Comparison of clinical prognoses of anterior and posterior circulatory large vessel occlusive ischemic stroke after successful endovascular recanalization / 中华神经医学杂志

Objective:To analyze the clinical characteristics of patients with anterior and posterior circulation large vessel occlusion ischemic stroke and clinical prognoses after successful endovascular recanalization.Methods:A retrospective analysis was performed; 170 patients with large vessel occlusive ischemic stroke, admitted to Stroke Center, Second Hospital of Dalian Medical University from January 2016 to September 2022 were chosen; these patients had modified Thrombolysis in Cerebral Infarction (mTICI) 2b or 3 after endovascular treatment. These patients were divided into anterior-circulation large vessel occlusion group ( n=138) and posterior-circulation large vessel occlusion group ( n=32) according to the locations of vessel occlusion. Clinical data, parameters related to endovascular treatment, and clinical prognoses of the 2 groups were collected and compared. Results:Posterior-circulation large vessel occlusion group had significantly higher percentages of male patients and patients with atherosclerotic type (81.3% vs. 61.6%; 78.1% vs. 47.1%), significantly higher ratio of neutrophil to lymphocyte and NIHSS scores (3.78 [1.93, 10.86] vs. 2.77[1.77, 4.72]; 20.50±8.96 vs. 14.83±4.67), significantly lower percentage of patients with atrial fibrillation (21.9% vs. 58%), and significantly longer times from onset to puncture, onset to recalculation, admission to puncture, and admission to recalculation (367.50 [246.25, 630.00] min vs. 240.00 [198.75, 330.00]; 515.00 [292.50, 701.25] vs. 345.50 [270.00, 425.75] min; 163.00 [123.25, 218.50] min vs. 125.50 [97.00, 161.00]; 258.00 [200.25,389.00] vs. 219.50 [178.00, 276.25]) than anterior-circulation large vessel occlusion group ( P<0.05). The NIHSS scores 24 h after endovascular treatment, NIHSS scores at discharge, and mortality within 90 d in posterior-circulation large vessel occlusion group were significantly higher than those in anterior-circulation large vessel occlusion group (21.31±9.23 vs. 15.74±6.53; 25.5 [4.25, 40.25] vs. 10.00 [4.00, 18.25]; 40.6% vs. 20.3%, P<0.05); however, no significant differences in symptomatic intracranial hemorrhage, incidence of intracranial hemorrhage, in-hospital mortality or 90-d good prognosis were noted between the 2 groups ( P>0.05). Conclusion:Posterior circulation large vessel occlusion ischemic stroke patients have higher neurological impairment at onset than anterior circulation acute large vessel occlusion ischemic stroke patients; both patients enjoy similar results in terms of 90-d good prognosis and complications, but 90-d mortality is higher than that in anterior ones.

Efficacy of mechanical thrombectomy in acute ischemic stroke with large vessel occlusion and analysis of related factors affecting its prognosis / 中华老年医学杂志

Objective:To compare the effectiveness of intravenous thrombolysis(IVT)alone versus mechanical thrombectomy(MT)in treating acute large vessel occlusive stroke(AIS-LVO).Amd to analyze the factors that are associated with the prognosis of MT.Methods:A total of 197 patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)who received intravenous thrombolysis(IVT)and/or mechanical thrombectomy(MT)at the Stroke Center of the Second Hospital of Dalian Medical University from April 2016 to July 2021 were included in this retrospective analysis.Baseline data, clinical data, and 90-day Modified Rankin Scale(mRS)scores were collected for each group.The efficacy and risk of IVT alone and MT were compared using univariate and multivariate logistic regression analysis.Additionally, factors influencing the prognosis of MT were identified.Results:A total of 197 patients who met the inclusion criteria were included in this study.Out of these, 62 patients were in the IVT alone group and 135 patients were in the MT group.The results of the univariate analysis showed that the MT group had lower admission systolic blood pressure(147±23 vs.158±27 mmHg, P=0.003), higher baseline NIHSS score[15(12, 19) vs.12(8, 16), P=0.003], and there were also differences in vascular occlusion between the two groups( χ2=15.504, P=0.004).Specifically, the middle cerebral artery and basilar artery occlusion were higher in the MT group.In terms of outcome, the MT group had a higher percentage of good outcomes at 90 days[53(39%) vs.13(21%), χ2=6.381, P=0.012], and there was no significant difference in symptomatic intracranial hemorrhage(sICH)and mortality within 90 days.Among the 135 patients who underwent MT, 53 patients were classified as having a good prognosis, while 82 patients were classified as having a poor prognosis.Multivariate analysis revealed that age( OR=1.078, 95% CI: 1.025-1.133, P=0.003), neutrophil to lymphocyte ratio(NLR)( OR=1.164, 95% CI: 1.013-1.338, P=0.032), time from onset to recanalization( OR=1.004, 95% CI: 1.000-1.007, P=0.049), sICH( OR=15.585, 95% CI: 1.397-173.865, P=0.026), ASPECTS/pc-ASPECTS score( OR=0.524, 95% CI: 0.017-0.582, P=0.024), and good recanalization( OR=0.099, 95% CI: 1.718-59.046, P=0.010)were identified as independent prognostic factors.The results indicate that percutaneous transluminal angioplasty, stent implantation, and the use of tirofiban and butylphthalide did not significantly affect the prognosis of the MT group. Conclusions:The use of mechanical thrombectomy(MT)in patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)is more effective than intravenous thrombolysis(IVT)alone and has a similar safety profile.However, there are certain factors that can influence the prognosis of MT treatment.Older age, higher neutrophil-to-lymphocyte ratio(NLR), longer time from symptom onset to recanalization, and the occurrence of postoperative symptomatic intracranial hemorrhage(sICH)were identified as independent predictors of poor prognosis in MT treatment.On the other hand, a higher ASPECTS/pc-ASPECTS score and successful recanalization were found to be protective factors associated with a favorable prognosis in MT treatment.

Study on the Correlation between the Severity of Leukoaraiosis and the Prognosis of Acute Ischemic Stroke with Large Vessel Occlusion treated with Mechanical Thrombectomy / 中风与神经疾病杂志

@#To explore whether the severity of LA in patients with acute ischemic stroke（AIS）with large vessel occlusion（AIS-LVO） was related to the prognosis of MT treatment. Methods A total of 75 AIS-LVO patients who received intravenous thrombolysis（IVT） bridging MT or MT alone were selected in the stroke center of our hospital from April 2016 to October 2021.According to the Fazekas score scale，the severity of LA was divided into non-mild group（0-2 points，n=44） and moderate-severe group（3～6 points，n=31）. The baseline data and postoperative outcome of MT were compared between the two groups. The prognosis at 90 days after operation was evaluated by modified Rankin scale（mRS）. The results were divided into two groups：good prognosis group（0～2 points，n=32） and poor prognosis group（3～6 points，n=43）. Univariate analysis and multivariate Logistic regression analysis were used to determine whether LA was related to the prognosis of at 90 days after MT.Results Univariate analysis showed that compared with the non-mild LA group，the moderate-severe LA group had an older age［（73.77±8.25） vs（63.00±10.50） years old］，higher female proportion（58.1% vs 22.7%），higher proportion of atrial fibrillation（61.3% vs 36.4%），lower proportion of hyperlipidemia（9.7% vs 29.5%），higher incidence of postoperative hemorrhage transformation（38.7% vs 13.6%），higher incidence of sICH at 72 hours after operation（19.4% vs 2%），higher rate of futile recanalization（78.6% vs 39.0%），and higher incidence of 90-day poor prognosis after operation（80.6% vs 40.9%）. There were significant differences between two groups（all P<0.05）. Univariate analysis showed that compared with the good prognosis group，the poor prognosis group had an older age［69.0（63.0，77.0）vs 63.5（53.0，75.5）years old］，higher baseline NIHSS score ［（17.8±6.8） vs（12.3±4.9） points］，higher fasting blood glucose level［6.78（5.71，10.43） vs 5.88（5.29，6.95）］ mmol/L］，higher neutrophil to lymphocyte ratio（NLR） ［4.48（1.92，8.11） vs 2.4（1.43，3.06）］，higher proportion of diabetes（37.2% vs 12.5%），and higher proportion of moderate-severe LA（58.1% vs 18.8%）. There were significant difference between two groups（all P<0.05）.Multivariate Logistic regressionanalysis showed that moderate-severe LA（OR=6.796，95%CI 1.564～29.530，P=0.011）and baseline NIHSS score（OR=1.156，95%CI 1.015～1.317，P=0.029） were independent risk factors for poor 90-day functional prognosis after MT.Conclusion Moderate-severe LA can independently predict the poor prognosis of patients with AIS-LVO after MT.

Comparison and evaluation of laboratory test techniques for severe fever with thrombocytopenia syndrome / 中华实验和临床病毒学杂志

Objective@#Compare the detection result of blood samples of severe fever with thrombocytopenia syndrome (SFTS) patients using different detection techniques, and observe the dynamic characteristics of the virus specific RNA, IgM antibody and IgG antibody, to provide theoretical basis for selection of diagnostic methods of disease.@*Methods@#Acute phase serum of suspected SFTS cases and convalescent serum samples of lab-confirmed cases were collected. Real-time fluorescence quantitative PCR and enzyme-linked immunosorbent assay (ELISA) were used to detect the virus specific RNA, IgM antibody and IgG antibody. The detection results of different methods, the relationship between positive results and the acquisition time, and the dynamic characteristics of viral nucleic acid and antibodies were analyzed.@*Results@#A total of 87 serum samples of the suspected SFTS patients were collected, the positive rate of virus specific RNA, IgM antibody and IgG antibody were 53.41%, 31.03% and 3.41%, respectively. Among 55 confirmed cases of SFTS, the consistent rate of virus specific RNA and IgM antibody detection methods was 36.36%, and the difference between the two methods was significant (χ2=6.82, P=0.009), kappa=-0.257. The sampling intervals of RNA positive samples were all within 12 days, of which the positive detection rate was highest after 7-9 days, and the difference was statistically significant (χ2=10.35, P=0.016). In 34 SFTS convalescent serum samples, all the nucleic acid tests were negative, the positive rate of IgM antibody was 41.18%, which was not significantly different from the acute phase serum samples (P=1.00). The positive rate of IgG antibody was 94.12%, which was significantly higher than that of acute IgG antibody (0%). The dynamic characteristics of IgM and IgG antibody showed that IgM antibody could be detected on the second day after onset, the latest detection time was 74 days after onset, and the highest absorbance value and antibody detection rate occurred in 30-60 days. The earliest detection time of IgG antibody was 12 days after onset, and the last detection time was 100 days.The detection rate of IgG antibody and absorbance value increased rapidly after 30 days, and maintained in a high level. The detection rate of IgG antibody was 100% in 30-60 days.@*Conclusions@#Blood samples taken from SFTS suspected patients within two weeks of onset may be prioritized for detection of viral nucleic acids using Real-time fluorescence PCR or for detection of IgM antibodies by ELISA. Although IgM antibody can be detected 2 days after the onset, the peak appeared much later, so the negative result can’t rule out the diagnosis. IgG antibody has a high seroconversion rate in convalescent samples, and can be used as an auxiliary tool for disease diagnosis.

Elimination of inter-domain interactions increases the cleavage fidelity of the restriction endonuclease DraIII

DraIII is a type IIP restriction endonucleases (REases) that recognizes and creates a double strand break within the gapped palindromic sequence CAC↑NNN↓GTG of double-stranded DNA (↑ indicates nicking on the bottom strand; ↓ indicates nicking on the top strand). However, wild type DraIII shows significant star activity. In this study, it was found that the prominent star site is CAT↑GTT↓GTG, consisting of a star 5' half (CAT) and a canonical 3' half (GTG). DraIII nicks the 3' canonical half site at a faster rate than the 5' star half site, in contrast to the similar rate with the canonical full site. The crystal structure of the DraIII protein was solved. It indicated, as supported by mutagenesis, that DraIII possesses a ββα-metal HNH active site. The structure revealed extensive intra-molecular interactions between the N-terminal domain and the C-terminal domain containing the HNH active site. Disruptions of these interactions through site-directed mutagenesis drastically increased cleavage fidelity. The understanding of fidelity mechanisms will enable generation of high fidelity REases.

Effect of the down regulation of p120-catenin on the proliferation and invasion of human bladder carcinoma cell line T24 in Vitro / 中国综合临床

Objective To investigate the regulating function of p120-catenin (p120ctn) on proliferation and invasion of human bladder cancer cell T24.Methods Special siRNA was used to silence the expression of p120ctn in T24 cells.MTT assay was used to examine the T24 cell growth rate.The invasion of T24 cells and the control cells were measured by transwell chamber assay.Results The silencing of p120ctn could improve the proliferation and the invasiveness of T24 tumor cells.Transwell chamber assay showed that the in vitro invasion function of T24 cells was significant increase after p120ctn-siRNA.Conclusion p120ctn inhibited the bladder cancer proliferation and invasiveness of bladder carcinoma cells.

Differentiation from rat bone marrow stromal stem cells into cardiomyocytes induced by 5-azacitidine in vitro / 中国组织工程研究

BACKGROUND: Bone marrow stromal stem cells (BMSCs) are characterized by rapid amplification and wide differentiation.Thus, to establish in vitro BMSC induction models contributes to the study of tissue engineering.OBJECTIVE: To investigate the possibility of inducing the differentiation of rat BMSCs into cardiomyocytes by 5-azacitidine in vitro.OESING, TIME AND SETTING: The cytological in vitro study was performed at the Central Laboratory of First Affiliated Hospital of Liaoning Medical University from June 2005 to June 2008.MATERIALS: A total of 20 Sprague Dawley rats were supplied by the Experimental Animal Center, Liaoning Medical University.5-azacitidine (Sigma, USA) was used.MHEHODS: Following anesthesia, the rats were used to isolate the femur and tibia. BMSCs were isolated and cultured by the whole bone marrow method + adherent method. When 90% BMSCs were confluence, BMSCs were passaged. BMSCs at the third passage were incubated in a 24-well plate at 2×10~4/well, with 5,10, 15, 20 μmol/L 5-azacitidine. Simultaneously, a blank control group (without inductor) was set. Following 24 hours of induction, BMSCs were incubated in normal medium for 3 weeks.MAIN OUTCOME MEASURES: The following parameters were measured: cell appearance and growth curve, morphological changes following induction, and expression of connexin-43 and a-striated muscle actin.RESULTS: Cultured BMSCs were spindle-shape, with some cell confluence. P3 cells following incubation entered static phase at 1 and 2 days, and entered logarithmic phase at 3 days, reached a peak at 9 days, and then entered platform stage. Cell number became decreased at 12 days. Following induction of 5 μmol/L 5-azacitidine, no significant difference was found in BMSCs.Following induction of 10 μmol/L 5-azacitidine, BMSCs became long and big, extended towards a direction, with the property of myotube formation cells. Following induction of 15 umol/L 5-azacitidine, a few cells survived surrounding the 24-well plate.Following induction of 20 μmol/L 5-azacitidine, cells died. Following induction of 10 μmol/L 5-azacitidine for 3 weeks, expression of connexin-43 and a-striated muscle actin was determined in BMSCs. However, a negative expression was detected in the blank control group.CONCLUSION: BMSCs cannot differentiate into cardiomyocytes by itself. Following in vitro induction, BMSCs can differentiate into cardiomyocytes. Low-dose 5-azacitidine concentration cannot induce the differentiation, but high-dose 5-azacitidine concentration will induce death in a large number of cells. Thus, 10 μmol/L is an optimal concentration.