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1.
J Int Med Res ; 49(5): 3000605211010051, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33951980

RESUMO

BACKGROUND: We examined the association of the Geriatric Nutritional Risk Index (GNRI) with the incidence of hypertension. METHODS: We used data of the China Health and Nutrition Survey in this study. Participants aged ≥60 years were eligible. The GNRI was defined as follows: GNRI = [1.489 × albumin (ALB; g/L)] + [41.7 × (actual weight/ideal weight)]. Participants with systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medication were defined as having hypertension. RESULTS: This study included 4853 participants, comprising 3612 control participants and 1241 participants with hypertension. The GNRI, ALB, and body mass index (BMI) were significantly associated with higher incidence of hypertension (HR: 1.030, 1.026, and 1.088; 95% CI: 1.020-1.041, 1.008-1.044, and 1.069-1.107, respectively). The GNRI, ALB, and BMI were associated with an earlier age of hypertension onset (ß = -0.403, -0.613, and -0.321; 95% CI: -0.493 to -0.314, -0.767 to -0.459, and -0.484 to -0.159, respectively). CONCLUSIONS: A higher GNRI was associated with increased incidence of hypertension. An elevated GNRI was associated with earlier age of hypertension onset.


Assuntos
Hipertensão , Avaliação Nutricional , Idoso , China/epidemiologia , Estudos de Coortes , Avaliação Geriátrica , Humanos , Hipertensão/epidemiologia , Medição de Risco , Fatores de Risco
2.
J Biomater Appl ; : 8853282211019517, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34027693

RESUMO

Nitinol is an excellent candidate material for developing various self-expanding endovascular devices due to its unique properties such as superelasticity, biocompatibility and shape memory effect. A low-energy laser joining technique suggests a high potential to create various large diameter Nitinol endovascular devices that contain complex geometries. The primary purpose of the study is to investigate the effects of laser joining process parameters with regard to the mechanical and biocompatible performance of Nitinol stents. Both the chemical composition and the microstructure of the laser-welded joints were evaluated using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). In vitro study results on cytotoxicity demonstrated that the joining condition of 8 Hz frequency and 1 kW laser power showed the highest degree of endothelial cell viability after thermal annealing in 500°C for 30 min. Also, in vitro study results showed the highest oxygen content at 0.9 kW laser power, 8 Hz frequency, and 0.3 mm spot size after the thermal annealing. Mechanical performance test results showed that the optimal condition for the highest disconnecting force was found at 1 Hz frequency and 1 kW power with 0.6 mm spot size. Two new endovascular devices have been fabricated using the optimized laser joining parameters, which have demonstrated successful device delivery and retrieval, as well as acute biocompatibility.

3.
Front Public Health ; 9: 663974, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33968888

RESUMO

Setting: Programmatic management of drug-resistant tuberculosis in Ningbo, China. Objective: To assess whether data-driven genetic determinants of drug resistance patterns could outperform phenotypic drug susceptibility testing in predicting clinical meaningful outcomes among patients with multidrug-resistant tuberculosis (MDR-TB). Design: We conducted a prospective cohort study of 104 MDR-TB patients. All MDR-TB isolates underwent drug susceptibility testing and genotyping for mutations that could cause drug resistance. Study outcomes were time to sputum smear conversion and probability of treatment success, as well as time to culture conversion within 6 months. Data were analyzed using latent class analysis, Kaplan-Meier curves, and Cox regression models. Results: We report that latent class analysis of data identified two latent classes that predicted sputum smear conversion with P = 0.001 and area under receiver-operating characteristic curve of 0.73. The predicted latent class memberships were associated with superior capability in predicting sputum culture conversion at 6 months and overall treatment success compared to phenotypic drug susceptibility profiling using boosted logistic regression models. Conclusion: These results suggest that genetic determinants of drug resistance in combination with phenotypic drug-resistant tests could serve as useful biomarkers in predicting treatment prognosis in MDR-TB.


Assuntos
Mycobacterium tuberculosis , Preparações Farmacêuticas , Antituberculosos/uso terapêutico , China/epidemiologia , Resistência a Medicamentos , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/genética , Estudos Prospectivos
4.
Commun Biol ; 4(1): 480, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33850296

RESUMO

The relationship between gut microbes and COVID-19 or H1N1 infections is not fully understood. Here, we compared the gut mycobiota of 67 COVID-19 patients, 35 H1N1-infected patients and 48 healthy controls (HCs) using internal transcribed spacer (ITS) 3-ITS4 sequencing and analysed their associations with clinical features and the bacterial microbiota. Compared to HCs, the fungal burden was higher. Fungal mycobiota dysbiosis in both COVID-19 and H1N1-infected patients was mainly characterized by the depletion of fungi such as Aspergillus and Penicillium, but several fungi, including Candida glabrata, were enriched in H1N1-infected patients. The gut mycobiota profiles in COVID-19 patients with mild and severe symptoms were similar. Hospitalization had no apparent additional effects. In COVID-19 patients, Mucoromycota was positively correlated with Fusicatenibacter, Aspergillus niger was positively correlated with diarrhoea, and Penicillium citrinum was negatively correlated with C-reactive protein (CRP). In H1N1-infected patients, Aspergillus penicilloides was positively correlated with Lachnospiraceae members, Aspergillus was positively correlated with CRP, and Mucoromycota was negatively correlated with procalcitonin. Therefore, gut mycobiota dysbiosis occurs in both COVID-19 patients and H1N1-infected patients and does not improve until the patients are discharged and no longer require medical attention.


Assuntos
/fisiopatologia , Disbiose/microbiologia , Microbioma Gastrointestinal/fisiologia , Influenza Humana/fisiopatologia , Adulto , Idoso , Bactérias/classificação , Bactérias/genética , Fezes/microbiologia , Feminino , Fungos/classificação , Fungos/genética , Microbioma Gastrointestinal/genética , Humanos , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Análise de Sequência de DNA/métodos
6.
Vet Res ; 52(1): 44, 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33691799

RESUMO

Small non-coding RNA RyhB is a key regulator of iron homeostasis in bacteria by sensing iron availability in the environment. Although RyhB is known to influence bacterial virulence by interacting with iron metabolism related regulators, its interaction with virulence genes, especially the Type III secretion system (T3SS), has not been reported. Here, we demonstrate that two RyhB paralogs of Salmonella enterica serovar Enteritidis upregulate Type III secretion system (T3SS) effectors, and consequently affect Salmonella invasion into intestinal epithelial cells. Specifically, we found that RyhB-1 modulate Salmonella response to stress condition of iron deficiency and hypoxia, and stress in simulated intestinal environment (SIE). Under SIE culture conditions, both RyhB-1 and RyhB-2 are drastically induced and directly upregulate the expression of T3SS effector gene sipA by interacting with its 5' untranslated region (5' UTR) via an incomplete base-pairing mechanism. In addition, the RyhB paralogs upregulate the expression of T3SS effector gene sopE. By regulating the invasion-related genes, RyhBs in turn affect the ability of S. Enteritidis to adhere to and invade into intestinal epithelial cells. Our findings provide evidence that RyhBs function as critical virulence factors by directly regulating virulence-related gene expression. Thus, inhibition of RyhBs may be a potential strategy to attenuate Salmonella.

7.
Anal Chim Acta ; 1152: 338267, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648648

RESUMO

Although SARS-CoV-2 can invade the intestine, though its effect on digestion and absorption is not fully understood. In the present study, 56 COVID-19 patients and 47 age- and sex-matched healthy subjects were divided into a discovery cohort and a validation cohort. Blood, faeces and clinical information were collected from the patients in the hospital and at discharge. The faecal metabolome was analysed using gas chromatography-mass spectrometry, and Spearman's correlation analyses of clinical features, the serum metabolome, and the faecal micro- and mycobiota were conducted. The results showed that, the faeces of COVID-19 patients were enriched with important nutrients that should be metabolized or absorbed, such as sucrose and 2-palmitoyl-glycerol; diet-related components that cannot be synthesized by humans, such as 1,5-anhydroglucitol and D-pinitol; and harmful metabolites, such as oxalate, were also detected. In contrast, purine metabolites such as deoxyinosine and hypoxanthine, low-water-soluble long-chain fatty alcohols/acids such as behenic acid, compounds rarely occurring in nature such as D-allose and D-arabinose, and microbe-related compounds such as 2,4-di-tert-butylphenol were depleted in the faeces of COVID-19 patients. Moreover, these metabolites significantly correlated with altered serum metabolites such as oxalate and gut microbesincluding Ruminococcaceae, Actinomyces, Sphingomonas and Aspergillus. Although levels of several faecal metabolites, such as sucrose, 1,5-anhydroglucitol and D-pinitol, of discharged patients were not different from those of healthy controls (HCs), those of oxalate and 2-palmitoyl-glycerol did differ. Therefore, alterations in the faecal metabolome of COVID-19 patients may reflect malnutrition and intestinal inflammation and warrant greater attention. The results of present study provide new insights into the pathogenesis and treatment of COVID-19.


Assuntos
/fisiopatologia , Disbiose/diagnóstico , Fezes/química , Microbioma Gastrointestinal/fisiologia , Metaboloma/fisiologia , Adulto , Bactérias/metabolismo , Estudos de Coortes , Disbiose/fisiopatologia , Fezes/microbiologia , Feminino , Fungos/metabolismo , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Pessoa de Meia-Idade
8.
Metabolism ; 118: 154739, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33662365

RESUMO

BACKGROUND: Metabolism is critical for sustaining life, immunity and infection, but its role in COVID-19 is not fully understood. METHODS: Seventy-nine COVID-19 patients, 78 healthy controls (HCs) and 30 COVID-19-like patients were recruited in a prospective cohort study. Samples were collected from COVID-19 patients with mild or severe symptoms on admission, patients who progressed from mild to severe symptoms, and patients who were followed from hospital admission to discharge. The metabolome was assayed using gas chromatography-mass spectrometry. RESULTS: Serum butyric acid, 2-hydroxybutyric acid, l-glutamic acid, l-phenylalanine, l-serine, l-lactic acid, and cholesterol were enriched in COVID-19 and COVID-19-like patients versus HCs. Notably, d-fructose and succinic acid were enriched, and citric acid and 2-palmitoyl-glycerol were depleted in COVID-19 patients compared to COVID-19-like patients and HCs, and these four metabolites were not differentially distributed in non-COVID-19 groups. COVID-19 patients had enriched 4-deoxythreonic acid and depleted 1,5-anhydroglucitol compared to HCs and enriched oxalic acid and depleted phosphoric acid compared to COVID-19-like patients. A combination of d-fructose, citric acid and 2-palmitoyl-glycerol distinguished COVID-19 patients from HCs and COVID-19-like patients, with an area under the curve (AUC) > 0.92 after validation. The combination of 2-hydroxy-3-methylbutyric acid, 3-hydroxybutyric acid, cholesterol, succinic acid, L-ornithine, oleic acid and palmitelaidic acid predicted patients who progressed from mild to severe COVID-19, with an AUC of 0.969. After discharge, nearly one-third of metabolites were recovered in COVID-19 patients. CONCLUSIONS: The serum metabolome of COVID-19 patients is distinctive and has important value in investigating pathogenesis, determining a diagnosis, predicting severe cases, and improving treatment.


Assuntos
/metabolismo , Metaboloma , Adulto , Idoso , Aminoácidos/sangue , Colesterol/sangue , Feminino , Frutose/sangue , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hidroxibutiratos/sangue , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Zhongguo Gu Shang ; 34(2): 126-30, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33665998

RESUMO

OBJECTIVE: To study mechanism of improvement of stress concentration on patellofemoral joint by stiletto needle releasing lateral patellar retinaculum guided by the theory of Jinshugu() and based on the finite element model of knee joint. and to elucidate the biomechanical mechanism of stiletto needle releasing changing patellar trajectory and reducing patellofemoral joint pressure. METHODS: CT data of knee joint from a normal male (aged 29, heighted 171 cm, weighted 58 kg) was selected. Starting with construction of three-dimensional model of knee joint by using finite element software, the finite element model of knee joint with complete tendonand bone structures were established through several steps, such as geometric reconstruction, reverse engineering, meshing, material assignment and loading analysis. The loading condition was set as 500 N load on knee joint, and the average tensile stress of quadriceps femoris tendon was about 200 N. To simulate the release of lateral patellar retinaculum by stiletto needle at 30 and 90 position of knee flexion in finite element model separately, and to compare the improvement of stress concentration of patellofemoral joint by stiletto needle intervention under different knee flexion conditions. RESULTS: The peak stress of patellofemoral joint and tibiofemoral joint decreased after stiletto needle releasing of patellofemoral lateral retinaculum compared with before intervention, which was(1) knee flexion at 30 degrees:patellar cartilage decreased by 0.498 MPa (decreased 9.06%), femoral trochlea decreased by 0.886 MPa(decreased 16.27%);(2) knee flexion at 90 degrees:patellar cartilage decreased by 0.558 MPa (decreased 8.6%), femoral trochlea decreasedby 0.607 MPa (decreased 9.94%). CONCLUSION: Releasing lateral patellofemoral retinaculum with stiletto needle could effectively alleviate the stress concentration of patellofemoral joint and reduce local stress peak value, which it is helpful to improve patellar trajectory and make stress distribution more uniform.


Assuntos
Articulação Patelofemoral , Adulto , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Articulação do Joelho , Masculino , Patela , Músculo Quadríceps , Amplitude de Movimento Articular
10.
Int J Biol Macromol ; 172: 170-177, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33450339

RESUMO

As a promising biodegradable resin, poly (butylene succinate) (PBS) is often blended with starch to reduce the cost. In this paper, 1-buyl-3-methylimidazolium halide pre-plasticized corn starch (CS) was blended with PBS to prepare PBS/corn starch blend material modified by ionic liquid (PBS/CS-IL). Ionic liquid (IL) acted as plasticizer and compatibilizer, and the effects of 1-butyl-3-methylimidazolium halide with different halogen anion on PBS/Starch blends were explored. The effects of IL on the structure and tensile property of PBS/Starch blends were evaluated by FTIR, SEM, DSC, TGA and XRD, respectively. Test results showed that the addition of IL significantly reduced the crystallinity of PBS/Starch blends, and the size of starch particles in the PBS matrix was also effectively reduced. IL also acted as a compatibilizer of starch and PBS, and induced the morphology of the blends to change from "sea-island" structure to homogeneous phase. The results of the tensile test showed that compared with the PBS/Starch blend without IL, the elongation at break of PBS/CS-IL increased from 22% to 93%. This study provided a simple and feasible method for the preparation of low-cost PBS bio-composite materials, and provided theoretical support for future industrial production.


Assuntos
Alcenos/química , Líquidos Iônicos/química , Amido/química , Ácido Succínico/química , Zea mays/química , Ânions/química , Plásticos Biodegradáveis/química , Halogênios/química
11.
Commun Biol ; 4(1): 98, 2021 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-33483610

RESUMO

G-quadruplex (G4) structures have been predicted in the genomes of many organisms and proven to play regulatory roles in diverse cellular activities. However, there is little information on the evolutionary history and distribution characteristics of G4s. Here, whole-genome characteristics of potential G4s were studied in 37 evolutionarily representative species. During evolution, the number, length, and density of G4s generally increased. Immunofluorescence in seven species confirmed G4s' presence and evolutionary pattern. G4s tended to cluster in chromosomes and were enriched in genetic regions. Short-loop G4s were conserved in most species, while loop-length diversity also existed, especially in mammals. The proportion of G4-bearing genes and orthologue genes, which appeared to be increasingly enriched in transcription factors, gradually increased. The antagonistic relationship between G4s and DNA methylation sites was detected. These findings imply that organisms may have evolutionarily developed G4 into a novel reversible and elaborate transcriptional regulatory mechanism benefiting multiple physiological activities of higher organisms.

12.
FEMS Microbiol Lett ; 368(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33338214

RESUMO

Solid-state fermentation with Agaricus brasiliensis and Agaricus bisporus on whole grain wheat was carried out. Phenolic compounds and antioxidant properties of fermented wheat were determined. The results showed that the maximum values of polyphenols contents in wheat fermented with A. brasiliensis and A. bisporus reached, respectively (3.16 ± 0.21) and (3.93 ± 0.23) mg GAE/g, which were 2.90 and 3.61 times of unfermented control. By employing ultra performance liquid chromatography coupled to mass spectrometry (UPLC-MS), 18 kinds of phenolic compounds were identified from fermented wheat. Compared with control, only 4-hydroxy-benzaldehyde was the same compound. It indicated that fermentation with the two fungi changed polyphenols contents and phenolic compounds composition in wheat to a great extent. Among these phenolic compounds, except for 4-hydroxy-benzaldehyde, 4-hydroxy-benzoic acid and ß-N-(γ-glutamyl)-4-formylphenylhydrazine, other 15 kinds of phenolic compounds were first identified from mushroom samples (including fruit bodies, mycelia and fermentation products). DPPH radical scavenging capacity, reducing power, ferrous ion chelating ability and inhibition of lipid peroxidation of fermented wheat were significantly stronger than control (P < 0.05).

13.
J Sep Sci ; 44(5): 1015-1025, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33355404

RESUMO

Superparamagnetic core-shell structured molecularly imprinted polydopamine nanospheres were constructed via self-polymerization of dopamine to attach the template onto the surface of magnetic Fe3 O4 substrate in tris-HCl solution. Then they were used for the specific recognition and extraction of perfluorooctane sulfonate from environmental water and human serum samples. The structural features and morphological characterization of the magnetic imprinting nanospheres were assessed, indicating that the magnetic polydopamine imprinted composite was successfully prepared and featured excellent magnetic separation characteristics. Adsorption experiments revealed that the magnetic adsorbents exhibited rapid adsorption kinetics and highly selective recognition properties toward perfluorooctane sulfonate. The stability and regeneration experiments indicated the materials had repeatable activity retention after repeated reuse. As a magnetic solid-phase extraction adsorbent, it was successfully applied for the extraction and quantification of perfluorooctane sulfonate in environmental water and human serum samples combined with liquid chromatography tandem mass spectrometry, with recoveries of ∼70-101.5% obtained in real samples. These results demonstrate that the prepared magnetic imprinting nanospheres are effective for the selective separation of perfluorooctane sulfonate from real samples. The synthesis technique is an effective and facile method that is conducted in aqueous solution and at ambient temperature, which is low cost, environmentally benign, and easy for scaling-up.

14.
BMC Infect Dis ; 20(1): 943, 2020 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-33302889

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection. METHODS: A retrospective analysis was used for PCR-confirmed COVID-19 (coronavirus disease 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration. RESULTS: One hundred patients with COVID-19, with a median age of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease. Age ([36-58] vs [51-70], P = 0.0001); sex (49% vs 77.6%, P = 0.0031); Body Mass Index (BMI) ([21.53-25.51] vs [23.28-27.01], P = 0.0339); hypertension (17.6% vs 57.1%, P < 0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P = 0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P < 0.0001); T lymphocyte count ([305-1178] vs [167.5-440], P = 0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P = 0.0001); white blood cell count ([3.9-7.6] vs [5.5-13.6], P = 0.0002); D2 dimer ([172-836] vs [408-953], P = 0.005), PCT ([0.03-0.07] vs [0.04-0.15], P = 0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P < 0.0001); AST ([16, 29] vs [18, 42], P = 0.0484); artificial liver therapy (2% vs 16.3%, P = 0.0148); and glucocorticoid therapy (64.7% vs 98%, P < 0.0001) were associated with the severity of the disease. Age and weight were independent risk factors for disease severity. CONCLUSION: Deterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease. Removing these factors may halt the progression of the disease. In addition, Oxygen support, early treatment with low doses of glucocorticoids and artificial liver therapy, when necessary, may help reduce mortality in critically ill patients.

15.
J Pharm Biomed Anal ; : 113784, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33280996

RESUMO

Chinese herbal drugs are often combined with chemotherapy drugs for the treatment of cancers. However, the combination administrations often do not have scientifically sound bases established on full preclinical and clinical investigations. A commonly used anti-colon-cancer herb-drug pair, irinotecan (CPT-11) hydrochloride injection and Kang'ai (KA) injection was taken as an example to investigate the possible pharmacokinetic interactions between Chinese herbal drugs and chemotherapy injections to determine the potential adverse drug reactions (ADRs). Rats were randomly divided into three groups and received 20 mg/kg CPT-11 injection 15 min after administration of 4 mL/kg saline for the CPT-11 single administration group and 4 mL/kg KA injection for the separated co-administration group, respectively. In the pre-mixed co-administration group, rats received a mixture of 20 mg/kg CPT-11 injection and 4 mL/kg KA injection. Blood samples were collected at 10 pre-determined time points between 0 and 24 h. The tissue samples were collected at 5 and 8 min after the injections, respectively. A reliable LC-MS/MS method was established for the simultaneous determination of CPT-11 and its metabolites, SN-38, SN-38 G and APC in the rat plasma and tissue samples, after full confirmation of two injections chemical and stability compatibilities. Compared to the C0 (5129 ± 757 ng/mL) and AUC0-t (7858 ± 1307 ng h/mL) of CPT-11 in the CPT-11 single administration group, the C0 (4574 ± 371 ng/mL) and AUC0-t (8779 ± 601 ng h/mL) after the separated co-administration remained unchanged, but the pre-mixed co-administration resulted with a significant increased C0 (29,454 ± 12,080 ng/mL) and AUC0-t (15,539 ± 5165 ng h/mL) (p < 0.05). Since the exposures of CPT-11 in most tissues in the pre-mixed co-administration group were dramatically lower than the separated co-administration group, the increased CPT-11 plasma concentration may be produced by the delayed tissue distribution because of the encapsulation by the components contained in KA injection, such as polysaccharides. Similar differences were also found in its metabolite, SN-38 G. There are obvious herb-drug interactions between CPT-11 injection and KA injection after the pre-mixed co-administration. The resulting excessive CPT-11 in the plasma may lead to many serious ADRs. Therefore, the full evaluation of herb-drug interactions is necessary and inappropriate combinations should be avoided.

16.
J Neurointerv Surg ; 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33229421

RESUMO

BACKGROUND: Intracranial vertebral artery (V4 segment) stenosis quantification traditionally uses the narrowest stenosis diameter. However, the stenotic V4 lumen is commonly irregularly shaped. Optical coherence tomography (OCT) allows a more precise calculation of V4 geometry. We compared the narrowest diameter stenosis (DS), measured by digital subtraction angiography (DSA), with the area stenosis (AS), measured by OCT. We hypothesized that DS is the gold standard for measuring the degree of stenosis. METHODS: Five neuroradiologists evaluated 49 stenosed V4 segments in a blinded protocol. V4 stenosis was measured in millimeters on DSA at its narrowest diameter. OCT was used to estimate the cross-sectional luminal area. We also used automated software to measure DS. Three different angles (anterior, lateral, and oblique views) were used for calculations, and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) methods were used in all measurements. Spearman's R values were calculated. Non-linear regression analysis was performed between the DS and AS, with statistically different correlations. RESULTS: A high correlation was observed between the WASID and NASCET methods to measure DS with observer measurement and automated software. A good correlation was found between DS measured by observers and AS measured by OCT. Non-linear regression analysis showed that only observer measurement using the oblique view and the WASID method could attain statistically significant differences, but it was weak (r=0.389). CONCLUSION: Measurement of the narrowest diameter was not a reliable predictor of the cross-sectional area of V4 stenosis. Larger studies are therefore needed to develop a new evaluation system based on V4 stenosis.

18.
J Neurointerv Surg ; 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067258

RESUMO

BACKGROUND: Drug-coated balloon (DCB) is a potential treatment for patients with low restenosis risk in vertebral artery origin stenosis (VAOS). However, the clinical data of long-term outcome are limited. OBJECTIVE: To evaluate the safety and efficacy of a DCB in patients with severe VAOS. METHODS: A prospective, non-randomized, single-center pilot study enrolled 30 patients with severe VAOS treated with DCB between 2017 and 2018. The first 20 patients were treated with a balloon-to-vessel ratio of predilation (pBVR)<0.8 (small-size balloon predilation) and the following 10 patients were treated with a pBVR 0.8-1.0 (large-size balloon predilation). Primary safety endpoints included 30-day death, stroke, and transient ischemic attack (TIA). The main efficacy outcome was restenosis at 6 months, defined as a peak systolic velocity >140 cm/s measured by Doppler ultrasound. Long-term outcomes, including TIAs, stroke, death, and modified Rankin Scale score, were followed up to 2 years. RESULTS: Technical success (<50% residual stenosis) was achieved in 26 patients (mean age 66.2±7.0; seven women). Four patients received bailout stenting and were excluded. Ultrasound confirmed restenosis at 6 months in 10 (38.5%) of 26, which was significantly less frequent in LSBP (LSBP vs SSBP=10% vs 56.3%, p<0.05). No adverse events occurred within 30 days of treatment. 19 patients were followed up for 2 years, with two deaths due to cancer. CONCLUSION: This pilot study suggests that DCB is a safe approach for VAOS. The relatively low restenosis rate indicates the its potential long-term efficacy for VAOS. Future randomized controlled trials to confirm its efficacy are warranted.

19.
Infect Dis Ther ; 9(4): 943-952, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32986226

RESUMO

INTRODUCTION: In December, 2019, an outbreak of the coronavirus disease 2019 (COVID-19), which was caused by a novel coronavirus, started in Wuhan, China. So far, there is limited clinical evidence on the effect of corticosteroid therapy for this disease. This study aims to investigate the association between corticosteroid therapy and the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) clearance among patients with mild COVID-19. METHODS: Patients with mild COVID-19 were enrolled from two medical centers in China between January 13, 2020 and February 29, 2020. Baseline characteristics and durations of RNA clearance were compared between the corticosteroid and non-corticosteroid therapy groups. The independent effects of corticosteroid therapy on the duration of RNA clearance were estimated by generalized linear models. RESULTS: Of 82 patients with a mild infection, 40 patients were male (48.8%), with a median age of 49 years (interquartile range, IQR 36-61). Among those patients, 36 patients (43.9%) received corticosteroid therapy. The adjusted multivariate models showed that the effects of corticosteroids were non-significant on the durations of onset to first RNA clearance [ß 2.48, 95% CI (95% confidence interval) - 0.42 to 5.38, P = 0.0926] and to persistent RNA clearance (ß 1.54, 95% CI - 1.41 to 4.48, P = 0.3016), and durations of therapy to first RNA clearance (ß 2.16, 95% CI - 0.56 to 4.89, P = 0.1184) and to persistent RNA clearance (ß 1.22, 95% CI - 1.52 to 3.95, P = 0.3787). CONCLUSIONS: Corticosteroid therapy in patients with mild COVID-19 was not associated with the duration of SARS-CoV-2 clearance, suggesting that the use of corticosteroids may not be beneficial for patients with mild COVID-19 and should be prudently recommended in clinical practice. However, further studies are needed to verify the findings.

20.
Chin Med J (Engl) ; 133(22): 2688-2695, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-32925292

RESUMO

BACKGROUND: Metabolic syndrome (MetS) is relatively common worldwide and an important risk factor for cardiovascular diseases. It is closely linked to arterial stiffness of the carotid artery. However, the association of MetS with the safety of carotid revascularization has been rarely studied. The aim of this study was to observe the current status of MetS and its components in Chinese carotid revascularized patients, and investigate the impact on major adverse clinical events (MACEs) after carotid endarterectomy (CEA) or carotid artery stenting (CAS). METHODS: From January 2013 to December 2017, patients undergoing CEA or CAS in the Neurosurgery Department of Xuanwu Hospital were retrospectively recruited. The changes in prevalence of MetS and each component with time were investigated. The primary outcome was 30-day post-operative MACEs. Univariable and multivariable analyses were performed to identify the impact of MetS on CEA or CAS. RESULTS: A total of 2068 patients who underwent CEA (766 cases) or CAS (1302 cases) were included. The rate of MetS was 17.9%; the prevalence rate of MetS increased with time. The occurrence rate of MACEs in CEA was 3.4% (26 cases) and in CAS, 3.1% (40 cases). There was no statistical difference between the two groups (3.4% vs. 3.1%, P = 0.600). For CEA patients, univariate analysis showed that the MACE (+) group had increased diabetes history (53.8% vs. 30.9%, P = 0.014) and MetS (34.6% vs. 15.8%, P = 0.023). For CAS patients, univariate analysis showed that the MACE (+) group had increased coronary artery disease history (40.0% vs. 21.6%, P = 0.006) and internal carotid artery tortuosity (67.5%% vs. 37.6%, P < 0.001). Furthermore, the MACE (+) group had higher systolic blood pressure (143.38 ±â€Š22.74 vs. 135.42 ±â€Š17.17 mmHg, P = 0.004). Multivariable analysis showed that the influencing factors for MACEs in CEA included history of diabetes (odds ratio [OR] = 2.345; 95% confidence interval [CI] = 1.057-5.205; P = 0.036) and MetS (OR = 2.476; 95% CI = 1.065-5.757; P = 0.035). The influencing factors for MACEs in CAS included systolic blood pressure (OR = 1.023; 95% CI = 1.005-1.040; P = 0.010), coronary artery disease (OR = 2.382; 95% CI = 1.237-4.587; P = 0.009) and internal carotid artery tortuosity (OR = 3.221; 95% CI = 1.637-6.337; P = 0.001). CONCLUSIONS: The prevalence rate of MetS increased with time in carotid revascularized patients. MetS is a risk for short-term MACEs after CEA, but not CAS.

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