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Yan Y, Zhang K, Zhong W, Yan S, Zhang B, Cheng J, Lou M. Influencing factors of futile recanalization after endovascular intervention in patients with acute basilar artery occlusion. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024:1-10. [PMID: 38501295 DOI: 10.3724/zdxbyxb-2023-0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
OBJECTIVES To explore the influence factors for futile recanalization following endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO). METHODS Clinical data of patients with acute BAO, who underwent endovascular treatment within 24 h of onset from January 2017 to November 2022, were retrospectively analyzed. The futile recanalization was defined as modified Thrombolysis in Cerebral Infarction (mTICI)≥2b or 3 after successful reperfusion, but the modified Rankin Scale score >2 at 90d after EVT. Binary logistic regression model was used to analyze the influencing factors of futile recanalization. RESULTS A total of 471 BAO patients with a median age of 68 (57-74) years were included and 68.9% were males, among whom 298 (63.27%) experienced futile recanalization. Multivariate analysis revealed that concomitant atrial fibrillation (OR=0.456, 95%CI: 0.287-0.737, P<0.01), bridging thrombolysis (OR=0.640, 95%CI: 0.416-0.985, P<0.05), achieving mTICI grade 3 (OR=0.554, 95%CI: 0.334-0.918, P<0.05), arterial occlusive lesion (AOL) grade 3 (OR=0.521, 95%CI: 0.326-0.834, P<0.01), and early postoperative statin therapy (OR=0.509, 95%CI: 0.273-0.948, P<0.05) were protective factors for futile recanalization after EVT in acute BAO patients; while high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR=1.068, 95%CI: 1.049-1.087, P<0.01), coexisting hypertension (OR=1.571, 95%CI: 1.017-2.427, P<0.05), multiple retrieval attempts (OR=1.237, 95%CI: 1.029-1.488, P<0.05) and postoperative hemorrhagic transformation (OR=8.497, 95%CI: 2.879-25.076, P<0.01) were risk factors. For TOAST classification, cardiogenic embolism (OR=0.321, 95% CI: 0.193-0.534, P<0.01) and other types (OR=0.499, 95% CI: 0.260-0.961, P<0.05) were also an independent risk factors for futile recanalization after EVT in acute BAO. CONCLUSIONS The incidence of futile recanalization after EVT in patients with acute BAO is high. Bridging venous thrombolysis before operation and an early postoperative statin therapy may reduce the incidence of futile recanalization.
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Affiliation(s)
- Yi Yan
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
- Department of Neurology, Zhenhai People's Hospital, Ningbo 315202, Zhejiang Province, China.
| | - Kemeng Zhang
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Shenqiang Yan
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Bing Zhang
- Department of Neurology, Huzhou Central Hospital, Huzhou 313099, Zhejiang Province, China
| | - Jianhua Cheng
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, Zhejiang Province, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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Zhu X, Zhang Z, Zhong W, He Y, Luo Z, Zhang N, Cheng C, Yang J, Lou M. Effect of anesthesia mode during endovascular treatment on neurological functional outcomes in patients with acute posterior circulation stroke. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024:1-9. [PMID: 38501285 DOI: 10.3724/zdxbyxb-2023-0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
OBJECTIVES To compare the effect of anesthesia mode on the neurological functional outcomes in patients undergoing endovascular treatment for acute posterior circulation ischemic stroke. METHODS Conscious sedation and general anesthesia clinical data of 656 patients undergoing intravascular therapy for acute posterior circulation ischemic stroke registered in online Acute Stroke Patients for Stroke Management Quality Evaluation Database from January 2017 to December 2022 were retrospectively analyzed, including 163 cases received conscious sedation and 493 cases received general anesthesia during the procedure. After propensity score matching, 428 patients were included in the analysis, including 155 cases in the conscious sedation group and 273 cases in the general anesthesia group. The differences of operation mode, etiology type, vascular recanalization, hemorrhagic transformation at 24 h, mRS score at 3 months and mortality within 3 months were compared between two groups. Binary logistic regression was used to explore the effect of different anesthesia mode on neurological functional outcomes. RESULTS There was significant difference in operation mode between two groups (P<0.01), while there were no significant differences in etiology type, good vascular recanalization, hemorrhagic transformation at 24 h, mRS score at 3 months or mortality within 3 months (all P>0.05). Binary logistic regression analysis revealed that anesthesia modes were not significantly associated with functional outcomes of patients (OR=1.151, 95%CI: 0.751-1.765, P=0.519). CONCLUSIONS Anesthesia mode (conscious sedation or general anesthesia) will not affect the neurological functional outcomes in patients with acute posterior circulation ischemic stroke undergoing endovascular treatment. The anesthesia mode can be chosen according to the condition of the treatment center and patients.
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Affiliation(s)
- Xiaofeng Zhu
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China.
- Department of Neurology, Tongxiang First People's Hospital, Jiaxing 314500, Zhejiang Province, China.
| | - Zheyu Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Yaode He
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Zhongyu Luo
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Ningyuan Zhang
- Department of Neurology, Tongxiang First People's Hospital, Jiaxing 314500, Zhejiang Province, China
| | - Chaochan Cheng
- Department of Neurology, Yongkang First People's Hospital, Jinhua 321300, China
| | - Jianhong Yang
- Department of Neurology, Ningbo First Hospital, Ningbo 315010, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China.
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Wang T, Zhong W, Chen Z, Shen K, Ye H, Yu Z, Luo J, Ma J, Lou M. Association between baseline hemoglobin level and early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024:1-7. [PMID: 38501300 DOI: 10.3724/zdxbyxb-2023-0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
OBJECTIVES To investigate the association between baseline hemoglobin level and early neurologic deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke (AIS). METHODS Data of AIS patients who received intravenous thrombolytic therapy at multiple hospitals across the country between January 2017 and July 2020 were collected from the online database Acute Stroke Patients for stroke Management Quality Evaluation (CASE-Ⅱ, NCT04487340). Binary logistic regression analysis was used to study the factors affecting the occurrence of END after intravenous thrombolytic therapy, and the correlation between baseline hemoglobin level and END was investigated by limiting cubic spline curve. RESULTS A total of 8162 patients were included. Patients with END had lower baseline hemoglobin levels (136 and 140 g/L, P<0.01) and higher rates of anemia (24.2% and 16.9%, P<0.01) compared with non-END patients. Binary logistic regression analysis showed that baseline hemoglobin level (OR=0.995, 95%CI: 0.991-0.999, P<0.05) and anemia (OR=1.238, 95%CI: 1.055-1.454, P<0.01) were independently correlated with the occurrence of END after intravenous thrombolysis in AIS patients. Restricted cubic spline regression showed that there was a U-shaped relationship between hemoglobin level and the risk of END after intravenous thrombolysis in AIS patients (P<0.01); while the relationship only existed in male patients (P<0.05), not in female patients (P>0.05). CONCLUSIONS There is a U-shaped correlation between baseline hemoglobin level and the risk of END in AIS patients after intravenous thrombolysis, that is, both lower and higher hemoglobin level may increase the risk of END.
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Affiliation(s)
- Tinghuan Wang
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
- Department of Neurology, First People's Hospital of Jiashan County, Jiaxing 314100, Zhejiang Province, China.
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhicai Chen
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Ke Shen
- Department of Neurology, Shaoxing Hospital Affiliated to China Medical University, Shaoxing 312099, Zhejiang Province, China
| | - Huiya Ye
- Department of Neurology, Shaoxing Hospital Affiliated to China Medical University, Shaoxing 312099, Zhejiang Province, China
| | - Zhihui Yu
- Department of Neurology, Shaoxing Hospital Affiliated to China Medical University, Shaoxing 312099, Zhejiang Province, China
| | - Jia Luo
- Department of Neurology, Shaoxing Hospital Affiliated to China Medical University, Shaoxing 312099, Zhejiang Province, China
| | - Jun Ma
- Department of Neurology, Shaoxing Hospital Affiliated to China Medical University, Shaoxing 312099, Zhejiang Province, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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Chen H, Ding Y, Huang L, Zhong W, Lin X, Zhang B, Zheng Y, Xu X, Lou M, Yuan C. The Association of Allergy-Related and Non-Allergy-Related Olfactory Impairment with Cognitive Function in Older Adults: Two Cross-Sectional Studies. Curr Alzheimer Res 2024; 21:CAR-EPUB-138670. [PMID: 38409711 DOI: 10.2174/0115672050284179240215052257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Evidence on the association of Olfactory Impairment (OI) with age-related cognitive decline is inconclusive, and the potential influence of allergy remains unclear. OBJECTIVE We aimed to evaluate the cross-sectional associations of allergy-related and non-allergy- related OI to cognitive function. METHODS We included 2,499 participants from the Health and Retirement Study (HRS)-Harmonized Cognitive Assessment Protocol (HCAP) sub-study and 1,086 participants from the English Longitudinal Study of Ageing (ELSA)-HCAP. The Olfactory Function Field Exam (OFFE) using Sniffin' Stick odor pens was used to objectively assess olfactory function and an olfactory score <6/11 indicated OI. Mini-Mental Status Examination (MMSE) was used to assess global cognitive function and define cognitive impairment (<24/30). A neuropsychologic battery was used to assess five cognitive domains. RESULTS Compared to non-OI participants, individuals with OI had lower MMSE z-score [βHRS = -0.33, 95% Confidence Interval (CI): -0.41 to -0.24; βELSA = -0.31, -0.43 to -0.18] and higher prevalence of cognitive impairment [Prevalence Ratio (PR)HRS = 1.46, 1.06 to 2.01; PRELSA = 1.63, 1.26 to 2.11]. The associations were stronger for non-allergy-related OI (βHRS = -0.36; βELSA = -0.34) than for allergy-related OI (βHRS = -0.26; βELSA = 0.13). Similar associations were observed with domain- specific cognitive function measures. CONCLUSION OI, particularly non-allergy-related OI, was related to poorer cognitive function in older adults. Although the current cross-sectional study is subject to several limitations, such as reverse causality and residual confounding, the findings will provide insights into the OI-cognition association and enlighten future attention to non-allergy-related OI for the prevention of potential cognitive impairment.
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Affiliation(s)
- Hui Chen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yihong Ding
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liyan Huang
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Lin
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baoyue Zhang
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Zheng
- Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai, China
| | - Xin Xu
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
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Pan X, Pei Y, Zhang M, Zhong W, Hu J, Wang Z, Xu D, Lou M, Chen H, Chen Z. Association of Atrial Fibrillation with Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results from a Multicenter Study in China. Neurol Ther 2024; 13:127-139. [PMID: 38032536 PMCID: PMC10787712 DOI: 10.1007/s40120-023-00563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the association between atrial fibrillation (AF), particularly newly diagnosed AF, and remote intracerebral hemorrhage (rICH) in patients with ischemic stroke who were treated with intravenous thrombolysis (IVT). METHODS This observational study was conducted on patients with ischemic stroke who received IVT with recombinant tissue-type plasminogen activator. The data were taken from a multicenter prospective registry of a Chinese population. rICH was defined as any extraischemic hemorrhage detected on computerized tomography (CT) 24 h after intravenous thrombolysis. We collected and compared the demographic data and clinical characteristics of all the patients with rICH to those of patients without any type of hemorrhagic transformation. The association between AF and rICH was analyzed using univariate analysis and binary logistic regression. RESULTS A total of 20,697 patients were included in the study, with 1566 (7.6%) experiencing intracerebral hemorrhage (ICH), 586 (2.8%) experiencing rICH, and 19,131 (92.4%) not experiencing any form of hemorrhagic transformation. Univariate analysis revealed significant differences in age, pre-thrombolysis systolic blood pressure, baseline National Institute of Health Stroke Scale score, previously known AF, newly diagnosed AF, coronary heart disease, congestive heart failure, hyperhomocysteinemia, and history of thrombolysis between the rICH and control groups (P < 0.05). Further multivariate logistic regression analysis indicated that total AF (OR 1.821, 95% CI 1.082-3.065, P < 0.05), previously known AF (OR 1.470, 95% CI 1.170-1.847), and newly diagnosed AF (OR 1.920, 95% CI 1.304-2.825) were independently associated with rICH. CONCLUSIONS This study suggests that AF, regardless of whether it is newly diagnosed or previously known, may be associated with the occurrence of rICH following intravenous thrombolysis. Interestingly, our findings suggest that newly diagnosed AF may have a stronger impact on rICH than previously known AF, although confirmation from more studies is needed.
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Affiliation(s)
- Xiaoling Pan
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, No. 365 Renmin East Road, Jinhua, 321000, Zhejiang Province, China
| | - Yingjian Pei
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Meixia Zhang
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, No. 365 Renmin East Road, Jinhua, 321000, Zhejiang Province, China
| | - Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Jin Hu
- Department of Neurology, The First Hospital of Jiaxing, Jiaxing, 314000, Zhejiang Province, China
| | - Zhimin Wang
- Department of Neurology, Taizhou First People's Hospital, Taizhou, 318020, Zhejiang Province, China
| | - Dongjuan Xu
- Department of Neurology, Dongyang People's Hospital, Dongyang, 322100, Zhejiang Province, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Hongfang Chen
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, No. 365 Renmin East Road, Jinhua, 321000, Zhejiang Province, China.
| | - Zhicai Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
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Zhang X, Zhong W, Xue R, Jin H, Gong X, Huang Y, Chen F, Chen M, Gu L, Ge Y, Ma X, Zhong B, Wang M, Hu H, Chen Z, Yan S, Chen Y, Wang X, Zhang X, Xu D, He Y, Lou M, Wang A, Zhang X, Ma L, Lu X, Wang J, Lou Q, Qian P, Xie G, Zhu X, He S, Hu J, Wen X, Liu Y, Wang Y, Fu J, Fan W, Liebeskind D, Yuan C, Lou M. Argatroban in Patients With Acute Ischemic Stroke With Early Neurological Deterioration: A Randomized Clinical Trial. JAMA Neurol 2024; 81:118-125. [PMID: 38190136 PMCID: PMC10775075 DOI: 10.1001/jamaneurol.2023.5093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/20/2023] [Indexed: 01/09/2024]
Abstract
Importance The effect of argatroban in patients with acute ischemic stroke (AIS) and early neurological deterioration (END) is unknown. Objective To assess the efficacy of argatroban for END in AIS. Design, Setting, and Participants This open-label, blinded-end point, randomized clinical trial was conducted from April 4, 2020, through July 31, 2022. The date of final follow-up was October 31, 2022. This was a multicenter trial. Eligible patients were adults with AIS who experienced END, which was defined as an increase of 2 or more points on the National Institutes of Health Stroke Scale within 48 hours from symptom onset. Patients who withdrew consent, experienced duplicate randomization, or were lost to follow-up were excluded from the study. Interventions Patients were randomly assigned to the argatroban group and control group within 48 hours of symptom onset. Both groups received standard therapy based on guidelines, including oral mono or dual antiplatelet therapy. The argatroban group received intravenous argatroban for 7 days (continuous infusion at a dose of 60 mg per day for 2 days, followed by 20 mg per day for 5 days) in addition to standard therapy. Main Outcome and Measure The primary end point was good functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 3. Results A total of 628 patients (mean [SD] age, 65 [11.9] years; 400 male [63.7%]) were included in this study (argatroban group, 314 [50%] and control group, 314 [50%]). Of these, 18 withdrew consent, 1 had duplicate randomization, and 8 were lost to follow-up. A total of 601 patients with stroke were included in the intention-to-treat analysis. Finally, 564 patients were included in the per-protocol analysis as 6 participants in the argatroban group and 31 participants in the control group did not follow the complete protocol. The number of patients with good functional outcome at 90 days was 240 (80.5%) in the argatroban group and 222 (73.3%) in the control group (risk difference, 7.2%; 95% CI, 0.6%-14.0%; risk ratio, 1.10; 95% CI, 1.01-1.20; P = .04). The proportion of symptomatic intracranial hemorrhage was 3 of 317 (0.9%) in the argatroban group and 2 of 272 (0.7%) in the control group (P = .78). Conclusions and Relevance Among patients with AIS with END, treatment with argatroban and antiplatelet therapy resulted in a better functional outcome at 90 days. This trial provided evidence to support the use of argatroban in reducing disability for patients with END. Trial Registration ClinicalTrials.gov Identifier: NCT04275180.
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Affiliation(s)
- Xuting Zhang
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Xue
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haidi Jin
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxian Gong
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhui Huang
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Fujian Chen
- Department of Neurology, People’s Hospital of Anji, Huzhou, China
| | - Mozi Chen
- Department of Neurology, People’s Hospital of Anji, Huzhou, China
| | - Liqun Gu
- Department of Neurology, First Hospital of Ninghai County, Ningbo, China
| | - Yebo Ge
- Department of Neurology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Xiaodong Ma
- Department of Neurology, Haiyan People’s Hospital, Jiaxing, China
| | - Bifeng Zhong
- Department of Neurology, Putuo Hospital, Zhoushan, China
| | - Mengjie Wang
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haitao Hu
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhicai Chen
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Chen
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Wang
- Department of Neurology, Yiwu Central Hospital, Yiwu, China
| | - Xiaoling Zhang
- Department of Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Dongjuan Xu
- Department of Neurology, Dongyang Affiliated Hospital of Wenzhou Medical University, Dongyang, China
| | - Yuping He
- Department of Neurology, Zhuji People’s Hospital, Zhuji, China
| | - Minfang Lou
- Department of Neurology, Quzhou Traditional Chinese Medicine Hospital, Quzhou, China
| | - Aiju Wang
- Department of Neurology, Xiangshan People’s Hospital, Xiangshan, China
| | - Xiong Zhang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China
| | - Li Ma
- Department of Neurology, Shaoxing Second Hospital, Shaoxing, China
| | - Xiaodong Lu
- Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jianer Wang
- Department of Neurology, The Second People’s Hospital of Yuhang District, Hangzhou, China
| | - Qiong Lou
- Department of Neurology, The Affiliated Hospital of Medicine School, Ningbo University, Ningbo, China
| | - Ping’an Qian
- Department of Neurology, Ningbo Ninth Hospital, Ningbo, China
| | - Guomin Xie
- Department of Neurology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Xiaofen Zhu
- Department of Neurology, Quzhou City Kecheng District People’s Hospital, Quzhou, China
| | - Songbin He
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, China
| | - Jin Hu
- Department of Neurology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiongjie Wen
- Department of Neurology, Tongxiang Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Yan Liu
- Department of Neurology, Zhenhai Longsai Hospital of Ningbo city, Ningbo, China
| | - Yanwen Wang
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jingjing Fu
- Department of Neurology, The 4th Affiliated Hospital of Zhejiang University, School of Medicine, Yiwu, China
| | - Weinv Fan
- Department of Neurology, Ningbo No.2 Hospital, Ningbo, China
| | - David Liebeskind
- David Geffen School of Medicine, Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles
| | - Changzheng Yuan
- School of Public Health, Zhejiang University, Hangzhou, China
- Department of Nutrition, Harvard T.H. School of Public Health, Boston, Massachusetts
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Pei Y, Chen Y, Zhong W, He Y, Luo Z, Lou M, Chen Z. Effect of computed tomography vs. computed tomography perfusion on mechanical thrombectomy outcomes within 6 hours. Eur Radiol 2024:10.1007/s00330-023-10545-y. [PMID: 38175220 DOI: 10.1007/s00330-023-10545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/12/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES It is unclear which selection strategy, plain CT vs. CT perfusion (CTP), is more powerful in predicting outcome after mechanical thrombectomy (MT). We aimed to compare the effect of plain CT and CTP in predicting outcome after MT within 6 h. METHODS We conducted a prospective analysis of a retrospective cohort from our single-center study, which had occlusion of the internal carotid artery and middle cerebral artery up to the proximal M2 segment and received MT within 6 h. According to the Alberta Stroke Program Early CT Score (ASPECTS), patients were divided into a high-ASPECTS group (≥ 6) and a low ASPECTS group (< 6). Similarly, patients were divided into mismatch and no-mismatch groups according to the DEFUSE3 criteria for CTP. A good outcome was defined as a 90-day modified Rankin Scale (mRS) score of ≤ 3. Univariate and binary logistic regression analyses were used to investigate the association between different imaging modality and 90-day mRS score, and mortalities, respectively. RESULTS The high ASPECTS group included 307 patients (89.2%). The mismatch group included 189 (54.9%) patients meeting the DEFUSE3 criterion. Compared to the low ASPECTS group, the high ASPECTS group had a good outcome (odds ratio (OR), 2.285; [95% confidence interval (CI) (1.106, 4.723)], p = 0.026) and lower mortality (OR, 0.350; [95% CI (0.163, 0.752)], p = 0.007). However, there were no significant differences in good outcomes and mortality between the mismatch and no-mismatch groups. CONCLUSIONS Compared with plain CT, CTP does not provide additional benefits in the selection of patients suitable for MT within 6 h. CLINICAL RELEVANCE STATEMENT CT perfusion is not superior to plain CT for the prediction of clinical outcomes when selecting patients for mechanical thrombectomy in the first 6 h. In that clinical setting, plain CT may be safe in the absence of perfusion data. KEY POINTS • The advantage of CT perfusion (CTP) over CT in pre-mechanical thrombectomy (MT) screening has not been proven for patients with a large infarct core. • CTP is not better than plain CT in predicting good outcome following MT within 6 h. • Plain CT is sufficient for selecting patients suitable for MT within 6 h of large artery occlusion.
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Affiliation(s)
- Yingjian Pei
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China
| | - Yuping Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China
| | - Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China
| | - Yaode He
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China
| | - Zhongyu Luo
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China.
| | - Zhicai Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China.
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Zhong W, Zhang L, Zhong JQ, He XP, Liu HQ, Zhu WQ, Fang CF. Comparison of outcomes between preservation or division of the uterine round ligament in laparoscopic groin hernia repair in females: a meta-analysis and trial sequential analysis. Hernia 2024:10.1007/s10029-023-02917-6. [PMID: 38165537 DOI: 10.1007/s10029-023-02917-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/14/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to perform a meta-analysis comparing the short-term and long-term outcomes in laparoscopic groin hernia repair with or without preservation of the uterine round ligament (URL) in females. METHODS We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively. RESULTS Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI - 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI - 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI - 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable. CONCLUSION In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.
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Affiliation(s)
- W Zhong
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - L Zhang
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - J Q Zhong
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - X P He
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - H Q Liu
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - W Q Zhu
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - C F Fang
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China.
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9
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Zhu X, Zhou Y, Zhong W, Li Y, Wang J, Chen Y, Zhang R, Sun J, Sun Y, Lou M. Higher Functional Connectivity of Ventral Attention and Visual Network to Maintain Cognitive Performance in White Matter Hyperintensity. Aging Dis 2023:AD.2022.1206. [PMID: 37163435 PMCID: PMC10389834 DOI: 10.14336/ad.2022.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/06/2022] [Indexed: 05/12/2023] Open
Abstract
Ventral attention network (VAN), associated with cognitive performance, is one of the functional networks that are most vulnerable in white matter hyperintensity (WMH). Considering the global interaction of networks for cognitive performance, we hypothesized that VAN-related between-network connectivity might play a role in maintaining cognition in patients with WMH. We included 139 participants for both cross-sectional and longitudinal analysis from CIRCLE study (ClinicalTrials.gov ID: NCT03542734) between January 2014 and January 2021. Differences of VAN-related between-network connectivity were compared between normal-cognition (NC) and cognitive-impairment (CI) groups cross-sectionally, and between cognitive-decline (CD) and cognitive non-decline (CND) groups longitudinally by using t-test. False Discovery Rate was used for multiple comparison correction. The relationship between the network connectivity and WMH was tested on linear and quadratic models. Subgroup analysis of different WMH burdens were performed to test the difference of network connectivity between NC and CI groups. Among VAN-related between-network connectivity, only VAN-Visual Network (VN) connectivity was higher both in NC (n = 106) and CND (n = 113) groups versus CI (n = 33) and CD groups (n = 26), respectively. There was an inverted U-shaped relation between periventricular WMH (PWMH) burden and VAN-VN connectivity. Normal-cognition participants had higher VAN-VN connectivity among high, but not low PWMH burden subgroups. These findings suggest that the VAN-VN connectivity plays an important role in maintaining cognitive performance in WMH patients. It may serve as a unique marker for cognitive prediction and a potential target for intervention to prevent cognitive decline in WMH patients.
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Affiliation(s)
- Xiao Zhu
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yifei Li
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junjun Wang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Yuping Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ruoxia Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jianzhong Sun
- Department of Radiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yu Sun
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Zhejiang University, Zhejiang, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Huang CJ, Zhong W, Zhong M, Liu ZD, Fan WX, Li YQ, Wang XF, Zhong ZX. [A case report of percutaneous closure of left ventricular pseudoaneurysm]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:1196-1198. [PMID: 37963757 DOI: 10.3760/cma.j.cn112148-20230907-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- C J Huang
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - W Zhong
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - M Zhong
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - Z D Liu
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - W X Fan
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - Y Q Li
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - X F Wang
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - Z X Zhong
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
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Wang YQ, Liang L, Zhong W, Yu HR, Qiao GQ, Li N, Liu SY, Wang LL. [A case report of ocular monkeypox]. Zhonghua Yan Ke Za Zhi 2023; 59:943-945. [PMID: 37724514 DOI: 10.3760/cma.j.cn112142-20230817-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
A 35-year-old male patient arrived at the clinic, reporting a persistent issue of his right eye being difficult to open for the past three weeks. Alongside this, he had been experiencing a gradual development of lesions around the eye. Notably, about a month prior to the onset of these symptoms, the patient had engaged in unprotected intercourse with a male partner. The initial manifestation was a papule near the eye, which then rapidly progressed. Laboratory analysis of samples taken from the lesions confirmed the presence of monkeypox through polymerase chain reaction testing. Furthermore, this patient received positive diagnoses for both HIV and syphilis infections. Notably, his absolute CD4 count was measured at an extremely low level of 2 cells/μl.(This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on September 18, 2023).
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Affiliation(s)
- Y Q Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
| | - L Liang
- Department of Ophthalmology, the First Affiliated Hospital Of USTC (Anhui Provincial Hospital), Hefei 230002, China
| | - W Zhong
- The National Engineering Research Center For the Emergence Drugs; Institute of Pharmacologyand Toxicology,the Academy of Military Medical Sciences, the PLA Academy of Military Sciences Beijing 100850, China
| | - H R Yu
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
| | - G Q Qiao
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
| | - N Li
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
| | - S Y Liu
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
| | - L L Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China
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Yuan X, Xie SB, Zhang H, Zhang JY, Wang FJ, Liu YZ, Meng L, Zhong W, Jiang WH, Xie ZH. [The efficacy and safety of standardized dust mite allergen subcutaneous immunotherapy in children with allergic rhinitis during treatment]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 58:878-884. [PMID: 37675526 DOI: 10.3760/cma.j.cn115330-20230331-00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Objective: To evaluate the efficacy and safety of standardized dust mite allergen subcutaneous immunotherapy (SCIT) in children with allergic rhinitis (AR) during treatment. Methods: A total of 283 children with AR diagnosed with definite dust mite allergy and completed 2 to 3 years of SCIT who attended the Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, from August 2019 to October 2021 were included, including 205 males and 78 females, with a mean age of 10.8 years. The total nasal symptoms score (TNSS), symptom medication score (SMS), rhinoconjunctivitis quality of life questionnaire (RQLQ) and visual analogue scale (VAS) before and after 2 to 3 years' treatment were recorded, and the differences before and after treatment were compared. Adverse reactions during SCIT were recorded to evaluate its safety. SPSS 22.0 software was used for statistical analysis. Results: The overall effectiveness rate during SCIT in 283 children with AR was 89.4% (253/283). Compared with baseline, all symptom scores, medication scores and quality of life scores were significantly lower after 2 to 3 years of SCIT (all P<0.05). Further group comparisons showed positive efficacy in patients with different clinical characteristics, including age, gender, smoking status, family history of AR, symptom severity, mono-or poly-allergy, and second immunization, with no statistically significant differences between groups (all P>0.05). A total of 12 735 injections were administered during the SCIT, and a total of 213 (1.67%) injections of local adverse reactions occurred, mainly in the initial treatment phase, and the diameter of the local air mass was mostly 5 to 20 mm; 71 (0.56%) injections of systemic adverse reactions occurred, mainly in the initial treatment phase, and most of them were grade 1 reactions with no serious systemic adverse reaction such as shock. Conclusion: Standardized dust mite SCIT has a good safety profile and definite efficacy in treating AR children with different clinical characteristics. It can significantly improve all symptoms, reduce the use of symptomatic drugs and improve their quality of life.
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Affiliation(s)
- X Yuan
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - S B Xie
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - H Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - J Y Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - F J Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - Y Z Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - L Meng
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - W Zhong
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - W H Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
| | - Z H Xie
- Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases, Changsha 410008, China
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Zhong W, Chen H, Gong X, Tong L, Xu X, Zong G, Yuan C, Lou M. Prevalent stroke, age of its onset, and post-stroke lifestyle in relation to dementia: A prospective cohort study. Alzheimers Dement 2023; 19:3998-4007. [PMID: 37157186 DOI: 10.1002/alz.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The association of age at stroke onset with dementia and the role of post-stroke lifestyle on dementia risk remains unclear. METHODS We leveraged data of 496,251 dementia-free participants from UK Biobank and explored the relationship between age at stroke onset and incident dementia. Among 8328 participants with stroke history, we further investigated the association of a healthy lifestyle with risk of dementia. RESULTS Participants with stroke history had a higher risk of dementia (hazard ratio [HR], 2.02). The association was stronger among participants with stroke onset at a younger age (≤50: HR, 2.63) compared with those at the age > 50 years (50-60: HR, 2.17; ≥60: HR, 1.58). Among participants with stroke history, a favorable lifestyle was associated with a lower risk of incident dementia. DISCUSSION Stroke onset in earlier life stage predicted a higher risk for dementia, but a favorable post-stroke lifestyle may protect against dementia.
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Affiliation(s)
- Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Hui Chen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoxian Gong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lusha Tong
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Xin Xu
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition, Harvard T.H. School of Public Health, Boston, Massachusetts, USA
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Hangzhou, Zhejiang, China
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Luo Z, Zhou Y, He Y, Yan S, Chen Z, Zhang X, Chen Y, Tong LS, Zhong W, Hu H, Zhang K, Yang J, Campbell BCV, Lou M. Treatment with intravenous alteplase in ischaemic stroke patients with onset time between 4.5 and 24 hours (HOPE): protocol for a randomised, controlled, multicentre study. Stroke Vasc Neurol 2023:svn-2022-002154. [PMID: 37527920 DOI: 10.1136/svn-2022-002154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/06/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND While intravenous thrombolysis is recommended for patients who had an acute ischaemic stroke (AIS) within 4.5 hours of symptom onset, there are few randomised trials investigating the benefits of thrombolysis beyond this therapeutic window. AIM To determine whether patients who had an AIS selected with the presence of potentially salvageable tissue on CT perfusion at 4.5-24 hours after stroke onset (for stroke with unknown onset time, the midpoint of the time last known to be well and symptom recognition time; for wake-up stroke, the midpoint of the time last known to be well or sleep onset and wake up time) will benefit from intravenous thrombolysis. DESIGN HOPE is a prospective, multicentre, randomised, open-label blinded endpoint trial with the stage of phase III. The treatment allocation employs 1:1 randomisation. The treatment arm under investigation is alteplase with standard therapy, the control arm is standard therapy. Eligibility imaging criteria include ischaemic core volume ≤70 mL, penumbra ≥10 mL and mismatch ≥20%. STUDY OUTCOMES The primary outcome is non-disabled functional outcome (assessed as modified Rankin Scale score of 0-1 at 90 days). DISCUSSION HOPE is the first trial to investigate whether intravenous thrombolysis with alteplase offers benefits in patients who had an AIS presenting within 4.5-24 hours, which has the potential to extend time window and expand eligible population for thrombolysis therapy.
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Affiliation(s)
- Zhongyu Luo
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Ying Zhou
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Yaode He
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Shenqiang Yan
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Zhicai Chen
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Xuting Zhang
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Yi Chen
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lu-Sha Tong
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Wansi Zhong
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Haitao Hu
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Kemeng Zhang
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Jiansheng Yang
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Min Lou
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
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Wang J, Zhou Y, Zhang K, Ran W, Zhu X, Zhong W, Chen Y, Li J, Sun J, Lou M. Glymphatic function plays a protective role in ageing-related cognitive decline. Age Ageing 2023; 52:afad107. [PMID: 37392401 PMCID: PMC10314787 DOI: 10.1093/ageing/afad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/24/2023] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVE The glymphatic pathway, characterised as a cerebral drainage system, influences cognitive function in neurodegenerative diseases; however, evidence is limited in a normal ageing population. The aim of this study was to investigate the effect of glymphatic function on ageing-related cognitive decline. METHODS We retrospectively reviewed the Cognitive Impairment, Retinopathy, and Cerebrovascular Lesions in the Elderly (CIRCLE) study, and participants with multi-model magnetic resonance imaging (MRI) scans and Mini-Mental State Examinations (MMSE) were enrolled. Glymphatic function was evaluated via the diffusion tensor imaging along the perivascular space (DTI-ALPS) index. Regression models were used to estimate the impact of the DTI-ALPS index on cognitive decline cross-sectionally and longitudinally. We further analysed the mediation effect of the DTI-ALPS on age and cognitive function. RESULTS A total of 633 participants were included in this study (48.2% female; mean age, 62.8 ± 8.9 years). The DTI-ALPS index was positively associated with cognitive function cross-sectionally (β = 0.108, P = 0.003), and was an independent protective factor for cognitive decline longitudinally (odds ratio (OR) = 0.029, P = 0.007). The DTI-ALPS index declined progressively with ageing (r = -0.319, P <0.001), and the decrease was more pronounced after 65 years of age. Furthermore, the DTI-ALPS index mediated the relationship between age and MMSE score (β = -0.016, P <0.001). The mediation effect accounted for 21.3%, which was higher in subjects aged over 65 years (25.3%) compared with those aged under 65 years (5.3%). CONCLUSION Glymphatic function played a protective role in normal ageing-related cognitive decline, which may serve as a potential therapeutic target against cognitive decline in future.
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Affiliation(s)
- Junjun Wang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
- Department of Neurology, Zhejiang Hospital, Hangzhou 310012, China
| | - Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Kemeng Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Wang Ran
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Xiao Zhu
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Yuping Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Jiaping Li
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Jianzhong Sun
- Department of Radiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
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16
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Li XY, Zhong W, Mao YM. [Statin-related drug-induced liver injury]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:659-663. [PMID: 37400395 DOI: 10.3760/cma.j.cn501113-20230418-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Statins are a kind of prescription drug that is widely used to treat hyperlipidemia, coronary artery disease, and other atherosclerotic diseases. A common side effect of statin use is a mild rise in liver aminotransferases, which occurs in less than 3% of patients. Statin-related liver injury is most commonly caused by atorvastatin and simvastatin, but severe liver injury is uncommon. Therefore, understanding and evaluating hepatotoxicity and weighing the benefits and risks is of great significance to better realize the protective effect of statins.
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Affiliation(s)
- X Y Li
- Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai Research Center of Fatty Liver Disease, Shanghai 200001, China
| | - W Zhong
- Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai Research Center of Fatty Liver Disease, Shanghai 200001, China
| | - Y M Mao
- Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai Research Center of Fatty Liver Disease, Shanghai 200001, China
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17
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Verdonk SJE, Storoni S, Zhytnik L, Zhong W, Pals G, van Royen BJ, Elting MW, Maugeri A, Eekhoff EMW, Micha D. Medical Care Use Among Patients with Monogenic Osteoporosis Due to Rare Variants in LRP5, PLS3, or WNT1. Calcif Tissue Int 2023:10.1007/s00223-023-01101-3. [PMID: 37277619 PMCID: PMC10371905 DOI: 10.1007/s00223-023-01101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
Pathogenic variants in the LRP5, PLS3, or WNT1 genes can significantly affect bone mineral density, causing monogenic osteoporosis. Much remains to be discovered about the phenotype and medical care needs of these patients. The purpose of this study was to examine the use of medical care among Dutch individuals identified between 2014 and 2021 with a pathogenic or suspicious rare variant in LRP5, PLS3, or WNT1. In addition, the aim was to compare their medical care utilization to both the overall Dutch population and the Dutch Osteogenesis Imperfecta (OI) population. The Amsterdam UMC Genome Database was used to match 92 patients with the Statistics Netherlands (CBS) cohort. Patients were categorized based on their harbored variants: LRP5, PLS3, or WNT1. Hospital admissions, outpatient visits, medication data, and diagnosis treatment combinations (DTCs) were compared between the variant groups and, when possible, to the total population and OI population. Compared to the total population, patients with an LRP5, PLS3, or WNT1 variant had 1.63 times more hospital admissions, 2.0 times more opened DTCs, and a greater proportion using medication. Compared to OI patients, they had 0.62 times fewer admissions. Dutch patients with an LRP5, PLS3, or WNT1 variant appear to require on average more medical care than the total population. As expected, they made higher use of care at the surgical and orthopedic departments. Additionally, they used more care at the audiological centers and the otorhinolaryngology (ENT) department, suggesting a higher risk of hearing-related problems.
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Affiliation(s)
- S J E Verdonk
- Department of Internal Medicine Section Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Rare Bone Disease Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
| | - S Storoni
- Department of Internal Medicine Section Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Rare Bone Disease Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
| | - L Zhytnik
- Rare Bone Disease Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia
| | - W Zhong
- Rare Bone Disease Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - G Pals
- Department of Human Genetics, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - B J van Royen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam and Location Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - M W Elting
- Department of Human Genetics, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - A Maugeri
- Department of Human Genetics, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - E M W Eekhoff
- Department of Internal Medicine Section Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Rare Bone Disease Center Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands.
| | - D Micha
- Rare Bone Disease Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Zhang R, Yan S, Zhong W, Chen L, Luo Z, Xu C, Li Q, Xu J, Zhang W, Liu C, Lou M. Impaired intracranial venous outflow profiles are associated with poor outcome in stroke after reperfusion therapy: A hypoperfusion-matched intracranial venous scale. Eur J Radiol 2023; 161:110745. [PMID: 36804310 DOI: 10.1016/j.ejrad.2023.110745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Arterial blood flow provided prognostic information in acute ischemic stroke (AIS). However, part of the patients with favorable arterial blood flow still suffered from poor outcomes after reperfusion therapy. We aimed to verify the hypothesis that intracranial venous outflow profiles (both cortical and deep) within the hypoperfusion area were associated with clinical outcome in AIS patients who received reperfusion therapy. METHOD We performed a retrospective analysis of prospectively collected data from anterior circulation AIS patients. All patients underwent pretreatment CTP and received reperfusion therapy. We constructed a 5-point hypoperfusion-matched Intracranial Venous Scale (hypo-IVS) from the sum of the contrast enhancement degree (1, attenuated contrast enhancement; 0, complete contrast enhancement) of 4 typical veins (superficial middle cerebral vein, vein of Labbé, vein of Trolard, and internal cerebral vein) whose outflow territories had matched hypoperfusion. Logistic and ordinal regression were used to analyze the association between hypo-IVS and clinical outcome. RESULTS A total of 751 patients were included. Higher Hypo-IVS was significantly associated with poor outcome (3-month mRS of >2; OR = 1.194; 95 % CI: 1.014-1.407; p = 0.033). The adjusted ORs for poor outcome and high 24-hour NIHSS were 1.172 (95 %CI: 1.035-1.328; p = 0.012) and 1.176 (95 %CI: 1.030-1.330; p = 0.010) in ordinal regression, respectively. Hypo-IVS > 2 was an independent risk factor of poor outcome (75.2 % vs 40.8 %; OR = 1.932; 95 %CI: 1.158-3.224; p = 0.012). CONCLUSIONS Intracranial venous outflow profiles deliver prognostic information in AIS and the hypo-IVS is a helpful tool to predict clinical outcomes after reperfusion therapy.
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Affiliation(s)
- Ruoxia Zhang
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Lin Chen
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhongyu Luo
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chao Xu
- Department of Neurology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Qingqing Li
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jinjin Xu
- Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wenhua Zhang
- Department of Neurology, Hang Zhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Chang Liu
- Department of Neurology, The 2nd Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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Zhong W, Oliver J, Mekhael O, Carter Z, Keshavjee S, Pilon A, Gelman A, Juvet S, Martinu T. Club Cell Secretory Protein (CCSP) Treatment in a Mouse Model of Chronic Lung Allograft Dysfunction (CLAD). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Li Y, Zhou Y, Zhong W, Zhu X, Chen Y, Zhang K, He Y, Luo Z, Ran W, Sun J, Lou M. Choroid Plexus Enlargement Exacerbates White Matter Hyperintensity Growth through Glymphatic Impairment. Ann Neurol 2023. [PMID: 36971336 DOI: 10.1002/ana.26648] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Choroid plexus (CP) is a key regulator in cerebrospinal fluid production, but its contribution to glymphatic clearance function and association with white matter hyperintensity (WMH) remains unclear. METHODS This retrospective study included 2 prospective 3.0-T magnetic resonance imaging (MRI) cohorts. In cohort 1, patients with indications for lumbar puncture underwent 3-dimensional T1-weighted sequence (3D-T1) before and at 39 hours after intrathecal administration of contrast agent (glymphatic MRI). In cohort 2, patients with WMH were enrolled from the CIRCLE study and had a median follow-up time of 1.4 years. WMH and CP of the lateral ventricles were automatically segmented on T2 fluid-attenuated inversion recovery (FLAIR) and 3D-T1, respectively. CP volume was expressed as a ratio to intracranial volume. Glymphatic clearance was measured as signal percentage change from baseline to 39 hours at 8 brain locations based on glymphatic MRI in the first cohort, or as noninvasive diffusion tensor image analysis along the perivascular space (DTI-ALPS) index based on DTI in the second cohort. RESULTS In cohort 1, a total of 52 patients were included. Higher CP volume was correlated with slower glymphatic clearance rate in all brain locations. In cohort 2, a total of 197 patients were included. Baseline CP volume was positively associated with WMH volume and its growth. Furthermore, DTI-ALPS index partially mediated the association of CP with both WMH load and growth. INTERPRETATIONS Enlarged CP volume could be an indicator for larger growth of WMH, potentially involving impaired glymphatic clearance function. The exploration of CP may provide a novel perspective to clarify the mechanism of WMH pathogenesis, as well as other glymphatic-related disorders. ANN NEUROL 2023.
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Affiliation(s)
- Yifei Li
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiao Zhu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yuping Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Kemeng Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yaode He
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhongyu Luo
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wang Ran
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jianzhong Sun
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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He Y, Xu J, Zhong W, Chen Z, Zhou Y, Li J, Luo Z, Lou M. Non-porous thrombi are less pervious and easier to be retrieved: implication from scanning electron microscopy study. J Neurointerv Surg 2023; 15:188-194. [PMID: 35347059 DOI: 10.1136/neurintsurg-2022-018689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/10/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Scanning electron microscopy (SEM) studies found that the porosity of thrombi might vary among individuals. However, its relationship with the clinical presentation and efficacy of mechanical thrombectomy (MT) remains unknown. We aimed to characterize the ultrastructure of thrombi and explore its association with the complexity of MT and clot perviousness. METHODS SEM was used to observe the morphological features of different components of thrombi obtained from patients with anterior circulation large vessel occlusion undergoing MT and to determine the porosity of thrombi by semi-quantitative analysis. Non-porous thrombi were defined as thrombi with porosity <2%. Clot perviousness was also evaluated using thrombus attenuation increase on CT perfusion (TAIctp). We assessed the complexity of MT by attempts of retrieval >3 and procedural duration >60 min, defined as the time interval between groin puncture and recanalization. RESULTS A total of 49 thrombi were analyzed and 31 (63.3%) were classified as non-porous thrombi. The presence of non-porous thrombi was negatively associated with procedure >60 min (OR 0.152, 95% CI 0.031 to 0.734, p=0.019) and attempts >3 (OR 0.194, 95% CI 0.046 to 0.822, p=0.026) after adjustment. Additionally, receiver operating characteristic curve analysis indicated that TAIctp <17.9 Hounsfield units could predict the presence of non-porous thrombi with an area under the curve of 0.915. CONCLUSIONS Non-porous thrombi on SEM are easier to be retrieved during MT and could be identified as less pervious clots on CT images.
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Affiliation(s)
- Yaode He
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jinjin Xu
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhicai Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiaping Li
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhongyu Luo
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Wang B, Chen H, Shen J, Zhong W, Zheng Y, Lou M, Tong L, Yuan C. Multiple Sensory Impairments in Relation to Cognitive Function: Two Nationwide Cross-sectional Studies. Curr Alzheimer Res 2023; 20:360-370. [PMID: 37587821 DOI: 10.2174/1567205020666230816090903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/08/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Sensory impairments (SIs, including visual, hearing, olfactory, and taste impairments) have been individually associated with age-related cognitive function. Little is known regarding their combined associations with cognitive function. METHODS We included 2,931 participants (mean age of 69.1 years) from the National Health and Nutrition Examination Survey (NHANES, 2011-2014) and 10,785 participants (mean age of 70.2 years) from the National Health Interview Survey (NHIS, 2021). Status of visual, hearing, olfactory, and taste functions were self-reported in structured questionnaires. In NHANES, cognitive function was objectively measured by a battery of tests, including memory, verbal fluency, and processing speed. NHIS participants answered a single question about subjective cognitive complaints (SCC). We used regression models to assess the relation of the total number and the individual sensory impairments to z-scores of cognitive domains (linear regression) in NHANES and to SCC (logistic regression) in NHIS. RESULTS A larger number of SI was related to poorer domain-specific cognitive function (all Ptrend <0.05), including memory (beta each additional SI = -0.12, 95% confidence interval: -0.17 to -0.08), verbal fluency (-0.05, -0.10 to -0.01), and processing speed (-0.13, -0.16 to -0.09). In NHIS, each additional SI was related to 96% higher odds of SCC. We also observed independent associations of sensory impairments (except olfactory impairment) with specific cognitive domains. In addition, each individual SI was associated with higher odds of SCC (the odds ratios ranged from 1.30 to 1.78). CONCLUSION A larger number of SI was related to worse cognitive function and higher odds of SCC.
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Affiliation(s)
- Binghan Wang
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Chen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Shen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Zheng
- Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lusha Tong
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Xue R, Zhong W, Zhou Y, He Y, Yan S, Chen Z, Wang J, Gong X, Lou M. Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion. J Am Heart Assoc 2022; 11:e027326. [PMID: 36533622 PMCID: PMC9798802 DOI: 10.1161/jaha.122.027326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background It remains uncertain whether patients with minor acute ischemic stroke with large vessel occlusion benefit from endovascular treatment (EVT). We aim to evaluate the outcomes of EVT in minor acute ischemic stroke with anterior circulation large vessel occlusion. Methods and Results Based on a nationwide prospective stroke registry, patients with minor acute ischemic stroke with anterior circulation large vessel occlusion within 24 hours of onset were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. Primary outcome was excellent functional outcome defined as modified Rankin Scale score 0 to 1 at 90 days. In addition, a multivariable logistic regression model was used to analyze the effect of EVT guided by perfusion imaging. A total of 572 patients with median age 68 years (interquartile range=60-77) and median National Institutes of Health Stroke score 3 (interquartile range =2-4) were identified and 123 patients were treated with standard medical treatment plus EVT. EVT was not associated with excellent functional outcome (unadjusted odds ratio [OR], 0.771 [95% CI, 0.516-1.151]; adjusted OR, 0.793 [95% CI, 0.515-1.219]; P=0.290). However, therapy selection guided by perfusion imaging was a modifier of EVT effect on outcomes, as EVT was significantly associated with excellent functional outcome (60.0% versus 50.8%, unadjusted OR, 1.451 [95% CI, 0.643-3.272]; adjusted OR, 2.849 [95% CI, 1.006-8.067]; P=0.049) but not with symptomatic intracerebral hemorrhage in the imaging-guided group. Conclusions Although functional outcomes in minor acute ischemic stroke caused by anterior circulation large vessel occlusion were not improved from the routine use of EVT, our results suggested that EVT guided by perfusion imaging could be beneficial for those patients. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04487340.
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Affiliation(s)
- Rui Xue
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
| | - Wansi Zhong
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
| | - Ying Zhou
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
| | - Yaode He
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
| | - Shenqiang Yan
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
| | - Zhicai Chen
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
| | - Jianan Wang
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
| | - Xiaoxian Gong
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
| | - Min Lou
- Department of NeurologyThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
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Chen L, Yan S, He Y, Zhong W, Gong X, Lou M. Prediction of Acute Myocardial Infarction in Asian Patients With Acute Ischemic Stroke: The CTRAN Score. JACC Asia 2022; 2:845-852. [PMID: 36713755 PMCID: PMC9876956 DOI: 10.1016/j.jacasi.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patients with acute ischemic stroke (AIS) are susceptible to acute myocardial infarction (AMI), which would lead to a dramatic increase of in-hospital mortality. OBJECTIVES The authors established and validated an easy-used model to stratify the risk of in-hospital AMI among patients with AIS. METHODS We consecutively included patients with AIS who were admitted within 7 days from symptom onset in our prospectively maintained database (NCT04487340) from January 2016 to December 2020. In the derivation cohort from 70 centers, we developed a score to predict in-hospital AMI by integrating the bedside-accessible predictors identified via multivariable logistic regression. Then in the validation cohort from 22 centers, we externally evaluated the performance of this score. RESULTS Overall, 96,367 patients were included. In-hospital AMI occurred in 392 (0.41%) patients. The final model, named CTRAN, incorporated 5 predictors including the history of coronary heart disease, malignant tumor, renal insufficiency, age, and baseline National Institutes of Health Stroke Scale score. The CTRAN score was confirmed in the validation cohort using receiver operating characteristic curve, which yielded an area under the curve of 0.758 (95% CI: 0.718-0.798). CONCLUSIONS The CTRAN score could be a good tool for clinicians to identify patients with AIS at high in-hospital AMI risk.
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Key Words
- AC, anterior circulation
- AIS, acute ischemic stroke
- AMI, acute myocardial infarction
- AUC, area under the curve
- CTRAN, the history of Coronary heart disease, malignant Tumor, Renal insufficiency, Age, and baseline NIHSS score
- ICD, International Classification of Diseases
- NIHSS, National Institutes of Health Stroke Scale
- PC, posterior circulation
- myocardial infarction
- natriuretic peptides
- risk
- stroke
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Affiliation(s)
| | | | | | | | | | - Min Lou
- Address for correspondence: Dr Min Lou, Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou 310009, China.
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Ye X, Guo D, Liu J, Ge J, Yu H, Wang F, LU Z, Sun X, Yuan S, Zhao L, Jin X, Li J, He C, Zhang Q, Meng Y, Yang X, Liang J, Liu R, Ding S, Zhao J, Li Z, Zhong W, Zhu B, Zhou S, Yuan T, Yan L, Hua X, Lu L, Yan S, Jin D, Kong S. AI Model of Using Stratified Deep Learning to Delineate the Organs at Risk (OARs) for Thoracic Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Serafin E, Mazzon G, Ferretti S, Claps F, Zhong W, Fiori C, Celentano G, Guarino G, Zamengo D, Piasentin A, Creta M, Longo N, Dordoni R, Pavan N, Brancelli C, Franceschini A, Cerruto M, Antonelli A, Celia A. Translation and validation of the italian version of the wisconsin stone quality of life (WISQOL) questionnaire: a multicentric study. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hong H, Zhang C, Liu SY, Fu R, Zhong W. EP05.02-006 Neoadjuvant DS-8201 for Stage III Non-small Cell Lung Cancer with HER2 20ins. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zhong W, Lin L, Gong X, Chen Z, Chen Y, Yan S, Zhou Y, Zhang X, Hu H, Tong L, Cheng C, Gu Q, Chen Y, Yu X, Huang Y, Yuan C, Lou M. Evaluation of a multicomponent intervention to shorten thrombolytic door-to-needle time in stroke patients in China (MISSION): A cluster-randomized controlled trial. PLoS Med 2022; 19:e1004034. [PMID: 35788767 PMCID: PMC9255731 DOI: 10.1371/journal.pmed.1004034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Rapid intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is crucial for improving outcomes. However, few randomized trials of interventions aimed at reducing in-hospital delay have been carried out in China. We aimed to evaluate the effect of a multicomponent intervention on thrombolytic door-to-needle time (DNT) of AIS patients via video teleconference based on the Behavior Change Wheel (BCW) method. METHODS AND FINDINGS This cluster-randomized trial, conducted between January 1, 2019 and December 31, 2019, randomly allocated 22 hospitals equally to PEITEM (Persuasion Environment reconstruction Incentivization Training Education Modeling) intervention or routine care plus stroke registry and subsequently enrolled 1,634 AIS patients receiving IVT within 4.5 hours upon stroke onset from participant hospitals. The PEITEM group received a 1-year PEITEM 6-component intervention based on the behavioral theory monthly via video teleconference. The primary outcome was the proportion of patients with a DNT of 60 minutes or less. A total of 987 patients participated in the PEITEM group (mean age, 69 years; female, 411 [41.6%]) and 647 patients in the control group (mean age, 70 years; female, 238 [36.8%]). Of all participants, the proportion of DNT ≤60 minutes in the PEITEM group was higher than in the control group (82.0% versus 73.3%; adjusted odds ratio, 1.77; 95% confidence interval (CI), 1.17 to 2.70; ICC, 0.04; P = 0.007). Among secondary outcomes, the average DNT was 43 minutes in the PEITEM group and 50 minutes in the control group (adjusted mean difference: -8.83; 95% CI, -14.03 to -3.64; ICC, 0.12; P = 0.001). Favorable functional outcome (score of 0 to 1 on the modified Rankin scale (mRS)) was achieved in 55.6% patients of the PEITEM group and 50.4% of the control group (adjusted odds ratio, 1.38; 95% CI, 1.00 to 1.90; ICC, 0.01; P = 0.049). Main study limitations include non-blinding of clinicians, and that specific interventions component responsible for the observed changes could not be determined. CONCLUSIONS The teleconference-delivered PEITEM intervention resulted in a moderate but clinically relevant shorter DNT and better functional outcome in AIS patients receiving IVT. TRIAL REGISTRATION Clinicaltrials.gov NCT03317639.
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Affiliation(s)
- Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Longting Lin
- Imaging Laboratory Manger, Sydney Brain Center, University of New South Wales, Australia
| | - Xiaoxian Gong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhicai Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yi Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xuting Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Haitao Hu
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Lusha Tong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chaochan Cheng
- Department of Neurology, Yongkang First People’s Hospital, Yongkang, China
| | - Qun Gu
- Department of Neurology, Huzhou First People’s Hospital, Huzhou, China
| | - Yong Chen
- Department of Neurology, Li Huili Hospital of Ningbo Medical Center, Ningbo, China
| | - Xiaojin Yu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Yuhui Huang
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Changzheng Yuan
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
- * E-mail: , (ML); (CY)
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- * E-mail: , (ML); (CY)
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Shi F, Zeng Q, Gong X, Zhong W, Chen Z, Yan S, Lou M. Quantitative Collateral Assessment on CTP in the Prediction of Stroke Etiology. AJNR Am J Neuroradiol 2022; 43:966-971. [PMID: 35738675 PMCID: PMC9262076 DOI: 10.3174/ajnr.a7549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/01/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Patients with stroke etiology of large-artery atherosclerosis were thought to have better collateral circulation compared with patients with other stroke etiologies. We aimed to investigate the association between stroke etiology and collateral circulation with a new quantitative collateral assessment method. MATERIALS AND METHODS This retrospective study reviewed data from consecutive patients with proximal anterior artery occlusion who underwent CTP before reperfusion therapy. CBF maps were derived from CTP. A new indicator, maximum CBF of collateral vessels within the Sylvian fissure (cCBFmax), was applied to quantitatively assess the collateral status. The relationship between collateral status and stroke etiology was investigated. RESULTS A total of 296 patients were finally analyzed. The median cCBFmax was significantly higher in patients with large-artery atherosclerosis than in those without it (92 [interquartile range, 65-123] mL/100 g/min versus 62 [interquartile range, 46-82] mL/100 g/min; P < .001). Multivariable analysis revealed that a higher cCBFmax score was independently associated with large-artery atherosclerosis etiology (OR, 1.010; 95% CI, 1.002-1.018; P = .017) after adjustment. The area under the curve, sensitivity, and specificity of the final model in predicting the etiology of large-artery atherosclerosis were 0.870, 89.7%, and 75.2%, respectively. CONCLUSIONS Patients with large-artery atherosclerosis had a more adequate collateral perfusion supply with the new quantitative collateral assessment. The new quantitative collateral measurement might contribute to the prediction of stroke etiology in the acute clinical scenario for patients with acute ischemic stroke.
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Affiliation(s)
- F. Shi
- From the Departments of Neurology (F.S., X.G., W.Z., Z.C., S.Y., M.L.),Department of Neurology (F.S.), Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Q. Zeng
- Neurosurgery (Q.Z.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - X. Gong
- From the Departments of Neurology (F.S., X.G., W.Z., Z.C., S.Y., M.L.)
| | - W. Zhong
- From the Departments of Neurology (F.S., X.G., W.Z., Z.C., S.Y., M.L.)
| | - Z. Chen
- From the Departments of Neurology (F.S., X.G., W.Z., Z.C., S.Y., M.L.)
| | - S. Yan
- From the Departments of Neurology (F.S., X.G., W.Z., Z.C., S.Y., M.L.)
| | - M. Lou
- From the Departments of Neurology (F.S., X.G., W.Z., Z.C., S.Y., M.L.),Zhejiang University Brain Research Institute (M.L.), Hangzhou, Zhejiang, China
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Zhong W, Chen Z, Yan S, Zhou Y, Zhang R, Luo Z, Yu J, Lou M. Multi-Mode Imaging Scale for Endovascular Therapy in Patients with Acute Ischemic Stroke (META). Brain Sci 2022; 12:brainsci12070821. [PMID: 35884628 PMCID: PMC9313044 DOI: 10.3390/brainsci12070821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background: With the guidance of multi-mode imaging, the time window for endovascular thrombectomy (EVT) has been expanded to 24 h. However, poor clinical outcomes are still not uncommon. We aimed to develop a multi-mode imaging scale for endovascular therapy in patients with acute ischemic stroke (META) to predict the neurological outcome in patients receiving endovascular thrombectomy (EVT). Methods: We included consecutive acute ischemic stroke patients with occlusion of middle cerebral artery and/or internal carotid artery who underwent EVT. Poor outcome was defined as modified Rankin Scale (mRS) score of 3−6 at 3 months. A five-point META score was constructed based on clot burden score, multi-segment clot, the Alberta Stroke Program early computed tomography score of cerebral blood volume (CBV-ASPECTS), and collateral status. We evaluated the META score performance using area under the curve (AUC) calculations. Results: A total of 259 patients were included. A higher META score was independently correlated with poor outcomes at 3 months (odds ratio, 1.690, 95% CI, 1.340 to 2.132, p < 0.001) after adjusting for age, hypertension, baseline National Institutes of Health Stroke Scale (NIHSS) score, and baseline blood glucose. Patients with a META score ≥ 2 were less likely to benefit from EVT (mRS 3−6: 60.8% vs. 29.2%, p < 0.001). The META score predicted poor outcomes with an AUC of 0.714, higher than the Pittsburgh Response to Endovascular therapy (PRE) score, the totaled health risks in vascular events (THRIVE) score (AUC: 0.566, 0.706), and the single imaging marker in the scale. Conclusions: The novel META score could refine the predictive accuracy of prognosis after EVT, which might provide a promising avenue for future automatic imaging analysis to help decision making.
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Affiliation(s)
- Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China; (W.Z.); (Z.C.); (S.Y.); (Y.Z.); (R.Z.); (Z.L.)
| | - Zhicai Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China; (W.Z.); (Z.C.); (S.Y.); (Y.Z.); (R.Z.); (Z.L.)
| | - Shenqiang Yan
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China; (W.Z.); (Z.C.); (S.Y.); (Y.Z.); (R.Z.); (Z.L.)
| | - Ying Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China; (W.Z.); (Z.C.); (S.Y.); (Y.Z.); (R.Z.); (Z.L.)
| | - Ruoxia Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China; (W.Z.); (Z.C.); (S.Y.); (Y.Z.); (R.Z.); (Z.L.)
| | - Zhongyu Luo
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China; (W.Z.); (Z.C.); (S.Y.); (Y.Z.); (R.Z.); (Z.L.)
| | - Jun Yu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China;
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China; (W.Z.); (Z.C.); (S.Y.); (Y.Z.); (R.Z.); (Z.L.)
- Correspondence: ; Tel.: +86-571-87784810; Fax: +86-571-87784850
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Chen Y, Gong X, Zhong W, Wang J, Yang Z, Yan S, Geng F, Zhou Y, Zhang X, Chen Z, Hu H, Tong L, Chen H, Ke S, He Y, Wang Y, Zhang X, Wang Z, Chen Z, Zhao H, Yuan C, Lou M. Evaluation of a Multilevel Program to Improve Clinician Adherence to Management Guidelines for Acute Ischemic Stroke. JAMA Netw Open 2022; 5:e2210596. [PMID: 35522283 PMCID: PMC9077486 DOI: 10.1001/jamanetworkopen.2022.10596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Promotion of clinician adherence to stroke guidelines can improve stroke outcomes. OBJECTIVE To investigate the outcomes of a multilevel system program on clinician adherence to guidelines for treatment of patients with acute ischemic stroke (AIS). DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used a prospective interrupted time series (ITS) and difference-in-difference (DID) design, from August 1, 2018, to January 31, 2020, divided into preprogram term and short and long postprogram terms; each term had 6 months. Data were collected during hospitalization and at discharge with an automated medical record data capture system in 58 public hospitals in Zhejiang province, China. Data were analyzed from August 2018 to January 2020. EXPOSURES The multilevel system program included a modularized standard template for medical records, centrally supported continuing education, continuous monitoring and feedback, and collaborative workshops. MAIN OUTCOMES AND MEASURES The primary outcome was adherence to 12 key performance indicators (KPIs), expressed as (1) percentage of patient-applicable KPIs achieved in each participant and (2) percentage of participants among whom all applicable KPIs were achieved (dichotomous all-or-none measure). The secondary outcome was severe disability or death (modified Rankin Scale 5-6) at discharge. RESULTS Among 45 091 patients (mean [SD] age, 69 [12] years; 18 347 female [40.7%]), 28 721 from 30 hospitals received the program and 16 370 from 28 hospitals continued routine care. In adjusted DID analysis, the program was associated with an increase in the absolute percentage of KPIs achieved per patient (6.46%; 95% CI, 5.49% to 7.43%), absolute rate of all-or-none success (8.29%; 95% CI, 6.99% to 9.60%), and decreased rate of severe disability or death at discharge (-1.68%; 95% CI, -2.99% to -0.38%). The ITS result showed the program was associated with an increase in KPIs achieved per patient per week (slope change in short-term period, 0.36%; 95% CI, 0.20% to 0.52%; level change in long-term period, (9.64%; 95% CI, 4.58% to 14.69%) and in all-or-none success (slope change in short-term period 0.34%; 95% CI, 0.23% to 0.46%; level change in long-term period 5.89%; 95% CI, 0.19% to 11.59%). CONCLUSIONS AND RELEVANCE The centrally supported program was associated with increases in clinician adherence to guidelines and reduced the proportion of severely disabled or deceased patients with AIS at discharge, providing support for its wider implementation.
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Affiliation(s)
- Yi Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiaoxian Gong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jianbing Wang
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zongming Yang
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Fangli Geng
- Health Policy program, Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts
| | - Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xuting Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhicai Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Haitao Hu
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Lusha Tong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Hongfang Chen
- Department of Neurology, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, China
| | - Shaofa Ke
- Department of Neurology, Taizhou Hospital, Wenzhou Medical University, Taizhou, China
| | - Yuping He
- Department of Neurology, Zhuji People's Hospital of Zhejiang Province, Shaoxing, China
| | - Yaxian Wang
- Department of Neurology, Huzhou Central Hospital, Huzhou, China
| | - Xiaoling Zhang
- Department of Neurology, Jiaxing Second Hospital, Jiaxing, China
| | - Zhimin Wang
- Department of Neurology, Taizhou First People's Hospital, Huangyan Hospital of Wenzhou Medical University, Taizhou, China
| | - Zhihui Chen
- Department of Neurology, Lanxi People's Hospital, Jinhua, China
| | - Heng Zhao
- Department of Neurosurgery, Stanford University, Stanford, California
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Zhong W, Yan S, Chen Z, Luo Z, Chen Y, Zhang X, Wu C, Tang W, Zhang X, Wang Y, Gu Q, Xu D, Chen H, Lou M. Stroke outcome of early antiplatelet in post-thrombolysis haemorrhagic infarction. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-328778. [PMID: 35473712 DOI: 10.1136/jnnp-2022-328778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Initiation of early antiplatelet (EA) therapy after acute ischaemic stroke (AIS) is essential. We aimed to investigate the safety and effectiveness of EA therapy in patients who had an AIS with haemorrhagic infarction (HI) after intravenous thrombolysis (IVT). METHODS Based on a multicentre stroke registry database, patients who had an AIS with post-thrombolysis HI at 24 hours were identified. EA users and non-EA users were defined as patients with HI who received or did not receive antiplatelet therapy between 24 and 48 hours after IVT. Primary outcome was favourable outcome defined as modified Rankin Scale scores 0-2 at 3 months. Secondary outcomes were early neurological deterioration (END) and haemorrhagic transformation expansion. RESULTS A total of 842 patients with HI were identified from 24 061 thrombolytic patients within 4.5 hours, and 341 (40.5%) received EA therapy. EA users were more likely to have a favourable outcome (55.7% vs 39.5%, OR 1.565; 95% CI 1.122 to 2.182; p=0.008) and lower rate of END (12.6% vs 21.4%, OR 0.585; 95% CI 0.391 to 0.875; p=0.009) compared with non-EA users. EA therapy was not associated with haemorrhagic transformation expansion (p=0.125). After propensity score matching, EA therapy was still independently associated with favourable outcome (54.3% vs 46.3%, OR 1.495; 95% CI 1.031 to 2.167; p=0.038) and lower risk of END (13.5% vs 21.2%, OR 0.544; 95% CI 0.350 to 0.845; p=0.007). CONCLUSIONS Antiplatelet therapy can be safely used between 24 and 48 hours when HI occurs after IVT, and such therapy is associated with reduced risk of END and improved neurological outcome in patients who had an AIS.
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Affiliation(s)
- Wansi Zhong
- Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhicai Chen
- Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhongyu Luo
- Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yi Chen
- Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xuting Zhang
- Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chenglong Wu
- Neurology, Shaoxing People's Hospital, Shaoxing, China
| | - Weiguo Tang
- Neurology, Zhoushan Hospital, Zhoushan, China
| | | | - Yaxian Wang
- Neurology, Huzhou Central Hospital, Huzhou, China
| | - Qun Gu
- Neurology, Huzhou First People's Hospital, Huzhou, China
| | - Dongjuan Xu
- Neurology, Dongyang People's Hospital, Jinhua, China
| | | | - Min Lou
- Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Yan S, Zhou Y, Zhao Y, Wang F, Tao A, Zhou L, Pan M, Zhong G, Hu L, Jiang X, Mao X, Tang H, Wang J, Qian S, Sun J, Gong X, Zhong W, Lou M. Effect of Imaging Markers on Reperfusion Therapy in Basilar Artery Occlusion. Ann Neurol 2022; 92:97-106. [PMID: 35438200 PMCID: PMC9323426 DOI: 10.1002/ana.26376] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 12/20/2022]
Abstract
Objective We aimed to investigate the effectiveness of endovascular therapy (EVT) versus intravenous thrombolysis (IVT) in patients with basilar artery occlusion (BAO), based on the information of advanced imaging. Methods We analyzed data of stroke patients with radiologically confirmed BAO within 24 hours. BAO subjects were categorized into “top‐of‐the‐basilar” syndrome (TOBS) and other types. An initial infarct size of <70ml and a ratio of ischemic tissue to infarct volume of ≥1.8 was defined as “target mismatch.” The primary outcome was a good outcome, defined as a modified Rankin Scale score of 0 to 3 at 3 months. Propensity score adjustment and inverse probability of treatment weighting (IPTW) propensity score methods were used. Results Among 474 BAO patients, 93 (19.6%) were treated with IVT prior to EVT, 91 (19.2%) were treated with IVT alone, 95 (20.0%) were treated with EVT alone, and 195 (41.1%) were treated with antithrombotic therapy. In IPTW analyses, we found no benefit of EVT over IVT for good outcome in either TOBS patients (odds ratio = 1.08, 95% confidence interval [CI] = 0.88–1.31) or those with other types (odds ratio = 1.13, 95% CI = 0.94–1.36). However, in patients with other types, if there existed a target mismatch, EVT was independently related to good outcome (odds ratio = 1.46, 95% CI = 1.17–1.81). Interpretation The “target mismatch profile” seems to be a possible candidate selection standard of EVT for those with other types of BAO. Future studies should separate TOBS from other types of BAO, and try to use advanced imaging. ANN NEUROL 2022;92:97–106
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Affiliation(s)
- Shenqiang Yan
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yuqi Zhao
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Feng Wang
- Department of Neurology, Taizhou Hospital of Zhejiang Province Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Anyang Tao
- Department of Neurology, Taizhou First People's Hospital, Taizhou, China
| | - Lin Zhou
- Department of Neurology, Zhoushan Hospital of Zhejiang Province, Zhoushan, China
| | - Mengxiong Pan
- Department of Neurology, First People's Hospital of Huzhou, Huzhou, China
| | - Genlong Zhong
- Department of Neurology, Sixth Affiliated Hospital of Wenzhou Medical University, People's Hospital of Lishui, Lishui, China
| | - Lingzhi Hu
- Department of Neurology, First People's Hospital of Yongkang, Yongkang, China
| | - Xuanfei Jiang
- Department of Neurology, Huzhou Central Hospital, Huzhou, China
| | - Xinlei Mao
- Department of Neurology, Wenzhou Central Hospital, Wenzhou, China
| | - Huan Tang
- Department of Neurology, Shaoxing People's Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Jianwei Wang
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Shuxia Qian
- Department of Neurology, Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jingping Sun
- Department of Neurology, Lishui Hospital of Zhejiang University (Lishui Municipal Central Hospital), Lishui, China
| | - Xiaoxian Gong
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Wang J, Gong X, Chen H, Zhong W, Chen Y, Zhou Y, Zhang W, He Y, Lou M. Causative Classification of Ischemic Stroke by the Machine Learning Algorithm Random Forests. Front Aging Neurosci 2022; 14:788637. [PMID: 35493925 PMCID: PMC9051333 DOI: 10.3389/fnagi.2022.788637] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Prognosis, recurrence rate, and secondary prevention strategies differ by different etiologies in acute ischemic stroke. However, identifying its cause is challenging. Objective This study aimed to develop a model to identify the cause of stroke using machine learning (ML) methods and test its accuracy. Methods We retrospectively reviewed the data of patients who had determined etiology defined by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) from CASE-II (NCT04487340) to train and evaluate six ML models, namely, Random Forests (RF), Logistic Regression (LR), Extreme Gradient Boosting (XGBoost), K-Nearest Neighbor (KNN), Ada Boosting, Gradient Boosting Machine (GBM), for the detection of cardioembolism (CE), large-artery atherosclerosis (LAA), and small-artery occlusion (SAO). Between October 2016 and April 2020, patients were enrolled consecutively for algorithm development (phase one). Between June 2020 and December 2020, patients were enrolled consecutively in a test set for algorithm test (phase two). Area under the curve (AUC), precision, recall, accuracy, and F1 score were calculated for the prediction model. Results Finally, a total of 18,209 patients were enrolled in phase one, including 13,590 patients (i.e., 6,089 CE, 4,539 LAA, and 2,962 SAO) in the model, and a total of 3,688 patients were enrolled in phase two, including 3,070 patients (i.e., 1,103 CE, 1,269 LAA, and 698 SAO) in the model. Among the six models, the best models were RF, XGBoost, and GBM, and we chose the RF model as our final model. Based on the test set, the AUC values of the RF model to predict CE, LAA, and SAO were 0.981 (95%CI, 0.978-0.986), 0.919 (95%CI, 0.911-0.928), and 0.918 (95%CI, 0.908-0.927), respectively. The most important items to identify CE, LAA, and SAO were atrial fibrillation and degree of stenosis of intracranial arteries. Conclusion The proposed RF model could be a useful diagnostic tool to help neurologists categorize etiologies of stroke. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT01274117].
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Affiliation(s)
- Jianan Wang
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xiaoxian Gong
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Hongfang Chen
- Department of Neurology, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, China
| | - Wansi Zhong
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yi Chen
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Wenhua Zhang
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yaode He
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Min Lou
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Zhang D, Zhong W, Chen L, Xu C, Yan S, Zhou Y, Ma X, Lou M. Corticospinal Tract Hypoperfusion Associated With Unexplained Early Neurological Deterioration After Intravenous Thrombolysis. Front Neurol 2022; 13:854915. [PMID: 35418926 PMCID: PMC8996180 DOI: 10.3389/fneur.2022.854915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Early neurological deterioration (END) occurs in 10% among patients with acute ischemic stroke (AIS) who are receiving intravenous thrombolysis (IVT). Over half of them have no straightforward causes, which is referred to as unexplained END. We aimed to explore whether the presence of baseline corticospinal tract (CST) hypoperfusion could predict the development of unexplained END at 24 h in patients with AIS after receiving IVT. Methods We retrospectively analyzed the clinical and imaging data from patients with AIS who received IVT. Unexplained END was defined as ≥ 2-point increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h without straightforward causes. Hypoperfusion lesions involving CST and other cerebral areas were identified on perfusion maps. Results Among 807 patients, CST hypoperfusion and non-CST hypoperfusion occurred in 488 (60.5%) and 319 (39.5%) patients, respectively. Patients with CST hypoperfusion were more likely to have unexplained END compared with patients with non-CST hypoperfusion (16.6 vs. 2.8%, P < 0.001). Binary logistics regression analysis showed that CST hypoperfusion was independently associated with unexplained END after IVT (OR = 5.64; 95% CI: 2.699–11.785; P < 0.001) after adjusting for baseline NIHSS, onset to needle time, baseline hypoperfusion volume, atrial fibrillation, and hypertension. Conclusions Patients with CST hypoperfusion were more likely to suffer from unexplained END after IVT, implying potential mechanisms and potential prevention of unexplained END.
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Affiliation(s)
- Danfeng Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.,Department of Neurology, Haiyan People's Hospital, Zhejiang, China
| | - Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Luowei Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chao Xu
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiaodong Ma
- Department of Neurology, Haiyan People's Hospital, Zhejiang, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Jie W, Wu YL, Lu S, Wang Q, Li S, Zhong W, Wang Q, Li W, Wang B, Chen J, Cheng Y, Duan H, Li G, Shan L, Liu Y, Huang X, Atasoy A, He J. 85P Adjuvant osimertinib in patients (pts) with stage IB–IIIA EGFR mutation-positive (EGFRm) NSCLC after complete tumour resection: ADAURA China subgroup analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gong X, Chen H, Wang J, Zhong W, Chen L, Yan S, Lou M. Undertreatment of Anticoagulant Therapy in Hospitalized Acute Ischemic Stroke Patients With Atrial Fibrillation. Front Cardiovasc Med 2022; 9:841020. [PMID: 35433893 PMCID: PMC9005870 DOI: 10.3389/fcvm.2022.841020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to investigate the prevalence and factors associated with the initiation of oral anticoagulation among patients with acute ischemic stroke (AIS) and concurrent atrial fibrillation (AF) at discharge in China. Methods We continuously included hospitalized patients with AIS with an AF diagnosis registered in the computer-based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation (CASE II) from January 2016 to December 2020 and divided them into a and non-anticoagulant groups according to the medications at discharge. Binary logistic regression was used to determine the factors associated with the prescription of anticoagulants in patients with AF. Results A total of 16,162 patients were enrolled. The mean age was 77 ± 9 years, 8,596 (53.2%) were males, and the median baseline National Institute of Health Stroke Scale score was 5 (2–12). Of the 14,838 patients without contraindications of antithrombotic therapy, 6,335 (42.7%) patients were initiated with anticoagulation treatment at discharge. Prior history of hemorrhagic stroke (OR 0.647, p < 0.001) and gastrointestinal bleeding (OR 0.607, p = 0.003) were associated with a lower rate of anticoagulation at discharge. Patients with any intracranial hemorrhage (OR 0.268, p < 0.001), gastrointestinal bleeding (OR 0.353, p < 0.001), or pneumonia during hospitalization (OR 0.601, p < 0.001) were less likely to receive anticoagulants at discharge. Among 7,807 patients with previously diagnosed AF and high risk of stroke (CHA2DS2-VASc ≥2), only 1,585 (20.3%) had been receiving anticoagulation treatment prior to the onset of stroke. However, the mean international normalized ratio (INR) was 1.5 on the first test during hospitalization in patients receiving warfarin. Patients complicated with a previous history of ischemic stroke/transient ischemic attack (TIA; OR 2.303, p < 0.001) and peripheral artery disease (OR 1.456, p = 0.003) were more common to start anticoagulants. Conclusions Less than half of patients with AIS and concurrent AF initiated guideline-recommended oral anticoagulation at discharge, while only 20% of patients with previously diagnosed AF with a high risk of stroke had been using anticoagulants prior to the onset of stroke, which highlights a large care gap in hospitalized stroke patients and the importance of AF management.
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Affiliation(s)
- Xiaoxian Gong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Hongfang Chen
- Department of Neurology, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, China
| | - Jianan Wang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Luowei Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- *Correspondence: Min Lou ;
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Ren Z, Zhao A, Zhang J, Yang C, Zhong W, Mao S, Wang S, Yuan Q, Wang P, Zhang Y. Safety and tolerance of Lacticaseibacillus paracasei N1115 in caesarean-born young children: a randomised, placebo-controlled trial. Benef Microbes 2022; 13:205-219. [PMID: 35300564 DOI: 10.3920/bm2021.0132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The administration of probiotics may help to improve dysbiosis and related health problems in children delivered by caesarean section. However, the effects are strain specific, and safety combined tolerance are considered a priority. The aim of this study was to evaluate the safety and tolerance of Lacticaseibacillus paracasei N1115 in caesarean-born children aged 6-24 months via a randomised, placebo-controlled intervention study. In total, 101 children were included and randomised to receive either a sachet of L. paracasei N1115 (2×1010 cfu/g, 2 g/day) or placebo (maltodextrin, 2 g/day) per day for 12 weeks. Anthropometric parameters were measured by trained nurses, and defecation characteristics, gastrointestinal symptoms, (serious) adverse events ((s)AEs), crying patterns and lifestyle behaviours were recorded by parents or guardians. Neurocognitive development was assessed by the Ages and Stages Questionnaires-3 (ASQ-3) before and after the intervention. The only difference between groups regarding defecation characteristics was a significant treatment × time effect on stool frequency (P=0.007), as the number of defecations was significantly higher in the probiotic group (around 1.2-1.3 times/day) than in the placebo group (around 1.0 times/day) in the later intervention period (P=0.035 at week 9; P=0.048 at week 10; P=0.026 at week 12). The use of L. paracasei N1115 also reduced the incidence rate of constipation (Incidence rate ratio (IRR): 0.120; 95% confidence interval (CI): 0.015, 0.967; P=0.046) and abdominal pain (IRR: 0.562; 95% CI: 0.358, 0.882; P=0.012). Changes in anthropometric parameters, including weight, height and head circumference, did not differ significantly between groups, nor did measures of crying, sleep, outdoor activity, temper, appetite or the ASQ-3 scores. No adverse events associated with consumption of the probiotic were reported. Thus, the administration of L. paracasei N1115 is safe and well-tolerated in caesarean-born children aged 6-24 months. Furthermore, it may ameliorate gastrointestinal function to some extent.
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Affiliation(s)
- Z Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China P.R
| | - A Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100091, China P.R
| | - J Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China P.R
| | - C Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China P.R
| | - W Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China P.R
| | - S Mao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China P.R
| | - S Wang
- Shijiazhuang Junlebao Dairy Co. Ltd., Shijiazhuang 050221, China P.R.,Peking University Medical Science-Junlebao Dairy Joint Laboratory of Breast Milk Science and Life Health, Beijing 100191, China P.R
| | - Q Yuan
- Shijiazhuang Junlebao Dairy Co. Ltd., Shijiazhuang 050221, China P.R.,Peking University Medical Science-Junlebao Dairy Joint Laboratory of Breast Milk Science and Life Health, Beijing 100191, China P.R
| | - P Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China P.R
| | - Y Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China P.R.,Peking University Medical Science-Junlebao Dairy Joint Laboratory of Breast Milk Science and Life Health, Beijing 100191, China P.R
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Li X, Yu L, Chen R, Peng S, Liang X, Zhong W, Pu H, Fang F, Li H, Wang L. Effects of various preservation treatments on diversity and abundance of microbial community in rice product (MiBa) during storage. AAlim 2022. [DOI: 10.1556/066.2021.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
To determine the most effective preservation method for MiBa (a traditional Chinese rice product), MiBa treated with 75% alcohol, 75% alcohol + inhibitor, ozone treatment; untreated (control); and raw rice were subjected to 16S rRNA gene and ITS three-generation sequencing by High-throughput Sequencing Technology. According to the results the preservation effects of different treatment methods ranked as follows: ozone treatment >75% alcohol treatment >75% alcohol+inhibitor > control. Bacterial composition analysis showed that the bacterial community on the surface of MiBa treated with ozone was dominated by genera Leuconostoc and Serratia. The fungal community consisted mainly of Aspergillus and Alternaria. In summary, ozone treatment proved to be the most effective in inhibiting microbial contamination during the storage of MiBa, effectively extending its shelf life.
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Affiliation(s)
- X.R. Li
- The Institute of Agro-Products Processing Science and Technology, Yunnan Academy of Agricultural Sciences, Kunming, 650205, China
| | - L.J. Yu
- The Institute of Agro-Products Processing Science and Technology, Yunnan Academy of Agricultural Sciences, Kunming, 650205, China
| | - R.D. Chen
- Yunnan Agricultural University, Kunming, 650201, China
| | - S. Peng
- Yunnan Agricultural University, Kunming, 650201, China
| | - X.R. Liang
- Yunnan Agricultural University, Kunming, 650201, China
| | - W. Zhong
- Huazhong Agricultural University, Wuhan, 430070, China
| | - H.M. Pu
- The Institute of Agro-Products Processing Science and Technology, Yunnan Academy of Agricultural Sciences, Kunming, 650205, China
| | - F. Fang
- Yunnan Agricultural University, Kunming, 650201, China
| | - H. Li
- The Institute of Agro-Products Processing Science and Technology, Yunnan Academy of Agricultural Sciences, Kunming, 650205, China
| | - L.F. Wang
- Huazhong Agricultural University, Wuhan, 430070, China
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Zhang X, Zhong W, Ma X, Zhang X, Chen H, Wang Z, Lou M. Ginkgolide With Intravenous Alteplase Thrombolysis in Acute Ischemic Stroke Improving Neurological Function: A Multicenter, Cluster-Randomized Trial (GIANT). Front Pharmacol 2021; 12:792136. [PMID: 34925044 PMCID: PMC8681856 DOI: 10.3389/fphar.2021.792136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/04/2021] [Indexed: 12/25/2022] Open
Abstract
Background and Purpose: We aimed to investigate the effect of Ginkgolide® treatment on neurological function in patients receiving intravenous (IV) recombinant tissue plasminogen activator (rt-PA). Methods: This cluster randomized controlled trial included acute ischemic stroke patients in 24 centers randomized to intervention of intravenous Ginkgolide® or control group within the first 24 h after IV rt-PA therapy (IVT). Clinical outcome at 90 days was assessed with modified Rankin Scale (mRS) score and dichotomized into good outcome (0-2) and poor outcome (3-6). Hemorrhagic transformation represented the conversion of a bland infarction into an area of hemorrhage by computed tomography. Symptomatic intracerebral hemorrhage (sICH) was defined as cerebral hemorrhagic transformation in combination with clinical deterioration of National Institutes of Health Stroke Scale (NIHSS) score ≥4 points at 7-day or if the hemorrhage was likely to be the cause of the clinical deterioration. We performed logistic regression analysis and propensity score matching analysis to investigate the impact of Ginkgolide® treatment with IV rt-PA on good outcome, hemorrhagic transformation and sICH, respectively. Results: A total of 1113 patients were finally included and 513 (46.1%) were in the intervention group. Patients in the Ginkgolide® group were more likely to have good outcomes (78.6 vs. 66.7%, p < 0.01) and lower rate of sICH (0 vs. 2.72%, p < 0.01), compared with patients in the control group. The intra-cluster correlation coefficient (ICC) for good outcome at 90 days was 0.033. Binary logistic regression analysis revealed that treatment with Ginkgolide® was independently associated with 90-day mRS in patients with IV rt-PA therapy (OR 1.498; 95% CI 1.006-2.029, p = 0.009). After propensity score matching, conditional logistic regression showed intervention with Ginkgolide® was significantly associated with 90-day good outcome (OR 1.513; 95% CI 1.073-2.132, p = 0.018). No significant difference in hemorrhage transformation was seen between the 2 matched cohorts (OR 0.885; 95% CI 0.450-1.741, p = 0.724). Conclusion: Using Ginkgolide® within 24-hour after IV rt-PA is effective and safe and might be recommended in combination with rtPA therapy in acute ischemic stroke. Clinical Trial Registration: http://www.clinicaltrials.gov, identifier NCT03772847.
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Affiliation(s)
- Xuting Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiaodong Ma
- Department of Neurology, Haiyan People's Hospital, Jiaxing, China
| | - Xiaoling Zhang
- Department of Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hongfang Chen
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Zhimin Wang
- Department of Neurology, The First People's Hospital of Taizhou, Taizhou, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Sun S, Zou L, Wang T, Liu Z, He J, Sun X, Zhong W, Zhao F, Li X, Li S, Zhu H, Ma Z, Wang W, Meng J, Zhang F, Hou X, Wei L, Hu K. Age ≥60 y May Not be an Appropriate Adverse Risk Factor in Adjuvant Treatment of Patients With Early-Stage Endometrial Carcinoma: A Multi-Institutional Analysis in China. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hu Y, Liang D, Chen X, Chen L, Bai J, Li H, Yin C, Zhong W. [MiR-671-5p negatively regulates SMAD3 to inhibit migration and invasion of osteosarcoma cells]. Nan Fang Yi Ke Da Xue Xue Bao 2021; 41:1562-1568. [PMID: 34755673 DOI: 10.12122/j.issn.1673-4254.2021.10.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore the role of miR-671-5p in regulating the migration and invasion of osteosarcoma and the underlying mechanisms. METHODS The differentially expressed microRNAs (miRNAs) in osteosarcoma were screened in the NCBI online database, and the target proteins of these miRNAs were predicted and their functions were analyzed. Osteosarcoma cells were transfected with a plasmid overexpressing miR-671-5p, and the transfection efficiency was assessed using quantitative real-time PCR (qRT-PCR). The changes in the migration and invasion of the transfected cells were examined with Transwell assay, and the expressions of proteins related with epithelial-mesenchymal transition (EMT) were detected using Western blotting. Dual-luciferase reporter assay was performed to determine whether the 3'UTR of SMAD3 contained a targeted binding site of miR-671-5p. RESULTS MiR-671-5p was significantly down-regulated in both osteosarcoma tissues and osteosarcoma cells (P < 0.05). The osteosarcoma cells overexpressing miR-671-5p showed significantly reduced migration and invasion abilities (P < 0.05) with obviously lowered expressions of EMT-related proteins (P < 0.05). SMAD3 was highly expressed in osteosarcoma cells (P < 0.05), and dual-luciferase reporter assay confirmed the presence of a targeted binding site between miR-671-5p and the 3'UTR of SMAD3 (P < 0.05). In osteosarcoma cells transfected with a SMAD3-overexpressing plasmid (P < 0.05), the high expression of SMAD3 significantly inhibited by miR-671-5p overexpression (P < 0.05). Transwell assay demonstrated that SMAD3 overexpression significantly promoted the migration and invasion of osteosarcoma cells (P < 0.05), and while miR-671-5p overexpression obviously reversed this effect (P < 0.05). CONCLUSION MiR-671-5p can inhibit the invasion and migration of osteosarcoma cells by negatively regulating SMAD3.
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Affiliation(s)
- Y Hu
- Department of Pathology, Weifang Medical University, Weifang 261053, China
| | - D Liang
- First Department of Joint Surgery, Weifang Medical University, Weifang 261053, China
| | - X Chen
- Department of Pathology, Weifang Medical University, Weifang 261053, China
| | - L Chen
- Department of Pathology, Weifang Medical University, Weifang 261053, China
| | - J Bai
- Department of Pathology, Weifang Medical University, Weifang 261053, China
| | - H Li
- Medicine Research Center, Weifang Medical University, Weifang 261053, China
| | - C Yin
- College of Nursing, Weifang Medical University, Weifang 261053, China
| | - W Zhong
- First Department of Joint Surgery, Weifang Medical University, Weifang 261053, China
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Liu Y, Liu J, Tan Z, Jiang X, Wang L, Lu Y, Fu X, Song Q, Zhao L, Yuan S, Bi N, Xu Y, Zhu Z, Zhu G, Li J, Xie C, Ma X, Xiao G, Ge H, Liu H, Zhao J, Liang J, Shen Q, Xu Q, Liu R, Zhou S, Kong W, Zhong W, Jin X, Wang Y, Jiang Y, Fu Z, Xie Y, Cai J, Li Z, Machtay M, Curran W, Kong F. P29.05 Gross Tumor Volume Contouring Variations in Radiation Therapy of Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Liu J, Jiang X, Tan Z, Li Z, Wang Y, Xie Y, Cai J, Zhu G, Li J, Xie C, Ma X, Xiao G, Liu H, Ge H, Zhao J, Liang J, Shen Q, Xu Q, Liu R, Zhou S, Zhong W, Kong W, Jiang Y, Xu Y, Fu Z, Liu Y, Zhu Z, Bi N, Yuan S, Zhao L, Song Q, Lu Y, Fu X, Wang L, Machtay M, Curran W, Kong F. P29.03 Thoracic Organs at Risk (OARs) Contouring Variations and Consensus in Radiation Therapy for Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dong S, Wang Z, Zhou Q, Yang L, Zhang J, Chen Y, Liu S, Lin J, Liao R, Tu H, Xu C, Yang X, Zhong W, Yang J, Wu Y. P49.01 Drug Holiday Based on Minimal Residual Disease Status After Local Therapy Following EGFR-TKI Treatment for Patients With Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Liao R, Xu C, Yang X, Liu S, Zhong W, Tu H, Wang Z, Wu Y. P40.02 Pemetrexed in Advanced-stage Lymphoepithelioma Carcinoma of Lung. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Background Patients with large vessel occlusion stroke (LVOS) need to be rapidly identified and transferred to comprehensive stroke centers. However, current prehospital evaluation and strategies still remain challenging. Methods and Results We retrospectively reviewed our prospectively collected database of patients with acute ischemic stroke (AIS). Based on the items of National Institutes of Health Stroke Scale and medical history that had a strong association with LVOS, we designed the 4‐item Stroke Scale (4I‐SS) and validated it in multi‐centers. The 4I‐SS incorporated gaze, level of consciousness, arm weakness, and atrial fibrillation. Receiver operating characteristic analysis was used to compare the 4I‐SS with previously established prehospital prediction scales. Finally, 1630 and 11 440 patients were included in the derivation and validation cohort, respectively. In the validation cohort, Youden Index, area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the 4I‐SS≥4 to predict LVOS were 0.494, 0.800, 0.657, 0.837, 0.600, 0.868, and 0.788, respectively, and that of the 4I‐SS≥7 to predict basilar artery occlusion were 0.200, 0.669, 0.229, 0.971, 0.066, 0.974, and 0.899, respectively. Youden Index and area under the curve were higher than previously published scales for predicting LVOS. Further analysis showed that for predicting whether cardiogenic embolism was the cause, its accuracy was 0.922 when the 4I‐SS score, including atrial fibrillation, was ≥6, and its accuracy of predicting the occluded vessel was intracranial internal carotid artery or M1 segment of the middle cerebral artery when it was ≥7 was 0.590. Conclusions The 4I‐SS is an effective and simple tool that can identify LVOS and its cause. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03317639.
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Affiliation(s)
- Jianan Wang
- Department of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou China
| | - Xiaoxian Gong
- Department of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou China
| | - Wansi Zhong
- Department of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou China
| | - Ying Zhou
- Department of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou China
| | - Min Lou
- Department of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou China
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48
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André T, Shiu K, Kim T, Jensen B, Jensen L, Punt C, Smith D, Garcia-Carbonero R, Alcaide García J, Gibbs P, De la Fouchardière C, Rivera Herrero F, Elez E, Bendell J, Le D, Yoshino T, Zhong W, Fogelman D, Marinello P, Diaz L. O-8 Final overall survival for the phase 3 KN177 study: Pembrolizumab versus chemotherapy in microsatellite instability-high/mismatch repair deficient metastatic colorectal cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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49
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Abstract
Subtypes (1-4) of the hyperpolarization-activated cyclic nucleotide-gated (HCN) channels are widely expressed in the central and peripheral nervous systems, as well as the cells of smooth muscles in many organs. They mainly serve to regulate cellular excitability in these tissues. The HCN channel blocker ZD7288 has been shown to reduce apomorphine-induced conditioned taste aversion on saccharin preference in rats suggesting potential antinausea/antiemetic effects. Currently, in the least shew model of emesis we find that ZD7288 induces vomiting in a dose-dependent manner, with maximal efficacies of 100% at 1 mg/kg (i.p.) and 83.3% at 10 µg (i.c.v.). HCN channel subtype (1-4) expression was assessed using immunohistochemistry in the least shrew brainstem dorsal vagal complex (DVC) containing the emetic nuclei (area postrema (AP), nucleus tractus solitarius and dorsal motor nucleus of the vagus). Highly enriched HCN1 and HCN4 subtypes are present in the AP. A 1 mg/kg (i.p.) dose of ZD7288 strongly evoked c-Fos expression and ERK1/2 phosphorylation in the shrew brainstem DVC, but not in the in the enteric nervous system in the jejunum, suggesting a central contribution to the evoked vomiting. The ZD7288-evoked c-Fos expression exclusively occurred in tryptophan hydroxylase 2-positive serotonin neurons of the dorsal vagal complex, indicating activation of serotonin neurons may contribute to ZD7288-induced vomiting. To reveal its mechanism(s) of emetic action, we evaluated the efficacy of diverse antiemetics against ZD7288-evoked vomiting including the antagonists/inhibitors of: ERK1/2 (U0126), L-type Ca2+ channel (nifedipine); store-operated Ca2+ entry (MRS 1845); T-type Ca2+ channel (Z944), IP3R (2-APB), RyR receptor (dantrolene); the serotoninergic type 3 receptor (palonosetron); neurokinin 1 receptor (netupitant), dopamine type 2 receptor (sulpride), and the transient receptor potential vanilloid 1 receptor agonist, resiniferatoxin. All tested antiemetics except sulpride attenuated ZD7288-evoked vomiting to varying degrees. In sum, ZD7288 has emetic potential mainly via central mechanisms, a process which involves Ca2+ signaling and several emetic receptors. HCN channel blockers have been reported to have emetic potential in the clinic since they are currently used/investigated as therapeutic candidates for cancer therapy related- or unrelated-heart failure, pain, and cognitive impairment.
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Affiliation(s)
| | - N. A. Darmani
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, United States
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50
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Zhang J, Dong S, Zhu Q, Zhao G, Li P, Zhou Q, Yang J, Zhang X, Guan Y, Xia X, Yang X, Zhong W, Wu Y. P59.03 Intratumoral Heterogeneity and Clonal Evolution in Large Non-Small Cell Lung Cancer (>7cm) Delineated by Multiregion Sequencing. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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