Effects of intravenous rtPA in patients with minor stroke.

BACKGROUND: Whether minor ischemic stroke (MIS) patients can benefit from intravenous thrombolysis (IVT) remains controversial. The association between the efficacy of IVT and baseline National Institute of Health Stroke Scale (NIHSS) score is unclear in MIS, while the association in moderate and severe stroke is known. This study aimed to explore the effect of IVT in patients with MIS and analyze its efficacy in patients with different baseline NIHSS scores. METHODS: Patients with a NIHSS score ≤5 within 4.5 h of stroke onset were screened in 32 centers. Patients with and without IVT were matched to a ratio of 1:1 with propensity scores. An excellent outcome was defined as a modified Rankin Scale (mRS) score ≤1 at three months after stroke onset. Safety outcomes included mortality and symptomatic intracranial hemorrhage (sICH). Multivariate analysis was used to compute the adjusted odds ratio (OR) for excellent outcomes. The effect of IVT was further analyzed in subgroups according to the baseline NIHSS score. RESULTS: Of the 23,853 screened, 3336 patients with MIS who arrived at the hospital within 4.5 h of onset were included. The 1163 patients treated with IVT were matched with 1163 patients without IVT. IVT in minor strokes generated an adjusted OR of 1.38 (95% CI: 1.09-1.75, p = 0.009) for excellent outcomes. There were no significant differences in mortality (0.17% vs. 0.09%, p = 1.000) and sICH (0.69% vs. 0.86%, p = 0.813) between patients with and without IVT. Subgroup analysis showed that there was no significant effect of IVT in the baseline NIHSS 0-1 or 2-3 subgroups, with adjusted OR of 0.816 (95% CI 0.437-1.53, p = 0.525) and1.22 (95% CI 0.845-1.77, p = 0.287), respectively. In patients with NIHSS score of 4-5, IVT was significantly effective, with an adjusted OR of 1.53 (95% CI 1.02-2.30, p = 0.038). CONCLUSION: IVT can improve MIS outcomes. The risks of sICH and mortality did not increase, especially in patients with NIHSS scores 4 to 5, who could benefit from IVT significantly.

Overall, intravenous thrombolysis can improve the outcomes of patients with minor stroke.Minor stroke patients with a baseline NIHSS score of 4-5 can benefit the most from intravenous thrombolysis.

An investigation on the changes of serum CCK-8, substance P, and 5-HT in patients with post-stroke insomnia.

BACKGROUND: At present, the pathogenesis of post-stroke insomnia (PSI) is still inconclusive. OBJECTIVE: To explore the changes and significance of serum cholecystokinin-8 (CCK-8), substance P (SP), and 5-hydroxytryptamine (5-HT) in patients with PSI. METHODS: Ninety-one patients with stroke were selected as the research subjects, and according to the score of the Athens Insomnia Scale (AIS), they were divided into the insomnia group and the non-insomnia group. The serum levels of CCK-8, SP, and 5-HT in the two groups were compared to explore their relationships with PSI. RESULTS: Among the 91 patients, 56 were in the insomnia group and 35 were in the non-insomnia group, and the incidence of insomnia was 61.5%. There was no significant difference in the serum levels of CCK-8, SP, and 5-HT between the two groups (P= 0.696, 0.980, and 0.809, respectively). One-way analysis of variance showed that there was no significant correlation between the serum levels of CCK-8, SP, 5-HT, and the AIS score (P= 0.7393, 0.9581, and 0.5952, respectively). CONCLUSION: The incidence of PSI was relatively high, but it could not be proved that CCK-8, SP, and 5-HT were involved in the pathogenesis of PSI. There might exist other neurotransmitters involved in the pathophysiological process of PSI, which should be further explored.

Gerstmann-Sträussler-Scheinker syndrome misdiagnosed as cervical spondylotic myelopathy: A case report with 5-year follow-up.

RATIONALE: Gerstmann-Sträussler-Scheinker syndrome (GSS) is a rare autosomal dominant disease caused by a mutation in the prion protein gene (PRNP) that is not well known among neurologists and is therefore easily misdiagnosed. PATIENT CONCERNS: : A 49-year-old man was admitted for the first time because of an unsteady walk with mogilalia for 1 year. He underwent a cervical discectomy and a plate-screw fixation 6 months prior, although postoperative gait instability did not improve. DIAGNOSIS: Whole exome sequencing identified a pathogenic and heterozygous mutation in the PRNP 4 years after onset. The patient was eventually diagnosed with GSS. INTERVENTIONS: Symptomatic treatment to improve cerebrocirculation and cerebrometabolism was provided. OUTCOMES: The neurological decline continued. The Mini-Mental State Examination and modified Rankin Scale scores changed from 19 to 11 and 2 to 5, respectively. Progressive cerebral and cerebellar atrophy on magnetic resonance imaging was observed. LESSONS: Cerebral and cerebellar atrophy are neuroimaging features symptomatic of GSS that become more apparent as the disease progresses. This atrophy is positively correlated with the severity of symptoms and reduced quality of life. Neurologists treating middle-aged patients with progressive ataxia, cognitive impairment or dysarthria, and brain atrophy need to consider the possibility of GSS.

Successive development of ischemic stroke and hemorrhagic stroke in a patient with essential thrombocythemia: a case report.

Patients with essential thrombocythemia (ET) can experience hemorrhagic or ischemic vascular events. The prevention of these complications is challenging, and the overall risk of vascular events caused by ET is often overlooked. A 34-year-old man was admitted for a 10-day history of weakness and numbness in his right limbs. He had been diagnosed with ET in 2008 but had stopped receiving treatment half a year before admission. Physical examination showed a superficial sense of disturbance in the right limbs and decreased muscle strength in the right upper and lower limbs (4/5). His platelet count (459 × 109/L) was elevated. Magnetic resonance imaging showed acute watershed infarction, and he was treated successfully. However, he was readmitted for headache and left limb weakness 14 months later. A head computed tomography scan revealed spontaneous subdural hemorrhage. He underwent subdural hematoma removal and decompressive craniectomy. Surgery and pathological investigation revealed no venous sinus thrombosis or vascular malformation. His condition improved, and he exhibited a stable condition 1 year after discharge. Successive development of ischemic stroke and spontaneous subdural hemorrhage is rare in a patient with ET. This case suggests that ET is not only a risk factor for stroke but can also cause highly heterogeneous strokes.

Prognostic nomogram for patients with minor stroke and transient ischaemic attack.

BACKGROUND: Ischaemic stroke and transient ischaemic attack (TIA) share a common cause. We aim to develop and validate a concise prognostic nomogram for patients with minor stroke and TIA. METHODS: A total of 994 patients with minor stroke and TIA were included. They were split into a derivation (n=746) and validation (n=248) cohort. The modified Rankin Scale (mRS) scores 3 months after onset were used to assess the prognosis as unfavourable outcome (mRS≥2) or favourable outcome (mRS<2). RESULT: The final model included seven independent predictors: gender, age, baseline National Institute of Health Stroke Scale (NIHSS), hypertension, diabetes mellitus, white blood cell and serum uric acid. The Harrell's concordance index (C-index) of the nomogram for predicting the outcome was 0.775 (95% CI 0.735 to 0.814), which was confirmed by the validation cohort (C-index=0.787 (95% CI 0.722 to 0.853)). The calibration curve showed that the nomogram-based predictions were consistent with actual observation in both derivation cohort and validation cohort. CONCLUSION: The proposed nomogram showed favourable predictive accuracy for minor stroke and TIA. This has the potential to contribute to clinical decision-making.

Micro-Nanopore Structure and Fractal Characteristics of Tight Sandstone Gas Reservoirs in the Eastern Ordos Basin, China.

The complex pore system in tight sandstone reservoirs controls the storage and transport of natural gas. Thus, quantitatively characterizing the micro-nanopore structure of tight sandstone reservoirs is of great significance to determining the accumulation and distribution of tight gas. The pore structure of reservoirs was determined through polarizing microscopy, scanning electron microscopy (SEM), and the combination of mercury injection capillary pressure (MICP) and nuclear magnetic resonance (NMR) experiments on Late Paleozoic conventional and tight sandstone samples from the Linxing Block, Ordos Basin. The results show that in contrast to conventional sandstone, dissolution pores, with diameters less than 8 µm, are the main contributors to the gas storage space of tight sandstone reservoirs. The pore size distribution derived from the MICP experiment demonstrates that the main peak of tight sandstones corresponds to a pore radius in the range of 247 nm to 371 nm, while the secondary peak usually corresponds to 18 nm. The results of the NMR test illustrate that the T2 spectra of tight sandstones are unimodal, bimodal and multimodal, and the main NMR peak is highly related to the MICP peak. Fractal theory was proposed to quantitatively characterize the complex pore structure and rough porous surface. The sandstones show fractal characteristics including nanopore fractal dimension DN obtained from the MICP and large pore fractal dimension DL obtained from the NMR experiment. Both DN and DL are positively correlated with porosity and negatively correlated with permeability, demonstrating that complex and heterogeneous pore structure could increase the gas storage space and reduce the connectivity.

Micro-Nanoscale Characteristics of Pyrite and Its Implications for Gold Mineralization: Two Cases of Gold Deposits in the Youjiang Basin and Southwestern Tianshan Mountains.

The mineralogical and compositional characteristics of gold-bearing minerals and the occurrence of gold are not only of great significance to exploring the sources of ore-forming materials and their formation mechanisms but also helpful for designing reasonable beneficiations and smelting schemes and achieving remarkable economic benefits. This paper presents an integrated study on the crystal characteristics, elemental composition and distribution of pyrite (the main gold-bearing minerals), on the basis of electron probe microanalysis (EPMA), scanning electron microscopy (SEM), laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) and nano-secondary ion mass spectrometry (NanoSIMS). The occurrence of gold in the Shuiyindong gold deposit and Ashawayi gold deposit has been studied by means of microscopy, SEM, and EPMA images, elemental correlations, S-Fe-As ternary diagrams, logAs-logAu diagrams and Au/As ratios. The gold in pyrite of the Shuiyindong deposit is in the form of nano gold inclusions and lattice gold. The gold in pyrite of the Ashawayi deposit dominantly exists in the form of nano gold inclusions or is present as micro-nano gold particles in the cracks or edges of pyrite, some of which can exist as lattice gold. The ore-forming hydrothermal solution of the Shuiyindong gold deposit is mainly underground hot brine, but it may be reformed by a deep magmatic hydrothermal solution or volcanic-subvolcanic hydrothermal solution. The ore-forming hydrothermal solution of the Ashawayi gold deposit is mainly derived from the metamorphic hydrothermal solution formed during the orogenic process, and the ore-forming process or post-mineralization process may be reformed by the leaching of underground hot brine. Finally, the characteristics of ore-forming fluids and evolution of the two types of deposits are determined via pyrite element surface scanning. This paper shows that micro-nanoscale study of gold-bearing pyrite is of great significance to understanding the gold mineralization process and is worth further study.

Effect of Composition on the Micropore Structure of Non-Marine Coal-Bearing Shale: A Case Study of Permian Strata in the Qinshui Basin, China.

The nanopore network in organic-rich shale plays a key role in shale gas storage and migration, and micropores are an important structural unit in connecting the migration channel. In this study, we selected six non-marine coal-bearing shales from the Qinshui Basin to investigate the effect of composition on micropore structure using X-ray diffraction, total organic carbon (TOC), vitrinite reflectance, and CO2 adsorption methods. The results indicate that non-marine shale with higher TOC content possesses more micropores, leading to a more complex pore structure and improving the heterogeneity of shale reservoirs. With the increase in TOC content, the micropore surface area and micropore volume clearly increases, which greatly improves the gas storage space in shale reservoirs. The thermal evolution of organic matter promotes the development of micropores to a certain extent in non-marine shale. Clay minerals possess a rough surface and develop more micropores, and their influence on the micropore structure of non-marine shale is relatively strong, while terrestrial quartz exhibits significant micropore development. The obviously positive correlations between micropore volume and kaolinite, chlorite contents in the non-marine shale suggest that kaolinite and chlorite make a certain contribution to micropore volume. The characteristics of micropore structures in coal mainly depend on lithotypes, TOC content, and ash content, while clay content, quartz content, and TOC content are the key factors controlling the formation of micropores in non-marine shale.

Smoking Status Affects the Association Between Hematoma Heterogeneity and Hematoma Expansion.

OBJECTIVE: The purpose of this study was to verify the relationship between hematoma heterogeneity and hematoma expansion and explore any effect modifiers through subgroup analyses. METHODS: Clinical records of 357 patients with spontaneous cerebral hemorrhage at Shenzhen Second People's Hospital from March 2016 to October 2018 were included in the study. Hematoma heterogeneity was measured on the first noncontrast computed tomography image according to the Barras scale. Hematoma expansion was defined as an absolute hematoma volume increase of 6 mL, or a 33% increase. We performed univariate and multivariate logistic regression analyses, as well as subgroup analyses, to assess the relationship between the presence of heterogeneity on noncontrast computed tomography and hematoma expansion. RESULTS: Hematoma expansion occurred in 79 (22.13%) of the 357 patients with intracerebral hemorrhage (ICH). Among the patients with ICH, there were 83 smokers, accounting for 23.24%. The average patient age was 56.21 ± 13.75 years, and 74.51% were male. Compared with the absence of heterogeneity, the risk of hematoma expansion increased by 1.06 times (odds ratio, 2.06; 95% confidence interval, 1.10-3.86). Based on the subgroup analysis, smoking status was found to modify the association between heterogeneity and hematoma expansion; the association was stronger in smokers than in nonsmokers (odds ratio, 10.23; 95% confidence interval, 2.15-48.65). CONCLUSIONS: Heterogeneity independently predicts hematoma expansion, especially in smoking patients.

Fast-tracking acute stroke care in China: Shenzhen Stroke Emergency Map.

China has the largest stroke population and at-risk population in the world. However, it has a lower thrombolytic therapy rate and longer onset-to-needle time/door-to-needle time for patients who had an acute stroke compared with developed countries, which might be due to redundant procedures or inefficient systems. Things are changing due to some new initiatives. Two years ago, a new emergency system in China, Stroke Emergency Map, was first launched as a regional emergency system in Shenzhen, the bustling metropolis just north of Hong Kong. As a result of the Stroke Emergency Map in Shenzhen, the number of thrombolytic cases increased in the last 2 years, from 568 to 809 annually. The Stroke Emergency Map, first pioneered in Shenzhen and now spreading to the rest of China, is a comprehensive and interdisciplinary system. The benefits are not just the immediate improvements in the acute stroke care because the continuous data collection and audit allows for improvements in logistics and future strategies.