Argatroban in Patients With Acute Ischemic Stroke With Early Neurological Deterioration: A Randomized Clinical Trial.

Importance: The effect of argatroban in patients with acute ischemic stroke (AIS) and early neurological deterioration (END) is unknown. Objective: To assess the efficacy of argatroban for END in AIS. Design, Setting, and Participants: This open-label, blinded-end point, randomized clinical trial was conducted from April 4, 2020, through July 31, 2022. The date of final follow-up was October 31, 2022. This was a multicenter trial. Eligible patients were adults with AIS who experienced END, which was defined as an increase of 2 or more points on the National Institutes of Health Stroke Scale within 48 hours from symptom onset. Patients who withdrew consent, experienced duplicate randomization, or were lost to follow-up were excluded from the study. Interventions: Patients were randomly assigned to the argatroban group and control group within 48 hours of symptom onset. Both groups received standard therapy based on guidelines, including oral mono or dual antiplatelet therapy. The argatroban group received intravenous argatroban for 7 days (continuous infusion at a dose of 60 mg per day for 2 days, followed by 20 mg per day for 5 days) in addition to standard therapy. Main Outcome and Measure: The primary end point was good functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 3. Results: A total of 628 patients (mean [SD] age, 65 [11.9] years; 400 male [63.7%]) were included in this study (argatroban group, 314 [50%] and control group, 314 [50%]). Of these, 18 withdrew consent, 1 had duplicate randomization, and 8 were lost to follow-up. A total of 601 patients with stroke were included in the intention-to-treat analysis. Finally, 564 patients were included in the per-protocol analysis as 6 participants in the argatroban group and 31 participants in the control group did not follow the complete protocol. The number of patients with good functional outcome at 90 days was 240 (80.5%) in the argatroban group and 222 (73.3%) in the control group (risk difference, 7.2%; 95% CI, 0.6%-14.0%; risk ratio, 1.10; 95% CI, 1.01-1.20; P = .04). The proportion of symptomatic intracranial hemorrhage was 3 of 317 (0.9%) in the argatroban group and 2 of 272 (0.7%) in the control group (P = .78). Conclusions and Relevance: Among patients with AIS with END, treatment with argatroban and antiplatelet therapy resulted in a better functional outcome at 90 days. This trial provided evidence to support the use of argatroban in reducing disability for patients with END. Trial Registration: ClinicalTrials.gov Identifier: NCT04275180.

Significant delay and decreased chance of treatment for acute ischemic stroke patients on remote outer islets of China compared with the main island: the PUTUO Study.

INTRODUCTION: Data from acute ischemic stroke patients throughout 2021 from one district of an archipelago city of China were collected and analyzed retrospectively to determine the management difference due to time lags from onset of symptoms to the arrival at the stroke center (FMCT) of two regions: main island (MI) and outer islets (OIs). METHODS: All patients information from 1 January to 31 December 2021 was retrieved through the electronic medical records system of the only stroke center in MI. After screening and exclusion, each patient's medical record was reviewed by two neurologists separately. Before OI patients were allocated to a group, their residential addresses at onset of the stroke were confirmed by telephone. Comparisons were analyzed between the two regions for gender, age, pre-stroke risk factors and peri-admission management parameters. RESULTS: A total of 326 patients met the inclusion criteria: 300 from the MI group and 26 for the OI group. Intergroup comparisons for gender, age and most of the risk factors showed no significant difference. FMCT were shown to be significantly distinct (p<0.001). Hospitalization expenses also showed significant difference. The odds ratio of the definite treatment IV thrombolysis was 0.131 (OI group to MI group range: 0.017-0.987, p=0.021). CONCLUSION: The diagnosis and treatment of acute ischemic stroke patients from OIs was significantly postponed compared to those from MI. Therefore, new effective and efficient solutions are urgently needed.

Concentrations and Exposure Evaluation of Metals in Diverse Food Items from Chengdu, China.

A total of 520 food samples belonging to 29 food types and 63 drinking water were collected in Chengdu market of China in 2014 to investigate the concentrations of 11 metals, and to assess the related exposure to the local consumers by estimating the hazard quotient and carcinogenic risk (CR). The results showed that metals concentrations in drinking water were below the limit values suggested by the Ministry of Health of the People's Republic of China, and FAO/WHO (Food and Agriculture Organization of the United Nations/World Health Organization). While As, Cd, and Cr were found at concentrations higher than the limit values in some of the foodstuffs. Children in Chengdu intake more metals compared to adults, with the same order of Mn > Zn > Cu > Sr > Cr > Ni > As > Cd > Pb > Co > Sb. Among all of the diverse food, rice, flour, and fish and seafood were the primary sources to intake metals for Chengdu residents. Residents in Chengdu are subjected to both carcinogenic and non-carcinogenic risks based on the calculated HI and CR values, especially for children. Finally, total daily metals intakes for both children and adults were calculated based on the current study and our previous studies, including consumption of food and drinking water and intake of outdoor and indoor dust. Dietary exposure is the predominant exposure route to metals for Chengdu residents, accounting for more than 75.8% of the total daily metals intakes for both children and adults.

Occurrence of perchlorate in groundwater, paired farmland soil, lettuce, and rhizosphere soil from Chengdu, China.

A total of 28 groundwater, paired farmland soil, lettuce, and its rhizosphere soil samples were collected from Chengdu, China to detect perchlorate levels and to evaluate the relationships of perchlorate concentrations among these matrices. The perchlorate concentrations in the groundwater, farmland soil, lettuce, and rhizosphere soil samples ranged from below detection limit to 60.2 µg L-1, from below detection limit to 249 µg kg-1 dry weight (dw), from 2.07 to 1010 µg kg-1 wet weight, and from below detection limit to 314 µg kg-1 dw, respectively. Significant correlation was found in the perchlorate levels among the farmland soil, lettuce, and rhizosphere soil, suggesting that they have common pollution sources, or perchlorate might transfer from farmland soil-rhizosphere soil-plant. However, there is no significant correlation between groundwater and the other three matrices, indicating that infiltration from perchlorate contaminated farmland soil was not the predominant source for groundwater pollution in Chengdu. The perchlorate concentrations in the farmland soil and lettuce samples were significantly higher than those in the rhizosphere soil, primarily due to uptake of perchlorate through the rhizosphere micro-environment by lettuce, or accelerated degradation by rhizospheric microorganisms, which contributed more needs further investigation.