Differential associations between pre-diabetes,diabetes and stroke occurrence among West Africans

BackgroundThere are limited data from Africa on the burden and associations between pre-diabetes (pre-DM), diabetes mellitus (DM) and stroke occurrence in a region experiencing a profound rise in stroke burden.PurposeTo characterize the associations between stroke and dysglycemic status among West Africans.MethodsThe Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with clinical and radiological evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular factors were performed. Pre-diabetes was defined as HBA1c of 5.7%-6.4% or Fasting blood glucose (FBG) 5.6-7.0 mmol/L and DM as HBA1c >6.5% or FBG>7.0 mmol/L. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval.ResultsAmong 2,935 stroke cases the mean age was 60.0 ± 14.2 years with 55.2% being males. By glycemic status, 931 (31.7%) were euglycemic, 633 (21.6%) had Pre-diabetes and 1371 (46.7%) had DM. Of the age- and sex-matched stroke-free controls 69.2% were euglycemic, 13.3% had pre-DM and 17.5% had DM. Pre-DM [aOR (95% CI): 3.68(2.61-5.21)] and DM [4.29 (3.19-5.74)] were independently associated with stroke. The aOR of Pre-DM for ischemic stroke 3.06 (2.01–4.64)] was lower than 4.82 (3.37-6.89) for DM. However, the aOR of Pre-DM for hemorrhagic stroke 6.81 (95% CI: 3.29 – 14.08)] was higher than 3.36 (1.94–5.86) for DM. Furthermore, the aOR of pre-DM for ischemic stroke subtypes were 9.64 (1.30-71.57) for cardio-embolic stroke, 3.64 (1.80–7.34) for small-vessel occlusive disease and 4.63 (0.80-26.65) for large-vessel disease.ConclusionPre-DM is strongly and independently associated with stroke in Africans. Improving glycemic control through screening, healthy lifestyle and pharmacotherapy at a population level may be strategic in reducing the rising burden of stroke in Africa.     

Climate change transformation: A definition and typology to guide decision making in urban environments

Climate change presents a threat to the sustainability of cities and their societies, and must be adequately addressed. Urban environments (cities) are responsible for the creation of a significant amount of greenhouse gas emissions which are the source of climate change. Cities have been increasingly the focus of action to address climate change, yet emissions are not significantly reducing. Additionally, there a lack of integration between adaptation and mitigation. This prevents responses adequate to limit global warming to 1.5^OC, and to be well adapted to anticipated changes. This paper critically analyses existing definitions and typologies of climate change actions. A definition of ‘climate change transformation’ is proposed which includes the integration of adaptation and mitigation goals to enable a new regime in which global warming is limited to 1.5^OC. A new three-part typology: ‘coping, malaction and transformation,’ is presented for categorising climate change actions by the extent to which they integrate adaptation and mitigation, and define a new regime. The typology is accompanied by illustrations to demonstrate the relationship between adaptation and mitigation. The definition, typology and illustration serve to guide effective climate change decision making, and provides principles to guide application in urban environments.     

Perceptions on basilar artery occlusion management in China versus other countries: Analysis of the after the BEST of BASICS (ABBA) survey

IntroductionUncertainty remains on the optimal management of basilar artery occlusion (BAO). Two large randomized controlled trials (RCTs) in 2019 and 2021 demonstrated neutral results with respect to the use of endovascular therapy (EVT) for BAO. This study aimed to understand regional variation in physicians' perceptions towards the treatment of BAO as stratified by physician respondents from China versus outside China, prior to the publication of studies demonstrating a benefit of EVT for BAO.MethodsAn international online survey was conducted of stroke neurologists and neurointerventionalists from January to March 2022. Survey questions evaluated physician opinions toward the use of EVT in BAO, as well as the clinical and imaging features underlying treatment decisions. Respondents were dichotomized as either from China or from other countries and differences between groups were analyzed.ResultsThere were 1245 physician respondents across 73 countries of which 295 (23.7%) were from China. Compared to respondents from the rest of the world, respondents from China were more likely to be interventionalists (71.5% vs 35.0%; p < 0.0001). Overall, more than 95% of respondents believed that EVT was superior to medical therapy under certain circumstances. Chinese respondents were more likely to believe that further RCTs were necessary than respondents from other countries (93.6% vs 76.2%; p < 0.0001). Chinese respondents were more likely to use advanced imaging in later time windows and use a premorbid mRS threshold of ≤2 for BAO selection to EVT.ConclusionMost stroke physicians believe EVT is beneficial in selected patients with BAO. Clinical and imaging modality differences were observed in the selection criteria used for EVT. There was greater inclination to enroll all trial eligible patients in a BAO RCT by respondents from China as compared to other parts of the world.     

Relationship between CYP2C19*2, *3 gene polymorphism and the recurrence in ischemic stroke patients treated with clopidogrel in China: A meta-analysis

BackgroundThe relationship between CYP2C19 *2,*3 gene variants and the recurrence in ischemic stroke patients treated with clopidogrel is still controversial according to the available published literature. To evaluate correlations between CYP2C19 *2,*3 gene variants, metabolic typing according to *2, *3 SNPs (the polymorphism of rs4244285, rs4986893) and stroke recurrence, we performed this study through meta-analysis.MethodsLiteratures reporting the relationship between CYP2C19*2 and *3 polymorphism and the recurrence in ischemic stroke patients treated with clopidogrel were searched in CNKI, Wanfang Database, VIP, China Biomedical Database, PubMed and Cochrane Library from the establishment database to December 2020. Meta-analysis was performed with RevMan 5.3.ResultsA total of 9 articles with 10 trials involving 1333 ischemic stroke patients were included. The results of meta-analysis showed CYP2C19*2 GA/AA genotype had a higher risk of recurrent stroke than GG in patients with ischemic stroke treated with clopidogrel(P<0.05) (GA+AA vs. GG:OR=2.50, 95% CI:1.66～3.75;GA vs. GG:OR=2.16, 95% CI:1.41～3.31;AA vs. GG:OR=4.40, 95% CI:2.39～8.08; AA vs. GA:OR=2.15, 95% CI:1.20-3.84; allele A vs. G:OR=2.08, 95% CI:1.58-2.75). There was no significant difference in stroke recurrence risk between CYP2C19*3 GA vs. GG genotype (P=0.65)(OR=0.86,95% CI:0.44～1.67). Compared with extensive metabolizer (EM), patients with intermediate metabolizer (IM) and poor metaholizer (PM) of CYP2C19 had a higher risk of stroke recurrent after clopidogrel treatment (IM+PM vs. EM:OR=2.20, 95%CI:1.58～3.08, P<0.05; IM vs. EM:OR=2.06,95% CI: 1.45～2.91, P<0.05;PM vs. EM: OR=3.32,95% CI:1.98～5.56, P<0.05; PM vs. IM: OR=1.45,95% CI: 0.91～2.32,P=0.11).ConclusionAmong ischemic stroke patients taking clopidogrel, CYP2C19*2 gene mutation and CYP2C19 metabolizer were associated with stroke recurrence, CYP2C19*2 and *3 gene carriers were more likely to stroke recurrent than CYP2C19*1 gene carriers.     

Several practical issues toward implementing myoelectric pattern recognition for stroke rehabilitation

High density surface electromyogram (sEMG) recording and pattern recognition techniques have demonstrated that substantial motor control information can be extracted from neurologically impaired muscles. In this study, a series of pattern recognition parameters were investigated in classification of 20 different movements involving the affected limb of 12 chronic stroke subjects. The experimental results showed that classification performance could be improved with spatial filtering and be maintained with a limited number of electrodes. It was also found that appropriate adjustment of analysis window length, sampling rate, and high-pass cut-off frequency in sEMG conditioning and processing would be potentially useful in reducing computational cost and meanwhile ensuring classification performance. The quantitative analyses are useful for practical myoelectric control toward improved stroke rehabilitation.     

Differential effect of LPS and IL-1β in term placental explants

IntroductionInflammation is an important cause of placental dysfunction often associated with pregnancy complications. One well-known cause of inflammation is infection, through conserved “pathogen-associated molecular patterns” (PAMPs). Endogenous inducers of inflammation, known as “damage-associated molecular patterns” (DAMPs), have also been associated with pathological pregnancies and could contribute to the observed placental inflammation. Although both stimuli (i.e. PAMPs/DAMPs) can induce inflammation, they have yet to be studied together to compare their inflammatory effects on the placenta.MethodsWe used a model of term placental explants to compare the effects of a classical PAMP, bacterial lipopolysaccharide (LPS), and a DAMP, the pro-inflammatory cytokine interleukin (IL)-1. Gene and protein expression of several cytokines were analysed by qPCR and ELISAs and immunohistochemistry performed to study placental resident immune cells and apoptosis.ResultsLPS induced pro-inflammatory mediators (IL-6, IL-1β/α, TNF-α) whereas IL-1β induced only IL-6. Furthermore, LPS but not IL-1 exposure, led to elevated IL-10 and IL-1Ra secretion. Blocking the IL-1 signalling pathway abrogated the pro-inflammatory actions of LPS, whilst anti-inflammatory effects were preserved. The number of CD45 ⁺ immune cells was elevated in explants treated with LPS only. A subpopulation of CD45 ⁺ cells were positive for PCNA indicating proliferation of tissue resident macrophages.DiscussionWe conclude that LPS, a classical PAMP, and IL-1, a DAMP, have shared and distinct actions with pro-inflammatory effects mediated through IL-1 but anti-inflammatory actions having a distinct pathway. Identification of an inflammatory mediator (i.e. IL-1) common to multiple stimuli could be a therapeutic target to preserve the placenta.     

Safety and efficacy of basic fibroblast growth factors for deep second–degree burn patients

IntroductionBurn injuries are common afflictions; however, conservative wound care frequently leads to poor treatment compliance and physical disability in deep burn patients. Therefore, regenerative biologic materials, which are more effective for tissue repair, are required, particularly for deep second-degree burns. A novel spray formulation of basic fibroblast growth factors (bFGF) was produced by synthesizing fibroblast growth factor proteins. In this post-marketing surveillance (PMS) study, we assessed the safety and efficacy of bFGF and indirectly compared this formulation with cultured epidermal autografts (CEAs) for treating deep second-degree burns.Materials and methodsA total of 3173 patients treated at 15 hospitals were used for PMS of bFGF in South Korea for six years. In total, 1630 patients with deep second–degree burns were selected for assessing adverse events (AEs) of bFGF treatments. Efficacy was evaluated according to time periods until re-epithelialization, and clinical usefulness of bFGF was indirectly compared with that of CEAs.ResultsAEs occurred in 37 patients (2.3%) and included application site pain (1.7%) and contact dermatitis (0.6%). All AEs were mild and were evaluated as probably unrelated with bFGF. The average time for re-epithelialization was 8 days; this time span was significantly longer after major burns (9.7 days) than after minor (7.8 days) or moderate burns (7.9 days). Most treated burn wounds (99.8%) were assessed as improved. The indirect comparison included 534 patients using the same inclusion criteria for CEA patients (n = 35). The bFGF treatment demonstrated superior efficacy compared to CEAs by significantly reducing the average day to application (5.4 vs. 8.8 days) and re-epithelialization time (7.1 vs. 13.7 days).ConclusionOur study demonstrated that bFGF is a compelling regenerative therapy with competitive clinical efficacy and safety for deep second–degree burns and reduced treatment time, which is expected to reduce medical costs, particularly for deep second–degree burn patients.     

Outcomes among patients with primary angiitis of the CNS: A Nationwide United States analysis

BackgroundPrimary angiitis of the central nervous system (PACNS) is a relapsing-remitting disease with a heterogeneous course. Case series have delineated the long-term disease course but not acute outcomes or their determinants. The national United States hospital burden of PACNS has not been quantified.MethodsAnalysis of the United States Nationwide Readmissions Database (2016–2018) to characterize the frequency of PACNS hospitalizations, demographic features, inpatient mortality, and discharge outcomes.ResultsDuring the 3-year study period, unweighted 1843 (weighted 3409) patients with PACNS were admitted to the 1078 Healthcare Cost and Utilization Project HCUP participating hospitals; with weighting, this value indicates that 1136 patients were admitted each year to US hospitals, representing yearly 0.01 cases per 100 000 national hospitalizations. The majority of patients were hospitalized in metropolitan teaching hospitals (81.6%). The median age at admission was 54.9 (IQR: 44.0–66.5) years and 59.4% were women. Neurologic manifestations included ischemic stroke in 38.2%, transient ischemic attack in 20.2%, seizure disorder in 22.8%, and intracranial hemorrhage in 13.0%. Overall, 60.0% of patients were discharged home, 35.0% discharged to a rehabilitation facility or nursing home and 5.0% died before discharge. Patient features independently associated with the discharge to another facility or death included older age (odds ratio [OR], 1.03 [95% CI, [1.03–1.04]]), male sex (OR, 1.22 [1.04–1.43]), intraparenchymal hemorrhage (OR, 1.41 [1.08–1.84]), ischemic stroke (OR, 2.79 [2.38–3.28]), and seizure disorder (OR, 1.57 [1.31–1.89]).ConclusionOur study showed PACNS is still a rare inflammatory disorder of the blood vessels of the central nervous system suggesting an annual hospitalization of 5.1 cases per 1,000,000 person-years in the more diverse and contemporary US population. Overall, 4 in 10 had unfavorable discharge outcome, being unable to be discharged home, and 1 in 20 died before discharge.     

小鼠BTLA胞外功能区基因克隆表达及其对DC表面B7分子表达的影响

目的:研究重组谷胱甘肽S-转移酶(GST)-小鼠B/T细胞弱化因子包外功能区(mBTLAext)融合蛋白(GST-mBT-LAext)对小鼠树突状细胞系DC2.4表面B7分子表达的影响。方法:采用RT-PCR技术从小鼠脾细胞总RNA中逆转录mB-TLAcDNA。将其胞外功能区基因克隆入原核表达载体pGEX-4T-2中,构建重组表达质粒pGEX-4T-2/mBTLAext并转化E.coliBL21(DE3),以1mmol/L的IPTG诱导表达。提取包涵体,经变性、负性后,采用GlutathioneSepharose4B柱纯化可溶性的GST-mBTLAext。将不同浓度的GST-mBTLAext加入到DC2.4的培养体系中,采用流式细胞术检测其对DC上B7-1和B7-2表达的影响。结果:成功地克隆了mBTLA基因,并构建了重组原核表达载体。变性、复性,经GlutathioneSepharose4B柱纯化,获得了可溶性的GST-mBTLAext融合蛋白。经SDS-PAGE鉴定表明,融合蛋白的相对分子质量(Mr)为43000,同预期的结果一致。流式细胞术检测显示,GST-mBTLAext可上调DC2.4上B7-1的表达并呈剂量依赖性,这一作用可被抗GST-mBTLAext血清阻断。未检测到GST-mBT-LAextDC2.4上B7-2的表达有影响。结论:BTLA对DC2.4表面B7分子表达的上调可能是BTLA-HVEM途径反向信号对DC作用的结果,对进一步研究其对DC生物学行为的影响及其分子机制具有重要的理论意义。