The effects of the coronavirus disease pandemic on intravenous thrombolytic therapy among patients with acute ischemic stroke in Dalian, China.

BACKGROUND: We investigated the influence of the coronavirus disease 2019 (COVID-19) pandemic on the number of patients with acute ischemic stroke who received intravenous thrombolytic therapy (ITT) in Dalian, China, in 2020. METHODS: This retrospective descriptive study, conducted from February 1, 2020, to August 31, 2020, examined 13 hospitals in Dalian that participated in the "stroke emergency map". To use this "stroke emergency map" of China, patients followed the official "Stroke Map" WeChat account and dialed 120 for emergency medical services. We analyzed the number of patients with acute ischemic stroke who underwent ITT. In particular, we examined the onset-to-door time (ODT), door-to-needle time (DNT), onset-to-needle time (ONT), mode of transportation to the hospital, and National Institutes of Health Stroke Scale (NIHSS) scores before and after ITT. Data were collected for the aforementioned period and compared with the 2021 baseline data from the same time of year. The Mann‒Whitney U test was performed for data analysis. RESULTS: Compared with the data from 2020, the number of patients with acute ischemic stroke who underwent ITT increased (from 735 to 1719 cases) in 2021, but the DNT decreased (from 59 to 45 min; P = 0.002). Moreover, 83.9% of patients in 2020 presented to the hospital without ambulance transport, compared to 81.1% of patients in the 2021 non-COVID-19 pandemic period. Patients with NIHSS scores of 6-14 were more likely to call an ambulance for transport to the hospital than to transport themselves to the emergency department. CONCLUSIONS: During the 2020 COVID-19 pandemic, the DNT was prolonged as a result of strengthened fever surveillance. In 2021, the number of patients with acute ischemic stroke who underwent ITT increased compared to the previous year. Notably, the growth in the number of patients with acute ischemic stroke who underwent ITT benefited from both the "stroke emergency map" of China and the "green channel," a novel treatment approach that focuses on the rational design of the rescue process. TRIAL REGISTRATION: Our study was a retrospective descriptive study, not a clinical trial, thus we did not have to register for clinical trials.

Platelet-specific antibodies and differences in their expression in childhood immune thrombocytopenic purpura predicts clinical progression.

IMPORTANCE: Immune thrombocytopenic purpura (ITP) is the most common bleeding disorder in children. Despite the highly spontaneously remission, still almost 20% of cases progress into chronic or refractory ITP, which seriously affects children's quality of life. Currently there is no method to predict the initial stage of childhood ITP. OBJECTIVES: To evaluate platelet-specific antibodies and compare differences in their expression in childhood ITP to predict clinical progression. METHODS: This is a single-center prospective cohort study from April 2014 to October 2015. We enrolled children initially diagnosed as ITP. Anti-GPIIb/IIIa and GPIb/IX antibodies were assayed by enzyme-linked immunoadsorbent assay (ELISA) and patients were followed up for 1 year. We also analyzed the relationship between the expression of the platelet-specific antibodies GPIIb/IIIa and GPIb/IX and their respective clinical prognoses. RESULTS: Overall, 134 cases were enrolled including 77 boys and 57 girls with a median age of 19 months (range: 1 to 159). Positive rates of anti-platelet antibodies were 79.8%. After a 1-year observation period, 84.3% were diagnosed as newly diagnosed ITP and 13.4% were diagnosed as chronic ITP. Patients with anti-GPIIb/IIIa antibody had a higher risk for newly diagnosed ITP compared with patients who were anti-GPIb/IX antibody positive only (93% vs 25%, P = 0.005; 87% vs 25%, P = 0.014, respectively). There were more anti-GPIb/IX antibody positive only cases, diagnosed as chronic ITP, compared with anti-GPIIb/IIIa antibody positive only cases and double GPIIb/IIIa and GPIb/IX antibody positive cases (75% vs 7%, P = 0.005; 75% vs 13%, P = 0.014, respectively). Interpretation. INTERPRETATION: Patients with anti-GPIIb/IIIa antibody (either single or double) were predicted to have a good prognosis, whereas anti-GPIb/ IX antibody only predicted a poor prognosis. These results should be confirmed via a larger cohort multicenter study.

Protein modified upconversion nanoparticles for imaging-guided combined photothermal and photodynamic therapy.

In this work, we develop a multifunctional nano-platform by coating upconversion nanoparticles (UCNPs) with bovine serum albumin (BSA), obtaining UCNP@BSA nanoparticles with great solubility and stability in physiological environments. Two types of dye molecules, including a photosensitizer, Rose Bengal (RB), and an NIR-absorbing dye, IR825, can be simultaneously loaded into the BSA layer of the UCNP@BSA nanoparticles. In this carefully designed UCNP@BSA-RB&; IR825 system, RB absorbs green light emitted from UCNPs under 980-nm excitation to induce photodynamic cancer cell killing, while IR825 whose absorbance shows no overlap with upconversion excitation and emission wavelengths, offers nanoparticles a strong photothermal perform under 808-nm laser irradiation. Without showing noticeable dark toxicity, the obtained dual-dye loaded nanoparticles are able to kill cancer via combined photothermal and photodynamic therapies, both of which are induced by NIR light with high tissue penetration, by a synergetic manner both in vitro and in vivo. In addition, the intrinsic paramagnetic and optical properties of Gd(3+)-doped UCNPs can further be utilized for in vivo dual modal imaging. Our study suggests that UCNPs with well-designed surface engineering could serve as a multifunctional nano-platform promising in cancer theranostics.

[The diagnosis and treatment of rapidly growing non-tuberculous mycobacterial keratitis].

OBJECTIVE: To study the clinical features, diagnosis and treatment of non-tuberculous mycobacterial keratitis (NTMK). METHODS: It was retrospective case series study. Twelve eyes in 12 patients with NTMK following corneal foreign body trauma in 2007 were studied retrospectively including the case histories, clinical findings, laboratory examinations, diagnosis, treatment and prognosis. The main laboratory examination included corneal scrapings by culturing, polymerase chain reaction (PCR) and transmission electron microscopy (TEM), corneal lesions by histopathologic examinations and TEM. The patients received local and systemic antibiotics therapy, lesion cleaning followed by cauterization with tincture of iodine (5%) and (or) keratoplasty. RESULTS: All cases had a history of corneal trauma, there was corneal metallic foreign body removal at one hospital in 11 cases, corneal reed trauma in 1 case. The characteristic signs involved grayish-blue crystalloid keratopathy, multifocal infiltrates, satellites, radical form changes in the Descemet's membrane. The results of laboratory examinations of the scrapings of the cornea infection were as follows: all cultures (12/12) were positive for rapidly growing mycobacteria, and isolates from 5 patients were all diagnosed as mycobacterium chelonae subspecies abscess; acid-fast staining revealed positive bacilli in all the 4 patients; seven of 8 patients were positive for bacterium by PCR. Transmission electron microscopy in all the 3 specimens showed many slender rod-shaped or short coarse-shaped bacteria which were phagocytized by monocytes, and some necrotic tissue. Infections in 10 eyes were resolved by combined treatment regimen including a combination of antimicrobial agents (amikacin, rifampin, gatifloxacin, ciprofloxacin, azithromycin and/or ofloxacin, etc.) and local lesion cleaning followed by cauterization with 5% tincture of iodine within 2-5 months; two cases resolved by keratoplasty which poorly responded to antibiotic therapy for 6 months. CONCLUSIONS: NTMK is a rare, recalcitrant opportunistic infection which can occur in an epidemic fashion following corneal foreign body trauma. The diagnosis of NTMK is difficult, and may easily be misdiagnosed as fungal keratitis. Acid-fast staining, TEM, especially bacterial culture can help to obtain definitive diagnosis. NTMK has a long response period to medical management. The majority of patients can be cured by local and systemic antibiotics therapy, and the recalcitrant infections could be resolved by keratoplasty.