Prevalence and clinical impact of sarcopenia in liver transplant recipients: A meta-analysis

BACKGROUND

The prevalence of sarcopenia in patients undergoing liver transplantation (LT) remains to be determined partly because of different diagnostic criteria. Sarcopenia has recently been recognized as a new prognostic factor for predicting outcomes in LT candidates.

AIM

To estimate the prevalence of sarcopenia and evaluate its clinical effect on LT candidates.

METHODS

This systematic search was conducted in PubMed, Web of Science, Embase, and Cochrane Library for original English-language articles that investigated the prevalence and influence of sarcopenia in patients undergoing LT from database inception to November 30, 2022. Cohort studies of the definition of sarcopenia that estimate sarcopenia prevalence and evaluate its effect on clinical outcomes and the risk of mortality were included.

RESULTS

Twenty-five studies involving 7760 patients undergoing LT were included. The pooled prevalence of sarcopenia in patients undergoing LT was 40.7% [95% confidence intervals (95%CI): 32.1-49.6]. The 1-, 3-, and 5-year cumulative probabilities of post-LT survival in patients with preoperative sarcopenia were all lower than those without sarcopenia (P < 0.05). Sarcopenia was associated with an increased risk of post-LT mortality in patients undergoing LT (adjusted hazard ratio: 1.58; 95%CI: 1.21-2.07). Patients with preoperative sarcopenia had a longer intensive care unit stay, a high risk ratio of sepsis, and serious post-LT complications than those without sarcopenia.

CONCLUSION

Sarcopenia is prevalent in a substantial proportion of patients undergoing LT and is strongly and independently associated with higher a risk of mortality risk.

[Urban-rural disparities of depression symptoms and its influencing factors among the elderly aged ≥65 years old in Anhui Province from 2019 to 2020]

Objective: To analyze the difference in depression symptoms and influencing factors between urban and rural elderly people aged ≥65 years old in Anhui Province. Methods: Based on the data from a survey of 68 communities in Anhui Province that implemented the National Elderly Psychological Care Project from 2019 to 2020, the current status of depression symptoms in the elderly was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The difference in the detection rate of depression symptoms between urban and rural elderly people with different characteristics was compared by using the χ2 test. The logistic regression model was used to analyze the relevant factors of depression symptoms in urban and rural elderly people. Results: A total of 15 532 elderly people aged≥65 years old were included in the survey. The detection rate of depressive symptoms was 7.12%, which was higher in rural areas (9.08%) than in urban areas (6.48%). Logistic regression showed that chronic diseases were risk factors for depressive symptoms in elderly people from both urban and rural areas. Positive attitudes towards aging and good mental resilience were protective factors for depressive symptoms in elderly people. Having hobby (OR=0.64, 95%CI: 0.45-0.91), good relationship with children (OR=0.56, 95%CI: 0.41-0.76), good relationship with spouse (OR=0.51, 95%CI: 0.37-0.71), and having at least 6 friends (OR=0.48, 95%CI: 0.32-0.71) were the protective factors for depressive symptoms in urban elderly people. A good relationship with neighbors (OR=0.58, 95%CI: 0.41-0.82) and having 1-2 friends (OR=0.40, 95%CI: 0.25-0.64) were the protective factors for depressive symptoms in rural elderly people. Women (OR=1.49, 95%CI: 1.06-2.10) and higher education level (OR=1.81, 95%CI: 1.19-2.74, compared with illiterate/semi-illiterate in primary school; OR=2.94, 95%CI: 1.82-4.76, compared with illiterate/semi-illiterate in junior high school and above) were the risk factors for depressive symptoms in rural elderly people. Conclusion: There are differences between urban and rural areas in depressive symptoms among elderly people in Anhui Province. The detection rate of depression symptoms among rural elderly people is higher, and the influencing factors of depressive symptoms between urban and rural elderly people are also different, which should be treated specifically in the implementation of intervention measures.

[Efficacy evaluation of novel oral anticoagulants in patients with cirrhosis accompanied with portal vein thrombosis: a meta-analysis]

Objective: To analyze the safety and efficacy of using novel oral anticoagulants (rivaroxaban and others) in patients with cirrhosis accompanied with portal vein thrombosis (PVT). Methods: Clinical research literature published from the establishment of the database to June 20, 2021, was retrieved from PubMed, Web of Science, CNKI, Wanfang, and Weipu databases by combining subject terms and free words. RevMan software was used for the random group meta-analysis model. Results: In terms of PVT recanalization, the novel oral anticoagulants (such as low molecular weight heparin and others) had a higher recanalization rate than traditional anticoagulants (OR = 13.75, 95%CI 3.58-52.9, P = 0.000 1). In terms of bleeding, the novel oral anticoagulants did not increase the risk of bleeding compared with traditional anticoagulants (OR = 2.42, 95%CI 0.62-9.41, P = 0.20). Conclusion: The novel oral anticoagulant drugs are superior to traditional anticoagulants in terms of the occurrence of PVT recanalization; however, there is no statistically significant difference in terms of the occurrence of bleeding between the two groups.

Diacerein versus non-steroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common musculoskeletal condition affecting millions of people worldwide and posing a significant challenge to clinicians and researchers. Emerging evidence suggests that the multifaceted symptomatology of KOA may be alleviated by diacerein. With this in mind, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of diacerein in patients with KOA.

METHODS

We systematically searched Embase, PubMed, Cochrane Library, Web of Science, Chinese Biomedical Literature Database (CBM), Wanfang Database (WanFang), China National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (VIP) from their inception to August 2022 for randomized controlled trials (RCTs) of diacerein intervention on patients with KOA. Two reviewers independently performed the selection of eligible studies and the extraction of relevant data. The meta-analysis was performed using RevMan 5.4 and R 4.1.3 software tools. Depending on the type of outcome indicator selected, summary measures were expressed as mean differences (MD), standardized mean differences (SMD), or odds ratio (OR) with 95% confidence intervals (CI).

RESULTS

Twelve RCTs with 1732 patients were included. The results revealed that diacerein had comparable efficacy to non-steroidal anti-inflammatory drugs (NSAIDs) in reducing pain indicators such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (SMD = 0.09, 95% CI [-0.10, 0.28], P = 0.34) and visual analogue scale (VAS) (SMD = -0.19, 95% CI [-0.65, 0.27], P = 0.42). However, diacerein outperformed NSAIDs in terms of global efficacy assessment by both patients and investigators (patients: 1.97, 95% CI [1.18, 3.29], P = 0.01; investigator: 2.18, 95% CI [0.99, 4.81], P = 0.05) at the end of treatment and sustained effectiveness in reducing WOMAC score and VAS score at four weeks after treatment. Moreover, there was no significant difference in adverse events incidence between the diacerein and NSAID groups. However, the GRADE evaluation indicated that the majority of the evidence quality was low.

CONCLUSIONS

The results of this study suggest that diacerein could potentially be considered as a pharmacological agent with significant efficacy for the treatment of patients suffering from KOA, offering a potential alternative treatment strategy for those patients contraindicated to NSAIDs. However, further high-quality studies with longer follow-up are needed to make more informed decisions about its efficacy in the treatment of KOA.

Molecular dynamics study of three amino acids as corrosion inhibitor for copper in hydrochloric acid solution

Molecular dynamics (MD) simulation is used to study the corrosion inhibition mechanism of cysteine (Cys), glutamic (Glu) and glycine (Gly) for copper in hydrochloric acid solution. The adsorption energy and radial distribution function results show that all three amino acids can spontaneously adsorb on Cu (111) surface by chemical adsorption. The absolute value of adsorption energy and intensity is Cys > Glu > Gly. The diffusion coefficient and relative concentration curve show that all the three amino acids can inhibit the diffusion and aggregation ability of corrosion particles, so the three amino acids not only can slow down the aggregation of corrosive particles, but also effectively repel corrosive particles to protect the substrate. The inhibition ability obtained by the MD simulation shows the trend of Cys > Glu > Gly, which is consistent with the experimental results. The inhibition efficiency is determined by both the adsorption strength on the substrate surface and inhibition ability for the diffusion and aggregation ability of corrosion particles.

A new calnexin modulates antibacterial immune response in obscure puffer Takifugu obscurus

Calnexin (Cnx) is a membrane-bound lectin chaperone of the endoplasmic reticulum. In this study, a novel Cnx homologue from the obscure puffer Takifugu obscurus was characterized, tentatively named ToCnx. The cDNA of ToCnx was 1803 bp, and it contained an open reading frame encoding a polypeptide of 600 amino acid residues with a calculated molecular weight of 67.5 kDa. Multiple alignment of the deduced amino acid sequences of ToCnx and other related fish Cnxs revealed that ToCnx had typical characteristics of fish Cnxs. Sequence comparison and phylogenetic tree analysis showed that ToCnx had the closest relationship with Cnxs from Takifugu flavidus and Takifugu rubripes. ToCnx transcripts were detected in all the tissues examined, and they were mainly expressed in the liver, kidney, and intestine. Upon Vibrio harveyi, Edwardsiella tarda, and Aeromonas hydrophila infection, ToCnx transcripts were all significantly upregulated in the kidneys. The recombinant calreticulin domain of ToCnx (rToCnx) was prepared by prokaryotic expression. In the absence of calcium, rToCnx was able to bind three Gram-negative bacteria (V. harveyi, E. tarda, and A. hydrophila) and two bacterial saccharides, such as lipopolysaccharide and peptidoglycan. In the presence of calcium, rToCnx could agglutinate all the detected microorganisms. In addition, rToCnx possessed the effect of inhibiting the growth of three microbe strains. These observations suggested that ToCnx is an important participant in host immune defense against bacteria.

[Clinical diagnosis and treatment of 27 cases of metanephric adenoma]

The clinical features, imaging features, treatment methods and pathological features of 27 patients with metanephric adenoma were analyzed. It was found that the clinical features and imaging features of metanephric adenoma were difficult to differentiate from renal malignantology. Pathology can be clearly diagnosed and some can be combined with malignant components. Nephron sparing surgery is the first choice, and the prognosis is good, but still need regular follow-up.

[Effect of neurally adjusted ventilatory assist on trigger of mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease patients with intrinsic positive end-expiratory pressure]

Objective: To compare the trigger delay and work of trigger between neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with intrinsic positive end-expiratory pressure (PEEP) during mechanical ventilation. Methods: AECOPD patients with intrinsic PEEP (PEEPi) greater than or equal to 3 cmH(2)O (1 cmH(2)O=0.098 kPa) were enrolled during invasive mechanical ventilation. Subjects were ventilated with low, medium and high pressure under either NAVA or PSV mode. Servo Tracker software continuously recorded the waveform of ventilator and respiratory mechanics indexes (including respiratory frequency, inspiratory tidal volume (Vti), minute ventilation volume (VE), peak airway pressure (PIP), inspiratory time), and calculated trigger and expiratory conversion delay time, work of trigger and total work of breath. Results: A total of 14 AECOPD patients were enrolled with the average PEEPi (4.3±1.3) cmH(2)O. PSV inspiratory trigger delay time was positively correlated with PEEPi (r=0.913, P<0.05). Compared with PSV, NAVA significantly decreased trigger delay time in low, medium and high pressure level groups [(48±17) ms vs. (167±86) ms, (63±65) ms vs. (247±240) ms, (63±49) ms vs. (342±192) ms,respectively all P<0.05]. Similar results were shown as to work of trigger [(0.92±0.36) μV∙s vs. (1.22±0.70) μV∙s, (1.08±0.51) μV∙s vs. (1.62±1.25) μV∙s, (1.20±0.96) μV∙s vs. (2.29±1.02) μV∙s, all P<0.05]. Trigger delay time increased according to the increase of pressure level in PSV mode. Conclusion: The presence of PEEPi in AECOPD patients leads to obvious trigger delay under PSV mode, which is positively correlated with PEEPi level. NAVA significantly reduces trigger delay time and work of trigger compared with PSV mode.

Visual field impairment predicts recurrent stroke after acute posterior circulation stroke and transient ischemic attack

AIMS

To evaluate whether visual field impairment (VFI) can predict stroke recurrence in patients with vertebral-basilar (VB) stroke.

METHODS

A total of 326 patients were eligible for a VFI evaluation within 1 week of stroke onset. One-year follow-up data were obtained after VB stroke and other vascular events. All predictors were determined using Cox regression models.

RESULTS

The overall incidence of recurrent VB stroke and transient ischemic attack (TIA) was 29% (n = 92). After multivariate adjustment, severe and moderate VFI were predictors of recurrent VB stroke and TIA.

CONCLUSIONS

VFI is an independent predictor of recurrent VB stroke and TIA.

[Killing effect and its mechanism of low-temperature plasma on different human cancer cell lines]

Objective: To investigate the killing effect of low-temperature plasma (LTP) on HepG2, A549 and HeLa cell lines and explore its possible mechanism. Methods: The inhibitory effect of LTP on the proliferation of HepG2, A549 and HeLa cells was determined by MTT assay. Transmission electron microscopy was used to observe the ultrastructural changes of HepG2, A549 and HeLa cells treated with LTP. Cell apoptosis was detected by Muse cytometry. Western blot was used to detect the expression of apoptosis-related proteins. Results: The survival rates of LTP-irradiated HepG2 cells (irradiated for 107 s), HeLa cells (irradiated for 121 s) and A549 cells (irradiated for 127 s) were 50%. LTP destroyed the ultrastructure of HepG2, A549 and HeLa cells to different degrees, showing nuclear fragmentation and organelle damages. The apoptosis rates of the three cell lines were increased at 24 h after exposure to LTP for 1/6 IC₅₀ irradiation time. Furthermore, LTP irradiation also suppressed the protein expression of Bcl-2 and XRCC1 and increased that of Bax. Conclusions: LTP has an obvious killing effect on HepG2, A549 and HeLa cancer cell lines. This effect may be related to the induction of cell apoptosis and inhibition of DNA repair.

Fractional Flow Assessment for the Evaluation of Intracranial Atherosclerosis: A Feasibility Study

PURPOSE

Current studies on endovascular intervention for intracranial atherosclerosis select patients based on luminal stenosis. Coronary studies demonstrated that fractional flow measurements assess ischemia better than anatomical stenosis and can guide patient selection for intervention. We similarly postulated that fractional flow can be used to assess ischemic stroke risk.

METHODS

This was a feasibility study to assess the technical use and safety of applying a pressure guidewire to measure fractional flow across intracranial stenoses. Twenty patients with severe intracranial stenosis were recruited. The percentage of luminal stenosis, distal to proximal pressure ratios (fractional flow) and the fractional flow gradients across the stenosis were measured. Procedural success rate and safety outcomes were documented.

RESULTS

All 20 patients had successful crossing of stenosis by the pressure guidewire. Ten patients underwent angioplasty, and 5 had stenting performed. There was one perforator stroke, but not related to the use of the pressure wire. For the 13 patients with complete pre- and postintervention data, the mean preintervention stenosis, fractional flow and translesional pressure gradient were 76.2%, 0.66 and 29.9 mm Hg, whilst the corresponding postintervention measurements were 24.7%, 0.88 and 10.9 mm Hg, respectively. Fractional flow (r = -0.530, p = 0.001) and the translesional pressure gradient (r = 0.501, p = 0.002) only had a modest correlation with the luminal stenosis.

CONCLUSION

Fractional flow measurement by floating a pressure guidewire across the intracranial stenosis was technically feasible and safe in this study. Further studies are needed to validate its use for ischemic stroke risk assessment.

Bioequivalence of clopidogrel hydrogen sulfate tablets in healthy Chinese volunteers

We aimed to evaluate the bioequivalence of clopidogrel in healthy Chinese volunteers after administration of a single oral dose. We administered a single oral dose of 75 mg clopidogrel (test and reference) to 32 healthy Chinese volunteers according to an open, randomized, crossover design. The concentration of clopidogrel acid (carboxylic metabolite of clopidogrel) in the plasma was determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Bioequivalence of the test and reference preparations were calculated using analysis of variance and one-sided t-test by using the DAS 2.0 software. The pharmacokinetic parameters of the test and reference preparations were as follows: peak plasma concentration (Cmax), 1351.101 ± 654.955 ng/mL and 1184.652 ± 607.713 ng/mL; area under the curve, 2642.017 ± 1093.848 ng·h/mL and 2780.666 ± 1283.100 ng·h/mL; and time to reach Cmax (Tmax), 0.789 ± 0.318 h and 0.953 ± 0.633 h, respectively. The relative bioavailability of the formulation was 101.7 ± 35.3%, which indicated that the test preparation was bioequivalent to the reference drug.

Combined use of stent angioplasty and mechanical thrombectomy for acute tandem internal carotid and middle cerebral artery occlusion

PURPOSE

Tandem internal carotid and middle cerebral artery occlusion carries a grave prognosis, with intravenous and intra-arterial thrombolytics having low efficacy. Currently, endovascular therapy is a promising means for treatment in which the proximal carotid lesion can be treated with angioplasty and stenting, whilst mechanical thrombectomy can be used for the treatment of the distal occlusion. Two approaches can be used - the antegrade (proximal-to-distal) approach or the retrograde (distal-to-proximal) approach, although there has not yet been any consensus on which is the better approach.

CASE REPORT

We present two patients with tandem occlusions, one treated using the antegrade and one using the retrograde approach, with different revascularization outcomes, despite having similar functional outcome on follow-up.

CONCLUSION

The combined use of stent angioplasty and mechanical thrombectomy can be used to treat tandem occlusions, and with procedural modifications, the antegrade approach may more easily achieve technical success.

Positive association between PPARD rs2016520 polymorphism and coronary heart disease in a Han Chinese population

PPARD encodes peroxisome proliferator-activated re-ceptor delta, which has been shown to play an important role in control-ling lipid metabolism and atherosclerosis. In this case-control study, we explored the relationship between PPARD rs2016520 polymorphism and coronary heart disease (CHD) in a Han Chinese population. A to-tal of 657 CHD cases and 640 controls were included in the associa-tion study. rs2016520 polymorphism genotyping was performed using the melting temperature-shift polymerase chain reaction method. The PPARD rs2016520-G allele reduced CHD risk by 17.9% (χ(2) = 5.061, P = 0.025, OR = 0.821, 95%CI = 0.692-0.975). Furthermore, a signifi-cant difference in CHD risk was observed for the PPARD rs2016520 polymorphism in the dominant model (AG + GG vs AA: χ(2) = 4.751, degrees of freedom (df) = 1, P = 0.029, OR = 0.784, 95%CI = 0.631- 0.976). Analysis by age suggested that the G-allele decreased CHD risk by 14.8% in ages greater than 65 years (χ(2) = 4.446, P = 0.035, OR = 0.852, 95%CI = 0.684-1.060). In contrast, meta-analysis of PPARD rs2016520 among 3732 cases and 5042 controls revealed no associa-tion between PPARD rs2016520 and CHD (P = 0.19). We found that the PPARD rs2016520-GG genotype decreased CHD risk in a Han Chinese population. Moreover, we found an association between serum high-density lipoprotein cholesterol level and PPARD rs2016520 in senior individuals aged ≥ 65 years. The meta-analysis revealed no association between PPARD rs2016520 and CHD, suggesting ethnic differences in the association between the PPARD locus and CHD.

Higher risk of recurrent ischemic events in patients with intracranial in-stent restenosis

BACKGROUND AND PURPOSE

Reliable data concerning prognosis of patients with intracranial in-stent restenosis (ISR) is lacking. We prospectively studied long-term outcomes of patients with and without a catheter angiography-verified ISR.

METHODS

Between September 2001 and May 2009, 540 consecutive patients with symptomatic intracranial atherosclerosis received stenting treatment at our institute. Of them, 226 patients with 233 stented arteries had catheter angiography follow-up after stenting and were enrolled into this study. They were clinically followed up until the end of December 2011. Primary end point was ischemic stroke or transient ischemic attack in the territory of the stented artery after the catheter angiography follow-up. ISR was defined as a catheter angiography-verified stenosis of ≥50% within or immediately adjacent (within range of 3 mm) to the implanted stent.

RESULTS

During a mean follow-up of 38.9 months, 27 (11.6%, 27/233) primary end point events were recorded. The risk of primary end point in ISR group was higher compared with non-ISR group (21.1% [12/57] versus 8.5% [15/176]; hazard ratio, 2.94; 95% confidence interval, 1.37-6.30; P=0.005). Multivariable analysis showed that the ISR was an independent risk factor for the primary end point (hazard ratio, 2.79; 95% confidence interval, 1.20-6.49; P=0.017). The median occurrence time of primary end point was 9.9 (interquartile range, 5.0, 21.1) months in ISR group, earlier than that in non-ISR group (26.6 [13.1, 52.9] months; P=0.01).

CONCLUSIONS

In-stent restenosis after stenting of intracranial atherosclerosis is significantly associated with an increased risk and an earlier occurrence of recurrent ischemic events in the territory of the stented intracranial artery.

Entrapment of a micro-guidewire during stenting of basilar stenosis

Entrapment of a microwire related to intracranial endovascular therapy is an uncommon complication. A 64-year-old man with symptomatic basilar artery stenosis was treated with stenting. A 300 cm Synchro microwire became trapped in the P1 segment of the left posterior cerebral artery during the procedure. The decision was made to leave the microwire in place, considering that aggressive retrieval procedures could cause injury to the cerebral vasculature. The entrapped microwire was later inadvertently dislocated and removed while pulling the microwire back into the femoral artery with a looped catheter from the left femoral access. This demonstrates that, although entrapment of a microwire during endovascular therapy is a rare event, an optimal salvage technique needs to be explored further.

Entrapment of a micro-guidewire during stenting of basilar stenosis

Entrapment of a microwire related to intracranial endovascular therapy is an uncommon complication. A 64-year-old man with symptomatic basilar artery stenosis was treated with stenting. A 300 cm Synchro microwire became trapped in the P1 segment of the left posterior cerebral artery during the procedure. The decision was made to leave the microwire in place, considering that aggressive retrieval procedures could cause injury to the cerebral vasculature. The entrapped microwire was later inadvertently dislocated and removed while pulling the microwire back into the femoral artery with a looped catheter from the left femoral access. This demonstrates that, although entrapment of a microwire during endovascular therapy is a rare event, an optimal salvage technique needs to be explored further.

MicroRNA expression profiling identifies miR-328 regulates cancer stem cell-like SP cells in colorectal cancer

Background:

Side population (SP) cells and their relationship to stem cell-like properties have been insufficiently studied in colorectal cancer (CRC). MicroRNAs (miRNAs) have attracted much attention but their roles in the maintenance of SP phenotype remain unclear.

Methods:

The SPs from CRC cell lines and primary cell cultures were analysed for stem cell-like properties. MiRNA microarray analysis identified miR-328 as a potential stemness miRNA of SP phenotype. The level of miR-328 expression in clinical samples and its correlation with SP fraction were determined. Gain-of-function and loss-of-function studies were performed to examine its roles in cancer stem-like SP cells. Furthermore, bioinformatics prediction and experimental validation were used to identify miR-328 target genes.

Results:

The SP cells sorted from CRC possess cancer stem cell (CSC)-like properties, including self-renewal, differentiation, resistance to chemotherapy, invasive and strong tumour formation ability. MiR-328 expression was significantly reduced in SP cells compared with Non-SP cells (P<0.05). Moreover, miR-328 expression was downregulated in CRC (n=33, P<0.05) and low miR-328 expression tend to correlate with high SP fraction (n=15, r=0.6559, P<0.05, Pearson's correlation). Functional studies indicated that miR-328 expression affects the number of SP cells. In addition, miR-328 overexpression reversed drug resistance and inhibited cell invasion of SP cells. Furthermore, luciferase reporter assay demonstrated that miR-328 directly targets ABCG2 and MMP16 and affects the levels of mRNA and protein expression in SP cells.

Conclusion:

These findings indicate that CRC contain cancer stem-like SP cells. MiR-328 has an important role in maintaining cancer stem-like SP phenotype that may be a potential target for effective CRC therapy.

Symptomatic Intracranial Stenosis: Cerebrovascular Complications from Elective Stent Placement

PURPOSE

To retrospectively evaluate the cerebrovascular complications from elective stent placement for symptomatic intracranial stenosis and to explore preliminarily which factors are associated with complications.

MATERIALS AND METHODS

Institutional ethics committee approval was obtained, with waiver of informed consent. Records were reviewed of 181 consecutive elective stent placement procedures in 169 patients (mean age, 51.8 years; 142 male and 27 female patients) with symptomatic intracranial stenosis of more than 50% diameter reduction. Complications were evaluated. Fisher exact or chi(2) tests were used to assess statistical differences between rates for discrete variables. Stratification analysis was used to assess the significant relationship (P < .05) between a potential risk factor and a complication.

RESULTS

Complications occurred in 20 patients (11.8%) of 169 patients: Ten patients (5.9%) had stroke (four patients had symptomatic intracranial hemorrhages [ICHs], and two of these patients died; six patients had ischemic strokes). Six patients had target-lesion thrombosis for which intrathrombus thrombolysis resulted in early complete patency without sequelae, two had asymptomatic ICHs, one had transient ischemic attack, and one had asymptomatic dissection. Perioperative noncompliance with antiplatelet therapy was found to be significantly associated with target-lesion thrombosis (two of eight patients [noncompliance] vs four of 161 patients [compliance], P = .027). Stratification analysis revealed a significant correlation between the use of double stents for a lesion and ICH (P = .005).

CONCLUSION

Cerebrovascular complications from elective stent placement for intracranial stenosis are diverse. The use of double stents for a lesion is an independent risk factor for ICH. Perioperative noncompliance with antiplatelet therapy is associated with a higher frequency of target-lesion thrombosis.

Long-term outcome of elective stenting for symptomatic intracranial vertebrobasilar stenosis

Seventy-nine consecutive patients with symptomatic atherosclerotic stenosis > or = 50% of intracranial vertebrobasilar artery (VBA) were treated by elective stenting. There were five strokes within 30 days, and three strokes in the VBA territory after 30 days (mean of 812 days). The annual stroke rate in the VBA territory (including any stroke and death within 30 days) was 4.6%. At the last follow-up time, 73 patients were independent (modified Rankin scale grade < or = 2). The outcome compares favorably with medical therapy.

Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis

OBJECTIVE

To test whether symptomatic severe intracranial atherosclerotic stenosis was associated with a higher subsequent stroke risk than moderate stenosis after elective angioplasty with a balloon-expandable stent and to explore which factors were associated with the subsequent stroke.

METHODS

Between September 2001 and June 2005, there were 220 symptomatic intracranial atherosclerotic stenoses in 213 patients undergoing elective stenting at our institute. Of these stenoses, 126 in 121 patients were > or =70% severe stenoses, and 94 in 92 patients were 50% to 69% moderate stenoses. Primary endpoints included lesion-related ischemic stroke, and symptomatic brain or subarachnoid hemorrhage.

RESULTS

Ten primary endpoint events occurred in the severe stenosis group (six within 30 days and four in mean follow-up of 26.0 months after 30 days), and seven occurred in the moderate stenosis group (four within 30 days and three in mean follow-up of 27.6 months after 30 days). There was no significant difference in cumulative probability of primary endpoints between the severe (7.2% at 1 year and 8.2% at 2 years) and moderate (5.3% at 1 year and 8.3% at 2 years) stenosis groups. No single factor was found to be associated with primary endpoints in the moderate stenosis group. Multivariable analysis revealed that stent failure was the only predictor of primary endpoints in the severe stenosis group (hazard ratio 5.31, 95% CI 1.35 to 20.91).

CONCLUSION

Symptomatic severe intracranial atherosclerotic stenosis did not present a higher subsequent stroke risk than moderate stenosis after elective angioplasty with a balloon-expandable stent. Patients with severe stenosis may benefit from successful stent placement, and randomized trials are necessary to demonstrate this possible benefit.

Perforator stroke after elective stenting of symptomatic intracranial stenosis

OBJECTIVE

To study the frequency, clinical course, and functional outcome of perforator stroke (PS) resulting from elective stenting of symptomatic intracranial stenosis.

METHODS

Between September 2001 and November 2004, 169 consecutive patients with 181 symptomatic intracranial stenoses underwent stenting procedure at our institute. The preoperative perforator infarct adjacent to the stenotic segment (PIAS) on MRI was evaluated blindly. Patients who developed PS after stenting were enrolled. Each patient was assessed by an experienced stroke neurologist by neurologic examination and NIH Stroke Scale score every day until discharge and at day 30, and by modified Rankin Scale (mRS) score at the end of the first, third, and sixth month, and then at intervals of 6 months.

RESULTS

PS frequency was 3.0% (5/169 patients). The patients with preoperative PIAS had a higher frequency of PS and PS exacerbation, resulting from intracranial stenting (8.2%, 4/49), vs patients without preoperative PIAS (0.8%, 1/120; p = 0.031). Four PSs occurred during the procedure and one 10 hours after stenting. Four PSs reached the maximum deficit almost at once, and one after 2 hours from onset. All five patients were functionally independent (mRS <or= 1) within 12 months.

CONCLUSION

Patients with preoperative perforator infarct adjacent to the stenotic segment have a higher perforator stroke frequency after elective stenting of intracranial stenosis. Most perforator strokes occur during the procedure and reach the maximum deficit almost immediately. Functional outcomes are relatively good.

Establishment of a porcine model of patent foramen ovale

OBJECTIVE

To investigate the feasibility of developing an animal model of patent foramen ovale (PFO) in piglets by percutaneous atrial septal puncture and balloon dilation.

METHODS

A standardized percutaneous atrial trans-septal puncture and balloon dilation was conducted in 11 healthy piglets under general anesthesia. A Rups-100 system inserted through a femoral vein was used for the transseptal puncture, and subsequent balloon dilatation was performed at the puncture site to imitate a PFO. Euthanasia and autopsy were performed on day 1 in one piglet (early autopsy), and on day 21 in the remaining ten piglets (late autopsy).

RESULTS

Artificial PFO was successfully created in all piglets and verified by fluoroscopy. No major technical difficulty or complication was encountered except in one which developed mild hemopericardium. In the piglet that had early autopsy, the artificial foramen was measured 0.8 x 0.7 cm(2) in cross-section and aggregates of erythrocytes were revealed over its rim under light microscopy. In the late autopsy group (n=10), seven piglets had the created foramens healed and sealed off, while the other three showed relatively small residual lumens measured 0.1 x 0.2 cm(2), 0.2 x 0.2 cm(2) and 0.1 x 0.3 cm(2) in cross-section, respectively. Histological examination of specimens from the late autopsy group showed variable neointima hyperplasia, cardiac muscle necrosis and focal fibrosis at the puncture site, regardless of the course of healing.

CONCLUSION

Artificial creation of PFO in piglets is feasible by percutaneous atrial septal puncture and balloon dilation. This protocol may serve as a research model for PFO-related stroke in human.

[Clinical study on cinobufotalin in treating chronic hepatitis B virus carriers]

In a preliminary study, carriers of hepatitis B virus were treated with Cinobufotalin, a preparation from toad, for 1-3 course of treatment. Results indicated that negative conversion rate was markedly higher in the treated groups (21.09%, 38.89%, 63.64% and 50%) than that of control groups (2.1%, 10.87%, 33.33% and 7.7% P < 0.001). By the end of treatment, positive conversion rate of anti-HBs and anti-HBe were also markedly higher in the former (19.29% and 23.45%) than that in the latter (4.26% and 7.14% P < 0.001). During the follow-up of 3-6 months, the positive rate of HBeAg in treated group (50%) raised as compared with the control group (20% P = 0.08). The results indicated that Cinobufotalin had a significant effect in inhibiting the replication of HBV.

[Clinical study and immunological observation on potenlini treatment of epidemic hemorrhage fever]

439 cases of epidemic hemorrhagic fever (EHF) in the febrile stage of the disease were randomly divided into two groups. 226 cases in therapeutic group were treated with daily intravenous drip of 60-100 ml potenlini for 3 days. Other measures of treatment in this group was just the same as those in the control group. The results showed that the duration of both the febrile stage and the hypotensive shock stage were shorter and the rate of recovering from hypotensive shock stage and oliguric stage in the therapeutic group (P less than 0.01) was higher as compared with the control group. BUN, ALT, urinary protein, white blood cells and platelets returned to normal level earlier than expected (P less than 0.01). The occurrence rate of complication and case fatality rate in therapeutic group were lower. The research showed that potenlini in the treatment of EHF has effects. But it has not remarkable effects on immune adjustment.