[Efficacy and outcome of transcatheter closure of patent foramen ovale in patients with cryptogenic stroke].

Objective: To investigate the efficacy and outcome of transcatheter patent foramen ovale (PFO) closure in patients with cryptogenic stroke (CS). Methods: Sixty consecutive patients with cryptogenic stroke who undertook transcatheter PFO closure between May 2015 and September 2017 in Beijing Tiantan Hospital were enrolled in this prospective study.Transcranial Doppler (TCD) bubble test was performed and right-left shunt(RLS) was confirmed in all patients.Closure success rate,effective closure rate, complications, recurrence of ischemic stroke and new onset atrial fibrillation were evaluated. Results: A total of 60 patients (42 male,age range 24-68 (47±11)years) were included in the study.PFO size (motionless state) was (1.6±0.6)mm.RLS before closure was graded and 11 patients had moderate RLS and 48 patients had large RLS (include 41 patients who experienced shower or curtain effect).Closure success rate was 100% (60/60).No severe complications were observed.At 6 months,45 patients completed TCD bubble test.Of these, 4 patients suffered from moderate to large residual and thus effective closure rate was 91%(41/45).The mean follow-up period was 2-29 (median 12) months. During the follow-up, only 1 patient experienced recurrent cerebral infarction.New onset atrial fibrillation was not detected. Conclusion: Transcatheter PFO closure is effective,safe and related with a good outcome in reduction of recurrent CS for patients with PFO.

Prognosis value of Serum Cytokine levels among burn-induced ards patients.

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Do patients with basilar or vertebral artery stenosis have a higher stroke incidence poststenting?

BACKGROUND AND AIM: Posterior circulation stenosis may be a risk factor associated with stroke after intracranial stenting as compared with anterior circulation stenosis. Our aim was to test our hypothesis that there was no difference in clinical outcome poststenting between patients with severe stenosis of the basilar artery (BA) and intracranial vertebral artery (VA). METHODS: Using the Cox proportional hazards regression model adjusted for prespecified factors (qualifying event, and timing of stenting after the qualifying event), we compared primary endpoint (ischemic stroke in the vertebrobasilar territory, including any stroke or death within 30 days of stenting) between patients with severe symptomatic atherosclerotic BA and VA stenosis who underwent elective stenting in our prospective database. Analysis was by intention-to-treat principle. RESULTS: Primary endpoint event occurred in 13 (18.8%) of 69 patients with BA stenosis during a mean 23.4 months (9 within 30 days and 4 afterward) and 3 (4.3%) of 70 patients with VA stenosis during a mean 26.4 months (2 within 30 days and 1 afterward). Patients with BA stenosis had a significantly higher risk of the primary endpoint (adjusted HR=4.87, 95% CI 1.37 to 17.29; p=0.014) or any stroke or death within 30 days of stenting (adjusted HR=5.13, 95% CI 1.10 to 23.96; p=0.038) than those with VA stenosis. CONCLUSION: A significantly higher stroke risk poststenting exists in patients with severe BA stenosis than those with VA stenosis. The discrepancy in clinical outcome after stenting between patients with BA and VA stenosis should be considered in clinical practice and stenting trials.

Effects of calcium propionate supplementation on lactation performance, energy balance and blood metabolites in early lactation dairy cows.

To evaluate the effects of calcium propionate (CaP) supplementation on feed intake, milk yield and milk composition, energy balance, blood metabolites and urine ketones in early lactation Holstein dairy cows from 1 to 63 days in milk (DIM), 32 multiparous Holstein dairy cows, blocked by lactation number, previous 305-day milk production, and expected calving date, were arranged into four groups in a randomized block design. Treatments were control, LCaP, MCaP and HCaP with 0, 100, 200 and 300 g calcium propionate per cow per day respectively. The supplement of food grade CaP (99.8% of CaP) was hand-mixed into the top one-third of the daily ration. Cows were fed ad libitum a total mixed ration consisting of equal proportion of forage and concentrate. Feed intake, milk yield and components were not affected by CaP supplementation. The energy balance, expressed as the difference between energy input and output, tended to be higher (p = 0.08) for CaP-supplemented cows during the 63-DIM period, especially during the first 21-DIM lactation. Calcium propionate-supplemented cows showed a trend (p = 0.09) towards less loss of body weight (BW) during the 63-DIM period. Concentrations of glucose in plasma and insulin in serum were higher for cows fed CaP relative to control and linearly (p < 0.01) increased with increasing CaP supplementation. Concentrations of non-esterified fatty acids (NEFA), beta-hydroxybutyrate (BHBA) and urine ketones were lower for CaP-supplemented cows at 7, 14 and 21 DIM of lactation and linearly (p < 0.01) decreased with increasing CaP supplementation. These results indicated that nutrient digestibilities and energy status may have been improved.

Effects of isovalerate on ruminal fermentation, urinary excretion of purine derivatives and digestibility in steers.

The objective of this study was to evaluate the effects of isovalerate supplementation on rumen fermentation, urinary excretion of purine derivatives and feed digestibility in the total tract of steers. Eight ruminally cannulated Simmental steers were used in a replicated 4 · 4 Latin square experiment. The treatments were: control (without isovalerate), low isovalerate (LIV), medium isovalerate (MIV) and high isovalerate (HIV) dosage of isovalerate at 100, 200 and 300 mg isovalerate per kg dry matter (DM) intake respectively. Diets consisted of corn stover and concentrate (60/40, DM basis). Dry matter intake was approximately 9 kg per day that was 90% of ad libitum intake including 5.4 kg corn stover and 3.6 kg concentrate. Ruminal pH (6.72­6.54) was linearly (p < 0.03) reduced, whereas total volatile fatty acid concentration (64.6­74.7 mmol/l) was linearly (p < 0.01) and quadratically (p < 0.01) increased with increasing isovalerate supplementation. Ratio of acetate to propionate increased linearly (p < 0.01) from 2.78 to 3.39 as isovalerate supplementation increased because of the increase in acetate production and decrease in propionate production. In situ ruminal degradation of amylase-treated neutral detergent fibre (aNDF) of corn stover was improved, but crude protein (CP) degradability of soybean meal decreased with increasing isovalerate supplementation. Urinary excretion of purine derivatives was quadratically (p < 0.01) changed by altering isovalerate supplementation (50.5, 54.3, 58.9 and 55.2 mmol/day for control, LIV, MIV and HIV, respectively). Similarly, digestibilities of organic matter, aNDF and CP in the total tract were linearly and quadratically increased with increasing isovalerate supplementation. The results of this study indicate that supplementation of diet with isovalerate improved ruminal fermentation and feed digestion in beef cattle. It was suggested that the isovalerate stimulated the digestive microorganisms or enzymes in a dose-dependent manner.

Effects of malic acid on rumen fermentation, urinary excretion of purine derivatives and feed digestibility in steers.

The objective of this study was to evaluate the effects of malic acid (MA) supplementation on rumen fermentation, urinary excretion of purine derivatives (PDs) and whole gastro-intestinal tract feed digestibility in steers. Eight ruminally cannulated Simmental steers (465 ± 13 kg) were used in a replicated 4 × 4 Latin square design. The treatments were: control (without MA), LMA (MA-low), MMA (MA-medium) and HMA (MA-high) with 0.0, 7.8, 15.6 and 23.4 g MA per kg dry matter (DM), respectively. Diets consisted of corn stover and concentrate (60/40, DM basis). DM intake was approximately 9 kg per day, which was 90% of ad libitum intake including 5.4 kg corn stover and 3.6 kg concentrate. Ruminal pH (range of 6.91 to 6.56), ratio of acetate to propionate (range of 3.88 to 3.25), ammonia N (range of 9.03 to 6.42 mg/100 ml) and lactate (range of 91.25 to 76.31 mg/100 ml) decreased linearly as MA supplementation increased, whereas total volatile fatty acid (VFA) concentration (range of 55.68 to 61.49 mM) linearly (P < 0.05) increased with increase in MA supplementation. In situ ruminal neutral detergent fiber (aNDF) degradation of corn stover was improved but the crude protein (CP) degradability of concentrate mix was decreased with increasing the dose of MA. Urinary excretion of PDs was quadratically (P < 0.01) changed with altering MA supplementation (67.88, 72.74, 75.81 and 73.78 mmol/day for control, LMA, MMA and HMA, respectively). Similarly, digestibilities of DM, organic matter (OM), NDF and acid detergent fiber (ADF) in the total tract were also quadratically increased with increasing MA, and no differences in terms of CP and ether extract digestibility were observed. The results indicate that MA supplementation has the potential to improve rumen fermentation and feed digestion in beef cattle. The MA stimulates the digestive microorganisms or enzymes in a quadratic response. In the experimental conditions of this trial, the optimum MA dose was 15.6 g MA per kg DM.

Effects of feeding propylene glycol on dry matter intake, lactation performance, energy balance and blood metabolites in early lactation dairy cows.

The objectives of this study were to evaluate effects of feeding propylene glycol (PG) on feed intake, milk yield and milk composition, blood metabolites and energy balance in Holstein dairy cows from 1 to 63 days in milk. Thirty-two multiparous cows, blocked by lactation number, previous 305-day milk production and expected calving date, were arranged into four groups in a randomized block design. Treatments were: control, low PG, medium PG and high PG with 0, 150, 300 and 450 ml PG per cow per day, respectively. The supplement of food grade PG (0.998 g/g PG) was hand-mixed into the top one-third of the daily ration. Cows were fed ad libitum a total mixed ration consisting of forage and concentrate (50 : 50, dry matter basis). Feed intake, milk yield and milk components were not affected (P > 0.05) by PG supplementation. Overall, body weight (BW) loss tended (P < 0.08) to be linearly reduced, and energy status was linearly improved with increasing PG supplementation. Concentrations of glucose in plasma were higher for cows fed PG relative to control (55.6 v. 58.9 mg/dl) and linearly increased (P < 0.01) with increasing PG supplementation. Plasma concentrations of non-esterified fatty acids and beta-hydroxybutyrate were linearly increased, but urine acetoacetate concentration was quadratically changed with the highest for control diet and the lowest for 450 ml/day of PG. These results indicated that supplementation of PG in the early lactating cow diets had minimal effects on feed intake and milk production, but may potentially reduce contents of milk fat and milk protein. Supplementation of early lactating dairy cow diets with PG is beneficial in terms of improving energy status and reducing BW loss.

Apollo stent for symptomatic atherosclerotic intracranial stenosis: study results.

BACKGROUND AND PURPOSE: A recent trial shows an 8.3 per 100-patient-years' ischemic stroke rate in the territory of the intracranial stenotic artery, despite aspirin treatment. Our aim was to prospectively study the feasibility and outcome of a new intracranial balloon-expandable Apollo stent for symptomatic atherosclerotic intracranial stenosis (SAIS). MATERIALS AND METHODS: Forty-six patients (41 men and 5 women; median, 54 years of age) with forty-eight >or=50% SAISs were enrolled. Procedural feasibility was evaluated by stent success (residual stenosis or=24 months), which varied from 1 month to 30.7 months (median, 23.9 months). After 30 days, 1 patient (2.2%, 1/46) developed minor stroke in the target-lesion artery territory at 6.7 months. Primary end point rate was 4.3 per 100 patient years. Angiographic follow-up was performed in 25 patients. Seven restenoses (28%, 7/25) were detected, 1 of which was symptomatic. CONCLUSION: Angioplasty with the Apollo stent for symptomatic atherosclerotic intracranial stenosis is feasible. Severe tortuosity is an independent predictor of stent failure. Our clinical outcome seems to compare favorably with results of aspirin therapy, but the restenotic rate was high.

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