitic CaCO3 films comprising spatial heterogeneity, where epitaxial match assumedly favors the successive deposition of both granular and rhombohedral layers. The scenario of consecutive growth is disclosed, where the thickness of the granular layers can become a valuable indicator to reflect the retardancy degree of crystallization. The evaluation of the physicochemical properties of the hydrogels finally establishes a direct correlation between the cationic diffusivity of the hydrogels and the appearance of the heterogeneous structures. The current work therefore sheds light on the implementation of rational morphogenetic approaches to crystalline materials with tailored complex architectures.

Unusual interfacial magnetic interactions for τ-MnAl with Fe(Co) atomic layers.

The interfacial magnetic interaction and coupling mechanism for τ-MnAl with Fe(Co) atomic layers have been studied using first principles calculations. The stable surface and interface were firstly determined by the surface energy of τ-MnAl and interface energy of τ-MnAl/Fe(Co) films, respectively. Their magnetic coupling interactions were investigated by varying the Fe(Co) atomic layer numbers. It is noted that both Fe and Co exhibited ferromagnetic coupling with τ-MnAl. Interestingly, an unusual oscillation phenomenon of magnetic coupling for τ-MnAl with Fe(Co) atomic layers was observed depending on the layer thickness of Fe(Co). Moreover, Fe and Co showed different oscillation modes. The energy difference between antiferromagnetic and ferromagnetic states is larger for τ-MnAl/Fe and τ-MnAl/Co when the Fe(Co) layer numbers are even and odd, respectively. Their mechanisms were analyzed based on the band structures and the confinement of electrons in quantum wells. It is found that the magnetic coupling oscillation in τ-MnAl/Fe originated from both the spin up Δ1 band and spin down Δ5 band at the [capital Gamma, Greek, macron] points. Comparatively, the oscillation of τ-MnAl/Co is due to the spin up band at the X[combining macron] point. The present results could provide insight to further understand interfacial exchange interactions among magnetic layers.

[Pulmonary hypertension in patients with chronic obstructive pulmonary disease: clinical characteristics and risk factors].

OBJECTIVE: To investigate the clinical characteristics of pulmonary hypertension(PH) in patients with chronic obstructive pulmonary disease(COPD) and study the related risk factors. METHODS: Patients with stable COPD enrolled in this study, undergoing examinations including full pulmonary function tests (PFT), 6-minute walk distance (6MWD), Exercise Oxyhemoglobin, Saint. George's respiratory questionnaire (SGRQ) and transthoracic echocardiography. Pulmonary artery systolic pressure(sPAP) ≥36 mmHg (1 mmHg=0.133 kPa) was defined as PH. RESULTS: A total of 251 patients were finally evaluable in this study. The frequency of PH was 55.4% (139/251) in patients with stable COPD. Significant differences were seen between patients with PH and without PH respectively in the following factors (mean P<0.05): proportion of age ≥ 60 years (69.8% vs 57.1%), forced expiratory volume in one second (FEV(1)) (% predicted) [(47.5±8.2)% vs (61.2±10.2)% and (49.8±7.9)% vs (66.4±11.3)%], sPAP [(41.9±9.1) mmHg vs (28.2±3.2) mmHg], exercise oxyhemoglobin desaturation [(-5.5±3.2)% vs (-2.2±1.2)%], 6MWD [(316.0±55.2)m vs (390.0±75.2)m]. The following variables were negatively correlated with sPAP : 6MWD (r=-0.330, P=0.003), FEV(1)(% predicted) (r=-0.210, P=0.024 and r=-0.130, P=0.012, respectively). The following variables were positively correlated with sPAP: age (r= 0.560, P= 0.031), exercise oxyhemoglobin desaturation> 3% (r= 0.540, P= 0.001). Logistic regression test has showed that age ≥ 60 years, exercise oxygen desaturation>3%, FEV(1) (% predicted) <50%, 6MWD <350 m were risk factors for PH in COPD. CONCLUSION: The incidence of PH in COPD increases with age, yet the performance of lung function and the activity of endurance decrease in elder patients. Sixty years or older, exercise oxygen desaturation> 3%, FEV(1) (% predicted) <50%, 6MWD <350 m are risk factors of PH in COPD. Echocardiography or right heart catheterization when needed should be considered to confirm the diagnosis.

BMPR2 germline mutation in chronic thromboembolic pulmonary hypertension.

INTRODUCTION: Heterozygous germline mutations of the bone morphogenetic protein type II receptor (BMPR2) gene BMPR2 are the most important predisposing factors for heritable pulmonary arterial hypertension. BMPR2 mutation was occasionally reported in pulmonary veno-occlusive disease, appetite suppressant-related pulmonary arterial hypertension (PAH), and PAH with congenital heart disease. MATERIALS AND METHODS: In this study we identified a missense mutation (c.2296A > G) located in BMPR2 exon 12 in a patient with chronic thromboembolic pulmonary hypertension (CTEPH). CONCLUSION: It is the first report of a BMPR2 mutation in CTEPH. Our study provides innovative insight into etiology of CTEPH. The genetic predisposing factor is an important component in the process of this CTEPH patient.

Sustainable structural polysaccharides conversion: How does DES pretreatment affect cellulase adsorption, thereby improving enzymatic digestion of lignocellulose?

Biomass conversion aims at degrading the structural polysaccharides of lignocellulose into reducing sugars. Pretreatment is necessary to overcome the recalcitrance of lignocellulose. The DES La/ChCl in this paper was selected based on our previous study. To examine cellulase adsorption of lignocellulose after DES pretreatment, sorghum straw was pretreated with DES under different condition. The adsorption improvement of cellulase on lignocellulose after DES pretreatment has positive impact on reducing sugar production of biomass. After DES pretreatment, 1. pore corrosion caused the upward trend of pore radius and the downward trend of SSA. 2. the hydrogen bounding force of pretreated sorghum straw and MCC decreased, the hydrogen bounding force of pretreated lignin increased. 3. although the unsaturation of pretreated lignin increased, DES pretreatment is helpful for the removal of lignin. 4. The decrease in the hydrophobicity of sorghum straw make it easier to disperse. 5. the Zeta potential of pretreated sorghum straw shifted towards the positively charged region, while pretreated lignin shifted towards the negatively charged region. 6. different adsorption behaviors were observed in specific components of cellulase mixtures (BGs, CBHs, EGs and xlylanase). These results revealing the mechanism of enzyme adsorption are conductive for understanding the role of pretreatment in biomass conversion.

Digital health integration for noncommunicable diseases: Comprehensive process mapping for full-life-cycle management.

AIM: To create a systematic digital health process mapping framework for full-life-cycle noncommunicable disease management grounded in key stakeholder engagement. METHODS: A triphasic, qualitative methodology was employed to construct a process mapping framework for digital noncommunicable disease management in Shanghai, China. The first phase involved desk research to examine current guidance and practices. In the second phase, pivotal stakeholders participated in focus group discussions to identify prevalent digital touchpoints across lifetime noncommunicable disease management. In the final phase, the Delphi technique was used to refine the framework based on expert insights and obtain consensus. RESULTS: We identified 60 digital touchpoints across five essential stages of full-life-cycle noncommunicable disease management. Most experts acknowledged the rationality and feasibility of these touchpoints. CONCLUSIONS: This study led to the creation of a comprehensive digital health process mapping framework that encompasses the entire life cycle of noncommunicable disease management. The insights gained emphasize the importance of a systemic strategic, person-centered approach over a fragmented, purely technocentric approach. We recommend that healthcare professionals use this framework as a linchpin for efficient disease management and seamless technology incorporation in clinical practice.

Enhanced Self-Cementation of Arsenic-Contaminated Soil via Activation of Non-Thermal Plasma-Irradiated Ferromanganese: A Mechanistic Investigation.

The self-cementation characteristics of arsenic (As)-contaminated soil were comprehensively investigated in this study. Different non-thermal plasma-irradiated binary (hydro)oxides of polyvalent ferromanganese (poly-Fe-Mn) were synthesized and exploratorily dispersed to soil samples to activate solidification and stabilization during the self-cemented process. The maximum compressive strength of 56.35 MPa and the lowest leaching toxicity of 0.004 mg/L were obtained in the proof test under optimal conditions (i.e., the mass ratio of the poly-Fe-Mn to the soil sample of 0.05; the mass ratio of the composite alkali activator (NaOH + CaO) to the soil sample of 0.25; the mass ratio of CaO to NaOH of 1.5; the mass ratio of the DI water to the binder of 0.515). The composite alkaline activator primarily contributed to the strength formation of the self-cemented matrix while the poly-Fe-Mn significantly influenced the reduction of the As-leaching toxicities. The poly-Fe-Mn maintained diffusion-controlled polycondensation and strengthened the nucleation process during self-cementation. The amount of water and the dosage of poly-Fe-Mn caused an interactive influence on the self-cemented solidification of contaminated soils. The solidified samples with poly-Fe-Mn exhibited better thermal decomposition than their counterparts, reflecting the enhancement of poly-Fe-Mn to the matrix. Some minerals including C-S-H, kaolinite, gehlenite, diopside sodian, augite, and albite were matched in the samples, directly demonstrating the geopolymerization-steered self-cementation of the As soil. The employment of poly-Fe-Mn not only reinforced the immobilization of As pollutants in the matrix but also induced the self-cementation of soils by intensifying the composite alkaline-activated geopolymerization kinetics.

Barriers and facilitators to self-management among women with gestational diabetes: A systematic review using the COM-B model.

BACKGROUND: Gestational diabetes mellitus is a common complication during pregnancy, and its prevalence rates have increased dramatically in recent years. Treatment of gestational diabetes requires the active self-management, however, this can be challenging. Understanding the barriers and facilitators of adherence to self-management recommendations is essential for designing effective interventions. AIM: To identify and synthesize barriers and facilitators to self-management of gestational diabetes reported by pregnant women. METHODS: This was a mixed-methods systematic review, including qualitative, quantitative, and mixed-methods studies. A literature search was conducted in four databases (PubMed, Embase, CINAHL, and the Web of Science). Eligible studies explored the barriers and/or facilitators, experiences and/or perceptions to engage in self-management in women with gestational diabetes. The Capability, Opportunity, Motivation, Behaviour model was used to classify barriers and facilitators affecting self-management. RESULTS: Thirty-six studies (23 qualitative, 11 quantitative, and 2 mixed-methods) met the inclusion criteria. We identified barriers and facilitators relating to capability (e.g., physical discomforts and constraints; lack of knowledge of GDM and self-management behaviours; forgetfulness), opportunity (e.g., limited education and resources; social support from family, friends, and peer groups; conflict with existing lifestyles or cultural norms), and motivation (e.g., perceived negative consequence of self-management behaviours or not perceived benefits; negative emotion; concern the health of the baby). CONCLUSION: In this study, we identified the barriers and facilitators of self-management in women with gestational diabetes, which were explained by relevant theoretical models. Interventions should be developed with full consideration of these findings to ensure that pregnant women have the correct knowledge and confidence to self-manage their complications.

Soil Cd increased the leaf litter Cd remains of Solanum nigrum and Solanum lycopersicum.

Plant litter decomposition is a natural pathway of heavy metal cycling in soil ecosystems, but the dynamics of heavy metal release during litter decomposition are relatively poorly understood. The purpose of this study was to investigate the effects of species, soil fauna and soil Cd addition on litter decomposition and Cd release dynamics. Therefore, we selected two plants, Solanum nigrum and S. lycopersicum with large differences in Cd accumulation capacity. First, they were enriched with Cd during the growing period and leaf litter was harvested after 6 months of pretreatment. Then, the decomposition of leaf litter was conducted with or without soil Cd and Eisenia fetida through lab pot tests. Our results showed that leaf litter Cd led to a significant decrease in litter decomposition rate (K value), with a maximum decrease of 32.1% in S. nigrum and 30.1% in S. lycopersicum. We observed that the presence of E. fetida significantly increased K value, but the effect was similar in the +leaf Cd treatment and the -leaf Cd treatment, both for S. nigrum and S. lycopersicum. Interestingly, the litter Cd concentration did not decrease during decomposition, but showed an increasing trend, especially for S. nigrum in the +soil Cd treatment. Moreover, the litter Cd remains was higher in the +soil Cd treatment compared to the -soil Cd treatment for both S. nigrum and S. lycopersicum, no matter whether with or without E. fetida. This result suggests that the Cd may be transferred from soil to litter, thus increasing the litter Cd remains. Overall, our study shows that leaf litter Cd slowed down the carbon cycling in ecosystems. In addition, the release of litter Cd has a lag, and the litter has a certain adsorption capacity for soil Cd, which intensifies the harm to the ecology during litter transfer.

Causal association between particulate matter 2.5 and Alzheimer's disease: a Mendelian randomization study.

Background: Although epidemiological evidence implies a link between exposure to particulate matter (PM) and Alzheimer's disease (AD), establishing causality remains a complex endeavor. In the present study, we used Mendelian randomization (MR) as a robust analytical approach to explore the potential causal relationship between PM exposure and AD risk. We also explored the potential associations between PM exposure and other neurodegenerative diseases. Methods: Drawing on extensive genome-wide association studies related to PM exposure, we identified the instrumental variables linked to individual susceptibility to PM. Using summary statistics from five distinct neurodegenerative diseases, we conducted two-sample MR analyses to gauge the causal impact of PM on the risk of developing these diseases. Sensitivity analyses were undertaken to evaluate the robustness of our findings. Additionally, we executed multivariable MR (MVMR) to validate the significant causal associations identified in the two-sample MR analyses, by adjusting for potential confounding risk factors. Results: Our MR analysis identified a notable association between genetically predicted PM2.5 (PM with a diameter of 2.5 µm or less) exposure and an elevated risk of AD (odds ratio, 2.160; 95% confidence interval, 1.481 to 3.149; p < 0.001). A sensitivity analysis supported the robustness of the observed association, thus alleviating concerns related to pleiotropy. No discernible causal relationship was identified between PM and any other neurodegenerative diseases. MVMR analyses-adjusting for smoking, alcohol use, education, stroke, hearing loss, depression, and hypertension-confirmed a persistent causal relationship between PM2.5 and AD. Sensitivity analyses, including MR-Egger and weighted median analyses, also supported this causal association. Conclusion: The present MR study provides evidence to support a plausible causal connection between PM2.5 exposure and AD. The results emphasize the importance of contemplating air quality interventions as a public health strategy for reducing AD risk.

Association between ASPECTS region of infarction and clinical outcome in non-acute large vessel occlusion ischaemic stroke after endovascular recanalisation.

PURPOSE: This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score (ASPECTS) regions is associated with clinical outcome in patients with symptomatic non-acute internal carotid or middle cerebral artery occlusion who underwent endovascular recanalisation (ER). METHODS: Preoperative ASPECTS and region of infarction were recorded before recanalisation. Clinical outcome was evaluated 90 days after the procedure using the modified Rankin Scale; a score>2 was defined as poor outcome. Secondary outcomes included postprocedural cerebral oedema, intracranial haemorrhage (ICH) and symptomatic ICH. RESULTS: Among the 86 patients included, 90-day outcome was poor in 30 (34.9%) and 40 experienced cerebral oedema (46.5%). Multivariate logistic regression models showed that lenticular nucleus infarction (OR 19.61-26.00, p<0.05), admission diastolic blood pressure (OR 1.07-1.08, p<0.05), preprocedural National Institutes of Health Stroke Scale (OR 1.96-2.05, p<0.001) and haemorrhagic transformation (OR 14.99-18.81, p<0.05) were independent predictors of poor 90-day outcome. The area under the receiver operating characteristic curve for lenticular nucleus infarction as a predictor of poor outcome was 0.73. M2 region infarction (OR 26.07, p<0.001) and low American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation grade (OR 0.16, p=0.001) were independent predictors of postprocedural cerebral oedema. The area under the receiver operating characteristic curve for M2 region infarction as a predictor of cerebral oedema was 0.64. Region of infarction did not significantly differ between patients with and without postprocedural ICH or symptomatic ICH. CONCLUSIONS: Lenticular nucleus and M2 region infarction were independent predictors of poor 90-day outcome and postprocedural cerebral oedema, respectively, in patients with non-acute anterior circulation large artery occlusion who underwent ER.