Cytokine storm syndrome in coronavirus disease 2019: A narrative review

Cytokine storm syndrome (CSS) is a critical clinical condition induced by a cascade of cytokine activation, characterized by overwhelming systemic inflammation, hyperferritinaemia, haemodynamic instability and multiple organ failure (MOF). At the end of 2019, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, and rapidly developed into a global pandemic. More and more evidence shows that there is a dramatic increase of inflammatory cytokines in patients with COVID-19, suggesting the existence of cytokine storm in some critical illness patients. Here, we summarize the pathogenesis, clinical manifestation of CSS, and highlight the current understanding about the recognition and potential therapeutic options of CSS in COVID-19.

A Robust Flow-Through Platform for Organic Contaminant Removal

Achieving the greatest cleanup efficiency with minimal footprint remains a paramount goal of the water treatment industry. Toxic organic compounds threaten drinking water safety and require effective pretreatment. Hydroxyl radicals produced by the Fenton process (Fe2+/H2O2) destroy organic contaminants based on their strong oxidation potential. An upgraded reaction using solid catalysts, referred to as the Fenton-like process, was recently adopted to avoid the ferric sludge generation during the conventional Fenton process. However, most heterogeneous Fenton-like catalysts operate optimally at pH 3-5 and quite weakly in near-neutral water bodies. Here, we evaluate the feasibility of an electrolytically localized acid compartment (referred to as the Ella process) produced by electrochemical water splitting under flow-through conditions to facilitate the Fenton-like process. The Ella process boosts the activity of an immobilized iron oxychloride catalyst >10-fold, decomposing organic pollutants at a high flow rate. The robust performance in complex water bodies further highlights the promise of this platform.

Position of the Benzene Ring Substituent Regulates the Excited-State Deactivation Process of the Benzyluracil Systems

A systematic theoretical study of the regulating effect of the substituent position on the photoinduced deactivation process of the benzyluracil systems has been performed based on the high-level static electronic structure calculations and on-the-fly full-dimensional excited-state dynamics simulations. Similarities and differences coexist for the two systems by comparative studies on the photoinduced deactivation process of the 5-benzyluracil (5-BU) and 6-benzyluracil (6-BU) systems. They both obey an S₂ → S₁ → S₀ two-step decay pattern, and the decay coordinates of the S₂ → S₁ and S₁ → S₀ processes are mainly driven by the elongation of the bridging bond and the out-of-plane ring deformation motion, respectively. However, the puckering motion occurring at the C2 atom in the uracil fragment dominates the decay pathway of the 5-BU system. On the contrary, the puckering motion at the C5 atom in the benzene fragment mainly drives the decay coordinate of the 6-BU system. Therefore, the substituent position could play significant roles in the deactivation process of the benzyluracil systems. Moreover, the S₁ → S₀ decay process of the 6-BU system consists of five pathways, possessing a more complex deactivation picture than the 5-BU system. The fitted time scale of the puckering motion is compatible with the experimentally observed lifetimes. This work provides a fundamental understanding of the photophysical and photochemical properties of the benzyluracil systems and can give rational suggestions to further design or regulate the bionic molecular systems.

[The problems and countermeasures in the training of public health talents in colleges and universities in China]

Colleges and universities are the cradle for public health talents training. Under the epidemic situation, the new requirements for the construction of public health service system and the promotion of population health, urged us to rethink how to reform the training of public health talents in colleges and universities. This research focused on key problems of the construction and distribution, scale, orientation, and contents of training for various public health talents in colleges and universities. It was suggested to reinforce the balanced development of public health in colleges and universities in various areas in China, to refine interdisciplinary training, to intensively cultivate technical and research-oriented talents, to expand talents within and outside the colleges and universities, as well as to introduce and cultivate public health teachers simultaneously, so as to better play the role of colleges and universities in the training of the public health talents.

HSP70 inhibits pig pituitary gonadotrophin synthesis and secretion by regulating the corticotropin-releasing hormone signaling pathway and targeting SMAD3

High levels or long periods of stress have been shown to negatively impact cell homeostasis, including with respect to abnormalities in domestic animal reproduction, which are typically activated through the hypothalamus-pituitary-adrenal axis, in which corticotropin-releasing hormone (CRH) and heat shock protein 70 (HSP70) are involved. In addition, CRH has been reported to inhibit pituitary gonadotrophin synthesis, and HSP70 is expressed in the pituitary gland. The aim of this study was to determine whether HSP70 was involved in regulating gonadotrophin synthesis and secretion by mediating the CRH pathway in the porcine pituitary gland. Our results showed that HSP70 was highly expressed in the porcine pituitary gland, with over 90% of gonadotrophic cells testing HSP70 positive. The results of functional studies demonstrated that the HSP70 inducer decreased FSH and LH levels in cultured porcine primary pituitary cells, whereas an HSP70 inhibitor blocked the negative effect of CRH on gonadotrophin synthesis and secretion. Furthermore, our results demonstrated that HSP70 inhibited gonadotrophin synthesis and secretion by blocking GnRH-induced SMAD3 phosphorylation, which acts as the targeting molecule of HSP70, while CRH upregulated HSP70 expression through the PKC and ERK pathways. Collectively, these data demonstrate that HSP70 inhibits pituitary gonadotrophin synthesis and secretion by regulating the CRH signaling pathway and inhibiting SMAD3 phosphorylation, which are important for our understanding the mechanisms of the stress affects domestic animal reproductive functions.

GALNT10 promotes the proliferation and metastatic ability of gastric cancer and reduces 5-fluorouracil sensitivity by activating HOXD13

OBJECTIVE

To investigate the expression and potential mechanism of GALNT10 in gastric cancer (GC).

PATIENTS AND METHODS

A total of 60 cases of GC tissues, as well as normal tissues were collected. The total RNA of GC specimens and cells were extracted by TRIzol method and the level of GALNT10 was examined by quantitative real-time polymerase chain reaction (qRT-PCR). In addition, the relationship between GALNT10 and clinical parameters and prognosis of GC patients was analyzed. Subsequently, Lentivirus was used to construct GALNT10 knockdown GC cell lines, and cell counting kit-8 (CCK-8) and transwell assays were applied to analyze the influence of GALNT10 on GC cell function. Bioinformatics and Luciferase assay was used to evaluate the relationship between GALNT10 and HOXD13. Furthermore, 5-fluorouracil (5-Fu)-resistant cells were used to detect the relationship between GALNT10 and 5-Fu sensitivity of GC cells.

RESULTS

qRT-PCR results revealed that GALNT10 level was markedly increased in tissues, as well as cell lines of GC. Statistical analysis suggested that GALNT10 expression was in close relation with the incidence of lymph node and distant metastasis along with poor prognosis in GC patients, but not with other indicators. CCK-8 and transwell migration experiment results indicated that GALNT10 silencing can inhibit the proliferative and migration ability of GC cells. Western blot results displayed that the HOXD13 level was remarkably decreased after GALNT10 knocking down. In addition, Luciferase gene assay indicated that GALNT10 could bind to HOXD13. Further rescue experiments showed that HOXD13overexpression can synergistically reverse the inhibitory effect of GALNT10 knockdown on GC cell proliferative and migration ability, which further demonstrated that GALNT10 could promote GC cell metastasis ability and reduce the sensitivity to 5-Fu by regulating HOXD13.

CONCLUSIONS

GALNT10 could regulate the proliferative and migration ability of GC cells and reduce the sensitivity to 5-Fu by enhancing the expression of HOXD13. Therefore, GALNT10 was expected to be a new therapeutic target for diagnosis of 5-fluorouracil resistance in GC.

Nomogram predicting early neurological improvement in ischaemic stroke patients treated with endovascular thrombectomy

BACKGROUND AND PURPOSE

Early neurological improvement (ENI) after endovascular thrombectomy (EVT) has been associated with favorable outcomes. This study aimed to identify the optimal definition of ENI and develop a nomogram for predicting ENI after EVT in acute ischaemic stroke.

METHODS

Patients with EVT were enrolled from a multicenter registry as the training cohort. The receiver operating characteristic curve was used to estimate the optimal threshold for ENI at 24 h of EVT. Logistic regression analysis was utilized to generate the best-fit nomogram for predicting ENI. The discrimination of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC). An additional 447 patients from two stroke centers were prospectively recruited as the test cohort for validating the nomogram.

RESULTS

A total of 612 patients with EVT were included in the training cohort. The optimal threshold for predicting 3-month favorable outcome (modified Rankin Scale 0-2) was an improvement of the National Institutes of Health Stroke Scale (NIHSS) score by ≥6 points (AUC 0.875; sensitivity 79.5%; specificity 90.7%). Age, blood glucose, recanalization, symptomatic intracranial hemorrhage (sICH) and baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were independently associated with ENI, and were incorporated in the nomogram. The AUC of the nomogram was 0.795 in the training cohort and 0.752 in the test cohort.

CONCLUSIONS

A reduction of NIHSS score ≥6 appeared to be the optimal definition of ENI. The nomogram composed of age, blood glucose, recanalization, sICH and baseline ASPECTS may predict the probability of ENI in ischaemic stroke patients treated with EVT.

Fast Heat Transport Inside Lithium-Sulfur Batteries Promotes Their Safety and Electrochemical Performance

Lithium-sulfur batteries are paid much attention owing to their high specific capacity and energy density. However, their practical applications are impeded by poor electrochemical performance due to the dissolved polysulfides. The concentration of soluble polysulfides has a linear relationship with the internal heat generation. The issue of heat transport inside lithium-sulfur batteries is often overlooked. Here, we designed a functional separator that not only had a high thermal conductivity of 0.65 W m⁻¹ K⁻¹ but also alleviated the diffusion of dissolved active materials to the lithium anode, improving the electrochemical performance and safety issue. Lithium-sulfur batteries with the functional separator have a specific capacity of 1,126.4 mAh g⁻¹ at 0.2 C, and the specific capacity can be remained up to 893.5 mAh g⁻¹ after 100 cycles. Pouch Cells with high sulfur loading also showed a good electrochemical performance under a lean electrolyte condition of electrolyte/sulfur (E/S) = 3 μL mg⁻¹.

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Fast heat transport inside Li-S batteries was designed by a simple method

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Pouch cells showed a good electrochemical performance under a lean electrolyte condition

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In situ 2D XANES was conducted to explore the mechanism of Li-S batteries

Pozzolanic and mechanical properties of Date Palm Seed Ash (Dpsa) concrete

This paper presents the findings of a research work conducted on how to improve the mechanical properties of concrete using Date Palm Seed Ash (DPSA) as partial replacement of cement. The DPSA used was obtained by controlled burning of date palm seed in a kiln at a maximum temperature of 630oC for eight hours and air cooled afterwards. The ash obtained was sieved through 75μm sieve and its oxide composition analysed using X-ray fluorescence (XRF) procedures. DoE method of mix design was used to produce concrete ingredients for grade 30N/mm2 giving a water-cement ratio of 0.53. The effect of partial replacement of cement with DPSA on cement paste and concrete using 0, 2.5, 5, 7.5, 10, 15 and 20% DPSA was investigated through consistency and setting times tests, workability test, compressive strength test (at 7, 21, 28 and 56 days curing duration), pozzolanic activity index evaluation and water absorption test. Results show that DPSA has high silicon dioxide (45.50%), aluminum oxide (20.75%) and Iron oxide (7.25%). Findings indicate that the consistency and setting times of cement-DPSA paste increased with increase in the replacement of cement with DPSA. The workability of DPSA concrete decreased with increase in cement replacement. Compressive strength test results show that cement can be replaced with DPSA up to 10% as the compressive strength at 10% replacement is 31.5N/mm2 as against the 31N/mm2 of the normal concrete, at 56 days. The pozzolanic activity index result also show that DPSA concrete meets up the minimum requirement of 75% specified by ASTM C618-15. Also, the water absorption capacity of DPSA concrete at the highest replacement (20%) is 11% less than that at 0%. Keywords: Cement, Compressive strength, Concrete, Date palm seed ash, Partial replacement, Pozzolana

[Meta-analysis of the effects of dexmedetomidine combined with ketamine during dressing changes in burn patients]

Objective: To systematically evaluate the safety and efficacy of dexmedetomidine combined with ketamine during dressing changes in burn patients using meta-analysis. Methods: Foreign language databases including PubMed, Cochrane Central, Embase, and Web of Science were searched with the terms of " burns, dexmedetomidine, ketamine, and dressing" , and Chinese databases including Chinese Journal Full-Text Database, Wanfang Data, and China Academic Journal Network Publishing Database were searched with the terms in Chinese version of ",,,,," to retrieve the publicly published randomized controlled trials on the application of dexmedetomidine combined with ketamine for sedation and analgesia during dressing changes in burn patients from the establishment of each database to March 2019. The outcome indexes included systolic blood pressure at 5 minutes after administration, arousal restlessness score, ketamine dosage, dressing change time, body movement/recovery time, pain score, Ramsay sedation scores at 10 minutes after the start of dressing change and 1 hour after dressing change, physician satisfaction score, neuropsychological symptoms, nausea and vomiting times, nausea and vomiting score. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results: A total of 396 burn patients were included in 7 articles, including 198 patients in dexmedetomidine+ ketamine group who received dexmedetomidine and ketamine for sedation and analgesia, and 198 patients in ketamine alone group who received ketamine alone for sedation and analgesia. The bias risks of the seven studies included were uncertain. Compared with those of ketamine alone group, the systolic blood pressure at 5 minutes after administration, arousal restlessness score, nausea and vomiting score of patients in dexmedetomidine+ ketamine group were significantly decreased, with standardized mean differences of -13.89, -0.84, and -0.99 (95% confidence interval=-20.89--6.89, -1.17--0.52, -1.31--0.68, P<0.01), the Ramsay sedation score at 10 minutes after the start of dressing change and that at 1 hour after dressing change were significantly increased, with standardized mean differences of 1.53 and 0.72 (95% confidence interval=1.05-2.02, 0.13-1.31, P<0.05 or P<0.01), and the number of neuropsychological symptom and number of nausea and vomiting were significantly reduced, with relative risks of 0.20 and 0.16 (95% confidence interval=0.07-0.58, 0.05-0.58, P<0.01). The patients in the two groups were similar in ketamine dosage, dressing change time, body movement/recovery time, pain score, and physician satisfaction score. There was no publication bias in dressing change time or ketamine dosage (P>0.05), while the other indexes might have publication bias (P<0.05). Conclusions: Compared with ketamine alone, combination of dexmedetomidine and ketamine during dressing changes in burn patients can reduce the occurrence of restlessness, nausea and vomiting, neuropsychological symptoms, and other complications, better stabilize blood pressure, and enhance sedation effect.

Sacrificial Poly(propylene carbonate) Membrane for Dispersing Nanoparticles and Preparing Artificial Solid Electrolyte Interphase on Li Metal Anode

Lithium-metal batteries have been regarded as next-generation high-energy-density candidates beyond lithium-ion batteries. However, the lithium-morphology instabilities accompanied by continuous side reactions with electrolytes inevitably leads to dissatisfactory performances and even safety issues, where the unstable interface between lithium-metal anode and electrolytes has been regarded as the root cause. Artificial solid electrolyte interphase engineering has attracted a lot of attention to stabilize lithium-metal anodes. Here, a novel method with universality is reported to produce the organic-inorganic artificial solid electrolyte interphase. Using poly(propylene carbonate) as a sacrificial matrix, nanoparticles are dispersed on lithium-metal anodes surface uniformly to prepare artificial solid electrolyte interphase, where poly(propylene carbonate) turns into liquid propylene carbonate upon contact with lithium-metal anode. Silicon, Li_1.5Al_0.5Ge_1.5(PO₄)₃, or Li_1.4Al_0.4Ti_1.6(PO₄)₃ nanoparticles are coated to suppress lithium-morphology instabilities and demonstrated ∼4 times longer cycle life. Preparing various organic/inorganic artificial solid electrolyte interphase is feasible by introducing various components in the fabrication process of poly(propylene carbonate) membrane, endowing this approach with huge potential in the research of artificial solid electrolyte interphase.

AB0919 WHAT IS LOWER EXTREMITY ENTHESEAL INVOLVEMENT IN ACUTE GOUT ATTACK? AN ULTRASOUND-STUDY

Background:

Articular involvement in acute gout attack is extremely common and mainly characterized by arthritis, which are usually transient, severe, reversible and well responsive to treatment. The involvement of tendons and entheses in lower extremity in monosodium urate-related disease through US (ultrasound) assessment have been described1,2. US findings in gout raising the hypothesis that entheseal involvement could be a missing target in the clinical evaluation of gout patients.

Objectives:

To evaluate by ultrasound (US) the frequency and characteristics of lower extremity entheseal involvement in acute gout attack patients.

Methods:

US assessment were performed by independent rheumatologist on 31 patients with acute gout attack. Presence of lower extremity entheseal involvement were evaluated by grey-scale (GS) and power Doppler (PD). US assessment contain quadriceps, patellar and Achilles tendons, and plantar fascia entheses according to the OMERACT definitions.

Results:

US revealed one or more abnormalities in at least one enthesis in 22 out of 31 gout patients (71.0%) and 47 out of 310 entheses (15.2%). Among the affected entheses, the patellar insertion of quadriceps tendon was most commonly involved (57.4%) during acute gout attack, followed by the calcaneal insertion of the Achilles tendon (17.0%) and distal insertion of the patellar tendon (14.9%). The proximal insertion of the patellar tendon and calcaneal insertion of the plantar fascia were involved in 8.5% and 2.1%, respectively. Bone erosions and osteophytes were found in affected entheses (10.6% and 25.5%, respectively).

Conclusion:

Our study identifies that lower extremity entheseal involvement is a missing target in the evaluation of patients with acute gout attack. US plays a key role in the assessment of both clinical and subclinical enthesitis in gout patients.

References:

[1]Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and Tendon Subclinical Involvement Suggestive of Gouty Arthritis in Asymptomatic Hyperuricemia: an Ultrasound Controlled Study.J Rheumatol.2011;38(6):1195-1195.

[2]Carroll M, Dalbeth N, Allen B, et al. Ultrasound Characteristics of the Achilles Tendon in Tophaceous Gout: A Comparison with Age- and Sex-matched Controls.J Rheumatol.2017;44(10):1487-1492.

Disclosure of Interests:

None declared

[A case of chronic ulcer with ectopic ossification in lower right extremity]

On January 1st, 2019, one male patient, aged 55 years, with chronic ulcer in right lower extremity was admitted to Northern Jiangsu People's Hospital. After admission, ulcer debridement and vacuum sealing drainage (VSD) surgery was performed in lower right extremity. Two pieces of bone-like tissue was removed from the lateral space between the Achilles tendon and fibula in the right leg, which was confirmed as ossification tissue by histopathological sections after surgery. The wounds were treated with VSD technique and dressing changes. On the 49th day after surgery, split-thickness skin graft was taken from the lateral left thigh and grafted to the wound area, which was then treated with VSD. The skin graft of patient survived well. The wound healed completely and the patient was discharged from hospital on day 77 post hospitalization. This case suggests that the patients with chronic ulcer should complete all related examinations in time, and improving the blood circulation of the wound and clearing the ectopic ossification in the wound are critical for wound healing.

20-Hydroxyecdysone receptor-activated Bombyx mori CCAAT/enhancer-binding protein gamma regulates the expression of BmCBP and subsequent histone H3 lysine 27 acetylation in Bo. mori

Cyclic adenosine monophosphate (cAMP) response element binding protein (CREB)-binding protein (CBP or CREBBP) plays important roles in regulating gene transcription and animal development. However, the process by which CBP is up-regulated to impact insect development is unknown. In this study, the regulatory mechanism of Bombyx mori CBP (BmCBP) expression induced by 20-hydroxyecdysone (20E) was investigated. In the Bo. mori cell line, DZNU-Bm-12, 20E enhanced BmCBP transcription and histone H3K27 acetylation. BmCBP RNA interference (RNAi) resulted in decreased histone H3K27 acetylation. Additionally, the luciferase activity analysis revealed that the transcription factor, Bo. mori CCAAT/enhancer-binding protein gamma (BmC/EBPg), activated BmCBP transcription, which was suppressed by BmC/EBPg RNAi and promoted by BmC/EBPg overexpression. Electrophoretic mobility shift assay and chromatin immunoprecipitation results demonstrated that BmC/EBPg could bind to the C/EBP cis-regulatory elements in two positions of the BmCBP promoter. Moreover, BmC/EBPg transcription was enhanced by the 20E receptor (BmEcR), which bound to the BmC/EBPg promoter. BmEcR RNAi significantly inhibited the transcriptional levels of BmC/EBPg and BmCBP in the presence of 20E. Furthermore, the BmEcR-BmC/EBPg pathway regulated the acetylation levels of histone H3K27. Altogether, these results indicate that BmEcR enhances the expression of BmC/EBPg, which binds to the BmCBP promoter, activates BmCBP expression and leads to histone H3K27 acetylation.

RUNX1-activated upregulation of lncRNA RNCR3 promotes cell proliferation, invasion, and suppresses apoptosis in colorectal cancer via miR-1301-3p/AKT1 axis in vitro and in vivo

PURPOSE

Long non-coding RNAs (lncRNAs) have participated in progression of colorectal cancer. This study aims to study the role of RUNX1/RNCR3/miR-1301-3p/AKT1 axis in colorectal cancer.

METHODS

The cancer tissues were from patients with colorectal cancer. The qRT-PCR was used to determine expression of lncRNA RNCR3, miR-1301-3p, and AKT1. Both dual-luciferase reporter assay and ChIP assay were conducted to investigate the binding sites of RUNX1 on RNCR3 promoter. Western blot was performed to analyze expression of AKT1 protein. Both dual-luciferase reporter assay and RIP assay were performed to detect the interacting sites between RNCR3 and miR-1301-3p. The CCK-8 assay, soft agar assay, transwell assay, and annexin-V-FITC/PI staining were applied to analyze the cell growth, invasion, and apoptosis, respectively.

RESULTS

The data demonstrated that RNCR3 was elevated in colorectal cancer, and it was negatively correlated with expression of miR-1301-3p which was decreased in cancers. Then, RNCR3 could interact with and suppress miR-1301-3p expression in HCT116 and SW480. Knockdown of RNCR3 or miR-1301-3p overexpression significantly inhibited cell growth, invasion, and increased apoptosis through suppressing expression of Cyclin A1, PCNA, N-cadherin, Bcl-2, and promoting expression of E-cadherin, Bax in vitro and in vivo. RUNX1 was directly bound to RNCR3 promoter to activate RNCR3 expression. Furthermore, overexpression of RNCR3 blocked tumor inhibitory effects of miR-1301-3p on proliferation, colony formation, invasion, and apoptosis in vitro and in vivo. Additionally, RNCR3 and miR-1301-3p synergistically modulated AKT1 expression.

CONCLUSION

RUNX1-activated upregulation of RNCR3 promoted colorectal cancer progression by sponging miR-1301-3p to elevate AKT1 levels in vitro and in vivo.

Temporal and spatial expression of Sox9, Pax1, TGF-β1 and type I and II collagen in human intervertebral disc development

PURPOSE

An accurate understanding of cellular biochemical changes in human intervertebral disc (IVD)s and the corresponding mechanisms during the developmental process still remain unknown and important for investigating the function of critical factors in normal IVD development as well as ascertaining the therapeutic targets for the IVD degeneration.

METHODS

Under ethical conditions, human fetal cervical IVDs at 4, 5, and 6 months of pregnancy were collected at abortion surgery. Normal adult human C3-C7 cervical IVDs were taken from cadaveric donors. Sox9, Pax1, TGF-β1 and type I/II collagen protein and RNA were detected. The number of positive cells was counted to calculate the optical density value for each factor.

RESULTS

Sox9, Pax1, and TGF-β1 expression in the IVD was remarkably reduced with the developmental stage. The location of high expression of Sox9, Pax1, and TGF-β1 changed with the developmental stage, and migrated from the nucleus pulposus to the annulus fibrosus and endplate. Higher Sox9, Pax1, and TGF-β1 expression was finally observed around the sclerotome of the vertebral body. The anabolism of type I/II collagens is significantly increased in the IVD in the mid-trimester fetus.

CONCLUSIONS

Sox9, Pax1 and TGF-β1 participate in the developmental process of the human IVD and vertebral body. However, these factors show a separate expression of mRNA and protein, suggesting that they are expressed in the strict time and spatial order.

Uric acid level and risk of symptomatic intracranial haemorrhage in ischaemic stroke treated with endovascular treatment

BACKGROUND AND PURPOSE

There are limited data on the association between uric acid (UA) and symptomatic intracranial haemorrhage (SICH) in patients who have undergone mechanical thrombectomy [endovascular treatment (EVT)]. In the present study, we aimed to investigate the role of serum UA level in SICH after EVT in a real-world practice.

METHODS

Patients were selected from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke (ACTUAL) registry. SICH was identified using the Heidelberg Bleeding Classification. Multivariable logistic regression analysis was performed to explore the relationship between serum UA and SICH.

RESULTS

Among 611 enrolled patients, 90 (14.7%) were diagnosed with SICH within 72 h after EVT. Patients with SICH had a significantly higher level of serum UA (median, 341.0 vs. 302.0 μmol/L; P = 0.003) than those without SICH. Univariate logistic regression analysis indicated that patients with UA levels in the fourth quartile, compared with the first quartile, were more likely to have SICH (odds ratio, 2.846; 95% confidence intervals, 1.429-6.003; P = 0.003). The association remained significant after multivariable adjustment for potential confounders. Furthermore, the multiple-adjusted spline regression model showed an inverted U-shaped association between UA and SICH (P = 0.047 for non-linearity).

CONCLUSION

Our study indicated that increased serum UA level was independently associated with SICH after EVT in acute ischaemic stroke.