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Zeng G, Li Y. Gastrointestinal: Small intestinal angioedema induced by angiotensin-converting enzyme inhibitors. J Gastroenterol Hepatol 2024. [PMID: 38644669 DOI: 10.1111/jgh.16583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024]
Affiliation(s)
- G Zeng
- Department of Gastroenterology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Y Li
- Department of Gastroenterology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Yang Q, Guo C, Yue C, Song J, Yang J, Peng Z, Yu N, Huang J, Li L, Huang J, Chen Y, Zheng C, Jiang S, Ruan Z, Zhang M, Song D, Luo X, Tian Y, Yang M, Deng S, Wei S, Wu Y, Tang Y, Yang D, Tan X, Zeng G, Cheng D, Liu W, He W, Cai T, Pan C, Liao J, Lei B, Pu S, Jin Z, Li J, Xia Z, Zhang G, Luo J, Sun Y, Xiong X, Wang J, Li B, Peng Y, Chen K, Shan Y, Zhou P, Huang X, Luo S, Zhang J, Liu C, Jiang L, Yang D, Tian Y, Hu J, Qiu Z, Ma J, Xu X, Fan S, Liu X, Xie D, Niu J, Zheng H, Ouyang Q, Wang D, Nguyen TN, Saver JL, Nogueira RG, Li F, Zi W. Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke: The MARVEL Randomized Clinical Trial. JAMA 2024; 331:840-849. [PMID: 38329440 PMCID: PMC10853866 DOI: 10.1001/jama.2024.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
Importance It is uncertain whether intravenous methylprednisolone improves outcomes for patients with acute ischemic stroke due to large-vessel occlusion (LVO) undergoing endovascular thrombectomy. Objective To assess the efficacy and adverse events of adjunctive intravenous low-dose methylprednisolone to endovascular thrombectomy for acute ischemic stroke secondary to LVO. Design, Setting, and Participants This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 82 hospitals in China, enrolling 1680 patients with stroke and proximal intracranial LVO presenting within 24 hours of time last known to be well. Recruitment took place between February 9, 2022, and June 30, 2023, with a final follow-up on September 30, 2023. Interventions Eligible patients were randomly assigned to intravenous methylprednisolone (n = 839) at 2 mg/kg/d or placebo (n = 841) for 3 days adjunctive to endovascular thrombectomy. Main Outcomes and Measures The primary efficacy outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores (range, 0 [no symptoms] to 6 [death]). The primary safety outcomes included mortality at 90 days and the incidence of symptomatic intracranial hemorrhage within 48 hours. Results Among 1680 patients randomized (median age, 69 years; 727 female [43.3%]), 1673 (99.6%) completed the trial. The median 90-day modified Rankin Scale score was 3 (IQR, 1-5) in the methylprednisolone group vs 3 (IQR, 1-6) in the placebo group (adjusted generalized odds ratio for a lower level of disability, 1.10 [95% CI, 0.96-1.25]; P = .17). In the methylprednisolone group, there was a lower mortality rate (23.2% vs 28.5%; adjusted risk ratio, 0.84 [95% CI, 0.71-0.98]; P = .03) and a lower rate of symptomatic intracranial hemorrhage (8.6% vs 11.7%; adjusted risk ratio, 0.74 [95% CI, 0.55-0.99]; P = .04) compared with placebo. Conclusions and Relevance Among patients with acute ischemic stroke due to LVO undergoing endovascular thrombectomy, adjunctive methylprednisolone added to endovascular thrombectomy did not significantly improve the degree of overall disability. Trial Registration ChiCTR.org.cn Identifier: ChiCTR2100051729.
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Affiliation(s)
- Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhouzhou Peng
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Nizhen Yu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Linyu Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiandi Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yifei Chen
- Department of Neurology, Qujing No. 1 Hospital Affiliated Hospital of Kunming Medical University, Qujing, China
| | - Chong Zheng
- Department of Neurology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shunfu Jiang
- Department of Neurology, Jingdezhen No. 1 People's Hospital, Jingdezhen, China
| | - Zhongfan Ruan
- Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Min Zhang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Dengwen Song
- Department of Neurology, Hospital 302 Attached to Guizhou Aviation Group, Anshun, China
| | - Xiaojun Luo
- Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China
| | - Yaoyu Tian
- Department of Neurology, Qian Xi Nan People's Hospital, Xingyi, China
| | - Mei Yang
- Department of Neurology, Dali Bai Autonomous Prefecture People's Hospital, Dali, China
| | - Shenglin Deng
- Department of Neurology, People's Hospital of Wushen County, Guang'an, China
| | - Shirong Wei
- Department of Neurology, The People's Hospital of Hechi and the Hechi Hospital Affiliated to Youjiang Medical University for Nationalities, Hechi, China
| | - Youlin Wu
- Department of Neurology, Chongzhou Hospital, Chongzhou, China
| | - Yufeng Tang
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - De Yang
- Department of Neurology, Chongqing University Fuling Hospital, Fuling, China
| | - Xiaolin Tan
- Department of Neurology, Meishan Second People's Hospital, Meishan, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Daoyou Cheng
- Department of Neurology, Xingyi People's Hospital, Xingyi, China
| | - Wenhua Liu
- Department of Neurology, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
| | - Wencheng He
- Department of Neurology, Guiping People's Hospital, Guiping, China
| | - Tieying Cai
- Department of Neurology, Yunyang County People's Hospital, Yunyang, China
| | - Chengde Pan
- Department of Neurology, People's Hospital of Chongqing Banan District, Banan, China
| | - Jiasheng Liao
- Department of Neurology, Suining First People's Hospital, Suining, China
| | - Bo Lei
- Department of Cerebrovascular Diseases, The People's Hospital of Leshan, Leshan, China
| | - Shengxiong Pu
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhenglong Jin
- Department of Neurology, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Jinglun Li
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhongbin Xia
- Department of Neurology, Jiujiang University Affiliated Hospital, Jiujiang, China
| | - Guling Zhang
- Department of Neurology, The People's Hospital of Danzhai, Danzhai, China
| | - Jun Luo
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Yaxuan Sun
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xiaoping Xiong
- Department of Neurology, Chongqing University Qianjiang Hospital, Qianjiang District, China
| | - Jian Wang
- Department of Neurology, Yaan People's Hospital, Ya'an, China
| | - Bo Li
- Department of Neurology, Bazhong Central Hospital, Bazhong, China
| | - Yuqi Peng
- Department of Neurology, Sichuan Science City Hospital, Mianyang, China
| | - Kechun Chen
- Department of Neurology, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Yuanjun Shan
- Department of Neurology, Xiangzhou District People's Hospital, Xiangyang, China
| | - Peiyang Zhou
- Department of Neurology, Xiangyang No. 1 People's Hospital, Xiangyang, China
| | - Xinyuan Huang
- Department of Neurology, The Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang, China
| | - Shiwei Luo
- Department of Neurology, Jieyang People's Hospital, Jieyang, China
| | - Jie Zhang
- Department of Neurology, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, China
| | - Chang Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, China
| | - Lin Jiang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dahong Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yan Tian
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jinrong Hu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jinfu Ma
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xu Xu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shitao Fan
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiang Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dongjing Xie
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jianqin Niu
- Department of Histology and Embryology, Army Medical University, Chongqing, China
| | - Hongting Zheng
- Department of Endocrinology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qin Ouyang
- Department of Medicinal Chemistry, Army Medical University, Chongqing, China
| | - Duolao Wang
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles
| | - Raul G Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburgh, UPMC Stroke Institute, Pittsburgh, Pennsylvania
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Sang H, Cao Z, Du J, Nguyen TN, Saver JL, Mao A, Nogueira RG, Tao Z, Zhou S, Han Q, Sun D, Lei B, Liu S, Zeng G, Yin C, Xie D, Luo W, Jin Z, Qiu Z. Intravenous Tirofiban Versus Alteplase Before Endovascular Treatment in Acute Ischemic Stroke: A Pooled Analysis of the DEVT and RESCUE BT Trials. Stroke 2024. [PMID: 38362756 DOI: 10.1161/strokeaha.123.044562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND The present study aimed to evaluate the efficacy and safety of intravenous tirofiban versus alteplase before endovascular treatment (EVT) in acute ischemic stroke patients with intracranial large vessel occlusion. METHODS This was a post hoc analysis using data from 2 multicenter, randomized trials: the DEVT trial (Direct Endovascular Treatment for Large Vessel Occlusion Stroke) from May 2018 to May 2020 and the RESCUE BT trial (Intravenous Tirofiban Before Endovascular Thrombectomy for Acute Ischemic Stroke) from October 2018 to October 2021. Patients with acute intracranial large vessel occlusion within 4.5 hours from last known well were dichotomized into 2 groups: tirofiban plus EVT versus alteplase bridging with EVT. The primary outcome was functional independence (modified Rankin Scale score of 0-2) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 3-month mortality. Multivariable logistic regression (adjusting for baseline systolic blood pressure, occlusion site, onset-to-puncture time, anesthesia, and first choice of EVT) and propensity score overlap weighting (balance in demographic covariates, stroke characteristics, and initial management between groups) were performed. RESULTS One-hundred and eighteen alteplase-treated patients in the DEVT trial and 98 tirofiban-treated patients in the RESCUE BT trial were included (median age, 70 years; 115 [53.2%] men). The rate of functional independence was 60.2% in the tirofiban group compared with 46.6% in the alteplase group (adjusted odds ratio, 1.25 [95% CI, 0.60-2.63]). Compared with alteplase, tirofiban was not associated with increased risk of symptomatic intracranial hemorrhage (6.8% versus 9.2%; P=0.51) and mortality (17.8% versus 19.4%; P=0.76). The propensity score overlap weighting analyses showed consistent outcomes. CONCLUSIONS Among patients with intracranial large vessel occlusion within 4.5 hours of onset, tirofiban plus EVT was comparable to alteplase bridging with EVT regarding the efficacy and safety outcomes. These findings should be interpreted as preliminary and require confirmation in a randomized trial. REGISTRATION URL: https://www.chictr.org.cn; Unique identifiers: ChiCTR-IOR-17013568 and ChiCTR-INR-17014167.
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Affiliation(s)
- Hongfei Sang
- Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, China (H.S., C.Y.)
| | - Zhihua Cao
- Xiangyang No. 1 People's Hospital, Hubei University of Medicine, China (Z.C.)
| | - Jie Du
- Kaizhou District People's Hospital, Chongqing, China (J.D.)
| | | | - Jeffrey L Saver
- David Geffen School of Medicine at University of California at Los Angeles (J.L.S.)
| | - An Mao
- The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China (A.M., Z.T., S.Z., Q.H., Z.Q.)
| | - Raul G Nogueira
- UPMC Stroke Institute, University of Pittsburgh School of Medicine, PA (R.G.N.)
| | - Zhaojun Tao
- The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China (A.M., Z.T., S.Z., Q.H., Z.Q.)
| | - Simin Zhou
- The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China (A.M., Z.T., S.Z., Q.H., Z.Q.)
| | - Qin Han
- The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China (A.M., Z.T., S.Z., Q.H., Z.Q.)
| | - Dong Sun
- Zhongnan Hospital, Wuhan University, China (D.S.)
| | - Bo Lei
- Leshan People's Hospital, China (B.L.)
| | - Shudong Liu
- Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, China (S.L.)
| | | | - Congguo Yin
- Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, China (H.S., C.Y.)
| | - Dongjing Xie
- Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (D.X., W.L., Z.Q.)
| | - Weidong Luo
- Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (D.X., W.L., Z.Q.)
| | - Zhenglong Jin
- Department of Neurology, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, China (Z.J.)
| | - Zhongming Qiu
- Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (D.X., W.L., Z.Q.)
- The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China (A.M., Z.T., S.Z., Q.H., Z.Q.)
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Zhu X, Guo Z, Tian L, Zeng G, Zhou P, Yuan Z, Sang H, Qiu Z, Yang Q, Wu Y, Li J. Efficacy and safety of tirofiban combined with endovascular therapy for basilar artery occlusion stroke due to large artery atherosclerosis. J Stroke Cerebrovasc Dis 2024; 33:107526. [PMID: 38096657 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy and safety of adjuvant tirofiban in patients with acute basilar artery occlusion due to large-artery atherosclerotic (LAA) receiving endovascular therapy (EVT). METHODS This was a non-randomized, multicenter study using data from the Endovascular Treatment for Acute BASILAR Artery Occlusion (BASILAR) registry. Patients with acute basilar artery occlusion due to LAA within 24h of symptom onset who underwent EVT were included. Patients were divided into tirofiban and non-tirofiban groups according to whether tirofiban was used. The primary outcome was the ordinal modified Rankin scale score at 90 days. Safety outcomes were mortality within 90 days and symptomatic intracranial hemorrhage (sICH) within 48 h. RESULTS A total of 417 patients were included, of whom 275 patients were in the tirofiban group and 142 patients in the non-tirofiban group. Compared with patients in the non-tirofiban group, patients in the tirofiban group were associated with a favorable shift in functional outcome at 90 days (6[4-6] vs 5 [2-6]; adjusted common OR, 2.51; 95 % CI, 1.64-3.83). The mortality was lower in the tirofiban group than the non-tirofiban group (40.7 % vs 58.5 %; adjusted OR, 0.35; 95 % CI, 0.21-0.56). The rate of sICH was 12.2 % in the non-tirofiban group and 5.2 % in the tirofiban group (adjusted OR, 0.37; 95 % CI, 0.17-0.80; P = 0.012). CONCLUSION Tirofiban plus EVT might improve functional outcomes with a good safety for patients with acute basilar artery occlusion due to LAA. The results need to be confirmed in a randomized trial.
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Affiliation(s)
- Xiurong Zhu
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Department of Neurology, Chongzhou People's Hospital, Chongzhou 611230, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan 430000, China
| | - Ling Tian
- Department of Neurology, Yuhuangding Hospital, Qingdao University, Yantai 264000, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou 341000, China
| | - Peiyang Zhou
- Department of Neurology, The First People's Hospital of Xiangyang, Hubei Medical University, Xiangyang 441000, China
| | - Zhengzhou Yuan
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Youlin Wu
- Department of Neurology, Chongzhou People's Hospital, Chongzhou 611230, China
| | - Jinglun Li
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
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Li QQ, Wang YF, Chen XY, Zhu HL, Zeng G, Sun JQ, Wu YF. [Associations of blood pressure change with change in foods' intake among adults with mild to moderate hypertension]. Zhonghua Xin Xue Guan Bing Za Zhi 2024; 52:49-57. [PMID: 38220455 DOI: 10.3760/cma.j.cn112148-20231013-00316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Objective: To explore the association between the intake and changes in various types of food and the changes in blood pressure in patients with mild to moderate hypertension. Methods: Mild to moderate hypertension participants with complete baseline and outcome data were included from DECIDE-Diet study, a multicenter, randomized controlled trial. Dietary records and blood pressure measurements at both 7-day run-in (baseline) and 28-day intervention phases were collected for enrolled participants. Blood pressure change was defined as the difference between blood pressure at the end of trial and the baseline blood pressure. Baseline intake of food was the average daily intake during the run-in period, and the intake increment was defined as the difference between the average intake during the trial period and the average intake during the run-in period. After adjusting for age, sex, study center, intervention groups, baseline body mass index (kg/m2), antihypertension medication use, and baseline total calorie intake, a linear regression model was used to analyze the associations of the before-after-intervention change in blood pressure with baseline intake and intake increment of foods. Results: A total of 258 patients with mild to moderate hypertension were included, including 133 males, aged (56.5±9.9) years. (1) After adjusting for confounding factors, there was no significant association between baseline intake of food and baseline blood pressure (all P>0.05). The blood pressure change was negatively associated with baseline intakes of tubers, vegetables, and vegetable oils but positively with baseline intake of meats; and was negatively associated with intake increment of whole grains and fish (all P<0.05). (2) The multiple linear regression analysis showed that baseline intake of vegetables (β=-0.021, P=0.004), vegetable oils (β=-0.260, P=0.002), and increment in intake of fish (β=-0.128, P=0.026) were all significantly associated with changes in systolic blood pressure; baseline intake of vegetables (β=-0.017, P=0.002), vegetable oils (β=-0.182, P=0.001), dairy products (β=0.021, P=0.022), and increment in intake of fish (β=-0.092, P=0.010) were all significantly associated with changes in diastolic blood pressure. Conclusion: Increasing the intake of whole grains, vegetables, vegetable oils, and fish and decreasing the intake of meat may be beneficial for blood pressure control in patients with mild to moderate hypertension.
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Affiliation(s)
- Q Q Li
- Peking University First Hospital, Beijing 100034, China Peking University Clinical Research Institute, Beijing 100091, China
| | - Y F Wang
- Peking University Clinical Research Institute, Beijing 100091, China
| | - X Y Chen
- Peking University Clinical Research Institute, Beijing 100091, China
| | - H L Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - G Zeng
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - J Q Sun
- Clinical Nutrition Center of Huadong Hospital Affilicated to Fudan University, Shanghai 200040, China
| | - Y F Wu
- Peking University Clinical Research Institute, Beijing 100091, China
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Yi T, Li K, Lin XH, Lin DL, Wu YM, Pan ZN, Zheng XF, Chen RC, Zeng G, Chen WH. Predictors of futile recanalization in basilar artery occlusion patients undergoing endovascular treatment: a post hoc analysis of the ATTENTION trial. Front Neurol 2023; 14:1308036. [PMID: 38178887 PMCID: PMC10765589 DOI: 10.3389/fneur.2023.1308036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
Background Few studies have focused on factors associated with futile recanalization in patients with an acute basilar artery occlusion (BAO) that was treated with modern endovascular therapy (EVT). The aim of this study was to explore the factors associated with futile recanalization in patients with an acute BAO presented within 12 h. Methods This is a post-hoc analysis of the ATTENTION trial (The Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion, ClinicalTrials.gov, number NCT04751708). Demographics, clinical characteristics, acute stroke workflow interval times, and imaging characteristics were compared between the futile recanalization and favorable recanalization groups. The favorable outcome was defined as a modified Rankin scale (mRS) score of 0-3 at 90 days, successful reperfusion was defined as thrombolysis in cerebral infarction (TICI) 2b and 3 on the final angiogram, and futile recanalization was defined as failure to achieve a favorable outcome despite successful reperfusion. A multivariate analysis was performed to identify the predictors of futile recanalization. Results In total, 185 patients were included in the final analysis: 89 (48.1%) patients had futile recanalization and 96 (51.9%) patients had favorable recanalization. In the multivariable logistic regression analysis, older age (OR 1.04, 95% CI 1.01 to 1.08, p = 0.01) and diabetes mellitus (OR 3.35, 95% CI 1.40 to 8.01, p = 0.007) were independent predictors of futile recanalization. Conclusion Futile recanalization occurred in nearly half of patients with acute BAO following endovascular treatment. Old age and diabetes mellitus were identified as independent predictors of futile recanalization after endovascular therapy for acute BAO.
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Affiliation(s)
- Tingyu Yi
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Kai Li
- Department of Neurology, Heze Municipal Hospital, Heze, China
| | - Xiao-hui Lin
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Ding-lai Lin
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Yan-Min Wu
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Zhi-nan Pan
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Xiu-fen Zheng
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Rong-cheng Chen
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People’s Hospital, Ganzhou, China
| | - Wen-huo Chen
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
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Huang J, Kong W, Yang J, Wang M, Huang X, Wang Y, Luo J, Wu Y, Zeng G, Wan Y, Song J, Li L, Hu J, Liu S, Luo W, Tian Y, Sang H, Qiu Z, Li F, Schonewille W, Liu C, Zi W. Effect of the anastomosis between the posterior inferior cerebellar artery and the superior cerebellar artery on outcomes of acute basilar artery occlusion after endovascular treatment. J Neurointerv Surg 2023; 15:e161-e165. [PMID: 36192140 DOI: 10.1136/jnis-2022-019409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The effects of secondary collateral compensation on outcomes remain unclear in patients with acute basilar artery occlusion (BAO) after endovascular treatment (EVT). This study aimed to evaluate the benefits of the anastomosis between the posterior inferior cerebellar artery (PICA) and the superior cerebellar artery (SCA) in BAO after EVT. METHODS This cohort study was conducted using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry. Patients with acute BAO and treated with EVT were included. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (SICH) and 90-day mortality. RESULTS Of the 646 patients included in the study, 196 (30.3%) patients had a PICA-SCA anastomosis. The PICA-SCA anastomosis was significantly associated with independent functional outcome at 90 days (67/196 (34.2%) vs 109/450 (24.2%), adjusted OR (aOR) 1.80 (95% CI 1.13 to 2.86), p=0.01) and was significantly associated with a decreased rate of SICH (40/442 (9.0%) vs 5/193 (2.6%), aOR 0.29 (95% CI 0.11 to 0.76), p=0.01). No significant difference was found between PICA-SCA anastomosis and 90-day mortality (219/450 (48.7%) vs 80/196 (40.8%), aOR 0.72 (95% CI 0.48 to 1.08), p=0.11). Subgroup analysis showed that the association between independent functional outcome and PICA-SCA anastomosis was strongest in patients with middle BAO (27/77 (35.1%) vs 22/118 (18.6%), aOR 2.64 (95% CI 1.13 to 6.15), p=0.03). CONCLUSIONS The PICA-SCA anastomosis is significantly associated with better functional outcomes in patients with acute BAO after EVT, especially in those with middle BAO.
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Affiliation(s)
- Jiacheng Huang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Weilin Kong
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Jie Yang
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Maolin Wang
- Central Laboratory, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Xianjun Huang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yan Wang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, China
| | - Jun Luo
- Department of Neurology, 404 Hospital, Mianyang, Sichuan, China
| | - Youlin Wu
- Department of Neurology, People's Hospital of Chongzhou, Chongzhou, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Yue Wan
- Department of Neurology, Yangluo District of Hubei Zhongshan Hospital, Wuhan, China
| | - Jiaxing Song
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Linyu Li
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Jinrong Hu
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Shuai Liu
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Weidong Luo
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Yan Tian
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Fengli Li
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
| | - Wouter Schonewille
- Department of Neurology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Chang Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjie Zi
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, China
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8
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Ye J, Liu Q, Fu Q, Li B, Huang J, Zeng G. Tim-3, PD-1, CD244 and Foxp3 Positive T Cells' Relation to the Prognosis of Dermatomyositis and Polymyositis Patients. J Coll Physicians Surg Pak 2023; 33:421-426. [PMID: 37190715 DOI: 10.29271/jcpsp.2023.04.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To explore the frequency of circulating CD4+ T cells expressing PD-1+, TIM-3+ in polymyositis (PM) and dermatomyositis (DM) patients and its correlation with inflammatory factors, CD244+ and FOXP3+ T cell subtypes and prognosis. STUDY DESIGN Observational study. Place and Duration of the Study: Ganzhou people's Hospital, Ganzhou, Jiangxi, China, from July 2019 to June 2021. METHODOLOGY PM and DM patients were treated according to the institution's guidelines and followed up for 2 years. Fifty healthy volunteers were enrolled as controls. Serum interleukin (IL)-6, C-reactive protein (CRP), IL-17, and tumour necrosis factor α (TNF-α) levels were detected by enzyme-linked immunosorbent assay (ELISA). TIM-3+, PD-1+, CD244+, and FOXP3+ expressions were measured using flow cytometry. Inability to live normally, recurrence or death was defined as poor prognosis. RESULTS The ESR, ALT, AST, LDH and ferritin concentration in PM/DM patients were remarkably elevated than that in healthy volunteers. The frequencies of PD-1+, TIM-3+, CD244+, and FOXP3+ were all remarkably enhanced in PM/DM patients compared with the healthy volunteers. The frequencies of PD-1+, TIM-3+, FOXP3+, and TIM-3+/PD-1+ T cells were significantly elevated in the poor prognosis group compared with the good prognosis group. The frequency of CD4+TIM-3+PD-1+ had satisfactory diagnostic value for PM/DM patients with bad prognoses. IL-17, TIM-3+, PD-1+and TIM-3+ PD-1+ were the risk factors for PM/DM patients with bad outcomes. CONCLUSION The frequency of circulating CD4+ T cells expressing TIM-3+PD-1+ could be used to predict the prognosis of PM/DM patients. KEY WORDS Tim-3, PD-1, Dermatomyositis, Polymyositis, Inflammatory.
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Affiliation(s)
- Jin Ye
- Department of Medical Administration Department, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Qing Liu
- Department of Neurology, Ganzhou people's Hospital, Ganzhou, Jiangxi, China
| | - Qingqing Fu
- Department of Neurology, Ganzhou people's Hospital, Ganzhou, Jiangxi, China
| | - Bin Li
- Department of Neurology, Ganzhou people's Hospital, Ganzhou, Jiangxi, China
| | - Jinchang Huang
- Department of Pathology, Ganzhou people's Hospital, Ganzhou, Jiangxi, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou people's Hospital, Ganzhou, Jiangxi, China
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9
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Qiu Z, Yuan J, Xie D, Wu D, Luo W, Zhaojun T, Liu S, Han Q, Sun D, Lei B, Li J, Miao J, Liu S, Jin Z, Zeng G, Wen C, Yuan G, Yang Q, Nguyen T, Saver JL, Nogueira RG, Li F, Sang H, Zi W. Abstract 100: Endovascular Treatment With Intravenous Tirofiban Or Alteplase Versus Endovascular Treatment Alone For Acute Ischemic Stroke With Large Vessel Occlusion: A Pooled Analysis Of The Devt And Rescue Bt Trials. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
In acute ischemic stroke patients with large vessel occlusion, the role of intravenous tirofiban or alteplase as an adjunct to endovascular treatment (EVT) is still uncertain.
Methods:
This post hoc analysis used data from 467 patients included in two multicenter, randomized clinical trials that assessed intravenous adjunctive medications in stroke thrombectomy (DEVT and RESCUE BT). Patients were treated with EVT alone (EVT-alone group), intravenous tirofiban plus EVT (tirofiban+EVT group), and intravenous alteplase plus EVT (alteplase+EVT group). The primary outcome was functional independence (modified Rankin scale score 0-2) at 90 days. Safety outcomes included intracranial hemorrhage and mortality.
Results:
Of 467 patients included in the cohort, there were 172, 172, and 123 patients in EVT-alone, tirofiban+EVT, and alteplase+EVT group, respectively. Patients in the alteplase+EVT group were less likely to achieve functional independence than patients in the tirofiban+EVT group (adjusted risk ratio [RR], 0.80; 95% confidence interval [CI], 0.65-0.99;
P
= 0.04). Patients in the EVT-alone group compared with the tirofiban+EVT group (adjusted RR, 1.12; 95% CI, 0.92-1.36;
P
= 0.27) or the alteplase+EVT group (adjusted RR, 0.81; 95% CI, 0.65-1.02;
P
= 0.07) were similarly likely to obtain functional independence. Patients in the alteplase+EVT group had a higher risk of any intracranial hemorrhage than in the EVT-alone group (adjusted RR, 1.49; 95% CI, 1.03-2.14;
P
= 0.03) and tirofiban+EVT group (adjusted RR, 1.49; 95% CI, 1.02-2.18;
P
= 0.04). No significant difference was detected in the incidence of symptomatic intracranial hemorrhage and mortality among the three groups.
Conclusions:
Tirofiban before thrombectomy is associated with a better functional outcome and lower risk of any intracranial hemorrhage than alteplase among patients with large vessel occlusion treated within 4.5 hours after stroke onset.
Trial Registration:
chictr.org.cn, ChiCTR-IOR-17013568 and ChiCTR-INR-17014167.
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Affiliation(s)
- Zhongming Qiu
- Xinqiao Hosp and The Second Affiliated Hosp, Army Med Univ (Third Military Med Univ), Chongqing, China
| | - Junjie Yuan
- The 925th Hosp of The Chinese People’s Liberation Army, Guiyang, China
| | - Dongjing Xie
- Xinqiao Hosp and The Second Affiliated Hosp, Army Med Univ (Third Military Med Univ), Chongqing, China
| | - Deping Wu
- Huaian Med District of Jingling Hosp, Med Sch of Nanjing Univ, Huaian, China
| | - Weidong Luo
- The General Hosp of Tibet Military Area Command, Lhasa, China
| | - Tao Zhaojun
- The 903rd Hosp of The Chinese People’s Liberation Army, Hangzhou, China
| | - Shuai Liu
- Xinqiao Hosp and The Second Affiliated Hosp, Army Med Univ (Third Military Med Univ), Chongqing, China
| | - Qin Han
- The 903rd Hosp of The Chinese People’s Liberation Army, Hangzhou, China
| | - Dong Sun
- Zhongnan Hosp, Wuhan Univ, Wuhan, China
| | - Bo Lei
- Leshan People's Hosp, Leshan, China
| | - Jinglun Li
- Affiliated Hosp of Southwest Med Univ, Luzhou, China
| | - Jian Miao
- Xianyang Hosp of Yan'an Univ, Xianyang, China
| | - Shudong Liu
- Yongchuan Hosp of Chongqing Med Univ, Chongqing Key Laboratory of Cerebrovascular Disease Rsch, Chongqing, China
| | - Zhenglong Jin
- Wuyi Hosp of Traditional Chinese Medicine, Jiangmen, China
| | | | | | | | - Qingwu Yang
- Xinqiao Hosp and The Second Affiliated Hosp, Army Med Univ (Third Military Med Univ), Chongqing, China
| | | | | | | | - Fengli Li
- Xinqiao Hosp and The Second Affiliated Hosp, Army Med Univ (Third Military Med Univ), Chongqing, China
| | - Hongfei Sang
- Affiliated Hangzhou First People’s Hosp, Zhejiang Univ Sch of Medicine, Hangzhou, China
| | - Wenjie Zi
- Xinqiao Hosp of Army Med Univ, Chongqing, China
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Zhao J, Liu H, Chen W, Jian Y, Zeng G, Wang Z. Hydrogel of HEMA, NVP, and Morpholine-Derivative Copolymer for Sulfate Ion Adsorption: Behaviors and Mechanisms. Molecules 2023; 28:molecules28030984. [PMID: 36770649 PMCID: PMC9923838 DOI: 10.3390/molecules28030984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
SO42--containing compounds are widely present in wastewater generated from various industries and mining industries, such as slag leachate, pulp and paper wastewater, modified starch wastewater, etc. When the concentration of SO42- is too high, it will not only be corrosive to metal equipment but also accumulate in the environmental media. Based on this, a novel cationic hydrogel HNM was synthesized in this study by introducing morpholine groups into the conventional hydrogel HEMA-NVP system for the adsorption of SO42- in aqueous solutions. Characterizations by Fourier transform infrared (FTIR) spectroscopy and X-ray photoelectron spectroscopy (XPS) indicated that morpholine groups had been introduced into the as-synthesizedhydrogels. The scanning electron microscope (SEM) characterization results show that the introduction of morpholine groups changed the surface of the hydrogel from micron-scale wrinkles to nanoscale gaps, increasing the contact area with the solution. The results of static water contact angle (WCA), equilibrium water content (EWC), and SO42- adsorption capacity show that the introduction of morpholine groups not only further improved the equilibrium water content and hydrophilicity of the hydrogel but also greatly improved the SO42- adsorption capacity of the hydrogel, with the maximum SO42- adsorption amount of 21.59 mg/g, which was much higher than that of the hydrogel without morpholine groups of 5.15 mg/g. Further studies found that the adsorption of SO42- on the hydrogel HNM was pH-dependent, and acidic conditions were favorable for the adsorption. Therefore, the introduction of morpholine groups greatly enhanced the ability of conventional HEMA-NVP hydrogels to remove SO42- from aqueous solutions.
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Affiliation(s)
- Jing Zhao
- Laboratory of Organic Solid Waste Treatment and Recycling, College of Materials Science and Engineering, Henan Institute of Technology, Xinxiang 453003, China
| | - Haitao Liu
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325035, China
- Correspondence: (H.L.); (Y.J.); (Z.W.)
| | - Wenwen Chen
- Department of Chemistry, Lishui University, Lishui 323000, China
| | - Yu Jian
- Department of Chemistry, Lishui University, Lishui 323000, China
- Correspondence: (H.L.); (Y.J.); (Z.W.)
| | - Guoyong Zeng
- Department of Chemistry, Lishui University, Lishui 323000, China
| | - Zhenyu Wang
- Department of Environmental Engineering, College of Ecology, Lishui University, Lishui 323000, China
- Correspondence: (H.L.); (Y.J.); (Z.W.)
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11
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Ye J, Zhang F, Li B, Liu Q, Zeng G. Knockdown of ATF3 suppresses the progression of ischemic stroke through inhibiting ferroptosis. Front Mol Neurosci 2023; 15:1079338. [PMID: 36743288 PMCID: PMC9890179 DOI: 10.3389/fnmol.2022.1079338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Current therapies towards ischemic stroke (IS) are still not satisfied, and alternative strategies targeting ferroptosis may be another choice. The purpose of this study is to screen potential ferroptosis-related genes involving in IS. Methods A rat model of IS was established via middle cerebral artery occlusion. Differentially expressed genes (DEGs) were screened from the model rats through transcriptional sequencing. Among the isolated DEGs, the expression of several attractive DEGs relating with ischemic injury was confirmed by qRT-PCR. Then, ATF3 relating with both IS and ferroptosis was selected a candidate gene for functional assays. After knockdown of ATF3 in the model rats, the infarction, histopathology, apoptosis, and ferroptosis in brain tissues were evaluated. Results IS model was successfully established in rats, exhibiting the emergence of infarction area, histopathological injury, and enhanced cell apoptosis. Total 699 up-regulated DEGs and 461 down-regulated DEGs were screened from the model rats. qRT-PCR verified the up-regulation of Hspa1b, Tfpi2, Ptx3, and Atf3, and the down-regulation of Smyd1 and Tacr2 in the Model group compared with those in the Sham group. It is noteworthy that knockdown of ATF3 decreased the infarction area, relieved histopathological injury, weakened apoptosis, and inhibited ferroptosis in the model rats. Conclusion Several candidate genes in relation with IS were revealed. More importantly, knockdown of ATF3 may relieve IS through inhibiting ferroptosis.
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Affiliation(s)
- Jin Ye
- The Office of Stroke Screening and Prevention, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Fan Zhang
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Bin Li
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Qing Liu
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China,*Correspondence: Guoyong Zeng,
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12
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Yang J, Li F, Qiu Z, Wang Y, Luo J, Wu Y, Zeng G, Wan Y, Liu S, Yue C, Song J, Luo W, Liu C, Li L, Sun R, Huang J, Sang H, Zhao C, Yang Q, Zi W. Effect of endovascular treatment within 6 hours for acute basilar artery occlusion. J Neurosurg 2023; 138:205-214. [PMID: 35623368 DOI: 10.3171/2022.4.jns22355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/05/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the efficacy and safety of endovascular treatment (EVT) plus standard medical treatment (SMT) in patients with acute basilar artery occlusion (BAO) within 6 hours of the estimated occlusion time, based on a Chinese population. METHODS The authors selected patients from the Endovascular Treatment of Acute Basilar Artery Occlusion Study (BASILAR) registry, which was a nationwide prospective registry, within 6 hours after the estimated time of onset of a stroke in acute BAO. Patients were divided into the SMT-alone group or the EVT+SMT group according to treatment modalities. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score between 0 and 3 at 90 days. Safety outcomes included death at 90 days and symptomatic intracerebral hemorrhage. RESULTS The authors assessed 590 patients for eligibility. Of these patients, 127 received SMT alone and 463 were treated with EVT plus SMT. EVT was associated with a higher rate of a favorable functional outcome (adjusted OR 3.804, 95% CI 1.890-7.658; p < 0.001) and a lower proportion of deaths at 90 days (adjusted OR 0.364, 95% CI 0.223-0.594; p < 0.001). Lower age (adjusted OR 0.978, 95% CI 0.960-0.997; p = 0.022); lower baseline National Institutes of Health Stroke Scale score (adjusted OR 0.926, 95% CI 0.902-0.950; p < 0.001); higher baseline posterior circulation Alberta Stroke Program Early CT Score (adjusted OR 1.681, 95% CI 1.424-1.984; p < 0.001); absence of diabetes mellitus (adjusted OR 0.482, 95% CI 0.267-0.871; p = 0.016); and modified Thrombolysis in Cerebral Infarction scores 2b-3 (adjusted OR 5.117, 95% CI 2.304-11.367; p < 0.001) were independent factors for a favorable outcome in the EVT+SMT group. CONCLUSIONS Based on the study design, patients with acute BAO who received EVT within 6 hours were associated with improved favorable outcome and decreased deaths compared with patients who received SMT. Predictors of desirable outcome in patients undergoing EVT included lower age, lower baseline National Institutes of Health Stroke Scale score, higher baseline posterior circulation Alberta Stroke Program Early CT Score, absence of diabetes mellitus, and modified Thrombolysis in Cerebral Infarction scores 2b-3.
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Affiliation(s)
- Jie Yang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Fengli Li
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Zhongming Qiu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Yan Wang
- 2Department of Neurology, Chengdu Fifth People's Hospital, Chengdu
| | - Jun Luo
- 3Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang
| | - Youlin Wu
- 4Department of Neurology, Chongzhou People's Hospital, Chongzhou
| | - Guoyong Zeng
- 5Department of Neurology, Ganzhou People's Hospital, Ganzhou; and
| | - Yue Wan
- 6Department of Neurology, Yangluo District of Hubei Zhongshan Hospital, Wuhan, China
| | - Shuai Liu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Chengsong Yue
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Jiaxing Song
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Weidong Luo
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Chang Liu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Linyu Li
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Ruidi Sun
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Jiacheng Huang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Hongfei Sang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Chenhao Zhao
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Qingwu Yang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Wenjie Zi
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
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Yang J, Jin Z, Song J, Guo C, Xie D, Yue C, Kong W, Hu J, Luo W, Liu S, Huang J, Zeng G. Futile Recanalization After Endovascular Treatment in Patients With Acute Basilar Artery Occlusion. Neurosurgery 2022; 92:1006-1012. [PMID: 36700757 DOI: 10.1227/neu.0000000000002313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND It is estimated that >50% of acute basilar artery occlusion (ABAO) patients with successful reperfusion after endovascular treatment (EVT) have futile recanalization. However, few studies investigated the reasons behind this. OBJECTIVE To identify the factors associated with futile recanalization in ABAO after successful reperfusion. METHODS We recruited patients with successful reperfusion (expanded Thrombolysis In Cerebral Infarction score of ≥2b) after EVT from the Basilar Artery Occlusion Study registry. Patients were divided into meaningful recanalization (90-day modified Rankin Scale 0-3) and futile recanalization (90-day modified Rankin Scale 4-6) groups. Multivariable logistic regression analyses were used to identify the predictors of futile recanalization. RESULTS A total of 522 patients with successful reperfusion were selected. Of these, 328 patients had futile recanalization and 194 had meaningful recanalization. Multivariable logistic regression shows that higher neutrophil-to-lymphocyte ratio ( P = .01), higher baseline National Institutes of Health Stroke Scale score ( P < .001), longer puncture to recanalization time ( P = .02), lower baseline posterior circulation Alberta Stroke Program Early CT score ( P < .001), lower posterior circulation collateral score ( P = .02), incomplete reperfusion ( P < .001), and diabetes mellitus ( P < .001) were predictors of futile recanalization. CONCLUSION Higher neutrophil-to-lymphocyte ratio, longer puncture to recanalization time, incomplete reperfusion, stroke severity, lower baseline posterior circulation Alberta Stroke Program Early CT score, poor collaterals, and diabetes mellitus were independent predictors of futile recanalization in patients with ABAO with successful reperfusion after EVT. Moreover, multiple stent retriever passes were associated with a high proportion of futile recanalization in patients with late time windows.
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Affiliation(s)
- Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhenglong Jin
- Department of Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dongjing Xie
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weilin Kong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jinrong Hu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
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Tao C, Nogueira RG, Zhu Y, Sun J, Han H, Yuan G, Wen C, Zhou P, Chen W, Zeng G, Li Y, Ma Z, Yu C, Su J, Zhou Z, Chen Z, Liao G, Sun Y, Ren Y, Zhang H, Chen J, Yue X, Xiao G, Wang L, Liu R, Liu W, Liu Y, Wang L, Zhang C, Liu T, Song J, Li R, Xu P, Yin Y, Wang G, Baxter B, Qureshi AI, Liu X, Hu W. Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. N Engl J Med 2022; 387:1361-1372. [PMID: 36239644 DOI: 10.1056/nejmoa2206317] [Citation(s) in RCA: 168] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Data from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited. METHODS We conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control). The primary outcome was good functional status, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]), at 90 days. Secondary outcomes included a modified Rankin scale score of 0 to 2, distribution across the modified Rankin scale score categories, and quality of life. Safety outcomes included symptomatic intracranial hemorrhage at 24 to 72 hours, 90-day mortality, and procedural complications. RESULTS Of the 507 patients who underwent screening, 340 were in the intention-to-treat population, with 226 assigned to the thrombectomy group and 114 to the control group. Intravenous thrombolysis was used in 31% of the patients in the thrombectomy group and in 34% of those in the control group. Good functional status at 90 days occurred in 104 patients (46%) in the thrombectomy group and in 26 (23%) in the control group (adjusted rate ratio, 2.06; 95% confidence interval [CI], 1.46 to 2.91, P<0.001). Symptomatic intracranial hemorrhage occurred in 12 patients (5%) in the thrombectomy group and in none in the control group. Results for the secondary clinical and imaging outcomes were generally in the same direction as those for the primary outcome. Mortality at 90 days was 37% in the thrombectomy group and 55% in the control group (adjusted risk ratio, 0.66; 95% CI, 0.52 to 0.82). Procedural complications occurred in 14% of the patients in the thrombectomy group, including one death due to arterial perforation. CONCLUSIONS In a trial involving Chinese patients with basilar-artery occlusion, approximately one third of whom received intravenous thrombolysis, endovascular thrombectomy within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical care but was associated with procedural complications and intracerebral hemorrhage. (Funded by the Program for Innovative Research Team of the First Affiliated Hospital of USTC and others; ATTENTION ClinicalTrials.gov number, NCT04751708.).
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Affiliation(s)
- Chunrong Tao
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Raul G Nogueira
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yuyou Zhu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Jun Sun
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Hongxing Han
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Guangxiong Yuan
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Changming Wen
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Peiyang Zhou
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Wenhuo Chen
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Guoyong Zeng
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yuwen Li
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Zhengfei Ma
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Chuanqing Yu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Junfeng Su
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Zhiming Zhou
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Zhongjun Chen
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Geng Liao
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yaxuan Sun
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Youquan Ren
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Hui Zhang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Jie Chen
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Xincan Yue
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Guodong Xiao
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Li Wang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Rui Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Wenhua Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yong Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Li Wang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Chao Zhang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Tianlong Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Jianlong Song
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Rui Li
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Pengfei Xu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yamei Yin
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Guoping Wang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Blaise Baxter
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Adnan I Qureshi
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Xinfeng Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Wei Hu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
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Liu H, Zeng G, Zeng H, Yu Y, Yue F, Ke Y, Yan Z, Pu J, Zhang J, Wei W, He D, Wu Y, Huang X, Zhou P. Endovascular treatment for acute basilar artery occlusion due to different stroke etiologies of large artery atherosclerosis and cardioembolism. Eur Stroke J 2022; 7:238-247. [PMID: 36082244 PMCID: PMC9446314 DOI: 10.1177/23969873221101285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/27/2022] [Indexed: 10/07/2023] Open
Abstract
Introduction Stroke etiology may affect the prognosis of acute basilar artery occlusion (BAO). This study aimed to estimate the efficacy and safety of endovascular treatment (EVT) in BAO strokes due to the underlying stroke etiologies of large artery atherosclerosis (LAA) and cardioembolism (CE). Patients and methods Patients with LAA and CE subtypes from the registry EVT for Acute Basilar Artery Occlusion Study (BASILAR) were selected for this analysis. We estimated the EVT treatment effect relative to standard medical treatment (SMT) in these patients by using a propensity score approach with inverse probability of treatment weighted estimation. Outcomes included 90-day favorable functional outcomes (modified Rankin scale (mRS) 0-3), functional independence (mRS 0-2), all-cause mortality, and symptomatic intracranial hemorrhage (sICH). Results A total of 744 patients were included in the final analysis. After weighting with inverse probability of treatment estimation, the patients who, based on their characteristics, were treated with EVT rather than SMT, demonstrated higher rates of favorable functional outcomes in both the LAA (29.2% vs 11.7%, adjusted OR with 95% CI: 4.34 [2.15-8.78], p < 0.001) and the CE subtype (36.0% vs 8.1%, adjusted OR with 95% CI: 9.14 [1.96-42.55], p = 0.005). A similar finding was also observed for functional independence. EVT patients also demonstrated lower rates of mortality than SMT. Among EVT patients, no significant difference was observed in mortality or sICH between LAA and CE groups, but LAA patients had lower rates of favorable functional outcome and functional independence (29.2% vs 37% and 24.2% vs 32.9%, respectively), where the latter remained significant after adjustment for imbalances in baseline data (p = 0.04). Conclusions In acute BAO strokes, both LAA and CE patients who, based on their characteristics, were treated with EVT rather than SMT, demonstrated better outcomes. Among EVT patients, LAA and CE subtypes displayed important baseline and treatment differences, and LAA patients were less likely to achieve functional independence at 3 months, but mortality and sICH were similar between LAA or CE subtypes. These results need to be confirmed in future clinical trials.
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Affiliation(s)
- Huihui Liu
- Department of Neurology and Suzhou
Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of
Soochow University, Suzhou, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou
People’s Hospital, Ganzhou, China
| | - Hongliang Zeng
- Department of Neurology, Ganzhou
People’s Hospital, Ganzhou, China
| | - Yang Yu
- Department of Neurology, Nanyang
Central Hospital, Nanyang, China
| | - Feixue Yue
- Department of Neurology, The First
Affiliated Hospital of Jilin University, Changchun, China
| | - Yingbing Ke
- Department of Neurology, Yangluo Branch
of Hubei Zhongshan Hospital, Wuhan, China
| | - Zhizhong Yan
- Department of Neurology, The 904th
Hospital of The People’s Liberation Army, Wuxi, China
| | - Jie Pu
- Department of Neurology, Renmin
Hospital of Wuhan University, Wuhan, China
| | - Jun Zhang
- Department of Neurology, The First
Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wan Wei
- Department of Neurology, Affiliated
Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou,
China
| | - Dengke He
- Department of Neurology, Air Force
Health Care Center For Special Services Hangzhou, Hangzhou, China
| | - Yupeng Wu
- Department of Neurology, Xuzhou
Central Hospital, Xuzhou, Chin
| | - Xianjun Huang
- Department of Neurology, Xiangyang
No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Peiyang Zhou
- Department of Neurology, Yijishan
Hospital of Wannan Medical College, Wuhu, China
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16
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Qiu Z, Li F, Sang H, Luo W, Liu S, Liu W, Guo Z, Li H, Sun D, Huang W, Zhang M, Zhang M, Dai W, Zhou P, Deng W, Zhou Z, Huang X, Lei B, Li J, Yuan Z, Song B, Miao J, Liu S, Jin Z, Zeng G, Zeng H, Yuan J, Wen C, Yu Y, Yuan G, Wu J, Long C, Luo J, Tian Z, Zheng C, Hu Z, Wang S, Wang T, Qi L, Li R, Wan Y, Ke Y, Wu Y, Zhu X, Kong W, Huang J, Peng D, Chang M, Ge H, Shi Z, Yan Z, Du J, Jin Y, Ju D, Huang C, Hong Y, Liu T, Zhao W, Wang J, Zheng B, Wang L, Liu S, Luo X, Luo S, Xu X, Hu J, Pu J, Chen S, Sun Y, Jiang S, Wei L, Fu X, Bai Y, Yang S, Hu W, Zhang G, Pan C, Zhang S, Wang Y, Cao W, Yang S, Zhang J, Guo F, Wen H, Zhang J, Song J, Yue C, Li L, Wu D, Tian Y, Yang J, Lu M, Saver JL, Nogueira RG, Zi W, Yang Q. Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial. JAMA 2022; 328:543-553. [PMID: 35943471 PMCID: PMC9364124 DOI: 10.1001/jama.2022.12584] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy. OBJECTIVE To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion. DESIGN, SETTING, AND PARTICIPANTS This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022. INTERVENTIONS Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy. MAIN OUTCOMES AND MEASURES The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours. RESULTS Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]). CONCLUSIONS AND RELEVANCE Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.
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Affiliation(s)
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
- Department of Cardiovascular diseases, The General Hospital of Tibet Military Area Command, Lhasa, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Huagang Li
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Dong Sun
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Wenguo Huang
- Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China
| | - Min Zhang
- Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China
| | - Min Zhang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Weipeng Dai
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Peiyang Zhou
- Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Wei Deng
- Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Bo Lei
- Department of Cerebrovascular Diseases, Leshan People's Hospital, Leshan, China
| | - Jinglun Li
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhengzhou Yuan
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Bo Song
- Department of Neurosurgery, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Jian Miao
- Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Shudong Liu
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan, China
| | - Zhenglong Jin
- Department of Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Hongliang Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Junjie Yuan
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Yang Yu
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Guangxiong Yuan
- Department of Emergency, Xiangtan Central Hospital, Xiangtan, China
| | - Junxiong Wu
- Department of Emergency, Xiangtan Central Hospital, Xiangtan, China
| | - Chen Long
- Department of Emergency, Xiangtan Central Hospital, Xiangtan, China
| | - Jun Luo
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Zhenxuan Tian
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Chong Zheng
- Department of Neurology, Longyan First Affliated Hospital of Fujian Medical University, Longyan, China
| | - Zhizhou Hu
- Department of Neurology, Longyan First Affliated Hospital of Fujian Medical University, Longyan, China
| | - Shouchun Wang
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Tao Wang
- Department of Neurology, Huainan First People's Hospital, Huainan, China
| | - Li Qi
- Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China
| | - Rongzong Li
- Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China
| | - Yue Wan
- Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Yingbing Ke
- Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China
| | - Youlin Wu
- Department of Neurology, Chongzhou People's Hospital, Chongzhou, China
| | - Xiurong Zhu
- Department of Neurology, Chongzhou People's Hospital, Chongzhou, China
| | - Weilin Kong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Daizhou Peng
- Department of Neurology, Qianxinan People's Hospital, Xingyi, China
| | - Mingze Chang
- Department of Neurology, Xi'an Third Hospital, Xi'an, China
| | - Hanming Ge
- Department of Neurology, Xi'an Third Hospital, Xi'an, China
| | - Zhonghua Shi
- Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China
| | - Zhizhong Yan
- Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China
| | - Jie Du
- Department of Neurology, Kaizhou District People's Hospital, Kaizhou, China
| | - Ying Jin
- Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China
| | - Dongsheng Ju
- Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China
| | - Chuming Huang
- Department of Neurology, Shantou Central Hospital, Shantou, China
| | - Yifan Hong
- Department of Neurology, Shantou Central Hospital, Shantou, China
| | - Tianzhu Liu
- Department of Neurology, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, China
| | - Wenlong Zhao
- Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Wang
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Bo Zheng
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Li Wang
- Department of Neurology, The Third People's Hospital of Zigong, Zigong, China
| | - Shugai Liu
- Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China
| | - Xiaojun Luo
- Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China
| | - Shiwei Luo
- Department of Neurology, Jieyang People's Hospital, Jieyang, China
| | - Xinwei Xu
- Department of Neurology, Jieyang People's Hospital, Jieyang, China
| | - Jinrong Hu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Jie Pu
- Department of Neurology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Department of Neurology, People's Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Shengli Chen
- Department of Neurology, Chongqing University Three Gorges Central Hospital, Wanzhou, China
| | - Yaxuan Sun
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Shunfu Jiang
- Department of Neurology, Jingdezhen First People's Hospital, Jingdezhen, China
| | - Liping Wei
- Department of Neurointervention, Luoyang Central Hospital, Luoyang, China
| | - Xinmin Fu
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Yongjie Bai
- Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, China
| | - Shunyu Yang
- Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Wei Hu
- Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Guling Zhang
- Department of Neurology, Danzhai County People's Hospital, Danzhai, China
| | - Chengde Pan
- Department of Neurology, Banan District People's Hospital, Banan, China
| | - Shuai Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yan Wang
- Department of Neurology, The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Wenfeng Cao
- Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Shiquan Yang
- Department of Neurology, The 902nd Hospital of The People's Liberation Army, Bengbu, China
| | - Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fuqiang Guo
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Hongbin Wen
- Department of Neurology, Xiangyang Central Hospital, Hubei Arts and Science University, Xiangyang, China
| | - Jinhua Zhang
- Department of Neurology, Sir Run Run Shaw Hospital affiliated to Zhejiang University, Hangzhou, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Linyu Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Deping Wu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Yan Tian
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Mengjie Lu
- School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Centre, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
- Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing 400064, China
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17
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Gong C, Huang J, Kong W, Li F, Liu C, Yang J, Liu S, Qiu Z, Lin M, Guo Z, Yan Z, Huang X, Zhang S, Ling W, Zhou P, Wang Z, Liu Y, Xue D, Zhong Y, Yang S, Wan Y, Fang J, Huang W, Liu H, Luo J, Li R, Wen C, Fu X, Tu M, Wang L, Tian X, Peng H, Wu Z, Zeng G, Zi W, Yang Q. Five-Year Outcomes After Endovascular Treatment for Large Vessel Occlusion Stroke. Front Neurosci 2022; 16:920731. [PMID: 35911988 PMCID: PMC9326078 DOI: 10.3389/fnins.2022.920731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background The long-term outcomes of acute large vessel occlusion (LVO) in anterior circulation treated by endovascular treatment (EVT) remains to be determined. The aim of this study was to assess the 5-year outcomes of patients with LVO who underwent EVT. Methods This study was an observational, nationwide registry of consecutive patients with acute LVO who received EVT in 28 comprehensive stroke centers in China. The primary outcome was the proportion of favorable outcome [modified Rankin Scale score (mRS) 0–2] at 5 years. Secondary outcomes included proportions of patients with excellent outcome (mRS 0–1), all-cause mortality and risk of stroke recurrence at 5 years. Results A total of 807 patients were included into the study and had 90-day follow-up data, 657 patients had 5-year follow-up data. At 90 days, 218 patients (27.0%) had an excellent outcome, 349 patients (43.2%) had a favorable functional outcome. 199 patients (24.7%) died. At 5 years, 190 patients (28.9%) had an excellent outcome, 261 patients (39.7%) had a favorable functional outcome, 317 patients (48.2%) died and 129 (28.2%) had stroke recurrence. Because of missing 5-year follow-up data, among available 269 patients who achieved functional independence at 90 days, 208 (77.3%) maintained favorable outcome, 19 (7.1%) had disability (mRS 3–5) and 42 (15.6%) died at 5 years. Furthermore, among available 189 patients with mRS 3–5 at 90 days, 53 (28.0%) patients achieved favorable functional outcome, 60 (31.7%) patients maintained unfavorable functional outcome and 76 (40.2%) patients died within 5 years. Multivariate analyses identified that younger age [odds ratio (OR): 0.96; 95% CI, 0.93–0.99; P = 0.009], lower mRS at 90 days (OR: 0.15; 95% CI, 0.10–0.23; P < 0.001) and absence of stroke recurrence (OR: 0.001; 95% CI, 0.000–0.006; P < 0.001) were significantly associated with favorable outcome at 5 years. Advanced age (OR: 1.06, 95% CI, 1.04–1.08; P < 0.001), higher mRS at 90 days (OR: 0.84; 95% CI, 0.73–0.98; P = 0.021) and atrial fibrillation (OR: 1.63; 95% CI, 1.02–2.60; P = 0.04) were independent factors for stroke recurrence. Conclusion Our results indicated that the beneficial effect of EVT in patients with acute LVO can be sustained during the course of at least 5 years. Reducing the risk of stroke recurrence by anticoagulation for atrial fibrillation may be a crucial strategy to improve long-term outcome.
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Affiliation(s)
- Changxiong Gong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weilin Kong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chang Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Min Lin
- Department of Neurology, The Second Affiliated Hospital and Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Department of Neurology, The 900th Hospital of The People’s Liberation Army, Fuzhou, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Zhizhong Yan
- Department of Neurosurgery, The 904th Hospital of The People’s Liberation Army, Wuxi, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Shuai Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Wentong Ling
- Department of Neurology, Zhongshan People’s Hospital, Zhongshan, China
| | - Peiyang Zhou
- Department of Neurology, The First People’s Hospital of Xiangyang and Hubei Medical University, Xiangyang, China
| | - Zhen Wang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Yong Liu
- Department of Neurology, Lu’an Affiliated Hospital of Anhui Medical University, Lu’an, China
| | - Dongzhang Xue
- Department of Neurology, The 902th Hospital of The People’s Liberation Army, Bengbu, China
| | - Yaoyi Zhong
- Department of Neurology, The 175th Hospital of The People’s Liberation Army, Zhangzhou, China
| | - Shu Yang
- Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yue Wan
- Department of Neurology, Hubei Zhongshan Hospital, Wuhan, China
| | - Jiayang Fang
- Department of Neurology, The 476th Hospital of The People’s Liberation Army, Fuzhou, China
| | - Wenguo Huang
- Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China
| | - Huihui Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, Second Affiliated Hospital of Soochow, Suzhou, China
| | - Jun Luo
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Rongzhong Li
- Department of Neurology, The 924th Hospital of The People’s Liberation Army, Guilin, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Xinmin Fu
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Mingyi Tu
- Department of Neurology, Hubei Wuchang Hospital, Wuhan, China
| | - Li Wang
- Department of Neurology, The Third People’s Hospital of Zigong, Zigong, China
| | - Xiguang Tian
- Department of Neurology, The Chinese Armed Police Force Guangdong Armed Police Corps Hospital, Guangzhou, China
| | - Huiyuan Peng
- Department of Neurology, Chinese Medical Hospital of Zhongshan, Zhongshan, China
| | - Zhilin Wu
- Department of Neurology, Yunfu People’s Hospital, Yunfu, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People’s Hospital, Ganzhou, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- *Correspondence: Wenjie Zi,
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Qingwu Yang,
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, 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Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Lerch T, Meier M, Steppacher S, Zeng G, Schmaranzer F. Deep Learning for Automatic Bone Segmentation of the Pelvis using MRI with T1 VIBE Dixon for FAI Patients. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Meier M, Zeng G, Lerch T, Gerber N, Tannast M, Siebenrock K, Steppacher S, Schmaranzer F. Deep Learning Fully Automated 3D Models of Hip Labrum Based on MR Arthrography Are Feasible and Allow Detection of Differences in Labrum Volume among Different Hip Deformities: A Pilot Study. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tu R, Yu J, Zhang X, Zhu Y, Zeng G. Renal tubular acidosis and nephrogenic diabetes insipidus caused by Sjögren's syndrome with hypokalemic periodic paralysis as the first symptom: A case report. Rev Neurol (Paris) 2022; 178:861-864. [PMID: 35568514 DOI: 10.1016/j.neurol.2022.02.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Affiliation(s)
- R Tu
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - J Yu
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China.
| | - X Zhang
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - Y Zhu
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - G Zeng
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
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22
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Song K, Li F, Shi M, Yue F, Li C, Qi S, Wu Y, Yuan Z, Shi Q, Fu X, Wan Y, Pu J, He W, Zeng G, Guo Z, Zi W, Wang S. Basilar artery on computed tomography angiography score and clinical outcomes in acute basilar artery occlusion. J Neurol 2022; 269:3810-3820. [DOI: 10.1007/s00415-022-11013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/20/2022] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
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Chen L, Zhao C, Song J, Zi W, Sang H, Yuan J, Huang J, Li L, Luo W, Fu X, Zhou P, Wan Y, Zeng G, Xie D, Gao F, Li F, Qiu Z, Yang Q. Extended Thrombolysis In Cerebral Infarction (eTICI) grade 2c: a potential angiographic target for endovascular treatment in acute basilar artery occlusion? J Neurointerv Surg 2021; 14:1022-1026. [PMID: 34782398 DOI: 10.1136/neurintsurg-2021-018026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Higher extended Thrombolysis In Cerebral Infarction (eTICI) grades are associated with better clinical outcomes after endovascular treatment (EVT) for proximal intracranial occlusion of the anterior circulation. However, the relationship between eTICI grade and outcomes after EVT in patients with acute basilar artery occlusion (BAO) remains unclear. We aimed to explore which eTICI category was the cut-off correlating with better clinical outcomes in patients with BAO undergoing EVT. METHODS We included patients treated via EVT from the BASILAR study. Multivariable logistic regression analyses were performed to assess the impact of eTICI grades on 90-day favorable functional outcomes, defined as a modified Rankin Scale (mRS) score of 0-3. Other outcomes were functional independence (mRS 0-2), all-cause mortality, and symptomatic intracranial hemorrhage. RESULTS Among 647 patients treated with EVT, 127 (19.6%), 128 (24.5%), 110 (21.1%), and 282 (54%) patients achieved eTICI grades of 0-2a, 2b, 2c, and 3, respectively. Compared with eTICI grades 0-2a, higher rates of favorable functional outcomes (adjusted OR (aOR) 2.96, 95% CI 1.33 to 6.57, and aOR 7.40, 95% CI 3.63 to 15.09, respectively) were observed for grades 2c and 3, not 2b (aOR 1.93, 95% CI 0.86 to 4.36). The risks of mortality and symptomatic intracranial hemorrhage were also lower for eTICI grades 2c and 3 than for grades 0-2a. CONCLUSIONS An eTICI grade of 2c/3 may be a target for successful reperfusion after EVT in patients with acute BAO; however, further studies with larger sample sizes and clinical trials are needed.
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Affiliation(s)
- Luming Chen
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Chenghao Zhao
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Junjie Yuan
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Linyu Li
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Xinmin Fu
- Xuzhou Central Hospital, Xuzhou, China
| | - Peiyang Zhou
- The First People's Hospital of Xiangyang, Hubei Medical University, Department of Neurology, Xiangyang, China
| | - Yue Wan
- Hubei Zhongshan Hospital, Wuhan, China
| | - Guoyong Zeng
- Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Dongjing Xie
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Fei Gao
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China.,Neurology, 903th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
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Wang PP, Dong HL, Sun H, Pang XX, Cai CJ, Bai D, Li F, Yang MY, Lan X, Zeng G. [Association between dietary vitamin A intake and gestational diabetes mellitus in the first trimester]. Zhonghua Yu Fang Yi Xue Za Zhi 2021; 55:1293-1298. [PMID: 34749471 DOI: 10.3760/cma.j.cn112150-20201023-01305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the relationship between dietary vitamin A intake and its sources in the first trimester and gestational diabetes mellitus (GDM). Methods: A prospective study was conducted to select women at 6-14 weeks of gestation in an obstetric clinic of a maternal and child health care medical institution in Chengdu in 2017. The types and quantities of food during the first trimester were collected by 3-day 24-hour dietary recalls. Dietary vitamin A intake was calculated based on the Chinese Food Composition Table (2018), and it was divided into animal and plant vitamin A intakes according to its food sources. An oral glucose tolerance test was performed at 24-28 weeks of gestation to diagnose GDM according to the Chinese guidelines for diagnosis and treatment of gestational diabetes mellitus (2014). According to the estimated average requirement (EAR) and recommended nutrient intake (RNI), dietary vitamin A intake was divided into low-level group (<EAR), medium-level group (EAR-RNI) and high-level group (>RNI). Animal and plant vitamin A intakes were divided into four groups (Q1-Q4) according to the quartile method, respectively. The association between dietary vitamin A intake, its different sources of vitamin A intake and GDM in the first trimester was analyzed by log-binomial regression models. Results: A total of 1 298 valid samples were finally included. The average dietary vitamin A intake, animal and plant vitamin A intakes in the first trimester were 341.1 (227.8-501.0) μgRAE/d, 139.3 (69.6-195.3) μgRAE/d and 184.2 (99.4-301.1) μgRAE/d, respectively. After adjusting for confounding factors, log-binomial regression analysis showed that the risk of GDM in high-level group of dietary vitamin A intake was lower than that in low-level group [RR (95%CI):0.53 (0.36-0.80)]. Pregnant women in the highest quartile of animal vitamin A intake had a lower risk of GDM than those in the lowest quartile [RR (95%CI):0.66 (0.47-0.95)]. No relationship between plant vitamin A intake and GDM was found. Conclusion: Dietary vitamin A intake in the first trimester is associated with the occurrence of GDM, and higher intake than RNI may reduce the risk of GDM. Higher vitamin A intake from animal-derived food is associated with decreased risk of GDM.
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Affiliation(s)
- P P Wang
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - H L Dong
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - H Sun
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - X X Pang
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - C J Cai
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - D Bai
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - F Li
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - M Y Yang
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - X Lan
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - G Zeng
- Department of Nutrition and Food Safety, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Zhou W, Zeng G, Lyu C, Kou F, Zhang S, Wei H. The effect of strength-endurance training on serum and urine metabolic profiles of female adolescent volleyball athletes. Physiol Int 2021; 108:285-302. [PMID: 34181565 DOI: 10.1556/2060.2021.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
Aim Limited investigations on metabolic responses to exercise training in female adolescent volleyball athletes exist. The aim of this study was to obtain serum and urine metabolite markers in female adolescent volleyball athletes within 2-week strength-endurance training using a metabolomics approach coupled with biochemical analysis, which would be potential biomarkers for evaluating the physiological state of athletes. Methods Twelve female adolescent volleyball athletes were recruited for 2-week strength-endurance training. Differential serum and urine metabolic profiles between the pre- and post-training group were obtained on gas chromatography coupled to mass spectrometry (GC-MS) and data subsequently underwent orthogonal partial least-squares analysis (OPLS). Results Strength-endurance training exerted a significant influence on the athletes' serum and urine metabolic profiles. The changed metabolites were primarily involved in energy metabolism, lipid metabolism and amino acids metabolism. Results support the hypothesis that female athletes displayed an increased propensity to oxidize lipids as the major energy source. Exposure to strength-endurance training also led to a significant increase in cortisol, but a decrease in testosterone, indicating disordered hormone adjustment. Exercise-induced oxidative stress occurred, as was evidenced by the decrease in reduced glutathione, and increases in blood malondialdehyde and oxidized glutathione. Since the muscle damage markers creatine kinase and lactate dehydrogenase did not show significant changes, the training might not cause cell membrane damage and the athletes did not cross the adaptive injury level. Conclusion By measurement of endogenous metabolites, the metabolomics study has the potential to reveal the global physiological changes in response to exercise training.
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Affiliation(s)
- W Zhou
- 1Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.,4Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - G Zeng
- 2Department of Rehabilitation, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - C Lyu
- 3Shanghai Zhulian Intelligent Technology CO., LTD, Shanghai 201323, China
| | - F Kou
- 1Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - S Zhang
- 2Department of Rehabilitation, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - H Wei
- 1Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Shao Z, Wang B, Shi Y, Xie C, Huang C, Chen B, Zhang H, Zeng G, Liang H, Wu Y, Zhou Y, Tian N, Wu A, Gao W, Wang X, Zhang X. Senolytic agent Quercetin ameliorates intervertebral disc degeneration via the Nrf2/NF-κB axis. Osteoarthritis Cartilage 2021; 29:413-422. [PMID: 33242601 DOI: 10.1016/j.joca.2020.11.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/24/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Intervertebral disc degeneration (IDD) represents major cause of low back pain. Quercetin (QUE) is one of the approved senolytic agents. In this study, we evaluated the protective effects of QUE on IDD development and its underlying mechanism. METHODS Effects of senolytic agent QUE on the viability of nucleus pulposus cells (NPCs) were measured by CCK-8 assays and EdU staining. The senescence associated secreted phenotype (SASP) factors expressions were measured by qPCR, western blot, and ELISA; and NF-κB pathway was detected by immunofluorescence and western blot. Molecular docking was applied to predict the interacting protein of QUE; while Nrf2 was knocked down by siRNAs to confirm its role in QUE regulated senescence phenotype. X-ray, MRI, Hematoxylin-Eosin and Safranin O-Fast green staining were performed to evaluate the therapeutic effects of QUE on IDD in the puncture-induced rat model. RESULTS In in vitro experiments, QUE inhibited SASP factors expression and senescence phenotype in IL-1β-treated NPCs. Mechanistically, QUE suppressed IL-1β induced activation of the NF-κB pathway cascades; it was also demonstrated in molecular docking and knock down studies that QUE might bind to Keap1-Nrf2 complex to suppress NF-κB pathway. In vivo, QUE ameliorated the IDD process in the puncture-induced rat model. CONCLUSIONS Together the present work suggests that QUE inhibits SASP factors expression and senescence phenotype in NPCs and ameliorates the progression of IDD via the Nrf2/NF-κB axis, which supports senolytic agent QUE as a potential therapeutic agent for the treatment of IDD.
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Affiliation(s)
- Z Shao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - B Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Y Shi
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - C Xie
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - C Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - B Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - H Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - G Zeng
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - H Liang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Y Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Y Zhou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - N Tian
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - A Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - W Gao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - X Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
| | - X Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, Zhejiang Province, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Chinese Orthopaedic Regenerative Medicine Society, Hangzhou, Zhejiang Province, China.
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Zi W, Qiu Z, Wu D, Li F, Liu H, Liu W, Huang W, Shi Z, Bai Y, Liu Z, Wang L, Yang S, Pu J, Wen C, Wang S, Zhu Q, Chen W, Yin C, Lin M, Qi L, Zhong Y, Wang Z, Wu W, Chen H, Yao X, Xiong F, Zeng G, Zhou Z, Wu Z, Wan Y, Peng H, Li B, Hu X, Wen H, Zhong W, Wang L, Jin P, Guo F, Han J, Fu X, Ai Z, Tian X, Feng X, Sun B, Huang Z, Li W, Zhou P, Tu M, Sun X, Li H, He W, Qiu T, Yuan Z, Yue C, Yang J, Luo W, Gong Z, Shuai J, Nogueira RG, Yang Q. Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry. JAMA Neurol 2021; 77:561-573. [PMID: 32080711 DOI: 10.1001/jamaneurol.2020.0156] [Citation(s) in RCA: 194] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Several randomized clinical trials have recently established the safety and efficacy of endovascular treatment (EVT) of acute ischemic stroke in the anterior circulation. However, it remains uncertain whether patients with acute basilar artery occlusion (BAO) benefit from EVT. Objective To evaluate the association between EVT and clinical outcomes of patients with acute BAO. Design, Setting, and Participants This nonrandomized cohort study, the EVT for Acute Basilar Artery Occlusion Study (BASILAR) study, was a nationwide prospective registry of consecutive patients presenting with an acute, symptomatic, radiologically confirmed BAO to 47 comprehensive stroke centers across 15 provinces in China between January 2014 and May 2019. Patients with acute BAO within 24 hours of estimated occlusion time were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. Main Outcomes and Measures The primary outcome was the improvement in modified Rankin Scale scores (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days across the 2 groups assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. The secondary efficacy outcome was the rate of favorable functional outcomes defined as modified Rankin Scale scores of 3 or less (indicating an ability to walk unassisted) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage and 90-day mortality. Results A total of 1254 patients were assessed, and 829 patients (of whom 612 were men [73.8%]; median [interquartile] age, 65 [57-74] years) were recruited into the study. Of these, 647 were treated with standard medical treatment plus EVT and 182 with standard medical treatment alone. Ninety-day functional outcomes were substantially improved by EVT (adjusted common odds ratio, 3.08 [95% CI, 2.09-4.55]; P < .001). Moreover, EVT was associated with a significantly higher rate of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 4.70 [95% CI, 2.53-8.75]; P < .001) and a lower rate of 90-day mortality (adjusted odds ratio, 2.93 [95% CI, 1.95-4.40]; P < .001) despite an increase in symptomatic intracerebral hemorrhage (45 of 636 patients [7.1%] vs 1 of 182 patients [0.5%]; P < .001). Conclusions and Relevance Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.
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Affiliation(s)
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Neurology, The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Deping Wu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hansheng Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Wenguo Huang
- Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China
| | - Zhonghua Shi
- Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China
| | - Yongjie Bai
- Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, China
| | - Zhensheng Liu
- Department of Neurology, The First People's Hospital of Yangzhou, Yangzhou University, Yangzhou, China
| | - Li Wang
- Department of Neurology, The Third People's Hospital of Zigong, Zigong, China
| | - Shiquan Yang
- Department of Neurology, The 902th Hospital of The People's Liberation Army, Bengbu, China
| | - Jie Pu
- Department of Neurology, Hubei Province People's Hospital, Wuhan, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Shouchun Wang
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Qiyi Zhu
- Department of Neurology, Linyi People's Hospital, Linyi, China
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Congguo Yin
- Department of Neurology, The First People's Hospital of Hangzhou, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Lin
- Department of Neurology, The 900th Hospital of The People's Liberation Army, Fuzhou, China
| | - Li Qi
- Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China
| | - Yaoyi Zhong
- Department of Neurology, The 909th Hospital of The People's Liberation Army, Zhangzhou, China
| | - Zhen Wang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Wenjun Wu
- Department of Neurology, Zhongshan People's Hospital, Zhongshan, China
| | - Huisheng Chen
- Department of Neurology, Northern Theater General Hospital of The People's Liberation Army, Shenyang, China
| | - Xiaoxi Yao
- Department of Neurology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Feng Xiong
- Department of Neurology, Zhuzhou Central Hospital, ZhuZhou, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Zhilin Wu
- Department of Neurology, Yunfu People's Hospital, Yunfu, China
| | - Yue Wan
- Department of Neurology, Hubei Zhongshan Hospital, Wuhan, China
| | - Huiyuan Peng
- Department of Neurology, Chinese Medical Hospital of Zhongshan, Zhongshan, China
| | - Bing Li
- Department of Neurology, Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xinping Hu
- Department of Neurology, Jilin Central Hospital, Jilin, China
| | - Hongbin Wen
- Department of Neurology, Xiangyang Central Hospital, Hubei Arts and Science University, Xiangyang, China
| | - Wangtao Zhong
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Leyuan Wang
- Department of Neurology, Changle People's Hospital, Changle, China
| | - Ping Jin
- Department of Neurology, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, China
| | - Fuqiang Guo
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Ju Han
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Xinmin Fu
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Zhibing Ai
- Department of Neurology, Taihe Affiliated Hospital of Hubei Medical University, Shiyan, China
| | - Xiguang Tian
- Department of Neurology, The Chinese Armed Police Force Guangdong Armed Police Corps Hospital, Guangzhou, China
| | - Xiaoya Feng
- Department of Neurology, The Third Hospital of Shandong Province, Jinan, China
| | - Bo Sun
- Department of Neurology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Zhizhi Huang
- Department of Neurology, Baise People's Hospital, Baise, China
| | - Wei Li
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Peiyang Zhou
- Department of Neurology, The First People's Hospital of Xiangyang, Hubei Medical University, Xiangyang, China
| | - Mingyi Tu
- Department of Neurology, Hubei Wuchang Hospital, Wuhan, China
| | - Xiangrong Sun
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hua Li
- Department of Neurology, The 476th Hospital of The People's Liberation Army, Fuzhou, China
| | - Wencheng He
- Department of Neurology, Guiping People's Hospital, Guiping, China
| | - Tao Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Neurology, The First People's Hospital of Zigong, Zigong, China
| | - Zhengzhou Yuan
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jun Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zili Gong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Shuai
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Raul Gomes Nogueira
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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28
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Sang H, Li F, Yuan J, Liu S, Luo W, Wen C, Zhu Q, Chen W, Lin M, Qi L, Zhong Y, Wang Z, Ling W, Shi Z, Chen H, Liu W, Liu Z, Yao X, Xiong F, Zeng G, Hu X, Dong H, Mao A, Yang G, Huang J, Chen L, Gong Z, Tao J, Liu H, Wu D, Qiu Z, Yang Q, Zi W, Li F. Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion. Stroke 2021; 52:811-820. [PMID: 33567874 DOI: 10.1161/strokeaha.120.031371] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to analyze the impact of baseline posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) on the efficacy and safety of endovascular therapy (EVT) for patients with acute basilar artery occlusion. METHODS The BASILAR was a nationwide prospective registry of consecutive patients with a symptomatic and radiologically confirmed acute basilar artery occlusion within 24 hours of symptom onset. We estimated the effect of standard medical therapy alone (SMT group) versus SMT plus EVT (EVT group) for patients with documented pc-ASPECTS on noncontrast CT, both as a categorical (0-4 versus 5-7 versus 8-10) and as a continuous variable. The primary outcomes included favorable functional outcomes (modified Rankin Scale ≤3) at 90 days and mortality within 90 days. RESULTS In total, 823 cases were included: 468 with pc-ASPECTS 8 to 10 (SMT: 71; EVT: 397), 317 with pc-ASPECTS 5 to 7 (SMT: 85; EVT: 232), and 38 with pc-ASPECTS 0 to 4 (SMT: 13; EVT: 25). EVT was associated with higher rate of favorable outcomes (adjusted relative risk with 95% CI, 4.35 [1.30-14.48] and 3.20 [1.68-6.09]; respectively) and lower mortality (60.8% versus 77.6%, P=0.005 and 35.0% versus 66.2%, P<0.001; respectively) than SMT in the pc-ASPECTS 5 to 7 and 8 to 10 subgroups. Continuous benefit curves also showed the superior efficacy and safety of EVT over SMT in patients with pc-ASPECTS ≥5. Furthermore, the prognostic effect of onset to puncture time on favorable outcome with EVT was not significant after adjustment for pc-ASPECTS (adjusted odds ratio, 0.98 [95% CI, 0.94-1.02]). CONCLUSIONS Patients of basilar artery occlusion with pc-ASPECTS ≥5 could benefit from EVT. The baseline pc-ASPECTS appears more important for decision making and predicting prognosis than time to EVT. Registration: URL: http://www.chictr.org.cn. Unique identifier: ChiCTR1800014759.
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Affiliation(s)
- Hongfei Sang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).,Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China (H.S.)
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Junjie Yuan
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, China (C.W.)
| | - Qiyi Zhu
- Department of Neurology, Linyi People's Hospital, China (Q.Z.)
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, China (W.C.)
| | - Min Lin
- Department of Neurology, The 900th Hospital of The People's Liberation Army, China (M.L.)
| | - Li Qi
- Department of Neurology, The 924th Hospital of The People's Liberation Army, China (L.Q.)
| | - Yaoyi Zhong
- Department of Neurology, The 909th Hospital of The People's Liberation Army, China (Y.Z.)
| | - Zhen Wang
- Department of Neurology, Changsha Central Hospital, China (Z.W.)
| | - Wentong Ling
- Department of Neurology, Zhongshan People's Hospital, China (W. Ling)
| | - Zhonghua Shi
- Department of Neurosurgery (Z.S.), The 904th Hospital of The People's Liberation Army, China
| | - Huisheng Chen
- Department of Neurology, Northern Theater General Hospital of The People's Liberation Army, China (H.C.)
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, China (W. Liu)
| | - Zhensheng Liu
- Department of Neurology, The First People's Hospital of Yangzhou, Yangzhou University, China (Z.L.)
| | - Xiaoxi Yao
- Department of Neurology, The First People's Hospital of Chenzhou, China (X.Y.)
| | - Feng Xiong
- Department of Neurology, Zhuzhou Central Hospital, China (F.X.)
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, China (G.Z.)
| | - Xiaogang Hu
- Department of Military Patient Management (X.H.), The 904th Hospital of The People's Liberation Army, China
| | - Hui Dong
- Department of Cadre Health Care (H.D.), The 903th Hospital of The People's Liberation Army, China
| | - An Mao
- Department of Neurology (A.M., Z.Q.), The 903th Hospital of The People's Liberation Army, China
| | - Guoqiang Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Luming Chen
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Zili Gong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Jian Tao
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Hansheng Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Deping Wu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).,Department of Neurology (A.M., Z.Q.), The 903th Hospital of The People's Liberation Army, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
| | - Fangfei Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li)
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29
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Zi W, Qiu Z, Li F, Sang H, Wu D, Luo W, Liu S, Yuan J, Song J, Shi Z, Huang W, Zhang M, Liu W, Guo Z, Qiu T, Shi Q, Zhou P, Wang L, Fu X, Liu S, Yang S, Zhang S, Zhou Z, Huang X, Wang Y, Luo J, Bai Y, Zhang M, Wu Y, Zeng G, Wan Y, Wen C, Wen H, Ling W, Chen Z, Peng M, Ai Z, Guo F, Li H, Guo J, Guan H, Wang Z, Liu Y, Pu J, Wang Z, Liu H, Chen L, Huang J, Yang G, Gong Z, Shuai J, Nogueira RG, Yang Q. Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke: The DEVT Randomized Clinical Trial. JAMA 2021; 325:234-243. [PMID: 33464335 PMCID: PMC7816099 DOI: 10.1001/jama.2020.23523] [Citation(s) in RCA: 280] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE For patients with large vessel occlusion strokes, it is unknown whether endovascular treatment alone compared with intravenous thrombolysis plus endovascular treatment (standard treatment) can achieve similar functional outcomes. OBJECTIVE To investigate whether endovascular thrombectomy alone is noninferior to intravenous alteplase followed by endovascular thrombectomy for achieving functional independence at 90 days among patients with large vessel occlusion stroke. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, noninferiority trial conducted at 33 stroke centers in China. Patients (n = 234) were 18 years or older with proximal anterior circulation intracranial occlusion strokes within 4.5 hours from symptoms onset and eligible for intravenous thrombolysis. Enrollment took place from May 20, 2018, to May 2, 2020. Patients were enrolled and followed up for 90 days (final follow-up was July 22, 2020). INTERVENTIONS A total of 116 patients were randomized to the endovascular thrombectomy alone group and 118 patients to combined intravenous thrombolysis and endovascular thrombectomy group. MAIN OUTCOMES AND MEASURES The primary end point was the proportion of patients achieving functional independence at 90 days (defined as score 0-2 on the modified Rankin Scale; range, 0 [no symptoms] to 6 [death]). The noninferiority margin was -10%. Safety outcomes included the incidence of symptomatic intracerebral hemorrhage within 48 hours and 90-day mortality. RESULTS The trial was stopped early because of efficacy when 234 of a planned 970 patients had undergone randomization. All 234 patients who were randomized (mean age, 68 years; 102 women [43.6%]) completed the trial. At the 90-day follow-up, 63 patients (54.3%) in the endovascular thrombectomy alone group vs 55 (46.6%) in the combined treatment group achieved functional independence at the 90-day follow-up (difference, 7.7%, 1-sided 97.5% CI, -5.1% to ∞)P for noninferiority = .003). No significant between-group differences were detected in symptomatic intracerebral hemorrhage (6.1% vs 6.8%; difference, -0.8%; 95% CI, -7.1% to 5.6%) and 90-day mortality (17.2% vs 17.8%; difference, -0.5%; 95% CI, -10.3% to 9.2%). CONCLUSIONS AND RELEVANCE Among patients with ischemic stroke due to proximal anterior circulation occlusion within 4.5 hours from onset, endovascular treatment alone, compared with intravenous alteplase plus endovascular treatment, met the prespecified statistical threshold for noninferiority for the outcome of 90-day functional independence. These findings should be interpreted in the context of the clinical acceptability of the selected noninferiority threshold. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR-IOR-17013568.
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Affiliation(s)
- Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
- Department of Neurology, The 903rd Hospital of The Chinese People’s Liberation Army, Xihu District, Hangzhou, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Deping Wu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
- Huaian Medical District of Jingling Hospital, Medical School of Nanjing University, Huaian, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Junjie Yuan
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Zhonghua Shi
- Department of Neurosurgery, The 904th Hospital of The Chinese People’s Liberation Army, Wuxi, China
| | - Wenguo Huang
- Department of Neurology, Maoming Traditional Chinese Medicine Hospital, Maonan District, Maoming, China
| | - Min Zhang
- Department of Neurology, Maoming Traditional Chinese Medicine Hospital, Maonan District, Maoming, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, Qiaokou District, Wuhan, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Qiaokou District, Wuhan, China
| | - Tao Qiu
- Department of Neurology, The First People’s Hospital of Zigong, Da'an District, Zigong, China
| | - Qiang Shi
- Department of Neurology, The First People’s Hospital of Zigong, Da'an District, Zigong, China
| | - Peiyang Zhou
- Department of Neurology, The First People’s Hospital of Xiangyang, Fancheng District, Xiangyang, China
| | - Li Wang
- Department of Neurology, The Third People’s Hospital of Zigong, Gongjing District, Zigong, China
| | - Xinmin Fu
- Department of Neurology, Xuzhou Central Hospital, Quanshan District, Xuzhou, China
| | - Shudong Liu
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan District, Chongqing, China
| | - Shiquan Yang
- Department of Neurology, The 902nd Hospital of The Chinese People’s Liberation Army, Yuhui District, Bengbu, China
| | - Shuai Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, Guangling District, Yangzhou, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Yan Wang
- Department of Neurology, The Fifth People’s Hospital of Chengdu, Wenjiang District, Chengdu, China
| | - Jun Luo
- Department of Neurology, Sichuan Mianyang 404 Hospital, Fucheng District, Mianyang, China
| | - Yongjie Bai
- Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Jianxi District, Luoyang, China
| | - Min Zhang
- Department of Neurology, Jiangmen Central Hospital, Pengjiang District, Jiangmen, China
| | - Youlin Wu
- Department of Neurology, Chongzhou People's Hospital, Chongzhou, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Zhanggong District, Ganzhou, China
| | - Yue Wan
- Department of Neurology, Yangluo District of Hubei Zhongshan Hospital, Qiaokou District, Wuhan, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Wolong District, Nanyang, China
| | - Hongbin Wen
- Department of Neurology, Xiangyang Central Hospital, Xiangcheng District, Xiangyang, China
| | - Wentong Ling
- Department of Neurology, Zhongshan People's Hospital, Zhongshan, China
| | - Zhuo Chen
- Department of Neurology, Mianzhu People's Hospital, Mianzhu, China
| | - Miao Peng
- Department of Neurology, Deyang People’s Hospital, Jingyang District, Deyang, China
| | - Zhibing Ai
- Department of Neurology, Taihe Affiliated Hospital of Shiyan, Shiyan, China
| | - Fuqiang Guo
- Department of Neurology, Sichuan Provincial People’s Hospital, Qingyang District, Chengdu, China
| | - Huagang Li
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan, China
| | - Jing Guo
- Department of Neurology, Chongqing Three Gorges Central Hospital, Wanzhou District, Chongqing, China
| | - Haitao Guan
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Liwan District, Guangzhou, China
| | - Zhiyi Wang
- Department of Neurology, Huazhou People’s Hospital, Hexi District, Huazhou, China
| | - Yong Liu
- Department of Neurology, Lu'an People’s Hospital, Jin'an District, Lu'an, China
| | - Jie Pu
- Department of Neurology, Hubei Provincial People's Hospital, Wuchang District, Wuhan, China
| | - Zhen Wang
- Department of Neurology, Changsha Central Hospital, Yuhua District, Changsha, China
| | - Hansheng Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Luming Chen
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Guoqiang Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Zili Gong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Jie Shuai
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
| | - Raul G. Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
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Herzberg M, Zeng G, Mäkilä E, Murtomaa M, Søgaard SV, Garnæs J, Madsen AØ, Rantanen J. Effect of dehydration pathway on the surface properties of molecular crystals. CrystEngComm 2021. [DOI: 10.1039/d1ce00539a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Atomic force microscopy was used to determine roughness, elastic modulus and work function after thermally-induced and solvent-induced dehydration. These properties correlated with electric charging to provide insight into behaviour of bulk powders.
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Affiliation(s)
- M. Herzberg
- Department of Pharmacy, University of Copenhagen, Denmark
| | - G. Zeng
- Danish Fundamental Metrology, Hørsholm, Denmark
| | - E. Mäkilä
- Department of Physics and Astronomy, University of Turku, Finland
| | - M. Murtomaa
- Department of Physics and Astronomy, University of Turku, Finland
| | | | - J. Garnæs
- Danish Fundamental Metrology, Hørsholm, Denmark
| | - A. Ø. Madsen
- Department of Pharmacy, University of Copenhagen, Denmark
| | - J. Rantanen
- Department of Pharmacy, University of Copenhagen, Denmark
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Mazzon G, Choong S, Pavan N, Zeng G, Wu W, Durutovic O, Pirozzi M, Bada M, Vitale R, Celia A. Standard reporting outcomes for percutaneous nephrolithotomies: introducing the PNL-trifecta. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dong HL, Cai CJ, Bai D, Pang XX, Lan X, Zhang YQ, Zhang J, Zhou FM, Sun H, Zeng G. [Association between dietary glycemic load during first trimester and the risk of gestational diabetes mellitus: a prospective study]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:1352-1358. [PMID: 32867449 DOI: 10.3760/cma.j.cn112338-20190909-00659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the effects of dietary glycemic load (GL) during first trimester on the risk of gestational diabetes mellitus (GDM). Methods: A prospective study was conducted among healthy women with singleton pregnancy at 8-14 weeks of gestation in a maternity out-patient clinic of maternal-and-child health care institution in Chengdu, Sichuan province. Information on dietary intake during the first trimester was collected through a 3-day 24-hour dietary recall. Glycemic index (GI) values were obtained from China Food Composition Tables (Standard Edition) and International Tables of Glycemic Index and Glycemic Load Values (2008). Dietary GL and GLs of staple foods were calculated based on GI values and the amount of carbohydrate consumed per day. Diagnostic criteria of GDM was followed the Guidelines for Diagnosis and Treatment of Pregnancy Diabetes in China (2014), and used on participants who underwent an oral glucose tolerant test during 24-28 weeks of gestation. Log-binomial regression models were used to explore the associations between both quartiles of dietary GL, GLs of staple foods and the risks of GDM,respectively. Results: The medians of dietary GL and GL of staple foods were 145.70 (113.23-180.85) and 121.05 (89.08-155.70), respectively. The median GL of both rice and tubers were 73.14 (43.89-107.50) and 3.43 (0.00-9.84), respectively. After adjusting for the age at pregnancy, pre-pregnancy body mass index and other confounding factors, results of log-binomial regressions analysis showed that when compared with the lowest quartile of dietary GL group, the third and highest quartiles of dietary GL groups increased the risk of GDM (RR=1.47, 95%CI: 1.20-1.80; RR=1.31, 95%CI: 1.04-1.64), respectively. Compared with the lowest quartile of GL of staple foods, the third and highest quartiles of GL of staple foods groups also increased the risk of GDM (RR=1.28, 95%CI: 1.04-1.58; RR=1.27, 95%CI: 1.02-1.60), respectively. The third and highest quartiles of GL of rice groups increased the risk of GDM (RR=1.30, 95%CI: 1.06-1.59; RR=1.28, 95%CI: 1.03-1.59), respectively, than the lowest quartile of GL of rice group. When compared with the lowest quartile of GL of tubers group, the highest quartile of GL of tubers group increased the risk of GDM (RR=1.30, 95%CI: 1.09-1.54). However, we did not notice the effects of wheat GL and coarse grain GL on the risk of GDM. Conclusions: A positive association was found between dietary glycemic load and the risk of GDM. Higher dietary glycemic load, especially in rice and tubers during first trimester, seemed to have increased the risk of GDM.
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Affiliation(s)
- H L Dong
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - C J Cai
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - D Bai
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - X X Pang
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - X Lan
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Y Q Zhang
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - J Zhang
- Department of Clinical Nutrition, Sichuan Provincial Hospital for Women and Children, Chengdu 610045, China
| | - F M Zhou
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - H Sun
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - G Zeng
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Qiu Z, Liu H, Li F, Luo W, Wu D, Shi Z, Liu W, Huang W, Fu X, Qiu T, Wang L, Yang S, Zhang S, Wang Y, Bai Y, Liu X, Li H, Liu Y, Li W, Wan Y, Ai Z, Yao X, Luo J, Pu J, Zhou Z, Wang S, Wen C, Ling W, Liu S, Yang W, Zeng G, Wu Y, Guo F, Chen S, Huang J, Wang Z, Peng M, Zhang M, Zhou P, Chen L, Liu S, Yue C, Yang J, Gong Z, Shuai J, Sang H, Nogueira RG, Zi W, Yang Q. DEVT: A randomized, controlled, multicenter trial of direct endovascular treatment versus standard bridging therapy for acute stroke patients with large vessel occlusion in the anterior circulation - Protocol. Int J Stroke 2020; 16:229-235. [PMID: 32448089 DOI: 10.1177/1747493020925349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Eight randomized controlled trials have consistently shown that endovascular treatment plus best medical treatment improves outcome after acute anterior proximal intracranial large vessel occlusion strokes. Whether intravenous thrombolysis prior to endovascular treatment in patients with anterior circulation, large vessel occlusion is of any additional benefits remains unclear. OBJECTIVE This study compares the safety and efficacy of direct endovascular treatment versus intravenous recombinant tissue-type plasminogen activator bridging with endovascular treatment (bridging therapy) in acute stroke patients with intracranial internal carotid artery or middle cerebral artery-M1 occlusion within 4.5 h of symptom onset. METHODS AND DESIGN The DEVT study is a randomized, controlled, multicenter trial with blinded outcome assessment. This trial uses a five-look group-sequential non-inferiority design. Up to 194 patients in each interim analysis will be consecutively randomized to direct endovascular treatment or bridging therapy group in 1:1 ratio over three years from about 30 hospitals in China. OUTCOMES The primary end-point is the proportion of independent neurological function defined as modified Rankin scale score of 0 to 2 at 90 days. The primary safety measure is symptomatic intracerebral hemorrhage at 48 h and mortality at 90 days. TRIAL REGISTRY NUMBER ChiCTR-IOR-17013568 (www.chictr.org.cn).
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Affiliation(s)
- Zhongming Qiu
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Neurology, The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Hansheng Liu
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weidong Luo
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Deping Wu
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhonghua Shi
- Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Wenguo Huang
- Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China
| | - Xinmin Fu
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Tao Qiu
- Department of Neurology, The First People's Hospital of Zigong, Zigong, China
| | - Li Wang
- Department of Neurology, The Third People's Hospital of Zigong, Zigong, China
| | - Shiquan Yang
- Department of Neurology, The 902th Hospital of The People's Liberation Army, Bengbu, China
| | - Shuai Zhang
- Department of Neurology, The First People's Hospital of Yangzhou, 38043Yangzhou University, Yangzhou, China
| | - Yan Wang
- Department of Neurology, The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Yongjie Bai
- Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, China
| | - Xuan Liu
- Department of Neurology, 74731Xiangyang Central Hospital, Hubei Arts and Science University, Xiangyang, China
| | - Huagang Li
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yong Liu
- Department of Neurology, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, China
| | - Wei Li
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yue Wan
- Department of Neurology, Hubei Zhongshan Hospital, Wuhan, China
| | - Zhibing Ai
- Department of Neurology, Taihe Affiliated Hospital of Hubei Medical University, Shiyan, China
| | - Xiaoxi Yao
- Department of Neurology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Jun Luo
- Department of Neurology, The 404th hospital of Mianyang, Mianyang, China
| | - Jie Pu
- Department of Neurology, Hubei Province People's Hospital, Wuhan, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Shouchun Wang
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Wentong Ling
- Department of Neurology, Zhongshan People's Hospital, Zhongshan, China
| | - Shudong Liu
- Department of Neurology, 531595Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing, China
| | - Weimin Yang
- Department of Neurology, the 36639First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Youlin Wu
- Department of Neurology, Chongzhou People's Hospital, Chongzhou, China
| | - Fuqiang Guo
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shengli Chen
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Junjie Huang
- Department of Neurosurgery, The Second People's Hospital of Huaiyuan, Huaiyuan, China
| | - Zhen Wang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Miao Peng
- Department of Neurology, Deyang People's Hospital, Deyang, China
| | - Min Zhang
- Department of Neurology, 71537Jiangmen Central Hospital, Jiangmen, China
| | - Peiyang Zhou
- Department of Neurology, The First People's Hospital of Xiangyang, Hubei Medical University, Xiangyang, China
| | - Luming Chen
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chengsong Yue
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jun Yang
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zili Gong
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Shuai
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongfei Sang
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Neurology, The First People's Hospital of Hangzhou; Zhejiang University School of Medicine, Hangzhou, China
| | - Raul G Nogueira
- Marcus Stroke & Neuroscience Center, 71741Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Wenjie Zi
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingwu Yang
- Department of Neurology, 105785Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Wen L, Mu W, Lu H, Wang X, Fang J, Jia Y, Li Q, Wang D, Wen S, Guo J, Dai W, Ren X, Cui J, Zeng G, Gao J, Wang Z, Cheng B. Porphyromonas gingivalis Promotes Oral Squamous Cell Carcinoma Progression in an Immune Microenvironment. J Dent Res 2020; 99:666-675. [PMID: 32298192 DOI: 10.1177/0022034520909312] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Increasing evidence has revealed a significant association between microorganisms and oral squamous cell carcinoma (OSCC). Porphyromonas gingivalis, the keystone pathogen in chronic periodontitis, is considered an important potential etiologic agent of OSCC, but the underlying immune mechanisms through which P. gingivalis mediates tumor progression of the oral cancer remain poorly understood. Our cohort study showed that the localization of P. gingivalis in tumor tissues was related to poor survival of patients with OSCC. Moreover, P. gingivalis infection increased oral lesion multiplicity and size and promoted tumor progression in a 4-nitroquinoline-1 oxide (4NQO)–induced carcinogenesis mouse model by invading the oral lesions. In addition, CD11b+ myeloid cells and myeloid-derived suppressor cells (MDSCs) showed increased infiltration of oral lesions. Furthermore, in vitro observations showed that MDSCs accumulated when human-derived dysplastic oral keratinocytes (DOKs) were exposed to P. gingivalis, and CXCL2, CCL2, interleukin (IL)–6, and IL-8 may be potential candidate genes that facilitate the recruitment of MDSCs. Taken together, our findings suggest that P. gingivalis promotes tumor progression by generating a cancer-promoting microenvironment, indicating a close relationship among P. gingivalis, tumor progression of the oral cancer, and immune responses.
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Affiliation(s)
- L. Wen
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - W. Mu
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - H. Lu
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - X. Wang
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - J. Fang
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Y. Jia
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Q. Li
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - D. Wang
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - S. Wen
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - J. Guo
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - W. Dai
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - X. Ren
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - J. Cui
- State Key Laboratory of Oncology in South China, MOE Key Laboratory of Gene Function and Regulation, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - G. Zeng
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - J. Gao
- Discipline of Oral Bioscience, Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Z. Wang
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - B. Cheng
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Peng F, Wan J, Liu W, Huang W, Wang L, Qiu T, Yang S, Shi Q, Zhang S, Zeng G, Wang Y, Ai Z, Liu Y, Hu W, Wen C, Shi Z, Pu J, Qiu Z, Wu D, Gong Z, Shuai J, Yang Q, Zi W, Li F. Efficacy and safety of rescue stenting following failed mechanical thrombectomy for anterior circulation large vessel occlusion: propensity score analysis. J Neurointerv Surg 2019; 12:271-273. [PMID: 31530654 DOI: 10.1136/neurintsurg-2019-015154] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of rescue stenting (RS) after failed mechanical thrombectomy (MT) for patients with large artery occlusion in the anterior circulation. METHODS Consecutive patients who experienced failed reperfusion and subsequently did or did not undergo RS at 16 comprehensive stroke centers were enrolled from January 2015 to June 2018. Propensity score matching was used to achieve baseline balance between the patient groups. Symptomatic intracranial hemorrhage (sICH) at 48 hours and the modified Rankin Scale scores and mortality at 3 months in the two groups were compared. RESULTS A total of 90 patients with RS and 117 patients without RS after failed MT were enrolled. Propensity score matching analysis selected 132 matched patients. The good outcome rate was significantly higher in matched patients with RS than in those without RS (36.4% vs 19.7%, p=0.033), whereas the sICH (13.6% vs 21.2%, p=0.251) and mortality (31.9% vs 43.9%, p=0.151) were not significantly different between the groups. CONCLUSIONS RS seems to be an effective safe choice for patients with large vessel occlusion of the anterior circulation who underwent failed MT.
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Affiliation(s)
- Feng Peng
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Neurology, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Junfang Wan
- Department of Anesthesiology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, Hubei, China
| | - Wenguo Huang
- Department of Neurology, Maoming Traditional Chinese Medicine Hospital, Maoming, Guangdong, China
| | - Li Wang
- Department of Neurology, The Third People's Hospital of Zigong, Zigong, Sichuan, China
| | - Tao Qiu
- Department of Neurology, The First People's Hospital of Zigong, Zigong, Sichuan, China
| | - Shiquan Yang
- Department of Neurology, The 902th Hospital of The People's Liberation Army, Bengbu, Anhui, China
| | - Qiang Shi
- Department of Neurology, The First People's Hospital of Zigong, Zigong, Sichuan, China
| | - Shuai Zhang
- Department of Neurology, The First People's Hospital of Yangzhou, Yangzhou University, Yangzhou, Jiangsu, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Yan Wang
- Department of Neurology, The Fifth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Zhibin Ai
- Department of Neurology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yong Liu
- Department of Neurology, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, Anhui, China
| | - Wei Hu
- Department of Neurology, Anhui Provincial Hospital and and The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, Henan, China
| | - Zhonghua Shi
- Department of Neurosurgey, The 904th Hospital of The People's Liberation Army, Wuxi, Jiangsu, China
| | - Jie Pu
- Departmentof Neurology, Ren Min Hospital of Wu Han University, Wuhan, Hubei, China
| | - Zhongmin Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Deping Wu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zili Gong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Shuai
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Hao B, Chen Z, Zeng G, Huang L, Luan C, Xie Z, Chen J, Bao M, Tian X, Xu B, Wang Y, Wu J, Xia S, Yuan L, Huang J. Efficacy, safety and immunogenicity of live attenuated varicella vaccine in healthy children in China: double-blind, randomized, placebo-controlled clinical trial. Clin Microbiol Infect 2019; 25:1026-1031. [DOI: 10.1016/j.cmi.2018.12.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/18/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
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Zeng J, Tang T, Wang YJ, Lyu HK, Huang JH, Li XQ, Jia NN, Zeng G, Chen ZP. [Post-marketing multi-center safety surveillance of inactivated enterovirus A71 vaccine (Vero cell)]. Zhonghua Yu Fang Yi Xue Za Zhi 2019; 53:252-257. [PMID: 30841662 DOI: 10.3760/cma.j.issn.0253-9624.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the post-marketing safety profiles of the inactivated enterovirus type 71 (EV-A71) vaccine (Vero cell) after routine inoculation. Methods: Eleven cities of Zhejiang Province, Fengtai district of Beijing, Qinnan district, two counties as Pingle and Pingguo of Guangxi Zhuang Autonomous Region, and Dongtai city of Jiangsu Province were selected as the field sites. A total of 45 239 subjects were enrolled in this study from children who seeked the vaccination of EV-A71 vaccine during the period from July, 2016 to June, 2018. Different sampling method were adopted in different sites. All vaccinated children were invited to participate in the study in Fengtai and Dongtai, however, systematic sampling method were adopted in other sites. Active surveillance was conducted and information about adverse reactions (ARs) occurred in 30 min, 3 d and 30 d following each dose of EV-A71 immunization was collected by field observation, phone-call or face-to-face interview. The incidence of ARs in different types, symptoms and grades were described. Results: In total, there were 45 239 children who received 71 243 doses EV-A71 vaccine. The overall incidence of ARs was 1.079% (769 doses), with the highest incidence of 1.182% (177/14 973) in 5-11 month group and the lowest incidence of 0.849% (18/2 119) in ≥ 36 month group among different age groups. There was a higher incidence in solicited ARs, which was 1.047% (746 doses). The incidences of grade 1 and grade 2 ARs were also higher, which were 0.404% (288 doses) and 0.554% (395 doses), respectively. No grade 4 ARs occurred. The doses of the first and the second vaccination was 40 736 and 30 507, respectively, and the incidences of ARs were 1.281% (522 doses) and 0.810% (247 doses). Also, the incidences of ARs were 0.091% (37 doses) and 0.043% (13 doses) in local, and 1.168% (476 doses) and 0.760% (232 doses) in system. The symptoms of ARs after the two doses of vaccination were basically the same. Redness at the injection site was the most common local ARs after each dose vaccination, with doses of 24 and 11, while fever was the most common systemic ARs, with doses of 362 and 190. Moreover, ARs mainly occurred in 30 min to 3 d after each dose vaccination, with incidence of 1.016% (414 doses) and 0.698% (213 doses) in the first and second dose, respectively. Conclusion: The ARs had a low incidence after vaccination in children and most were mild or moderate. EV-A71 vaccine with good safety is suitable for inoculation in a large scale.
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Affiliation(s)
- J Zeng
- Clinical Research Department, Sinovac Biotech Co., Ltd, Beijing 100085, China
| | - T Tang
- Immunoprophylaxis Department, Beijing Fengtai District Center for Disease Control and Prevention, Beijing 100071, China
| | - Y J Wang
- Prevention and Control of Acute Infectious Diseases Department, Dongtai Municipal Center for Disease Control and Prevention, Yancheng 224200, China
| | - H K Lyu
- Immunization Program Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - J H Huang
- Immunization Program Department, Pingguo County Center for Disease Control and Prevention, Guangxi, Baise 531499, China
| | - X Q Li
- Immunization Program Department, Pingle County Center for Disease Control and Prevention, Guilin 542499, China
| | - N N Jia
- Clinical Research Department, Sinovac Biotech Co., Ltd, Beijing 100085, China
| | - G Zeng
- Clinical Research Department, Sinovac Biotech Co., Ltd, Beijing 100085, China
| | - Z P Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
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Deng T, Duan X, Liu B, Lan Y, Cai C, Zhang T, Zhu W, Mai Z, Wu W, Zeng G. Association between phosphodiesterase type 5 inhibitors use and risk of melanoma: a meta-analysis. Neoplasma 2019. [PMID: 29534582 DOI: 10.4149/neo_2018_170111n23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This meta-analysis aimed to clarify the actual association between the phosphodiesterase type 5 inhibitors (PDE5-Is) use and the risk of melanoma in erectile dysfunction (ED) patients. A systematic literature search was conducted in online databases in October, 2016 to identify studies focusing on the association between PDE5-Is use and the risk of melanoma. Summarized multivariate adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess the strength of associations. A total of six clinical trials containing more than one million participants were included. ED patients using PDE5-Is shared a significant high risk of melanoma (RR=1.12, 95% CI=1.03-1.21, p=0.006). Positive associations were observed in all kinds of prescriptions: single prescription (RR=1.20, 95% CI=1.06-1.35, p=0.003), medium number of prescription (RR=1.15, 95% CI=1.01-1.30, p=0.03), and high number of prescription (RR=1.18, 95% CI=1.05-1.34, P=0.006). Additionally, PDE5-Is were also found to be significantly associated with increased risk of basal cell carcinoma (RR=1.14, 95% CI=1.09-1.19, p<0.00001). Our study indicates that PDE5-Is use could significantly increase the risk of melanoma and basal cell carcinoma. However, the risk of melanoma did not rise significantly with the increased number of prescriptions. Consequently, owing to the lack of information about other potential synergistic factors, it is difficult for us to make a solid conclusion that application of PDE5-Is is the direct cause of increased risk of melanoma. Their relationship needs to be validated by further evidences.
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Schmaranzer F, Helfenstein R, Zeng G, Lerch TD, Siebenrock K, Tannast M, Zheng G. Automatic MRI-based 3D Models of Hip Cartilage Using a 3D U-net-like Fully Convolutional Network for Improved Morphologic and Biochemical Analysis. Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zhang YQ, Lan X, Zhang J, Zhou R, Dai ZY, Wu C, Bao YH, Yang LQ, Zhou FM, Zhao RP, Zeng G. [Association between gestational weight gain and adverse pregnancy outcomes: a prospective study]. Zhonghua Liu Xing Bing Xue Za Zhi 2018; 39:1626-1629. [PMID: 30572390 DOI: 10.3760/cma.j.issn.0254-6450.2018.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the association between gestational weight gain (GWG) and adverse pregnancy outcomes. Methods: A prospective study was conducted among 1 220 healthy singleton pregnant women in the first trimester of pregnancy, from Chengdu city, Sichuan province. Pre-gestational body mass and other basic information were collected through a set of questionnaires. Weight at the last week before delivery was measured and GWG was classified by IOM criteria (2009). Related information on pregnancy outcomes was collected after delivery, through the hospital information system. Multiple non-conditional logistic regression models were used to test the association between GWG and adverse pregnancy outcomes. Results: In total, data on 1 045 pregnant women were analyzed. Compared with adequate GWG, excessive GWG was associated with the increased risks of cord entanglement and large for gestational age (OR=1.641, 95%CI: 1.197-2.252; OR=1.678, 95%CI: 0.132-2.488), respectively. Additionally, when compared with the adequate GWG, insufficient GWG was associated with the increased risk of preterm delivery (OR=3.189, 95%CI: 1.604-6.341). Conclusions: Both excessive and insufficient GWG appeared associated with the pregnancy outcomes. Weight monitoring should be strengthened for pregnant women to reduce related risks on adverse pregnancy outcomes.
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Affiliation(s)
- Y Q Zhang
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - X Lan
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - J Zhang
- Department of Nutrition, Maternity and Child Health Care Central Hospital of Sichuan, Chengdu 610045, China
| | - R Zhou
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Z Y Dai
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - C Wu
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - Y H Bao
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - L Q Yang
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - F M Zhou
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - R P Zhao
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - G Zeng
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
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Sun W, Li G, Zeng X, Lai Z, Wang M, Ouyang Y, Zeng G, Peng J, Zhong J, Xiao D, Huang Z, Guo X. Clinical and Imaging Characteristics of Cerebral Infarction in Patients with Nonvalvular Atrial Fibrillation Combined with Cerebral Artery Stenosis. J Atheroscler Thromb 2018; 25:720-732. [PMID: 29877196 PMCID: PMC6099075 DOI: 10.5551/jat.43240] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/23/2018] [Indexed: 11/30/2022] Open
Abstract
AIMS Nonvalvular atrial fibrillation often occurs in combination with carotid atherosclerosis, but less is known about it in combination with cerebral artery stenosis. This study investigated the characteristics of cerebral infarction in patients with nonvalvular atrial fibrillation with or without cerebral artery stenosis. METHODS A retrospective analysis was conducted on 172 cerebral infarction patients with nonvalvular atrial fibrillation hospitalized at the Affiliated Ganzhou Hospital of Nanchang University between December 2011 and January 2016. The patients were divided into two groups (stenosis and non-stenosis groups) based on whether the cerebral infarction was combined with cerebral artery stenosis or not. Clinical characteristics, related supplementary examination, and the imaging characteristics of cerebral infarction lesions were compared between the groups. RESULTS Mean age [(75.73±8.46) years vs. (63.44±9.95) years], National Institute of Health stroke scale (NIHSS) score [(8.66±6.73) vs. (4.59±3.51)], CHA2DS2-VASc score [(2.93±1.40) vs. (0.96±0.98)], history of hypertension (74.4% vs. 30.0%), and history of stroke/ transient ischemic attack (TIA) (55.8% vs. 13.3%) were higher in the stenosis group (n=107) than in the non-stenosis group (n=65) (P<0.01). In the stenosis group, there were different types of cerebral infarction lesions, including multiple infarction (multifocal type), massive infarction, watershed infarction, and lacunar infarction; in the non-stenosis group, the 60.0% lesions were multiple infarction (multifocal type), a significantly higher proportion than the stenosis group (26.2%, P<0.05). NIHSS score was an independent risk factor for worse prognosis at follow-up (OR (95%CI) 1.251-1.674, P<0.001). CONCLUSIONS Advanced age, hypertension, and stroke/TIA were increased in patients with cerebral infarction with nonvalvular atrial fibrillation combined with cerebral artery stenosis.
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Affiliation(s)
- Wei Sun
- Department of Neurology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Guangsheng Li
- Department of Neurology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Xiangjun Zeng
- Department of Neurology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Zhaohui Lai
- Department of Neurology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Mingqi Wang
- Department of Neurology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Yi Ouyang
- Department of Neurology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Guoyong Zeng
- Department of Neurology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Jidong Peng
- Department of Radiology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Junyuan Zhong
- Department of Radiology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Daoxiong Xiao
- Department of Radiology, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Zhiping Huang
- Department of Ultrasonography, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
| | - Xiaofen Guo
- Department of Ultrasonography, the Affiliated Ganzhou Hospital of Nanchang University, Jiangxi, China
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Zeng G, Ding W, Li Y, Sun M, Deng L. Morroniside protects against cerebral ischemia/reperfusion injury by inhibiting neuron apoptosis and MMP2/9 expression. Exp Ther Med 2018; 16:2229-2234. [PMID: 30186462 PMCID: PMC6122141 DOI: 10.3892/etm.2018.6457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/09/2018] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to investigate the effect of morroniside against matrix metalloproteinase (MMP)2/9 and focal cerebral ischemia/reperfusion (I/R) injury in rats. A rat model of focal cerebral I/R injury rats was established and rats were administered with 30, 90 or 270 mg/kg/day morroniside for 7 days. The expression of MMP2/9 and neuronal apoptosis were assessed. In addition, the expression of active caspase-3, B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) were measured. The results revealed that MMP2 and MMP9 expression was upregulated and the percentage of apoptotic neurons was increased in rats with focal cerebral I/R injury compared with the control. However, treatment with morroniside significantly inhibited I/R-induced MMP2/9 expression and neuron apoptosis compared with the untreated I/R injury group. Morroniside administration also decreased the expression of active caspase-3 and increased the Bcl-2/Bax ratio compared with untreated rats with focal cerebral I/R injury. The inhibitory effect of morroniside on MMP2/9 expression and neuron apoptosis was dose dependent. In summary, the results of the present study suggest that morroniside is able to protect against cerebral I/R injury in the brain and may have potential as a therapeutic treatment for patients who have suffered a stroke.
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Affiliation(s)
- Guoyong Zeng
- Department of Neurology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, P.R. China
| | - Weijiang Ding
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Yin Li
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Meiying Sun
- Department of Neurology, The People's Hospital of Fuzhou, Fuzhou, Jiangxi 344000, P.R. China
| | - Liying Deng
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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Aydin A, Ahmed K, Raison N, Abe T, Gözen A, Knoll T, Moltzahn F, Skolarikos A, Lantz A, Chew B, Thalmann G, Shinohara N, Rassweiler J, Zeng G, Khan M, Dasgupta P. International Multicentre Validation and Transferability of the SIMULATE Ureterorenoscopy Training Curriculum. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Guan Y, He F, Wu J, Zhao L, Wang X, Huang L, Zeng G, Ren B, Chen J, Liao X, Ma Z, Chen X, Zhong G, Huang M, Zhao X. A long-acting pegylated recombinant human growth hormone (Jintrolong ® ) in healthy adult subjects: Two single-dose trials evaluating safety, tolerability and pharmacokinetics. J Clin Pharm Ther 2018; 43:640-646. [PMID: 29959799 DOI: 10.1111/jcpt.12732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/09/2018] [Indexed: 12/20/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Jintrolong® is a pegylated recombinant human growth hormone (rhGH) (PEG-rhGH) developed for weekly subcutaneous (sc) injection. The current human tolerability trial and pharmacokinetics (PK) trial evaluated the safety, tolerability and PK of single-dose Jintrolong® injection in healthy adult subjects. METHODS Both trials were single-centre, randomized, open-label and single-dose studies. In the human tolerability trial, 34 healthy subjects were randomized to receive single-dose Jintrolong® sc injection (0.01, 0.06, 0.2, 0.5 or 0.8 mg/kg) or placebo. In the PK study, 30 healthy male subjects were evenly randomized into 3 groups to receive single-dose Jintrolong® sc injection (0.1, 0.2 or 0.4 mg/kg), and the subjects receiving 0.4 mg/kg Jintrolong® were given a single sc injection of conventional rhGH (0.067 mg/kg) after a 14-day washout period. Safety and PK profiles of Jintrolong® were evaluated. RESULTS AND DISCUSSION Jintrolong® was well tolerated with no serious adverse events or local injection responses. The PK trial showed that the plasma growth hormone concentration elevated quickly and stayed at peak level between 12 and 48 hours post-Jintrolong® injection, then decreased gradually back to baseline within 168 hours. Compared to single-dose conventional rhGH, Jintrolong® at all doses demonstrated significantly longer half time and time to maximum plasma concentration, lower clearance and higher systemic drug exposure, indicating prolonged presence of GH in the subjects' circulation. Additionally, systemic exposure to Jintrolong® increased in a dose-dependent manner. WHAT IS NEW AND CONCLUSION Single-dose Jintrolong® injection was well tolerated in healthy adult subjects, and the maximum tolerable dose was no lower than 0.8 mg/kg. Jintrolong® was long-acting with the potential for weekly administration.
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Affiliation(s)
- Y Guan
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - F He
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China.,Department of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - J Wu
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - L Zhao
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - X Wang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - L Huang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - G Zeng
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - B Ren
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - J Chen
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - X Liao
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Z Ma
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - X Chen
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - G Zhong
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - M Huang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - X Zhao
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
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Wang DY, Li X, Shen ZC, Gu PL, Pei YR, Zeng G, Leng HJ, Zhang WG. [Three-dimensional architecture of intraosseous vascular anatomy of the hamate: a micro-computed tomography study]. Beijing Da Xue Xue Bao Yi Xue Ban 2018; 50:245-248. [PMID: 29643522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To obtain three-dimensional intraosseous artery of the hamate and to provide the vascular anatomy basis of hamate fracture fixation. METHODS PbO (lead monoxide, Sinopharm Chemical Reagent Beijing Co. Ltd) was ground into particles less than 40 μm and suspended in turpentine oil (Chemical Reagent Beijing Co. Ltd) at ratios of 1 g : 1.5 mL, 1 g : 1 mL and 1 g : 0.5 mL. Three specimens were investigated. Brachial arteries were cannulated and perfused with lead-based contrast agent. Hamates were harvested and scanned using micro-computed tomography (microCT). The acquisition protocols were as follows: CT scan setup: total rotation [Degrees], 360; rotation steps, 360; X-ray detector setup: transaxial, 2048; axial, 2048; exposure time, 1 500 ms, Binning, 1; system magnification: high-med. X-ray tube setup: 80 kV, 500 mA current. The down-sampling factor used in the reconstruction was 2. The effective voxel size of the final image was 27.30 μm. The three-dimensional model of the hamate was generated and the distribution and pattern of vessels were evaluated. RESULTS There were abundant extraosseous vessels around the hamate. They were mainly running in the tendons and ligaments around the hamate. Four vascular zones were identified on the hamate surface. They were on the palmar platform of the hamate body, on the dorsal side, on the ulnar side and on the tip of hamulus, namely. There were anastomoses among 4 vascular zones. We did not observe any vessels penetrating through the articular cartilage. The extraosseous vessels of the vascular zones gave a number of intraosseous branches into the hamate. The hamate body received intraosseous blood supply from the dorsal, palmar and ulnar while the hamulus from the palmar, ulnar and hamulus tip. There were some intraosseous branches anastomosing with each other. CONCLUSION The extraosseous and intraosseous vessels of the hamate were more than what used to be considered. The hamate body and hamulus received blood supply from multiple directions and arteries anastomosed extensively both outside and inside the hamate, making it possible that the intraosseous perfusion survived after fracture. It is likely that the nonunion after the hamate fracture is not caused by the vascular damage but the malalignment of the fragments.
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Affiliation(s)
- D Y Wang
- Department of Human Anatomy & Histology and Embryology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - X Li
- Department of Human Anatomy & Histology and Embryology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - Z C Shen
- Department of Human Anatomy & Histology and Embryology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - P L Gu
- Department of Human Anatomy & Histology and Embryology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - Y R Pei
- School of Electronics Engineering and Computer Science, Peking University, Beijing 100871, China
| | - G Zeng
- School of Electronics Engineering and Computer Science, Peking University, Beijing 100871, China
| | - H J Leng
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - W G Zhang
- Department of Human Anatomy & Histology and Embryology, Peking University School of Basic Medical Sciences, Beijing 100191, China
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Zeng G. Mini-PCNL versus standard-PCNL for the management of 20-40 mm size kidney stones: The initial result of a multi-center randomized controlled trial. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31696-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nielsen CK, Subbiahdoss G, Zeng G, Salmi Z, Kjems J, Mygind T, Snabe T, Meyer RL. Antibacterial isoeugenol coating on stainless steel and polyethylene surfaces prevents biofilm growth. J Appl Microbiol 2017; 124:179-187. [PMID: 29119696 DOI: 10.1111/jam.13634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 09/28/2017] [Accepted: 10/19/2017] [Indexed: 01/11/2023]
Abstract
AIMS Pathogenic bacteria can spread between individuals or between food items via the surfaces they share. Limiting the survival of pathogens on surfaces, therefore, presents an opportunity to limit at least one route of how pathogens spread. In this study, we propose that a simple coating with the essential oil isoeugenol can be used to circumvent the problem of bacterial transfer via surfaces. METHODS AND RESULTS Two commonly used materials, stainless steel and polyethylene, were coated by physical adsorption, and the coatings were characterized by Raman spectroscopy, atomic force microscopy and water contact angle measurements. We quantified and visualized the colonization of coated and uncoated surfaces by three bacteria: Staphylococcus aureus, Listeria monocytogenes and Pseudomonas fluorescens. No viable cells were detected on surfaces coated with isoeugenol. CONCLUSIONS The isoeugenol coating prepared with simple adsorption proved effective in preventing biofilm formation on stainless steel and polyethylene surfaces. The result was caused by the antibacterial effect of isoeugenol, as the coating did not diminish the adhesive properties of the surface. SIGNIFICANCE AND IMPACT OF THE STUDY Our study demonstrates that a simple isoeugenol coating can prevent biofilm formation of S. aureus, L. monocytogenes and P. fluorescens on two commonly used surfaces.
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Affiliation(s)
- C K Nielsen
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
| | - G Subbiahdoss
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
| | - G Zeng
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
| | - Z Salmi
- Department of Engineering, Applied Surface Chemistry, Aarhus University, Aarhus, Denmark
| | - J Kjems
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
| | - T Mygind
- DuPont Nutrition Biosciences, Brabrand, Denmark
| | - T Snabe
- DuPont Nutrition Biosciences, Brabrand, Denmark
| | - R L Meyer
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark.,Department of Bioscience, Aarhus University, Aarhus, Denmark
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Kristensen MF, Zeng G, Neu TR, Meyer RL, Baelum V, Schlafer S. Osteopontin adsorption to Gram-positive cells reduces adhesion forces and attachment to surfaces under flow. J Oral Microbiol 2017; 9:1379826. [PMID: 29081915 PMCID: PMC5646589 DOI: 10.1080/20002297.2017.1379826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/07/2017] [Indexed: 01/27/2023] Open
Abstract
The bovine milk protein osteopontin (OPN) may be an efficient means to prevent bacterial adhesion to dental tissues and control biofilm formation. This study sought to determine to what extent OPN impacts adhesion forces and surface attachment of different bacterial strains involved in dental caries or medical device–related infections. It further investigated if OPN’s effect on adhesion is caused by blocking the accessibility of glycoconjugates on bacterial surfaces. Bacterial adhesion was determined in a shear-controlled flow cell system in the presence of different concentrations of OPN, and interaction forces of single bacteria were quantified using single-cell force spectroscopy before and after OPN exposure. Moreover, the study investigated OPN’s effect on the accessibility of cell surface glycoconjugates through fluorescence lectin-binding analysis. OPN strongly affected bacterial adhesion in a dose-dependent manner for all investigated species (Actinomyces naeslundii, Actinomyces viscosus, Lactobacillus paracasei subsp. paracasei, Staphylococcus epidermidis, Streptococcus mitis, and Streptococcus oralis). Likewise, adhesion forces decreased after OPN treatment. No effect of OPN on the lectin-accessibility to glycoconjugates was found. OPN reduces the adhesion and adhesion force/energy of a variety of bacteria and has a potential therapeutic use for biofilm control. OPN acts upon bacterial adhesion without blocking cell surface glycoconjugates.
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Affiliation(s)
- M F Kristensen
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - G Zeng
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
| | - T R Neu
- Department of River Ecology, Helmholtz Centre for Environmental Research - UFZ, Magdeburg, Germany
| | - R L Meyer
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark.,Section of Microbiology, Department of Bioscience;Aarhus University, Aarhus, Denmark
| | - V Baelum
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - S Schlafer
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Section of Microbiology, Department of Bioscience;Aarhus University, Aarhus, Denmark
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Dai ZY, Liu D, Li R, Wang Y, Zhang J, Liu J, Zhou R, Zeng G. [Association between gestational weight gain per trimester/total gestational weight gain and gestational diabetes mellitus]. Zhonghua Liu Xing Bing Xue Za Zhi 2017; 37:1336-1340. [PMID: 27765121 DOI: 10.3760/cma.j.issn.0254-6450.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To understand the association between gestational weight gain (GWG) per trimester/total (GWG) and gestational diabetes mellitus (GDM). Methods: A prospective cohort study was conducted among 829 healthy pregnant women from Chengdu who delivered a singleton during March-September 2013. Basic information about pre-pregnancy was collected at the first time, exercise information per trimester, dietary intake information per trimester and gestational age at delivery were obtained by questionnaire. Weight at the (12 ± 1)th, (28 ± 1)th, (36 ± 1)th and last week before delivery were measured. GDM was diagnosed according to the National Diabetes and Pregnancy Prevention Guidelines (2014). At last, a total of 682 pregnant women were analyzed. After controlling the potential confounders, multiple logistic regression models were used to test the associations between GWG per trimester/total GWG and GDM. Results: After adjusting for age at delivery, pre-pregnancy body mass index, family histories of type 2 diabetes and hypertension, exercise in the first trimester, parity and energy intake in trimester and other potential confounders. Compared with adequate GWG in the first trimester, insufficient and excessive GWG in the first trimester were associated with increased risk of GDM (OR=1.23, 95%CI: 0.63-2.38, and OR=2.20, 95%CI: 1.12-4.35). Compared with adequate GWG in the second trimester, insufficient and excessive GWG in the second trimester were associated with decreased risk of GDM (OR=0.47, 95%CI: 0.18-1.19, and OR=0.78, 95% CI: 0.43-1.42). Compared with adequate GWG in the third trimester, insufficient GWG in the third trimester was associated with increased risk of GDM (OR=1.48, 95%CI: 0.77-2.84), excessive GWG in the third trimester was associated with decreased risk of GDM (OR= 0.53, 95% CI: 0.28-0.99). Compared with adequate total GWG in pregnancy, insufficient GWG in pregnancy was associated with increased risk of GDM (OR=2.16, 95% CI: 1.04-4.46), excessive GWG in pregnancy was associated with decreased risk of GDM (OR=0.74, 95% CI: 0.38-1.46). Conclusions: Insufficient and excessive GWG in the first trimester were associated with increased risk of GDM, the first trimester may represent a critical period for risk of GDM. The effects of GWG in the second and third trimester on GDM need further study.
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Affiliation(s)
- Z Y Dai
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - D Liu
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - R Li
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - Y Wang
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - J Zhang
- Department of Health Care, Maternity and Child Health Care Central Hospital of Sichuan, Chengdu 610045, China
| | - J Liu
- Department of Women Health Care, Women and Children's Central Hospital of Chengdu, Chengdu 610091, China
| | - R Zhou
- Department of Obstetrics, West China Second University Hospital/West China Women's and Children's Hospital, Chengdu 610041, China
| | - G Zeng
- Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China
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Lee J, Garon E, Goldman J, Abtin F, Suh R, Wallace W, Zeng G, Elashoff D, Sharma S, Dubinett S. Phase I Trial of CCL21 Gene Modified Dendritic Cells in Lung Cancer Elicits Immune Responses. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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