[Prevalence and molecular characterization of Cryptosporidium in captive-bred Mustela putorius furo in Jiangsu Province]

OBJECTIVE

To investigate the prevalence and molecular features of Cryptosporidium in captive-bred Mustela putorius furo in Jiangsu Province.

METHODS

A total of 290 fresh stool samples were collected from a ferret farm in Jiangsu Province on May 2017, and the small subunit rRNA (SSU rRNA) gene of Cryptosporidium was amplified in stool samples using nested PCR assay. The actin, cowp and gp60 genes were amplified in positive samples and sequenced to characterize Cryptosporidium species/genotypes.

RESULTS

A total of 18 stool samples were tested positive for Cryptosporidium SSU rRNA gene, with a detection rate of 6.2%. Sequence and phylogenetic analyses of SSU rRNA, actin and cowp genes characterized Cryptosporidium isolated from captive-bred ferrets as Cryptosporidium sp. ferret genotype. In addition, gp60 gene was amplified in 10 out of 18 stool samples tested positive for Cryptosporidium.

CONCLUSIONS

Cryptosporidium is widely prevalent in captive-bred ferrets in Jiangsu Province, and Cryptosporidium sp. ferret genotype is the only Cryptosporidium genotype in ferrets.

[Analysis of risk factors for decompensated cirrhosis complicated with sepsis]

Objective: To investigate the related risk factors in patients with decompensated cirrhosis complicated with sepsis. Methods: 1 098 cases with decompensated cirrhosis were collected from January 2018 to December 2020. A total of 492 cases with complete data meeting the inclusion criteria were included. Among them, the sepsis group (240 cases) was complicated with sepsis and the non-sepsis group (252 cases) was not complicated with sepsis. Albumin, cholinesterase, total bilirubin, prothrombin activity, urea, creatinine, international normalized ratio and other indicators of the two groups of patients were collected. Child-Pugh classification and MELD score were performed on two groups of patients. Mann-Whitney U test was used for non-normally distributed measurement data, and rank sum test for grade data. Logistic regression analysis was performed on sepsis-related factors that may affect patients with decompensated cirrhosis complicated with sepsis. Results: 162 cases of gram negative bacteria, 76 cases of gram positive bacteria and 2 cases of Candida were detected. Child-Pugh grade C was mainly in the sepsis group, and Child- Pugh grade A and B was mainly in the non-sepsis group (z=-13.01, P＜0.05). MELD score was significantly higher in patients with sepsis than that of patients without sepsis (z=-12.30, P＜0.05). Neutrophils percentage, C-reactive protein, procalcitonin, and total bilirubin in patients with decompensated cirrhosis complicated with sepsis were 86.90% (79.00%, 91.05%), 48.48 (17.63, 97.55) mg/l,1.34 (0.40, 4.52) ng/l, and 78.50 (32.75149.80) μmol/L, which were significantly higher than that of patients without sepsis [69.55% (58.58%, 75.90%), 5.34 (5.00, 14.94) mg/l, 0.11(0.06,0.24) ng/l, 22.50(15.10,37.55) respectively] μmol/L, P＜0.05], while the albumin level, prothrombin activity level, and the cholinesterase level in sepsis patients were 27.30 (24.45, 30.60) g/L, 46.00% (33.50%, 59.00%), and 1.87 (1.29, 2.66) kU/L, respectively, which was significantly lower than the non-sepsis group [32.65 (28.95, 37.23) g/l, 73.00(59.75～84.85)%, 3.13(2.23～4.59) kU/L, P＜0.05]. Logistic regression analysis showed that serum total bilirubin, albumin, prothrombin activity level and diabetes mellitus were the independent risk factors for complicated sepsis. Conclusion: Patients with decompensated cirrhosis with poor liver function and higher MELD scores are more likely to be complicated with sepsis. Therefore, during the clinical diagnosis and treatment course, patients with decompensated cirrhosis with poor liver reserve function should be actively and dynamically monitored for infection-related indicators such as neutrophil percentage, procalcitonin, C-reactive protein, in an attempt to detect possible potential infections and sepsis, and improve early treatment and prognosis.

Correlating Cytologic and Histologic Features of Hepatic Epithelioid Hemangioendothelioma

Introduction/Objective

Epithelioid hemangioendothelioma (EHE) is a rare malignant vascular tumor composed of epithelioid and dendritic tumor cells embedded in myxoid or hyalinized stroma. It can occur in various organs and has nonspecific clinical and radiologic presentation. We report a case of EHE in the liver with correlation of cytologic and histological findings.

Methods/Case Report

A 68-year-old female presented for evaluation of a right hepatic lobe lesion that was noted on Imaging. MRI abdomen with contrast showed a well-circumscribed hypointense nodule with no contrast enhancement. CT-guided fine needle aspiration showed scattered atypical epithelioid cells in a background of benign hepatocytes which were positive for vascular markers (CD31 and CD34) as well as keratins and SMA. A diagnosis of atypical vascular neoplasm was rendered. A partial hepatectomy was performed a month later which showed a 3.2 cm mass with solid tan-white cut surface. Histologically, the mass was composed of epithelioid tumor cells with focal intracytoplasmic vacuoles which were partly solid and partly forming vascular-like spaces, embedded in a background of hyalinized stroma. Immunohistochemically, in addition to the vascular markers the tumor was positive for CAMTA1 confirming the presence of WWTR1-CAMTA1 gene fusion which is characteristic for epithelioid hemangioendothelioma. The patient was discharged in good condition.

Results (if a Case Study enter NA)

NA.

Conclusion

Diagnosis of EHE on FNA is challenging. It is characterized by discohesive atypical large polygonal cells with abundant dense cytoplasm in a background of benign hepatocytes. Characteristically, the tumor cells have intracytoplasmic vacuoles containing red blood cells, which resemble signet ring-like structures. Immunohistochemically, positivity for vascular markers and CAMTA1 is diagnostic.

Elastotic Mass-Forming Lesion of the Omentum; A New Pathological Entity

Introduction/Objective

Elastotic lesions are rare benign mass-forming entity. Although, few reports of mucosal and submucosal elastotic lesions have been previously described, localization of these lesions in the omentum is not previously described in the literature.

Methods/Case Report

We report a case of 60-year-old man with medical history of obesity, hypertension, diabetes mellitus, and a remote abdominal surgery in 1980s who presented to the emergency room complaining of abrupt severe constant epigastric pain that started few hours before. The pain was not relieved by antiacid or analgesic medications. CT of the abdomen showed multiple distended fluid-filled loops of small bowel in mid abdomen with infiltrative changes of mesentery. A diagnosis of small bowel obstruction was made, and patient proceed to have an exploratory laparotomy. During the procedure, extensive adhesions between small bowel and omentum and small bowel obstruction due to a phytobezoar were noted for which he underwent lysis of adhesion, excision of thickened omentum, and enterotomy for removal of significant food bezoar. Grossly, the omentum has multiple chalky tan-gray masses ranging between 1.2 and 1.0 cm in greatest dimension surrounded by indurated fatty tissue. Microscopically, multiple hypocellular foci are seen that are composed almost entirely of truncated elastic fibers, with sparse delicate bands of collagen and scattered prominent thick-walled vessels. Elastic stain highlights these elastic fibers while trichrome stains the elastic fibers pale gray in contrast to the bright blue color of the collagen fibers. Mucicarmine, and Congo red are negative. Patient tolerated the procedure well however, postoperatively he had local wound infection leading to prolonged skin dehiscence.

Results (if a Case Study enter NA)

NA.

Conclusion

Elastotic mass-forming lesions in the omentum is a new entity that has not been described before in this location that can clinically manifest with signs and symptoms of bowel obstruction. We suggested the name of elastomatosis omentum.

Erythrocytes from patients with ST-elevation myocardial infarction induce cardioprotection via the purinergic P2Y13 receptor and nitric oxide signalling

Background

Red blood cells (RBC) are suggested to act as important mediators in the regulation of cardiovascular function by exporting nitric oxide (NO) bioactivity and ATP under hypoxic/ischemic conditions. In addition, RBCs are known to protect from ischemia-reperfusion injury via the export of NO bioactivity in experimental settings. However, it remains unknown if such beneficial effects of RBCs are protective in patients with acute myocardial infarction.

Purpose

To investigate whether RBCs from patients with ST-elevation myocardial infarction (STEMI) protect against myocardial ischemia-reperfusion injury and whether such effect involves activation of purinergic and NO signalling in the RBCs.

Methods

RBCs were collected from patients with STEMI undergoing primary percutaneous coronary intervention and age- and gender-matched healthy controls. The RBCs were administered into the coronary circulation of isolated Langendorff-perfused rat hearts at the onset of global ischemia for 25 min followed by reperfusion of 60 min. Recovery of left ventricular developed pressure (LVDP) during reperfusion and infarct size were determined. All animal experiments and procedures were performed according to the guidelines by the U.S National Institutes of Health (NIH publication no 85–23, revised 1996). The present study was performed following The Code of Ethics of the World Medical Association outlined in the Declaration of Helsinki of 1975 and revised in 1983 for experiments that involve human subjects.

Results

Administration of RBCs from STEMI patients improved recovery of LVDP and reduced infarct size in hearts subjected to ischemia-reperfusion in comparison with RBCs from healthy controls (Figure 1A, B). Pre-incubation of the RBCs with the NO synthase (NOS) inhibitor L-NAME (Figure 1C, D) and the inhibitor of the NO receptor soluble guanylyl cyclase (sGC) ODQ abolished the cardioprotective effect of RBCs from STEMI patients. The cardioprotective effect was also attenuated by inhibition of cardiac cGMP-dependent protein kinase (PKG). Further, the purinergic P2Y13 receptor antagonist MRS2211 (Figure 1E, F), but not the P1 receptor antagonist 8PT applied to RBCs, attenuated the cardioprotection induced by RBCs from STEMI patients. Moreover, administration of RBCs from healthy subjects pre-incubated with a cell permeable ATP analogue improved post-ischemic recovery of LVDP and reduced infarct size. This cardioprotective effect was abolished by co-incubation of the RBCs with ODQ (Figure 2) and MRS2211.

Conclusion

Our findings demonstrate a novel function of RBCs in patients with STEMI that provides protection against myocardial ischemia-reperfusion injury via the activation of P2Y13 receptor and the NO-sGC pathway in RBCs and cardiac PKG.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Lung Foundation; Swedish Research Council

Systolic blood pressure time in range and long-term clinical outcomes in patients with ischaemic cardiomyopathy

Background

The relationship between systolic blood pressure (SBP) control and long-term clinical outcomes in patients with ischaemic cardiomyopathy remains unclear. It has been previously reported that either too high or too low SBP may lead to a poorer prognosis. But current SBP control metrics may not take into account the possible effects of fluctuating SBP overtime on patients.

Purpose

This study aimed to estimate the association between time in range (TIR) of SBP and long-term clinical outcomes in patients with ischaemic cardiomyopathy.

Methods

This study was a post-hoc analysis of The Surgical Treatment of Ischaemic Heart Failure (STICH) trial, a randomized controlled trial with two hypotheses that enrolled participants with coronary artery disease and left ventricular ejection fraction ≤35%. The SBP target range of the TIR was defined as 110 to 130 mmHg and the SBP TIR was calculated by linear interpolation method. Patients were equally divided into four groups by quartiles of TIR. Multivariable-adjusted Cox proportional hazards regression models were constructed to compare the effects of different levels of TIR on a 10-year prognosis. The primary outcome was all-cause mortality. Subgroup analyses were performed according to whether patients were assigned to coronary artery bypass grafting (CABG) or medical therapy (MED), and in populations with different baseline SBP.

Results

A total of 1194 eligible patients were included according to the purpose of our study. Compared with patients in the quartile 4 group (TIR 77.87–100%), the fully adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality were 1.32 (0.98–1.78) for quartile 3 group (TIR 54.81–77.63%), 1.40 (1.03–1.90) for quartile 2 group (TIR 32.59–54.67%), and 1.53 (1.14–2.04) for quartile 1 group (TIR 0–32.56%) (P for trend = 0.005). When evaluated TIR as a continuous variable, per 1-SD decrement (29.28%) in TIR significantly increased the incidence of all-cause mortality [1.15 (1.04–1.26)]. Similarly, the decrement in TIR significantly elevated the risk of cardiovascular (CV) mortality and the risk of all-cause mortality plus CV rehospitalization. Consistent results were also observed in subgroup analyses of either CABG or MED, or different baseline SBP, indicating the robustness of our findings.

Conclusions

This study suggested that in patients with ischaemic cardiomyopathy, a higher SBP TIR was significantly associated with a decreased risk of all-cause mortality, CV mortality and the composite of all-cause mortality plus CV rehospitalization, regardless of whether the patient received CABG or MED, and the level of baseline SBP. Our findings support that TIR might be a substitutable metric of SBP control for long-term clinical outcomes in patients with ischaemic cardiomyopathy.

Funding Acknowledgement

Type of funding sources: None.

Red blood cells induce endothelial dysfunction in patients with ST-elevation myocardial infarction and elevated C-reactive protein

Background

The important role of inflammation in atherosclerotic plaque progression and instability leading to myocardial infarction has been widely demonstrated. C-reactive protein (CRP) has been shown to be of predictive value in atherosclerotic cardiovascular disease. The red blood cell (RBC) is an important regulator of cardiovascular function through nitric oxide bioactivity and oxidative stress in ischemic heart disease. Also, arginase-1 has been shown to greatly influence nitric oxide bioactivity in RBCs and to cause endothelial dysfunction. However, the mechanisms by which RBCs regulate vascular function in patients with myocardial infarction and its relation to inflammation and arginase-1 remain unknown.

Objective

The study aimed to investigate the effect of RBCs on endothelial function in patients with ST-elevation myocardial infarction (STEMI) and its possible association with systemic inflammation and arginase-1.

Material and methods

Blood samples were collected from patients with STEMI within 36 h after admission and from age-matched healthy controls. RBCs were incubated with isolated rat aortic segments for 18 h after which the aortas were assessed for endothelium-dependent and endothelium-independent relaxations using wire myographs and application of acetylcholine and nitroprusside, respectively. The vascular response was evaluated in relation to the level of inflammation defined as CRP <2 and ≥2 mg/L at admission. The levels of 4-hydroxynonenal (4-HNE; a marker of oxidative stress formed by lipid peroxidation) and the expression of arginase-1 were visualized in rat aortas following incubation with RBCs by immunohistochemistry. All handling and procedures regarding human subjects and sampling were performed according to the Declaration of Helsinki. All animal experiments and procedures were performed according to the guidelines by the U.S National Institutes of Health (NIH publication no 85–23, revised 1996).

Results

RBCs from patients with STEMI and elevated CRP (≥2 mg/L, mean of 9.6 mg/L) induced significant impairment of endothelium-dependent relaxation compared to RBCs from patients with STEMI and low CRP (<2 mg/L, mean of 1.0 mg/L) and to the healthy controls (Fig. 1). Endothelium-independent relaxations did not differ between the groups. Immunohistochemical staining of the aorta revealed that incubation with RBCs from patients with STEMI and high CRP increased the expression of 4-HNE and arginase-1 compared to incubation of RBCs from healthy controls and patients with STEMI and low CRP (Fig. 2).

Conclusion

RBCs from patients with STEMI and elevated CRP induce endothelial dysfunction and increase the expression of 4-HNE and arginase-1, indicating that inflammation is involved in the mechanism by which RBCs induce endothelial dysfunction in STEMI.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Lung foundation

Maximally tolerated guideline-directed medical therapy and barriers to optimization in patients with heart failure with reduced ejection fraction: the COAPT trial

Background

The COAPT trial of MitraClip therapy employed a central screening eligibility committee (CSEC) of heart failure (HF) experts to ensure the use of maximally tolerated guideline-directed medical therapy (GDMT) and systematically document intolerances in all potential patients prior to approval for randomization.

Purpose

To describe the percentage of GDMT classes, doses tolerated, predictors of intolerance, and specific intolerances limiting GDMT among patients approved for randomization by the CSEC.

Methods

We analyzed baseline use, dose, and intolerances of i) angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) or angiotensin receptor neprilysin inhibitor (ARNI); ii) beta-blockers (BB); and iii) mineralocorticoid receptor antagonists (MRA) in the CSEC-approved COAPT population with HF with reduced ejection fraction (HFrEF; LVEF ≤40%). We analyzed variables associated with GDMT tolerance.

Results

In COAPT, 464 patients had HFrEF and complete screening medication information. Any dose of all 3, 2 or 1 GDMT classes were tolerated in 39%, 39% and 20% of patients respectively; only 2% of patients (n=9) could not tolerate any GDMT (Figure 1). BB were prescribed in the most (93%) patients followed by ACEI/ARB/ARNI (69%) and MRA (55%). Intolerances limiting each GDMT class differed, but hypotension and kidney dysfunction were most common (Figure 2). No patients tolerated goal doses of all 3 GDMT classes. For BB, only 32% tolerated ≥50% of the goal dose; while for ACEI/ARB/ARNI, no patients achieved goal doses, and only 1% tolerated ≥50% of the goal dose. For MRA, 86% of patients tolerated 25mg/day or less. Patients intolerant of BB were less likely to tolerate an ACEI/ARB/ARNI (OR 0.39, 95% CI 0.20–0.76; p=0.004) but not a MRA (p=0.21) compared with patients tolerating a low dose BB. Patients intolerant of MRA were less likely to tolerate ACEI/ARB/ARNI therapy (OR 0.37, 95% CI 0.25–0.57; p<0.0001) but not a BB (p=0.31) compared with patients tolerating MRA. Patients tolerating low dose ACEI/ARB/ARNI had a higher baseline mean eGFR (52±21 versus 40±21 ml/min/m2; p<0.0001) compared with patients intolerant of ACEI/ARB/ARNI. Likewise, patients tolerating MRA had a higher baseline mean eGFR (52±21 versus 42±21 ml/min/m2; p<0.0001) compared with patients intolerant of MRA.

Conclusion

In a contemporary trial in which HF specialists ensured GDMT optimization, many patients had medical intolerances prohibiting use of one or more GDMT classes, and few patients tolerated target doses. These findings indicate medical intolerances are the primary cause of low GDMT prescription rates in patients with moderate to severe HFrEF. Yet, use of GDMT in this very ill population was much better than “real world” registries of HFrEF suggesting that mandating careful CSEC review prior to study enrollment is important for clinical trials having the objective of randomizing a maximally treated patient cohort.

Funding Acknowledgement

Type of funding sources: None.

Overexpression of miR-210 ameliorates endothelial dysfunction in type 2 diabetic mice

Background

MicroRNA (miR)-210 plays a protective role in many cardiometabolic diseases, and its levels are reduced in whole blood, erythrocytes, and plasma in type 2 diabetes mellitus (T2DM). Our recent study demonstrated that miR-210 is downregulated in carotid artery plaques from patients with T2DM compared to non-diabetic patients. However, the functional role of miR-210 in endothelial dysfunction is not fully understood.

Purpose

This study aimed to investigate the potential therapeutic value of miR-210 overexpression against T2DM-associated endothelial dysfunction.

Methods

miR-210 transgenic mice (TG) at age of 8 weeks were subjected to Western Diet (WD) for 12 weeks. During the last 10 days of the diet regime, doxycycline or vehicle dissolved in drinking water was given to switch on miR-210 (miR-210/on) expression or keep it off (miR-210/off), respectively. Age-matched wild-type (WT) control mice received normal chow through the same period. Additionally, WT and T2DM db/db mice at age of 15–20 weeks received tail vein injections of miR-210 mimic or miR-210 scramble oligonucleotides. All animals were euthanized at the end of the treatment or 72h after the i.v. injections for determination of endothelial function by acetylcholine-induced endothelium-dependent relaxation (EDR) of isolated aortic segments from all groups of mice using wire myographs. The expression of protein tyrosine phosphatase 1B (PTP1B; a miR-210 target protein) and the levels of 4-hydroxynonenal (4-HNE; an oxidative stress marker) were measured in aortic segments by immunohistochemistry. All animal experiments and procedures were performed according to the guidelines by the U.S National Institutes of Health (NIH publication no 85–23, revised 1996).

Results

EDR in aortic segments from miR-210/off TG mice fed WD and T2DM db/db mice injected with miR-210 scramble was significantly impaired compared to vessels from WT controls fed with regular chow (Fig. 1A, B). Of note, EDR was markedly improved or even restored in aortae from miR-210/on TG mice treated with WD and T2DM db/db mice injected with miR-210 mimic (Fig. 1A, B). Furthermore, the expression of PTP1B and the levels of 4-HNE, which is formed by lipid peroxidation, were significantly elevated in the aortae from miR-210/off TG mice treated with WD when compared to WT controls (Fig. 2A–D). The expression was attenuated in aortae of miR-210/on TG mice treated with WD compared to miR-210/off TG mice (Fig. 2A–D). There was a significant increase in the expression of PTP1B and a trend to increased 4-HNE levels in aortae of db/db mice injected with miR-210 scramble vs. control mice (Fig. 2E–H). A significant reduction in PTP1B but not 4-HNE was observed in db/db mice injected with miR-210 mimic (Fig. 2E–H).

Conclusion

Genetic and pharmacological overexpression of miR-210 ameliorates endothelial dysfunction in mice fed with WD and db/db mice. Increasing miR-210 levels may become a potential treatment strategy.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Lung Foundation

Evolution and clinical implications of right ventricular dysfunction in ischemic cardiomyopathy with or without coronary artery bypass surgery

Background

The Surgical Treatment of Ischemic Heart Failure (STICH) trial demonstrated that coronary artery bypass grafting (CABG) provides additional survival benefits to patients with ischemic cardiomyopathy. However, it remains unclear whether this benefit is affected by preoperative right ventricular (RV) function and how post-therapeutic evolution of RV function influences long-term outcomes.

Purpose

We sought to investigate the implications of baseline RV function on therapeutic decision-making in patients with ischemic cardiomyopathy, and to evaluate the prognostic implications of post-therapeutic evolution of RV function.

Methods

Patients with available baseline echocardiographic RV function assessed by experienced Echocardiography Core Laboratory physicians were included from the hypothesis 1 of the STICH trial. The primary outcome was long-term all-cause mortality.

Results

A total of 1042 patients were included, among them 757 (72.7%) had normal RV function, 143 (13.7%) mild right ventricular dysfunction (RVD), and 142 (13.6%) moderate to severe RVD. After a median follow-up of 9.8 years, patients with RVD had a higher risk of all-cause mortality compared with patients with normal RV function [mild RVD: adjusted hazard ratio (aHR) 1.32; 95% confidence interval (CI) 1.06–1.64; moderate to severe RVD: aHR, 1.74; 95% CI 1.39–2.18]. Although no significant interaction was detected between RVD degree and treatment allocation (P for interaction = 0.399), a gradually decreasing survival benefit associated with CABG was observed among patients with normal RV function (aHR: 0.79; 95% CI: 0.65–0.96), mild RVD (aHR: 0.85; 95% CI: 0.56–1.29), and moderate to severe RVD (aHR: 0.97; 95% CI: 0.67–1.43). Among 746 patients with available RV function assessed at baseline and post-therapeutic 4-month follow-up, there was a gradient of increasing risk for all-cause mortality across patients with consistent normal RV function, recovery of RVD (aHR: 1.20; 95% CI: 0.88–1.64), newly developed RVD (aHR: 1.59; 95% CI: 1.18–2.14), and consistent RVD (aHR: 2.06; 95% CI: 1.60–2.67). Independent predictors of RVD recovery included baseline left ventricular ejection fraction (per 1-percent increment, adjusted odds ratio: 1.04; 95% CI: 1.00–1.09) and mitral regurgitation ≥ grade 2 (adjusted odds ratio: 0.42; 95% CI: 0.21–0.84).

Conclusions

Baseline RVD was associated with an increased risk of long-term mortality in patients with ischemic cardiomyopathy, and adding CABG to medical therapy might provide limited survival benefits in patients with moderate to severe RVD. A gradient of increasing risk for mortality was observed across different categories of RV function evolution, which emphasizes the necessity of pre- and post-therapeutic RV assessment for prognostic evaluation.

Funding Acknowledgement

Type of funding sources: None.

[Association of nutritional status with clinical outcomes of stroke patients with acute anterior circulation large vessel occlusion after emergency endovascular treatment]

OBJECTIVE

To explore the influence of nutritional status on 90-day functional outcomes of stroke patients with acute large vessel occlusion in the anterior circulation after endovascular treatment (EVT).

METHODS

We retrospectively analyzed the baseline, laboratory, surgical and 90-day follow-up data of patients with stroke resulting from acute large vessel occlusion in the anterior circulation, who underwent emergency endovascular treatment in our hospital from July, 2015 to December, 2020. A favorable outcome was defined as a modified Rankin scale score ≤2 at 90 days. Univariate and multivariate regression analyses were performed to explore the relationship between nutritional status and 90-day functional outcomes of the patients.

RESULTS

A total of 459 patients (mean age of 68.29±11.21 years, including 260 males) were enrolled in this study. According to their prognostic nutritional index (PNI), the patients were divided into normal nutrition group (392 cases, 85.4%), moderate malnutrition group (44 cases, 9.6%), and severe malnutrition group (23 cases, 5.0%). Univariate analysis showed that the patients with good clinical outcomes had a lower proportion of malnutrition with a younger age, a lower rate of diabetes, lower baseline blood pressure, lower baseline NIHSS score, higher baseline ASPECT score, and higher rates of good collateral circulation and complete vascular recanalization. Multivariate analysis showed that in addition to age, diabetes, baseline systolic blood pressure, successful recanalization, baseline ASPECT score, baseline NIHSS score and collateral circulation, a greater PNI was a protective factor for a good 90-day outcome of patients after EVT (moderate vs severe: OR=0.245, 95% CI: 0.066-0.908, P=0.035; normal vs severe: OR=0.185, 95% CI: 0.059-0.581, P=0.004).

CONCLUSION

Nutritional status an important factor affecting the 90-day outcomes after EVT of stroke patients with acute large vessel occlusion in the anterior circulation.

[Determination of chlorobenzene metabolite-p-chlorophenol in urine by solid phase extraction-gas chromatography]

Objective: A method to determine chlorobenzene metabolite-p-chlorophenol in urine by solid phase extraction-gas chromatography was established. Methods: In May 2021, the urine sample was hydrolyzed at 100 ℃ for 1.5 h with 2 ml concentrated hydrochloric acid. After cooling and filtering, the sample was enriched and purified by Oasis(®)MAX 6cc SPE column. Drip washing with 0.01 mol/L hydrochloric acid solution and elution with acetonitrile, the eluent was volumized to 5 ml with acetonitrile and determined by gas chromatography, and quantify by standard curve method. Results: Calibration curve of the method was linear within the range of 1.61-80.30 μg/ml and showed good linearity with r=0.9997, the regression equation was y=1.51602x-0.10234. The determination limit was 0.17 μg/ml, and the limit of quantitation was 0.55 μg/ml. Recovery rates were between 89.3%-104.4%, the relative standard deviation (RSD) of intra-day measurements ranged from 4.3% to 6.7%, and the RSD of inter-day measurements ranged from 4.5% to 6.7%. Conclusion: This method could optimize sample pretreatment, and eliminate the interference of impurities, which is sensitive, efficient and accurate for the determination of chlorobenzene metabolite-p-chlorophenol in urine.

[Cardiovascular biomarkers improve precise risk assessment for cardiovascular diseases]

Cardiovascular diseases (CVD) is an urgent threat to Chinese. It is of primary importance to assess risk for cardiovascular diseases. However, there are some limitations about traditional tools for CVD risk assessment. Recently, numbers of clinical trials demonstrated that CVD risk assessments based on cardiovascular biomarkers would significantly improve sensitivity and specificity of prediction. The comment review the limitations of traditional tools for CVD risk assessment, the application value of novel tools and advances of cardiovascular biomarkers in CVD prediction. It is benefit for precise stratification and management of general population during risk stage. Archieving the strategic goal of"Healthy China"would be promising soon.