ABSTRACT
Objective: Half of the patients with acute large artery occlusion (LAO) have poor outcomes after endovascular treatment (EVT). Early complications such as cerebral edema and symptomatic intracranial hemorrhage (sICH) can lead to early neurological deterioration (END), which correlates with hemodynamics. This study aimed to identify the hemodynamic predictors of END and outcomes in LAO patients after EVT. Methods: A total of 76 patients with anterior circulation LAO who underwent EVT and received transcranial Doppler (TCD) monitoring were included. Bilateral middle cerebral artery (MCA) blood flow velocities (BFVs) were measured repeatedly within 1 week. Mean flow velocities (MFV) and MFV index (ipsilateral MFV/contralateral MFV) were calculated. The primary outcome was the incidence of END within 72 h. The secondary outcome was the functional outcome at 90 days-a good outcome was defined as a modified Rankin scale (mRS) score of 0-2, while a poor outcome was defined as an mRS score of 3-6. Results: A total of 13 patients (17.1 %) experienced END within 72 h, including 5 (38.5 %) with cerebral edema, 5 (38.5 %) with sICH, and 3 (23.0 %) with infarct progression. Multivariable logistic regression analysis showed that a higher 24 h MFV index was independently associated with END (aOR 10.5; 95 % CI 2.28-48.30, p = 0.003) and a poor 90-day outcome (aOR 5.10; 95 % CI 1.38-18.78, p = 0.014). The area under the receiver operating characteristic (ROC) curve (AUC) of the 24 h MFV index for predicting END was 0.807 (95 % CI 0.700-0.915, p = 0.0005), the sensitivity was 84.6 %, and the specificity was 66.7 %. At the 1-week TCD follow-up, patients who had poor 90-day outcomes showed significantly higher 1-week iMFV [73.5 (58.4-99.0) vs. 57.7 (45.3-76.3), p = 0.004] and MFV index [1.24 (0.98-1.57) vs.1.0 (0.87-1.15) p = 0.007]. A persistent high MFV index (PHMI) was independently associated with a poor outcome (aOR 7.77, 95 % CI 1.81-33.3, p = 0.006). Conclusion: TCD monitoring within 24 h after EVT in LAO patients can help predict END, while dynamic follow-up within 1 week is valuable in predicting clinical outcomes.
ABSTRACT
BACKGROUND: Mobile short-form video is becoming increasingly popular among Chinese adolescents. Mobile short-form video dependence has become a pressing issue in Chinese adolescents, especially in left-behind adolescents. Previous studies, however, have focused on general mobile phone dependence and neglected specific types of mobile phone dependence. Few studies have explored the environmental and individual predictors of mobile short-form video dependence. OBJECTIVE: Based on theoretical and empirical evidence, the present study examined the unique and interactive effects of parental neglect, school connectedness, and trait self-control on mobile short-form video dependence among Chinese left-behind adolescents. METHODS: A total of 618 left-behind adolescents between 11 and 15 years of age completed the anonymous self-report survey. The PROCESS macro for SPSS was applied for data analysis. RESULTS: Parental neglect was positively associated with mobile short-form video dependence, whereas school connectedness and trait self-control were negatively associated with mobile short-form video dependence in left-behind adolescents. Examination of the two-way interactions indicated that school connectedness and trait self-control could buffer the association between parental neglect and left-behind adolescents' mobile short-form video dependence. However, self-control could not moderate the association between school connectedness and mobile short-form video dependence. In addition, the three-way interaction of parental neglect, school connectedness, and trait self-control showed a significant effect on mobile short-form video dependence. The moderating role of school connectedness was stronger for left-behind adolescents with low trait self-control than for those with high trait self-control, and the moderating role of trait self-control was stronger for left-behind adolescents with low school connectedness than for those with high school connectedness. CONCLUSIONS: The findings contribute significantly to revealing the complex mechanisms of mobile short-form video dependence and providing comprehensive and specific practical suggestions for the prevention and intervention of mobile short-form video dependence among left-behind adolescents.
Subject(s)
Adolescent Behavior , Students , Adolescent , Humans , Schools , Parents , ChinaABSTRACT
PURPOSE: The interactions between grapefruit juice (GFJ) and tacrolimus (FK506) metabolism remain obscure. The aim of this prospective study was to explore the effect of GFJ on the blood concentration of FK506 in liver transplant patients. METHODS: Thirty liver transplant patients were enrolled in the study 1 month post-transplant and randomly divided into three equal-sized groups. Group A patients were treated with the standard FK506-based immunosuppressant regimen only and therefore served as the control; group B and C patients were treated with the standard FK506-based immunosuppressant regimen as well as one of two different kinds of GFJ, respectively. The blood concentrations of FK506 on the seventh day after GFJ intake were compared within each group and among groups. The dose of FK506 was adjusted depending on the valley concentration measured to a treatment window. RESULTS: The blood concentration of FK506 in both group B and group C patients was significantly enhanced, by 1.56 +/- 0.95 and 10.33 +/- 5.59 ng/ml, respectively, following the administration of GFJ for 1 week (compared with the concentration at the start of the experiment in each group; p < 0.05). However, at the end time point, the blood concentration of FK506 in group C patients was significantly increased (p < 0.05) relative to that of the control patients, while this was not the case in group B patients (p > 0.05). Group C patients could be treated with a smaller dose of FK506 (decreased by 2.3 +/- 1.3 mg/day for all patients; p = 0.011), amounting to a decrease in drug costs of approximately $8.70 +/- 5.60/day (p = 0.011). CONCLUSION: In the setting of a controlled clinical study, the co-administration of GFJ with FK506 increased the bioavailability of FK506. However, the concentration of tacrolimus should be closely monitored and the dose adjusted to the treatment window.
