Elevated troponin I levels on admission predict long-term mortality in patients with acute cerebral infarction following thrombolysis.

BACKGROUND/OBJECTIVE: Cardiac diseases are frequently accompanied by elevated levels of biomarkers, among which, troponin is commonly investigated. The levels of plasma cardiac troponin I (cTnI), which has been shown to predict short-term mortality, are elevated in patients with acute cerebral infarction (ACI). However, few studies have assessed the association between cTnI concentration and long-term mortality in patients with ACI following thrombolysis. METHODS: Patients with ACI admitted between January 1, 2014, and December 31, 2016, were registered. Data on demographics and outcomes with elevated cTnI levels were also collected. RESULTS: A total of 145 patients with ACI were recruited; 97 (66%), 30 (20%), and 18 (12%) patients had cTnI concentrations < 0.030 (group 1), 0.030-0.10 (group 2), and > 0.10 µg/L (group 3), respectively. cTnI elevation was associated with older age, atrial fibrillation, congestive heart failure, renal insufficiency, coronary artery disease, stroke severity (National Institutes of Health Stroke Scale score), and prior smoking history at admission. After adjusting for comorbidities and severity at 3 months after ACI, cTnI elevation on admission was significantly associated with ascending 5-year mortality (hazard ratio, 1.80; 95% confidence interval, 1.22-2.65). CONCLUSIONS: Even after adjusting for several possible confounders, cTnI elevation in patients with ACI treated with rt-PA was associated with a 1.80-fold increased risk of 5-year mortality.

[Clinical survey on neuropathic pain in neurological outpatient department].

OBJECTIVE: To survey the features and its impact of neuropathic pain in neurological outpatients. METHODS: A total of 106 patients with neuropathic pain were selected from Neurology Clinic of the Second Affiliated Hospital of Zhejiang University. General status instrument, SF-36 Quality of Life Scale and Hamilton Anxiety Scale (HAMA) were used in the survey. RESULTS: Trigeminal neuralgia (23.6%), nerve root pain (21.7%), and post-herpetic neuralgia (13.2%) were the most common causes of neuropathic pain. The sequence of impairments in life quality of the patients was role-physical (21.2), bodily pain (39.9), role-emotional (41.2), general health (50.0), physical functioning (55.1), vitality (60.0), mental health (68.5), and social functioning (70.9). Pearson correlation coefficients were statistically significant between bodily pain and other dimensions of life quality (P<0.05). Western medication (45.3%) was the most common treatment adopted by physicians. CONCLUSION: The prevalence of neuropathic pain is common in elderly patients. The three major types of neuropathic pain seriously affect the quality of life in patients. Although western medicine is the first choice of treatment, clinical drug selection should be standardized with efforts of both doctors and patients.

Trust in AI-augmented design: Applying structural equation modeling to AI-augmented design acceptance.

With the emergence of Artificial Intelligence (AI) 2.0, computers are now equipped with new creative capabilities and are playing an increasingly significant role in design. The use of AI augmentation has the potential to enhance design performance, however, there is limited research on the acceptance of AI-augmented design. The research gap under consideration in this study is addressed by presenting an acceptance model designed for AI-augmented design. This model integrates a range of variables including perceived privacy risk, enjoyment, perceived value, perceived usefulness, perceived ease of use, perceived behavioral control, social influence, and behavioral intention. The proposed model was validated through a questionnaire survey of 249 designers in China. The results reveal that enjoyment, perceived value, perceived ease of use, perceived behavioral control, and social influence have a significant positive impact on users' intention to use AI-augmented design, while perceived privacy risk has a significant negative impact. Perceived value was found to mediate the relationship between enjoyment and behavioral intention, while perceived behavioral control play a mediation role in the relationship between social influence and behavioral intention. In conclusion, this study highlights the variables that influence the acceptance of AI-augmented design and provides valuable insights into the potential benefits and drawbacks of integrating AI technologies in design. The proposed acceptance model serves as a framework for future research in this area and can guide the development of more user-friendly and effective AI-augmented design tools and technologies.

Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion.

Background: Rapid recognition of acute stroke and large vessel occlusion (LVO) is essential in prehospital triage for timely reperfusion treatment. Objective: This study aimed to develop and validate a new screening tool for both stroke and LVO in an urban Chinese population. Methods: This study included patients with suspected stroke who were transferred to our hospital by emergency medical services between July 2017 and June 2021. The population was randomly partitioned into training (70%) and validation (30%) groups. The Staring-Hypertension-atrIal fibrillation-sPeech-weakneSs (SHIPS) scale, consisting of both clinical and medical history information, was generated based on multivariate logistic models. The predictive ability of the SHIPS scale was evaluated and compared with other scales using receiver operating characteristic (ROC) curve comparison analysis. Results: A total of 400 patients were included in this analysis. In the training group (n = 280), the SHIPS scale showed a sensitivity of 90.4% and specificity of 60.8% in predicting stroke and a sensitivity of 75% and specificity of 61.5% in predicting LVO. In the validation group (n = 120), the SHIPS scale was not inferior to Stroke 1-2-0 (p = 0.301) in predicting stroke and was significantly better than the Cincinnati Stroke Triage Assessment Tool (C-STAT; formerly CPSSS) and the Prehospital Acute Stroke Severity scale (PASS) (all p < 0.05) in predicting LVO. In addition, including medical history in the scale was significantly better than using symptoms alone in detecting stroke (training group, 0.853 versus 0.818; validation group, 0.814 versus 0.764) and LVO (training group, 0.748 versus 0.722; validation group, 0.825 versus 0.778). Conclusion: The SHIPS scale may serve as a superior screening tool for stroke and LVO identification in prehospital triage. Including medical history in the SHIPS scale improves the predictive value compared with clinical symptoms alone.

Large mismatch profile predicts rapidly progressing brain edema in acute anterior circulation large vessel occlusion patients undergoing endovascular thrombectomy.

Background: Brain edema is a severe complication in patients with large vessel occlusion (LVO) that can reduce the effectiveness of endovascular therapy (EVT). This study aimed to investigate the association of the perfusion profile at baseline computed tomography (CT) perfusion with rapidly progressing brain edema (RPBE) after EVT in patients with acute anterior LVO. Methods: We retrospectively reviewed consecutive data collected from 149 patients with anterior LVO who underwent EVT at our center. Brain edema was measured by the swelling score (0-6 score), and RPBE was defined as the swelling score increased by more than 2 scores within 24 h after EVT. We investigated the effect of RPBE on poor outcomes [National Institute of Health Stroke Scale (NIHSS) score and modified Rankin scale (mRS) score at discharge, the occurrence of hemorrhagic transformation, and mortality rate in the hospital] using the Mann-Whitney U-test and chi-square test. A multivariate logistic regression model was used to assess the relationship between perfusion imaging parameters and RPBE occurrence. Results: Overall, 39 patients (26.2%) experienced RPBE after EVT. At discharge, RPBE was associated with higher NIHSS scores (Z = 3.52, 95% CI 2.0-12.0, P < 0.001) and higher mRS scores (Z = 3.67, 95% CI 0.0-1.0, P < 0.001) including the more frequent occurrence of hemorrhagic transformation (χ2 = 22.17, 95% CI 0.29-0.59, P < 0.001) and higher mortality rates in hospital (χ2 = 9.54, 95% CI 0.06-0.36, P = 0.002). Univariate analysis showed that intravenous thrombolysis, baseline ischemic core volume, and baseline mismatch ratio correlated with RPBE (all P < 0.05). After dividing the mismatch ratio into quartiles and performing a chi-square test between quartiles, we found that the occurrence of RPBE in Q4 (mismatch ratio > 11.3) was significantly lower than that in Q1 (mismatch ratio ≤ 3.0) (P < 0.05). The result of multivariate logistic regression analysis showed that compared with baseline mismatch ratio <5.1, baseline mismatch ratio between 5.1 and 11.3 (OR:3.85, 95% CI 1.06-14.29, P = 0.040), and mismatch ratio >11.3 (OR:5.26, 95% CI 1.28-20.00, P = 0.021) were independent protective factors for RPBE. Conclusion: In patients with anterior circulation LVO stroke undergoing successful EVT, a large mismatch ratio at baseline is a protective factor for RPBE, which is associated with poor outcomes.

The role of thrombospondin-1 and transforming growth factor-beta after spinal cord injury in the rat.

Spinal cord injury (SCI) continues to result in high morbidity and mortality throughout the world. An effective neuroprotective agent is still not available to counteract secondary damage caused by traumatic injury. Thrombospondin-1 (TSP-1) and transforming growth factor-beta (TGF-beta) have a role in angiogenesis, scar deposition, inflammation and may affect astrocyte phenotype and mobility. We investigated the role of TSP-1 and TGF-beta in a model of spinal cord injury in rats. Forty female Sprague-Dawley rats were randomly divided into two equal groups: the experimental group was subject to SCI using an impactor and the sham-operated group was not subject to SCI. These animals were sacrificed at 12 h and 24 h after SCI for immunochemistry and Western blot analysis of the injured spinal segment for the expression of the TSP-1 and TGF-beta proteins. We found that TSP-1 and TGF-beta expression increased immediately after SCI in the injured segment. After 12 h, TSP-1 concentrations increased more rapidly and dramatically than TGF-beta in the injured segment of the spinal cord. Elevations in TSP-1 and TGF-beta concentrations persisted for 24 h after injury. These results show that elevated expression of TSP-1 and TGF-beta can be detected in the injured segment of the spinal cord 12 and 24 h after injury. Thus, TSP-1 and TGF-beta may have a role in SCI.

The effective clinical outcomes of the Gufoni maneuver used to treat 91 vertigo patients with apogeotropic direction-changing positional nystagmus (apo-DCPN).

This study aimed to observe and analyze the effects and outcomes of patients with apogeotropic direction-changing positional nystagmus (apo-DCPN) who received Gufoni maneuver.A total of 91 patients with positional vertigo admitted to the specialized dizziness clinic in Zhejiang Provincial People's Hospital from February 2014 to August 2017 were included. The immediate treatment responses to the Gufoni maneuver were observed and recorded. The patients in whom the treatment was ineffective were followed up for 4 weeks to observe the outcome of apo-DCPN.In 21 patients, the apo-DCPN was transformed after Gufoni maneuver, and 7 patients developed transformation within 4 weeks of follow-up. Spontaneous remission of apo-DCPN within the follow-up period was observed in 55 patients who were unresponsive to the Gufoni maneuver. The prevalence of migraine was significantly higher in the early remission group (P < .05) and the period between the initial visit and nystagmus remission was significantly shorter in the group of patients with migraine history (P < .05).This study demonstrates that the immediate treatment efficacy of the Gufoni maneuver is poor in positional vertigo patients with apo-DCPN. We believe that the reason for the low efficacy is that the Gufoni maneuver is only effective for some patients with apo-DCPN type HSC-BPPV. In patients with early spontaneous remission and a history of migraine, central positional nystagmus of probable vestibular migraine (VM) or benign recurrent vertigo should be considered for the mechanisms of apo-DCPN generation.