[Analysis of the effects of low/intermediate dose of coagulation factor Ⅷ on 30 adult patients with severe hemophilia A in a single center]

Objective: To evaluate the clinical effects of low- and intermediate-dose factor Ⅷ (F Ⅷ) prophylaxis in Chinese adult patients with severe hemophilia A. Methods: Thirty adult patients with severe hemophilia A who received low- (n=20) /intermediate-dose (n=10) F Ⅷ prophylaxis at Nanjing Drum Tower Hospital affiliated with Nanjing University Medical College were included in the study. The annual bleeding rate (ABR), annual joint bleeding rate (AJBR), number of target joints, functional independence score of hemophilia (FISH), quality of life score, and health status score (SF-36) before and after preventive treatment were retrospectively analyzed and compared. Results: The median follow-up was 48 months. Compared with on-demand treatment, low- and intermediate-dose prophylaxis significantly reduced ABR, AJBR, and the number of target joints (P<0.05) ; the improvement in the intermediate-dose prophylaxis group was better than that in the low-dose prophylaxis group (P<0.05). Compared with on-demand treatment, the FISH score, quality of life score, and SF-36 score significantly improved in both groups (P<0.05), but there was no significant difference between the two groups (P>0.05) . Conclusion: In Chinese adults with severe hemophilia A, low- and intermediate-dose prophylaxis can significantly reduce bleeding frequency, delay the progression of joint lesions, and improve the quality of life of patients as compared with on-demand treatment. The improvement in clinical bleeding was better with intermediate-dose prophylaxis than low-dose prophylaxis.

Automated Estimation of Quantitative Lesion Water Uptake as a Prognostic Biomarker for Patients with Ischemic Stroke and Large-Vessel Occlusion

BACKGROUND AND PURPOSE

Net water uptake is qualified as an imaging marker of brain edema. We aimed to investigate the ability of net water uptake to predict 90-day functional outcome in patients with acute ischemic stroke and large-vessel occlusion.

MATERIALS AND METHODS

A total of 295 consecutive patients were retrospectively enrolled. Automated ASPECTS-net water uptake was calculated on the admission CT. The relationship between ASPECTS-net water uptake and 90-day neurologic outcome was assessed. The independent predictors of favorable outcome (mRS score ≤2) were assessed using multivariate logistic regression analysis and receiver operating characteristic curves and stratified by the ASPECTS.

RESULTS

Favorable 90-day outcomes were observed in 156 (52.9%) patients. ASPECTS-net water uptake (OR, 0.79; 95% CI, 0.70-0.90), NIHSS scores (OR, 0.91; 95% CI, 0.87-0.96), age (OR, 0.96; 95% CI, 0.94-0.99), and vessel recanalization (OR, 7.78; 95% CI, 3.96-15.29) were independently associated with favorable outcomes at 90 days (all, P < .01). A lower ASPECTS-net water uptake independently predicted a good prognosis, even in the subgroup of patients with low ASPECTS (≤5) (P < .05). An outcome-prediction model based on these variables yielded an area under the receiver operating characteristic curve of 0.856 (95% CI, 0.814-0.899; sensitivity, 76.3%; specificity, 81.3%).

CONCLUSIONS

ASPECTS-net water uptake could independently predict 90-day neurologic outcomes in patients with acute ischemic stroke and large-vessel occlusion. Integrating ASPECTS-net water uptake with clinical models could improve the efficiency of outcome stratification.

Vascular epiphyte populations with higher leaf nutrient concentrations showed weaker resilience to an extreme drought in a montane cloud forest

Leaf stoichiometry can characterize plant ecological strategies and correlate with plant responses to climate change. The role of vascular epiphytes in the ecosystem processes of tropical and subtropical forest ecosystems cannot be ignored. Vascular epiphytes are very vulnerable to climate change, however, the relationship between the response of epiphytes to climate change and leaf stoichiometry is not well understood. We present data for 19 vascular epiphyte species that were collected during four consecutive censuses (in 2005, 2010, 2015, and 2020) over 15 years in a subtropical montane cloud forest. We assessed the relationships between the population dynamics and leaf stoichiometry of these vascular epiphytes. Experiencing an extreme drought, 14 of the 19 epiphyte species showed an obvious decrease in the number of individuals, and all species showed negative growth in the number of populations. Subsequently, the total number of individuals gradually recovered, increasing from 7,195 in 2010 to 10,121 in 2015, then to 13,667 in 2020. The increase in the number of vascular epiphyte individuals from 2010 to 2015 was significantly negatively correlated with leaf nitrogen and phosphorus concentration, and was significantly positively correlated with the leaf carbon-nitrogen ratio. Vascular epiphyte populations with higher leaf nutrient concentrations exhibited weaker resilience to the extreme drought, which demonstrated that a resource-conservative strategy was advantageous for the recovery of epiphyte populations. Our findings suggest that ecological stoichiometry can be a useful framework for forecasting the dynamics of vascular epiphyte populations in response to climate change.

Application value of transcranial contrast-enhanced ultrasonography in evaluating middle cerebral artery stenosis

OBJECTIVE

To detect the display rate and flow velocity of intracranial circle of Willis (anterior, middle, and posterior cerebral arteries) with transcranial contrast-enhanced transcranial color-coded sonography (CE-TCCS), using digital subtraction angiography (DSA) as the golden diagnostic standard.

PATIENTS AND METHODS

We collected data from 104 patients with suspected stroke treated in our hospital between December 2019 and October 2021. The detection rate of the intracranial circle of Willis, anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were analyzed based on routine TCCS and CE-TCCS data. Based on digital subtraction angiography (DSA) data, the degree of MCA stenosis was divided into mild stenosis (<50%), moderate stenosis (50-69%), severe stenosis (70-99%), and bilateral middle cerebral artery CE-TCCS examinations were performed. We evaluated MCA color blood flow on CE-TCCS, and recorded the peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean flow velocity (MFV).

RESULTS

The display rates of ACA, MCA, and PCA were significantly improved on the CE-TCCS, and the PSV, EDV and MFV of the MCA stenosis group were higher than those of the normal group. The flow velocity of each stenosis subgroup was increased compared to the normal group. The optimal cutoff values of normal and stenosis under the receiver operating characteristic (ROC) curve were PSV = 168.5 cm/s, EDV = 61.5 cm/s, and MFV = 110.5 cm/s. The optimal cutoff values for mild and moderate stenosis and for moderate and severe stenosis were PSV = 201.5 cm/s and 249.5 m/s, EDV = 95.2 cm/s and 141.5 cm/s, and MFV = 137.6 cm/s and 160.5 cm/s, respectively. PSV and MFV had the most significant sensitivity, specificity, and accuracy.

CONCLUSIONS

Transcranial contrast-enhanced ultrasonography can improve the display rate of intracranial blood vessels and can accurately diagnose MCA stenosis.

Increased Dietary Niacin Intake Improves Muscle Strength, Quality, and Glucose Homeostasis in Adults over 40 Years of Age

BACKGROUND AND AIMS

Age-related loss of skeletal muscle mass and strength begins at 40 years of age, and limited evidence suggests that niacin supplementation increases levels of nicotinamide adenine dinucleotide in mouse muscle tissue. In addition, skeletal muscle has a key role in the body's processing of glucose. Therefore, this study aimed to investigate the relationship between dietary niacin and skeletal muscle mass, strength, and glucose homeostasis in people aged 40 years and older.

METHODS

This study was an American population-based cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES). Considering that some outcomes are only measured in specific survey cycles and subsamples, we established three data sets: a grip strength dataset (2011-2014, n=3772), a body mass components dataset (2011-2018, n=3279), and a glucose homeostasis dataset (1999-2018, n=9189). Dietary niacin and covariates were measured in all survey cycles. Linear regression or logistic regression models that adjusted for several main covariates, such as physical activity and diet, was used to evaluate the relationship between dietary niacin and grip strength, total lean mass, appendicular lean mass, total fat, trunk fat, total bone mineral content, homeostasis model assessment of insulin resistance (HOMA-IR), fasting blood glycose, fasting insulin and sarcopenia risk. Subgroup analyses, a trend test, an interaction test, and a restricted cubic spline were used for further exploration.

RESULTS

Higher dietary niacin intake was significantly correlated with higher grip strength (β 0.275, 95% confidence intervals [CI] 0.192-0.357), higher total lean mass (β 0.060, 95% CI 0.045-0.074), higher appendicular lean mass (β 0.025, 95% CI 0.018-0.033), and higher total bone mineral content (β 0.005, 95% CI 0.004-0.007). By contrast, higher dietary niacin intake was significantly associated with lower total fat (β -0.061, 95% CI -0.076 to -0.046), lower trunk fat (β -0.041, 95% CI -0.050 to -0.032) and lower sarcopenia risk (OR 0.460, 95% CI 0.233 to 0.907). In addition, dietary niacin significantly reduced HOMA-IR, fasting blood glucose (in participants without diabetes), and fasting insulin (p <0.05).

CONCLUSION

Niacin is associated with improved body composition (characterized by increased muscle mass and decreased fat content) and improved glucose homeostasis in dietary doses. Dietary niacin supplementation is a feasible way to alleviate age-related muscular loss.

Association between Infarct Location and Hemorrhagic Transformation of Acute Ischemic Stroke following Successful Recanalization after Mechanical Thrombectomy

BACKGROUND AND PURPOSE

The association between infarct location and hemorrhagic transformation of acute ischemic stroke after mechanical thrombectomy is not understood. We aimed to evaluate the association between CTP-based ischemic core variables at admission and hemorrhagic transformation after a successful thrombectomy.

MATERIALS AND METHODS

We retrospectively analyzed patients who underwent endovascular thrombectomy for acute anterior circulation large-vessel occlusion between October 2019 and June 2021. We enrolled 146 patients with visible ischemic core on pretreatment CTP who had successful reperfusion. The ischemic core infarct territories were classified into the cortical and subcortical areas and then qualitatively and quantitatively analyzed by CTP. Logistic regression and receiver operating characteristic curve analyses were performed to determine the association between ischemic core variables and hemorrhagic transformation.

RESULTS

Of the 146 patients analyzed, 72 (49.3%) had hemorrhagic transformation and 23 (15.8%) had symptomatic intracerebral hemorrhage. Multivariate analysis showed that subcortical infarcts were independently associated with hemorrhagic transformation (OR, 8.06; 95% CI, 2.31-28.10; P = .001) and subcortical infarct volume was independently linked to symptomatic intracerebral hemorrhage (OR, 1.05; 95% CI, 1.01-1.09; P = .039). The receiver operating characteristic curve indicated that subcortical infarcts can predict hemorrhagic transformation accurately (area under the curve = 0.755; 95% CI, 0.68-0.82; P < .001) and subcortical infarct volume can predict symptomatic intracerebral hemorrhage (area under the curve = 0.694; 95% CI, 0.61-0.77; P = .002).

CONCLUSIONS

Subcortical infarcts seen on CTP at admission are associated with hemorrhagic transformation in patients after successful thrombectomy, and subcortical infarct volume may influence the risk of symptomatic intracerebral hemorrhage.

Ergonomic risk factors and work-related musculoskeletal disorders in clinical physiotherapy

Objectives

The purpose of this study was to objectively quantify and evaluate the ergonomic risk of clinical physiotherapy practices and evaluate physiotherapists for work-related musculoskeletal disorders and pain.

Methods

Twenty-nine physiotherapists in the rehabilitation department of a large-scale tertiary hospital were recruited in this study. The sampling period lasted for 2 weeks for each physiotherapist and interval sampling was adopted to avoid duplication of cases. Therapist posture during physiotherapy was captured, tracked and analyzed in real time using structured light sensors with an automated assessment program. The quantification of ergonomic risk was based on REBA (Rapid Entire Body Assessment) and the RPE (perceived physical exertion) scores of the therapists were recorded before and after treatment, respectively.

Results

Two hundred and twenty-four clinical physiotherapy cases were recorded, of which 49.6% were high risk and 33% were very high risk, with none of the cases presenting negligible risk. The positioning (p < 0.001) of physiotherapist had a considerable impact on ergonomic risk and pediatric physiotherapy presented a higher risk to physiotherapists than adults (p < 0.001). The RPE score of physiotherapist after performing physiotherapy was greater than before physiotherapy and was positively correlated with the REBA distribution.

Conclusion

Our study creates an automatic tool to assess the ergonomic risk of physiotherapy practices and demonstrates unacceptable ergonomic risk in common practices. The high prevalence of musculoskeletal disorders and pains recommends that rehabilitation assistance devices should be optimized and standard ergonomic courses should be included in physiotherapists' training plans.

Remote sensing to detect harmful algal blooms in inland waterbodies

Harmful algal blooms (HABs) are an issue of concern for water management worldwide. As such, effective monitoring strategies of HAB spatio-temporal variability in waterbodies are needed. Remote sensing has become an increasingly important tool for HAB detection and monitoring in large lakes. However, accurate HAB detection in small-medium waterbodies via satellite data remains a challenge. Current barriers include the waterbody size, the limited freely available high resolution satellite data, and the lack of field calibration data. To test the applicability of remote sensing for detecting HABs in small-medium waterbodies, three satellites (Planetscope, Sentinel-2 and Landsat-8) were used to understand how spatial resolution, the availability of spectral bands, and the waterbody size itself effect HAB detection skill. Different algorithms and a non-parametric method, Self-Organizing Map (SOM), were tested. Curvature Around Red and NIR minus Red had the best HAB detection skill of the 20 existing algorithms that were tested. Landsat 8 and Sentinel 2 were the best satellites for HAB detection in small to medium waterbodies. The most critical attribute for detecting HABs were the available satellite bands, which determine the detection algorithms that can be used. Importantly, algorithm performance was mostly unrelated to waterbody size. However, there remain some barriers in utilizing satellite data for HAB detection, including algae dynamics, macrophyte cover within the waterbody, weather effects, and the correction models for satellite data. Moreover, it is important to consider the match time between satellite overpass and sampling activities for calibration. Given these challenges, integrating regular sampling activities and remote sensing is recommended for monitoring and managing small-medium waterbodies.

A rare case of extrathoracic large bowel obstruction following colonic interposition

Transverse colon interposition for oesophageal replacement following oesophagectomy is a rarely seen entity; interposition of the colon exterior to the thoracic cage is rarer still. Here, we report the case of a patient presenting with a large bowel obstruction in a transverse colon interposition located subcutaneously anterior to the sternum, with the diaphragm fully intact, following chest compressions for multiple cardiac arrests. The need for specialty input was highlighted early on, and the large bowel decompressed via nasogastric tube insertion into the interpositioned colon. The patient was then transferred to the acute coronary unit for further observation and management.

The Value of Preoperative Phase-Contrast MRI in Predicting the Clinical Outcome of Moyamoya Disease after Encephalo-Duro-Arterial Synangiosis Surgery

BACKGROUND AND PURPOSE

In patients with Moyamoya disease, the relationship between preoperative hemodynamic status and prognosis after encephalo-duro-arterial synangiosis (EDAS) surgery was unclear. We aimed to explore the value of the preoperative hemodynamic status acquired by cine phase-contrast MR imaging in predicting collateral formation and clinical outcomes after EDAS surgery in patients with Moyamoya disease.

MATERIALS AND METHODS

Participants with Moyamoya disease were prospectively recruited and underwent preoperative phase-contrast MR imaging. All participants were classified into good and poor groups according to the collateral formation after EDAS surgery. On the basis of the change in the mRS system, participants were classified into the improved mRS group and the poor response group. Hemodynamic status including mean velocity, peak velocity, and blood volume flow of the superficial temporal artery was compared between groups. Logistic regression was performed to relate the phase-contrast MR imaging parameters to collateral formation and clinical outcomes.

RESULTS

A total of 45 patients with Moyamoya disease with unilateral EDAS surgery were finally included. Mean velocity, peak velocity, and blood volume flow of the ipsilateral superficial temporal artery were significantly greater in patients with good collateral formation compared with those with poor collateral formation (P = .011, .004, and .013, respectively). The mean velocity, peak velocity, and blood volume flow were independently associated with postoperative collateral formation after adjusting for confounding factors. Furthermore, the peak velocity of the ipsilateral superficial temporal artery was also significantly associated with improvement of the mRS score.

CONCLUSIONS

Good hemodynamic status of the ipsilateral superficial temporal artery as a donor artery evaluated by phase-contrast MR imaging was significantly associated with better collateral formation and improved mRS after EDAS surgery in patients with Moyamoya disease.