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1.
Ann Transl Med ; 10(20): 1111, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36388841

RESUMO

Background: The role of serum uric acid (SUA) in affecting outcomes after endovascular treatment (EVT) in patients with ischemic stroke remains unclear. This study investigated the association of SUA with outcomes of patients with acute large vessel occlusion (LVO) who had received EVT. Methods: Patients with acute LVO stroke who underwent EVT within 24 hours were enrolled from a prospective, nationwide registry study. Baseline characteristics and SUA level within 24 hours of EVT were collected. The primary outcome was an excellent 90-day functional outcome [modified Rankin Scale (mRS) score 0-1]. Secondary outcomes included a favorable 90-day outcome (mRS score 0-2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. The SUA level was analyzed in quartiles and as a continuous variable. We investigated the independent association of SUA with the primary outcome using multivariable logistic regression. Results: Among 780 patients (mean age 64 years; 66.28% males), 230 (29.49%) had an excellent 90-day outcome. A higher SUA level was significantly associated with an excellent outcome in univariate logistic regression (P=0.045) and after adjusting for confounders in multivariate analysis [adjusted odds ratio (aOR), 0.998; 95% confidence interval (CI), 0.996-1.000; P=0.018]. Multivariate logistic regression analysis showed patients with SUA level in the fourth quartile had an excellent 90-day outcome (aOR, 0.367; 95% CI, 0.154-0.876; P=0.024). There was no significant association for SUA level with favorable 90-day outcome, sICH, or 90-day mortality (P>0.05). Conclusions: Among patients with acute LVO type of stroke who received EVT, baseline high SUA level may predict a better 90-day functional outcome.

2.
Environ Pollut ; 315: 120357, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36220572

RESUMO

In recent years, increasing studies have been reported on characterization and detection of microplastics (MPs), and their interactions with organic pollutants (OPs) and heavy metals (HMs) in soils. However, a comprehensive review on the characteristics and factors that influence MPs distribution in soils, the sorption characteristics and mechanisms of soil contaminants by MPs, especially the interactions of MPs and their complexes with pollutants in the soil-plant systems remains rarely available at present. This review focuses on the sorption features and mechanisms of pollutants by MPs in soil and discussed the effects of MPs and their complexing with pollutants on soil properties, microbe and plants. The polarity of MPs significantly influenced the sorption of OPs, and different sorption mechanisms are involved for the hydrophobic and hydrophilic OPs. The sorption of OPs on MPs in soils is different from that in water. Aging of MPs can promote the sorption and migration of contaminants. The enhanced effects of biofilm in microplastisphere on the sorption of pollutants by MPs are critical, and interactions of soil environment-MPs-microbe-HMs-antibiotics increase the potential pathogens and larger release of resistance genes. The coexistence of HMs and MPs affected the growth of plants and the uptake of HMs and MPs by the plants. Moreover, the type, dose, shape and particle size of MPs have important influences on their interactions with pollutants and subsequent effects on soil properties, microbial activities and plant growth. This review also pointed out some knowledge gaps and constructive countermeasures to promote future research in this field.


Assuntos
Poluentes Ambientais , Metais Pesados , Poluentes do Solo , Poluentes Químicos da Água , Microplásticos , Poluentes do Solo/análise , Solo/química , Plásticos/química , Poluentes Ambientais/análise , Plantas , Poluentes Químicos da Água/análise
3.
Phytomedicine ; 107: 154461, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36198223

RESUMO

BACKGROUND: Patients with amyotrophic lateral sclerosis (ALS) have restricted pharmacotherapy options and thus resort to herbal medicines (HMs), despite limited and conflicting evidence. Therefore, use of HMs needs to be assessed in patients with ALS. PURPOSE: This study aimed to evaluate the benefits of HMs in ALS and to describe the characteristics of HM users. STUDY DESIGN: The correlation between HMs and prognosis was determined based on data obtained from the largest ALS database with high-quality clinical trials. Propensity score (PS) matching was used to address confounding and selection bias. METHODS: In total, 321 and 231 HM users with at least a 4-week HM prescription were identified and PS-matched with non-HM users at a 1:1 ratio based on predefined confounders. Time-to-event models with censoring at 12 or 18 months were established for survival analyses. For evaluating activity limitation and respiratory function, 320 and 376 HM users were included, respectively, and analyzed using multivariate analysis of variance (MANOVA). RESULTS: The profiles of 321 HM users indicated a better condition compared with that of non-HM users before PS-matching, including higher weight (median [IQR], 77.90 [21.8] kg vs. 74.00 [21.2] kg, p < 0.01), higher body mass index (26.00 [5.4] vs. 25.20 [5.8], p < 0.01), more percentage of limb onset (261 [81.3%] vs. 2366 [67.2%], p < 0.01), and slower progression (0.47 [0.5] vs. 0.51 [0.5], p = 0.03). HM did not significantly affect survival at 12 months (adjusted hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.49-1.03; log-rank p = 0.069), but it significantly prolonged survival at 18 months (adjusted HR 0.74, 95% CI 0.56-0.98; log-rank p = 0.038). After imputation of missing data, MANOVA revealed significant effectiveness of HMs in improving activity limitation (Pillai trace, 0.0195; p = 0.03). CONCLUSION: PS-based methods eliminated baseline differences between HM and non-HM users. Overall, the use of HM to treat patients with ALS is favored based on their association with prolonged overall survival within 18 months and improved activity limitation.


Assuntos
Esclerose Amiotrófica Lateral , Plantas Medicinais , Esclerose Amiotrófica Lateral/complicações , Esclerose Amiotrófica Lateral/tratamento farmacológico , Progressão da Doença , Medicina Herbária , Humanos , Pontuação de Propensão , Análise de Sobrevida
4.
Front Pharmacol ; 13: 933140, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36120362

RESUMO

Background: Acute ischemic stroke (AIS) is a common cause of death and long-term disability worldwide. Recent trials of platelet-activating factor receptor antagonists (PAFRA) appeared to indicate that they could play a neuroprotective role in the treatment of AIS; therefore, we conducted a systematic literature review to evaluate the clinical efficacy and safety of PAFRA in patients with AIS. Methods: A systematic literature search was performed in seven electronic databases from inception to 11 March 2022. All randomized controlled trials (RCTs) in which patients were treated with PAFRA strategies within 7 days of stroke onset were included. Modified Rankin Scale (mRS) was selected as the primary outcome of this systematic review. The methodological quality of included studies was assessed based on the Cochrane Collaborations tool. The review protocol was previously registered (PROSPERO CRD42020182075). Results: Fifteen RCTs comprising a total of 3,907 participants were included in this study. The PAFRA-related compounds included natural preparations of terpenoids, flavonoids, and saponins, namely, ginkgo endoterpene diester meglumine (GEDM, seven RCTs), ginkgo biloba dropping pill (GBDP, one RCT), ginkgolide injection (GDI, four RCTs), hesperidin (HES, one RCT), ginsenoside Rd injection (GSRI, one RCT), and hydroxysafflor yellow A (HSYA, one RCT). All studies were conducted in China between 2017 and 2021, employing a two-arm parallel design with sample sizes ranging from 40 to 1,113. Eight studies (53.3%) provided no information on their method of randomization, and only two studies (13.3%) utilized the double-blind design. Treatment was associated with improved clinical outcomes for (1) GEDM, GDI, and GBDP in patients treated with conventional treatment (CM) [GEDM + CM for AIS on mRS: MDmRS = -0.42, 95% CI (-0.47, -0.37), five trials, p < 0.00001; GEDM + CM for AIS on NIHSS: MDNIHSS = -1.02, 95% CI (-1.51, -0.52), four trials, p < 0.0001]; (2) GEDM and GDI in patients treated with neuroprotective agent (NPA) [GEDM + NPA + CM for AIS on mRS: MDmRS = -0.40, 95% CI (-0.54, -0.26), p < 0.00001; GEDM + NPA + CM for AIS on NIHSS: MDNIHSS = -3.93, 95%CI (-7.72, -0.14), p = 0.04]; (3) GBDP in patients treated with CM; (4) GDI and GSRI in patients treated with IV rt-PA therapy (IVT); and (5) HSYA in patients compared with Dengzhan Xixin injection (DZXXI). No access to improved clinical outcome was associated with HES in patients treated with IVT. Seven RCTs reported adverse events (AEs) but found that taking PAFRA-related preparations was not associated with an increased incidence of AEs. Conclusions: This systematic review not only makes an important contribution to the existing body of current evidence but also lays a well-conducted basis for providing opinions and recommendation on the evaluation of PAFRA-based medicine, which could also highlight the need for well-designed clinical trials of PAFRA for AIS to increase the quality of available evidence. Further research is required, using standardized functional outcome measures for AIS, adequate blinding and suitable comparator groups reflecting current best practice.

5.
J Vector Borne Dis ; 59(2): 115-126, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36124477

RESUMO

BACKGROUND & OBJECTIVES: Weather and climate are directly linked to human health including the distribution and occurrence of vector-borne diseases which are of significant concern for public health. METHODS: In this review, studies on spatiotemporal distribution of dengue, Barmah Forest Virus (BFV) and Ross River Virus (RRV) in Australia and malaria in Papua New Guinea (PNG) under the influence of climate change and/ or human society conducted in the past two decades were analysed and summarised. Environmental factors such as temperature, rainfall, relative humidity and tides were the main contributors from climate. RESULTS: The Socio-Economic Indexes for Areas (SEIFA) index (a product from the Australian Bureau of Statistics that ranks areas in Australia according to relative socio-economic advantage and disadvantage) was important in evaluating contribution from human society. INTERPRETATION & CONCLUSION: For future studies, more emphasis on evaluation of impact of the El Niño-Southern Oscillation (ENSO) and human society on spatio-temporal distribution of vector borne diseases is recommended to highlight importance of the environmental factors in spreading mosquito-borne diseases in Australia and PNG.


Assuntos
Infecções por Alphavirus , Alphavirus , Doenças Transmitidas por Vetores , Infecções por Alphavirus/epidemiologia , Animais , Austrália/epidemiologia , Humanos , Papua Nova Guiné/epidemiologia , Doenças Transmitidas por Vetores/epidemiologia
6.
BMC Microbiol ; 22(1): 210, 2022 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-36045321

RESUMO

BACKGROUND: To explore and utilize abundant soil microbes and their beneficial functions, the bacterial and fungal compositions in rhizospheres between red- and yellow-fruited tomato varieties were analyzed using high-throughput sequencing technique. RESULT: Our results indicated that different soil microbes in rhizospheres of tomatoes were exactly recruited by different color fruit tomatoes. For the reasons as not only soil bacterial community, but also soil fungal compositions were all different between red and yellow fruit tomatoes. For example, Nocardioides, norank_f_norank_o_Vicinamibacterales, norank_f_norank_o_norank_c_KD4-96, norank_f_Birii41, norank_f_norank_o_S085 and Bradyrhizobium were the specific dominant soil bacterial genera, and Lecythophora, Derxomyces and unclassified_f_Pyronemataceae were the dominant soil fungal genera in the rhizospheres of red tomato varieties. By contrast, unclassified_f__Micromonsporaceae, Acidipila, Roseisolibacter, Gaiella and norank_f_Xanthobacteraceae were the unique dominant soil bacterial genera in the rhizospheres of yellow tomato varieties. And unclassified_o__Onygenales, Trichocladium, unclassified_c__Sordariomycetes, Pseudogymnoascus, Acremonium, Oidiodendron, Phialemonium, Penicillium, Phialosimplex were the unique dominant soil fungal genera in rhizospheres of yellow tomato varieties. Moreover, a higher abundance of specific soil bacterial and fungal genera in the rhizosphere was found in rhizospheres of the yellow than those of the red tomato varieties. CONCLUSION: Soil bacterial and fungal compositions in rhizospheres between red- and yellow-fruited tomato varieties were found significantly different which growing in the same environment under the identical managements. It suggested that different soil microbes in rhizospheres exactly were recruited by different phenotypes tomato varieties related to fruit color formation.


Assuntos
Rizosfera , Bactérias/genética , Frutas , Fenótipo , Solo , Microbiologia do Solo
7.
Front Neurol ; 13: 877773, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35677333

RESUMO

Background: This study aims to examine the effects of early rehabilitation on functional outcomes in patients with acute ischemic stroke treated with endovascular treatment (EVT). Methods: Eligible patients with large vessel occlusion stroke treated with EVT, who received early rehabilitation or standard care treatment during hospitalization, were enrolled in a multicenter registration, prospective observational study, a registration study for Critical Care of Acute Ischemic Stroke After Recanalization. Early rehabilitation was defined as rehabilitation interventions initiated within 1 week after acute stroke. The primary outcome was the favorable functional outcome (defined as modified Rankin Scale scores of 0 to 2) at 90 days. Independent association between early rehabilitation and the primary outcome was investigated using multivariable logistic regression in the entire sample and in subgroups. Results: A total of 1,126 patients (enrolled from July 2018 to May 2019) were included in the analyses, 273 (24.2%) in the early rehabilitation group and 853 (75.8%) in the standard care group. There was no significant difference in favorable functional outcomes at 90 days between the two groups (45.4 vs. 42.6%, p = 0.41). Patients in the early rehabilitation group had a lower death rate within 90 days compared with the standard care group (6.2 vs. 20.5%, p < 0.01). The multivariable logistic regression analyses showed that the early rehabilitation was not significantly associated with the favorable functional outcome at 90 days (adjusted odds ratio, 1.01 [95% CI, 0.70-1.47]; p = 0.95). There was no significant difference between subgroups in the favorable functional outcome at 90 days. No significant interaction was found between subgroups. Conclusions: Patients with stroke receiving early rehabilitation had a lower death rate. However, these clinically meaningful effects of early rehabilitation did not show on functional outcome at 90 days in patients with large vessel occlusion stroke treated with EVT. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.

8.
Biomed Pharmacother ; 148: 112749, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35219118

RESUMO

Intracerebral hemorrhage (ICH) is a severe, life-threatening subtype of stoke that constitutes a crucial health and socioeconomic problem worldwide. However, the current clinical treatment can only reduce the mortality of patients to a certain extent, but cannot ameliorate neurological dysfunction and has a high recurrence rate. Increasing evidence has demonstrated that mitochondrial dysfunction occurs in the early stages of brain injury and participates in all stages of secondary brain injury (SBI) after ICH. As the energy source of cells, various pathobiological processes that lead to SBI closely interact with the mitochondria, such as oxidative stress, calcium overload, and neuronal injury. In this review, we discussed the structure and function of mitochondria and the abnormal morphological changes after ICH. In addition, we discussed recent research on the involvement of mitochondrial dynamics in the pathological process of SBI after ICH and introduced the pathological variations and related molecular mechanisms of mitochondrial dysfunction in the occurrence of brain injury. Finally, we summarized the latest progress in mitochondrion-targeted agents for ICH, which provides a direction for the development of emerging therapeutic strategies targeting the mitochondria after ICH.


Assuntos
Lesões Encefálicas/fisiopatologia , Hemorragia Cerebral/fisiopatologia , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Animais , Antioxidantes/metabolismo , Apoptose , Edema Encefálico/fisiopatologia , Lesões Encefálicas/metabolismo , Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/metabolismo , Modelos Animais de Doenças , Humanos , Inflamação/metabolismo , Camundongos , Dinâmica Mitocondrial , Neurônios/metabolismo , Estresse Oxidativo , Ratos , Espécies Reativas de Oxigênio/metabolismo
9.
Brain Res Bull ; 178: 144-154, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34838852

RESUMO

Intracerebral hemorrhage (ICH)-induced brain injury is a continuous pathological process that involves the deterioration of neurological functions, such as sensory, cognitive or motor functions. Cytotoxic byproducts of red blood cell lysis, especially free iron, appear to be a significant pathophysiologic mechanism leading to ICH-induced injury. Free iron has a crucial role in secondary brain injury after ICH. Chelating iron may attenuate iron-induced neurotoxicity and may be developed as a therapeutic candidate for ICH treatment. In this review, we focused on the potential role of iron toxicity in ICH-induced injury and iron chelation therapy in the management of ICH. It will hopefully advance our understanding of the pathogenesis of ICH and lead to new approaches for treatment.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/metabolismo , Ferroptose/efeitos dos fármacos , Quelantes de Ferro/farmacologia , Ferro/toxicidade , Síndromes Neurotóxicas/tratamento farmacológico , Animais , Humanos
10.
Stroke Vasc Neurol ; 7(3): 190-199, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34880112

RESUMO

BACKGROUND AND PURPOSE: It remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients who had acute ischaemic stroke (AIS) due to BAO. METHODS: Patients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study, and the efficacy and safety were compared between IVT+EVT and direct EVT. The primary outcome was 90-day functional independence. All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO. RESULTS: Of 310 enrolled patients with BAO, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 (95% CI 0.24 to 0.85), p=0.01). IVT+EVT was associated with a lower percentage of patients who needed ≥3 passes of stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r=0.14 (95% CI 0.05 to 0.24), p<0.01). CONCLUSIONS: This study showed that compared with direct EVT, EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset. The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO.


Assuntos
Arteriopatias Oclusivas , Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Arteriopatias Oclusivas/terapia , Artéria Basilar/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Estudos de Coortes , Humanos , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/tratamento farmacológico , Estudos Multicêntricos como Assunto , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Trombectomia/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
11.
Sci Total Environ ; 791: 148358, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34139490

RESUMO

Surface air temperature is an important factor for the permafrost thermal state in the Northern Hemisphere. It is therefore necessary to understand the variations and regional differences in air temperature to determine the interactions between permafrost degradation and climate change. In this study, we used observational data from the National Centers for Environmental Information, the China Meteorological Administration, and the World Data Centre for Meteorology to quantitatively analyze the variations and regional differences in air temperature from 1980 to 2018. The results demonstrated that the annual mean air temperatures were low in continuous permafrost regions and high in sporadic and isolated permafrost regions, with a significant warming rate of 0.371 ± 0.086 °C/decade. Air temperatures warmed the slowest during the winter and fastest during the spring, and no "warming hiatus" was observed in the permafrost regions of the Northern Hemisphere. The spatial patterns of freezing degree-days (FDDs) and thawing degree-days (TDDs) had different spatial characteristics. The decreasing rate of FDDs was -6.97 °C·days/year, while the increasing rate of TDDs was 6.4 °C·days/year. The air temperatures and warming trends had largely regional differences with respect to high latitude, transitional, and high altitude permafrost regions. Air temperature and its warming trend was the highest in high altitude regions. In addition, air temperature warming trends gradually decreased from the continuous permafrost zone to the island permafrost zone. The FDDs had a significant decreasing trend from the continuous permafrost zone to the island permafrost zone, whereas TDDs exhibited the opposite trend. The results indicate that the air temperature warming rate in the permafrost regions was approximately 2.0 times that of the global warming rate, and 1.3 times the global land warming rate from 1980 to 2018. These findings offer a perspective on the differences in permafrost and its thermal state across different regions under climate change.


Assuntos
Pergelissolo , Mudança Climática , Aquecimento Global , Estações do Ano , Temperatura
12.
Stroke ; 52(4): 1473-1477, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33657858

RESUMO

BACKGROUND AND PURPOSE: Intraluminal thrombus (ILT) is an emerging imaging marker in acute ischemic stroke. We aimed to investigate the association of ILT with outcomes of acute large vessel occlusion (LVO) patients receiving endovascular treatment. METHODS: Acute LVO stroke patients who underwent endovascular treatment within 24 hours, in a prospective, nationwide registry were enrolled. Pretreatment digital subtraction angiography was reviewed for the presence of ILT. The primary outcome was 90-day functional dependence (modified Rankin Scale scores, 3-6). Secondary outcomes included 24-hour LVO, 90-day death, and symptomatic intracranial hemorrhage. RESULTS: Among 711 patients enrolled, 75 (10.5%) with ILT were less likely to have 90-day functional dependence compared with those without ILT (adjusted odds ratio, 0.53 [95% CI, 0.31-0.90]; P=0.021). The same trend was found among those with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3; P=0.008) but not in those without successful reperfusion (P=0.107). Presence of ILT was also independently associated with a lower rate of 24-hour LVO (adjusted odds ratio 0.34 [95% CI, 0.13-0.89]; P=0.028). However, those with or without ILT had similar risks of symptomatic intracranial hemorrhage and 90-day death. CONCLUSIONS: Among acute LVO patients receiving endovascular treatment, pretreatment ILT-positive patients may have a better 90-day functional outcome (versus ILT-negative) but similar risk of death and symptomatic intracranial hemorrhage. The possibly favorable effect of ILT patients remained in those with successful reperfusion. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.


Assuntos
Procedimentos Endovasculares/métodos , AVC Isquêmico/patologia , AVC Isquêmico/cirurgia , Trombose/patologia , Idoso , Angiografia Digital , Feminino , Humanos , AVC Isquêmico/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento
13.
Stroke Vasc Neurol ; 6(2): 286-290, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33727409

RESUMO

BACKGROUNDS: Increased blood pressure (BP) for patients who had an acute ischaemic stroke is associated with poor functional outcome, however the optimal timing of antihypertensive therapy is unknown. AIMS: We aim to compare early antihypertensive treatment to delayed antihypertensive treatment for reducing the risk of composite major disability and mortality at 3 months in acute ischaemic stroke. DESIGN: The China Antihypertensive Trial in Acute Ischemic Stroke II (CATIS-2) trial is a multicentre, randomised, open-label, blinded-endpoints trial that will be conducted in 100 hospitals in China. The primary outcome is the composite of death and major disability (modified Rankin Scale score ≥3) at 3 months of randomisation. Antihypertensive treatment will be received immediately after randomisation in the early treatment group, aimed at average systolic BP by 10%-20% reduction within the first 24 hours, and achieving an average BP level of <140/90 mm Hg within 5 days. Patients in the delayed treatment group will discontinue any antihypertension medications for the first 7 days of randomisation, and will receive antihypertensive therapy achieving a BP goal of <140/90 mm Hg after 7 days. CONCLUSION: The CATIS-2 trial will be testing the hypotheses that early BP lowering leads to improved functional outcome without any other harms, and developing clinical guidelines of the BP management for patients who had an acute ischaemic stroke. TRIAL REGISTRATION NUMBER: NCT03479554.


Assuntos
Anti-Hipertensivos/uso terapêutico , Isquemia Encefálica , AVC Isquêmico , Pressão Sanguínea , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/tratamento farmacológico , China , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/tratamento farmacológico , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Tempo para o Tratamento , Resultado do Tratamento
14.
J Am Heart Assoc ; 10(5): e019350, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33634704

RESUMO

Background To investigate whether collateral status could modify the associations between post-thrombectomy blood pressure (BP) measures and outcomes. Methods and Results Patients with anterior-circulation large-vessel-occlusion successfully recanalized in a multicenter endovascular thrombectomy registry were enrolled. Pretreatment collateral status was graded and dichotomized (good/poor) in angiography. Maximum, minimum, and mean systolic BP (SBP) and BP variability (assessed by the SD, coefficient of variation) during the initial 24 hours after endovascular thrombectomy were obtained. The primary outcome was unfavorable 90-day outcome (modified Rankin Scale score 3-6). Secondary outcomes included symptomatic intracranial hemorrhage and 90-day mortality. Adjusted odds ratios (aOR) of BP parameters over the outcomes were obtained in all patients and in patients with good/poor collaterals. Among 596 patients (mean age 66 years; 59.9% males), 302 (50.7%) patients had unfavorable 90-day outcome. In multivariable analyses, higher mean SBP (aOR, 1.59 per 10 mm Hg increment; 95% CI, 1.26-2.02; P<0.001), mean SBP >140 mm Hg (versus ≤120 mm Hg; aOR, 4.27; 95% CI, 1.66-10.97; P=0.002), and higher SBP SD (aOR, 1.08 per 1-SD increment; 95% CI, 1.01-1.16; P=0.02) were respectively associated with unfavorable 90-day outcome in patients with poor collateral but not in those with good collateral. A marginal interaction between SBP coefficient of variation tertiles and collaterals on 90-day functional outcome (P for interaction, 0.09) was observed. A significant interaction between SBP coefficient of variation tertiles and collaterals on 90-day mortality (P for interaction, 0.03) was observed. Conclusions Higher postprocedural BP is associated with 90-day unfavorable outcomes after successful endovascular thrombectomy in patients with poor collateral. Registration URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.


Assuntos
Pressão Sanguínea/fisiologia , Circulação Colateral/fisiologia , Embolectomia/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Hipertensão/etiologia , AVC Isquêmico/fisiopatologia , Sistema de Registros , Doença Aguda , Idoso , Angiografia Cerebral/métodos , Feminino , Seguimentos , Humanos , Hipertensão/fisiopatologia , AVC Isquêmico/diagnóstico , AVC Isquêmico/cirurgia , Masculino , Período Pré-Operatório , Estudos Prospectivos , Resultado do Tratamento
15.
Soft Matter ; 16(40): 9393, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33030181

RESUMO

Correction for 'Time-dependent shear rate inhomogeneities and shear bands in a thixotropic yield-stress fluid under transient shear' by Yufei Wei et al., Soft Matter, 2019, 15, 7956-7967, DOI: 10.1039/C9SM00902G.

16.
Stroke ; 51(9): 2742-2751, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32811382

RESUMO

BACKGROUND AND PURPOSE: We aimed to evaluate the impact of cortical microinfarcts (CMIs) on functional outcome after endovascular treatment in patients with acute ischemic stroke. METHODS: In a multicenter registration study for RESCUE-RE (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization), eligible patients with large vessel occlusion stroke receiving endovascular treatment, who had undergone 3T magnetic resonance imaging on admission or within 24 hours after endovascular treatment were analyzed. We evaluated the presence and numbers of CMIs with assessment of axial T1, T2-weighted images, and fluid-attenuated inversion recovery images. The primary outcome was functional dependence or death defined as modified Rankin Scale scores of 3 to 6 at 90 days. Secondary outcomes included early neurological improvement, any intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality. We investigated the independent associations of CMIs with the outcomes using multivariable logistic regression in overall patients and in subgroups. RESULTS: Among 414 patients (enrolled from July 2018 to May 2019) included in the analyses, 96 (23.2%) patients had at least one CMI (maximum 6). Patients with CMI(s) were more likely to be functionally dependent or dead at 90 days, compared with those without (55.2% versus 37.4%; P<0.01). In multivariable logistic regression analyses, presence of CMI(s) (adjusted odds ratio, 1.78 [95% CI, 1.04-3.07]; P=0.04) and multiple CMIs (CMIs ≥2; adjusted odds ratio, 7.41 [95% CI, 2.48-22.17]; P<0.001) were independently, significantly associated with the primary outcome. There was no significant difference between subgroups in the associations between CMI presence and the primary outcome. CONCLUSIONS: Acute large vessel occlusion stroke patients receiving endovascular treatment with CMI(s) were more likely to have a poor functional outcome at 90 days, independent of patients' characteristics. Such associations may be dose-dependent. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.


Assuntos
Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Córtex Cerebral , Infarto Cerebral/complicações , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/cirurgia , Isquemia Encefálica/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/mortalidade , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico por imagem , Resultado do Tratamento
17.
Brain Res Bull ; 164: 314-324, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32858128

RESUMO

Inflammatory responses play an extraordinary role in the pathogenesis of cerebrovascular and neurological disorders. Baicalin is one of the important flavonoids, which is extracted from Scutellaria baicalensis Georgi. Recently, numerous in vivo and in vitro studies have shown that baicalin has salutary effects for anti-inflammatory and immunomodulatory and has been demonstrated to exert beneficial therapeutic properties in cerebrovascular and neurological diseases. In this review, we aim to discuss that baicalin exerts anti-inflammatory effects through multiple pathways and targets, thus affecting the production of a variety of inflammatory cytokines and neuroprotective process of neurological diseases; furthermore, the related targets of the anti-inflammatory effects of baicalin were analyzed via using the tools of network pharmacology, to provide theoretical basis and innovative ideas for the future clinical application of baicalin.


Assuntos
Anti-Inflamatórios/uso terapêutico , Transtornos Cerebrovasculares/tratamento farmacológico , Flavonoides/uso terapêutico , Fatores Imunológicos/uso terapêutico , Doenças do Sistema Nervoso/tratamento farmacológico , Animais , Anti-Inflamatórios/farmacologia , Flavonoides/farmacologia , Fatores Imunológicos/farmacologia
18.
Stroke Vasc Neurol ; 5(2): 159-176, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32561535

RESUMO

AIM: Stroke is the leading cause of disability and death in China. Ischaemic stroke accounts for about 60%-80% of all strokes. It is of considerable significance to carry out multidimensional management of ischaemic cerebrovascular diseases. This evidence-based guideline aims to provide the latest detailed and comprehensive recommendations on the diagnosis, treatment and secondary prevention of ischaemic cerebrovascular diseases. METHODS: We had performed comprehensive searches of MEDLINE (via PubMed) (before 30 June 2019), and integrated the relevant information into charts and distributed to the writing group. Writing group members discussed and determined the recommendations through teleconference. We used the level of evidence grading algorithm of Chinese Stroke Association to grade each recommendation. The draft was reviewed by the Guideline Writing Committee of Chinese Stroke Association Stroke and finalised. This guideline is fully updated every 3 years. RESULTS: This evidence-based guideline is based on the treatment, care and prevention of ischaemic cerebrovascular diseases, which emphasises on pathogenesis evaluation, intravenous thrombolysis, endovascular therapy, antiplatelet therapy, prevention and treatment of complications, and risk factor management. CONCLUSIONS: This updated guideline presents a framework for the management of ischaemic cerebrovascular diseases. Timely first-aid measures, professional care in the acute stage, and proactive secondary prevention will be helpful to patients.


Assuntos
Isquemia Encefálica/terapia , Medicina Baseada em Evidências/normas , Neurologia/normas , Acidente Vascular Cerebral/terapia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , China/epidemiologia , Tomada de Decisão Clínica , Consenso , Técnicas de Apoio para a Decisão , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Tempo para o Tratamento/normas , Resultado do Tratamento
19.
Front Neurol ; 11: 429, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32582001

RESUMO

Background: Early hematoma expansion (HE) occurs in patients with intracerebral hemorrhage (ICH) within the first few hours from ICH onset. Hematoma expansion has been considered as an independent predictor of poor clinical outcome and mortality after ICH. Island sign (IS) on the non-contrast computed tomography (NCCT) appears to increase the rate of detection of HE. However, there is insufficient evidence to declare that IS is an independent predictor for ICH patients prognosis and classification. Objectives: To investigate whether IS on NCCT could predict HE and functional outcome following ICH. Methods: Major databases were systematically searched, including PubMed, EMBASE, Cochrane library, and the Chinese database (CNKI, VIP, and Wanfang databases). Studies about the associations between IS and HE or IS and clinical outcome were included. The pooled result used the odds ratio (OR) with a 95% confidence interval (CI) as effect size. Heterogeneity and publication bias were assessed. Subgroup analysis and meta-regression were applied to detect potential factors of heterogeneity. Results: Eleven studies with 4,310 patients were included in the final analysis. The average incidence rate of IS and HE were 21.58 and 33%, respectively. The ideal timing for assessing HE was also not uniform or standardized. We separately performed two meta-analyses. First, 10 studies were included to estimate the association between IS and HE. The pooled OR was statistically significant (OR = 7.61, 95% CI = 3.10-18.67, P < 0.001). Second, four studies were included in the meta-analysis, and the pooled result showed that IS had a significantly positive relationship with poor outcome (OR = 3.83, 95% CI = 2.51-5.85, P < 0.001). Conclusions: This meta-analysis showed that NCCT IS is of great importance and value for evaluation of HE and poor outcome in patients with ICH. Future studies should focus on developing consensus guidelines, and more studies with large sample size and longitudinal design are needed to validate the conclusions.

20.
Soft Matter ; 15(39): 7956-7967, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31544190

RESUMO

We study the rheological responses and shear-rate inhomogeneities and shear banding behaviors of a thixotropic fumed silica suspension in shear startup tests and flow reversal tests. We find that this suspension under transient shear exhibits not only viscoelasticity, yielding, kinematic hardening, and thixotropy, but also time-dependent shear inhomogeneities including bands when the apparent shear rate is below a critical value between 0.1 and 0.25 s-1. Through multiple shear startup tests and flow reversal tests, we find that thixotropy promotes flow heterogeneity while kinematic hardening suppresses it. We propose a simple thixo-plastic constitutive equation that can qualitatively predict the important features of the rheological response and banding dynamics in shear startup tests and flow reversal tests.

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