Objective: To study the effects of infection on severe stroke patients in the neurological intensive care unit and to find the related risk factors for mortality of severe stroke patients.Methods: We conducted a retrospective study including 343 patients with ischaemic or haemorrhagic stroke and staying for more than 2 patient-days in the neurological intensive care unit at Beijing Chaoyang Hospital from January 2011 to December 2015 to analyse the infection features of patients with severe stroke in the neurological intensive care unit. All analyses were conducted using SPSS 18.0.Results: The mortality rate, hospital staying time and hospital costs between infected and uninfected stroke patients were higher in the infected patients than in the uninfected patients, P < 0.05, and except for the hospital staying time, the mortality rate and hospital costs were both significantly higher in the infected patients. Respiratory tract infection was the most common infection type at all time periods, P < 0.05. However, urinary tract infection increased at 72 h after stroke compared with infection within 72 h after stroke. Blood sugar level, mean arterial pressure, scores of APACHE II, history of stroke, history of heart diseases, infections and respiratory tract infection were significantly different in dead patients compared with the alive patients, P < 0.05.Conclusion: Infection can significantly influence the mortality rate and hospital costs of stroke patients, and is an independent risk factor for mortality of stroke patients.

Cotton fibers elongate rapidly after initiation of elongation, eventually leading to the deposit of a large amount of cellulose. To reveal features of cotton fiber cells at the fast elongation and the secondary cell wall synthesis stages, we compared the respective transcriptomes and metabolite profiles. Comparative analysis of transcriptomes by cDNA array identified 633 genes that were differentially regulated during fiber development. Principal component analysis (PCA) using expressed genes as variables divided fiber samples into four groups, which are diagnostic of developmental stages. Similar grouping results are also found if we use non-polar or polar metabolites as variables for PCA of developing fibers. Auxin signaling, wall-loosening and lipid metabolism are highly active during fiber elongation, whereas cellulose biosynthesis is predominant and many other metabolic pathways are downregulated at the secondary cell wall synthesis stage. Transcript and metabolite profiles and enzyme activities are consistent in demonstrating a specialization process of cotton fiber development toward cellulose synthesis. These data demonstrate that cotton fiber cell at a certain stage has its own unique feature, and developmental stages of cotton fiber cells can be distinguished by their transcript and metabolite profiles. During the secondary cell wall synthesis stage, metabolic pathways are streamed into cellulose synthesis.

The pathogenesis of white matter hyperintensities (WMH) is incompletely understood but blood–brain barrier (BBB) dysfunction may play a key role. This study aimed to investigate the relationship between BBB permeability and the severity of WMH burden. Consecutive participants without symptomatic stroke history presented for physical examination were recruited in this cross-sectional study and divided into three WMH burden groups according to total Fazekas scores. They received dynamic contrast-enhanced-magnetic resonance imaging to measure BBB permeability, and received Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). A total of 102 participants aged 49–90 years (mean age of 69.82 years) were enrolled (36 with low WMH burden, 35 with medium WMH burden, and 31 with high WMH burden). Multivariable linear regression analyses revealed that participants with higher WMH burden had significantly higher BBB leakage rate and area under the leakage curve in normal-appearing white matter, WMH, cortical gray matter, and deep gray matter (DGM) after adjustment for age, sex, and vascular risk factors. Scores on MMSE and MoCA decreased with increasing leakage rate in WMH and DGM after adjustment for age, sex, WMH burden, and education years. We found that higher BBB permeability is associated with higher WMH burden and cognitive decline. The compromised BBB integrity may be a critical contributor to the pathogenesis of WMH and part of a series of pathological processes that finally lead to cognitive impairment.

Abstract Background There is no consensus on the serum iron levels and Parkinson's disease (PD). The aim of this study is to conduct a systematic review and meta-analysis to analyse the relationship between serum iron levels and PD risk. Methods We searched the databases of PubMed, Web of knowledge, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI) and China Biology Medical literature to assess the association between serum iron levels and PD risk. Standardized mean differences (SMD) and 95% confidence intervals (CI) with random-effect model were used to combine the results. Results Eleven related articles met our selection criteria and contained a total of 829PD patients and 1219 healthy controls. Our meta-analysis results revealed that the serum iron levels in PD patients were significantly higher than those in healthy controls (SMD=0.27, 95% CI=0.18, 0.37, P <0.001). Subgroup analysis by ethnicity showed that the serum iron levels in PD patients were significantly higher than controls both in Asian populations and European populations. Significant associations were also found in prospective studies and case-control studies. Conclusions Our meta-analysis showed strong evidence that a significantly higher serum iron levels are present in PD patients when compared to the healthy controls. Highlights • Serum iron levels in PD patients were significantly higher. • Serum iron levels in PD patients were significantly higher than in Asian and European populations. • Significant associations were also found in prospective studies and case-control studies.

AbstractOur study aimed to investigate the changes of white matter microstructure of cortico-subcortical pathways using diffusion tensor imaging (DTI), and to explore the relationship between abnormal parameters of DTI and cognitive function underlying in patients with leukoaraiosis (LA).A total of 42 patients with LA and 42 age- and sex-matched healthy controls were recruited from Beijing Chaoyang Hospital, Capital Medical University between January 2012 and December 2012. All the subjects underwent scans of conventional magnetic resonance imaging and DTI, and a comprehensive neuropsychological battery was utilized. The regions of interest (ROIs) were located at the white matter of centrum semiovale, anterior and posterior periventricular white matter, basal ganglia, corpus callosum. The averaged values of mean diffusivity (MD) and fractional anisotropy (FA) were quantified both within white matter lesions (WMLs) and normal appearing white matter (NAWM). A linear regression analysis was performed to assess the association between diffusion parameters and decline in cognitive domains.Patients with LA were associated with comprehensive cognitive function deficits. We found that significantly decreased FA and increased MD in WMLs at the 5 ROIs than that of NAWM and controls (P < .05). The values of FA in NAWM were significantly lower and MD in NAWM were significantly higher at centrum semiovale and posterior periventricular white matter than that of controls (P < .05). The values of FA in WMLs at anterior periventricular white matter were positively related to the performances of cognition in patients with LA (P < .05). The values of FA in NAWM located at anterior periventricular white matter were positively related to the score of Digit-symbol test (r = 0.446, P = .002). The values of FA in NAWM located at anterior periventricular white matter correlated inversely with the Z scores of executive function (r = −0.418, P = .03).In our study, patients with LA exhibited significant cognitive impairment especially in the domains of executive function. The technique of DTI revealed that the reduced FA and increased MD at the corresponding regions of cortico-subcortical pathways in patients with LA. DTI may be of great help for an early pathology of white matter microstructure underlying in patients with LA.

BackgroundMild encephalitis/encephalopathy with reversible splenial lesion (MERS) is a rare clinico-radiological entity characterized by the magnetic resonance imaging (MRI) finding of a reversible lesion in the corpus callosum, sometimes involved the symmetrical white matters. Many cases of child-onset MERS with various causes have been reported. However, adult-onset MERS is relatively rare. The clinical characteristics and pathophysiologiccal mechanisms of adult-onset MERS are not well understood. We reviewed the literature on adult-onset MERS in order to describe the characteristics of MERS in adults and to provide experiences for clinician.MethodsWe reported a case of adult-onset MERS with acute urinary retension and performed literature search from PubMed and web of science databases to identify other adult-onset MERS reports from Januarary 2004 to March 2016. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed on selection process. And then we summarized the clinico-radiological features of adult-onset MERS.ResultsTwenty-nine adult-onset MERS cases were reviewed from available literature including the case we have. 86.2% of the cases (25/29) were reported in Asia, especially in Japan. Ages varied between 18 and 59 years old with a 12:17 female-to-male ratio. The major cause was infection by virus or bacteria. Fever and headache were the most common clinical manifestation, and acute urinary retention was observed in 6 patients. All patients recovered completely within a month.ConclusionAdult-onset MERS is an entity with a broad clinico-radiological spectrum because of the various diseases and conditions. There are similar characteristics between MERS in adults and children, also some differences.

Enlarged perivascular spaces (EPVS) are reported to be associated with impaired cognitive function and sleep disorders. It is of clinical importance to understand the risk factors for EPVS. Hyperuricemia increases the risk of hypertension and endothelial dysfunction, which are well recognized to be associated with EPVS. Therefore, we postulated that serum uric acid (SUA) might be associated with EPVS. A total of 665 lacunar stroke patients were enrolled in this study. The SUA concentrations of patients with severe EPVS were much higher than those of patients with mild EPVS (for basal ganglia: 5.25 ± 1.40 mg/dl vs. 4.75 ± 1.40 mg/dl, p < 0.001; for white matter: 5.31 ± 1.41 mg/dl vs. 4.88 ± 1.37 mg/dl, p = 0.009). The percentage of subjects with severe EPVS tended to be higher in the highest quartile of SUA (chi-square test: P = 0.002 for basal ganglia and 0.006 for white matter). Spearman correlation analysis indicated that the SUA concentrations were positively correlated with the severity of EPVS (rho > 0, p < 0.05). Multivariate logistic regression analysis showed that high normal SUA was independently associated with a higher severity of EPVS. This finding suggests that high SUA levels might be an independent risk factor for EPVS in lacunar stroke patients.

BACKGROUND Severe stroke patients have poor clinical outcome which may be associated with development of multiple organ dysfunction syndrome (MODS). Therefore； the aim of our study was to investigate independent risk factors for development of MODS in severe stroke patients. METHODS Ninety seven severe stroke patients were prospective recruited from Jan 2011 to Jun 2015. The development of MODS was identified by Sequential Organ Failure Assessment (SOFA) score (score ≥ 3； at least two organs)； which was assessed on day 1； 4； 7； 10 and 14 after admission. Baseline characteristics； Acute Physiology and Chronic Health Evaluation (APACHE) II score； Glasgow coma score (GCS) and cerebral imaging parameters were collected at admission. Cox regression was performed to determine predictors for the development of MODS. Medical complications after admission and in-hospital mortality were also investigated. RESULTS 33 (34%) patients were in MODS group and 64 (66%) were in non-MODS group within 14 days after admission. Patients in MODS group had more smoker (51.5% vs 28.1%； p = 0.023)； higher NIHSS score (23.48 ± 6.12 vs 19.81 ± 4.83； p = 0.004)； higher APACHE II score (18.70 ± 5.18 vs 15.64 ± 4.36； p = 0.003) and lower GCS score (6.33 ± 2.48 vs 8.14 ± 2.73； p = 0.002). They also had higher rate of infarction in multi vascular territories (36.4% vs 10.9%； p = 0.003). The most common complication in all patients was pulmonary infection； while complication scores were comparable between two groups. Patients with MODS had higher in-hospital mortality (69.7% vs 9.4%； p = 0.000). In Cox regression； NIHSS score (RR = 1.084； 95% CI 1.019-1.153) and infarction in multi vascular territories (RR = 2.345 95% CI 1.105-4.978) were independent risk factors for development of MODS. CONCLUSIONS In acute phase of stroke； NIHSS score and infarction in multi vascular territories predicted MODS in severe stroke patients. Moreover； patients with MODS had higher in-hospital mortality； suggesting that early identification of MODS is critical important.

BackgroundWe aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial.Methods and ResultsIn total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke (P=0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.ConclusionsConcurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

Abstract A total of 688 samples, including 520 food samples belonging to 29 food types in 10 groups, 63 drinking water, and 105 indoor dust samples were collected during May to November in 2014 in Chengdu and Tianjin (only dust samples in Tianjin), China to investigate the perchlorate levels in these samples and to estimate the related exposure to Chinese people. Significant difference in indoor dust perchlorate levels was found between Chengdu and Tianjin, with the concentrations ranging from 0.11 to 38.8 mg/kg in Chengdu, and from 0.72 to 119 mg/kg in Tianjin. The mean perchlorate levels in 10 groups of food samples were in the order of vegetables > wheaten flour ≈ egg, and wheaten flour > milk > sea food > livestock meats ≈ poultry ≈ freshwater fish > fruits > steamed rice, while no statistical difference in perchlorate levels was found between egg and milk. Exposure evaluation indicated that indoor dust contributed little (less than 5%) to the total daily perchlorate intake, and food consumption was the primary perchlorate exposure route for Chengdu people, followed by drinking water. Based on the median perchlorate levels obtained in this study, the daily perchlorate intake was below the reference does suggested by the US EPA. Graphical abstract Highlights • High perchlorate levels were found in the indoor dust and food samples. • Indoor dust contributed little to the daily perchlorate intake. • Food consumption was the primary perchlorate exposure route to Chengdu people. • The daily mean perchlorate intake was below the US EPA reference.

The processes and mechanisms underlying brain injuries due to ischemia and anoxia have yet to be determined. Additionally, few clinical treatements are currently available. Activins have a protective role in the restoration, differentiation, and survival of injured cells, including Activin A (ActA), which acts as a neuroprotectant. However, its exact mechanism of action remains to be determined. ActA has been shown to protect neurons following ischemic brain injury. In this study, PC12 cells were differentiated into neuron-like cells after stimulation with nerve growth factor to prepare an oxygen/glucose deprivation (OGD) model in neurons. The differentiated PC12 cells, subjected to the OGD model, were exposed to ActA. Results showed that the PC12 survival rate decreased after OGD, leading to an increase in caspase-3 expression in these cells. Pretreatment with ActA was able to partially prevent OGD-induced apoptosis, likely through the downregulation of caspase-3. Futhermore, ActA pretreatment increased the expression of key proteins in the ActA/Smads signal transduction pathway, which may promote neuroprotection after OGD. Therefore, exogenous ActA may function as a neuroprotectant and provide a novel therapeutic treatment for ischemic brain injury.

INTRODUCTION Type 2 diabetes mellitus (T2DM) progression often results in treatment intensification with injectable therapy to maintain glycemic control. Using pilot data from the Initiation of New Injectable Treatment Introduced after Anti-diabetic Therapy with Oral-only Regimens study, real-world treatment patterns among T2DM patients initiating injectable therapy with insulin glargine or liraglutide were assessed. METHODS This was a retrospective analysis of claims from the OptumInsight™ (OI； January 1, 2010 to July 30, 2010) and HealthCore(®) (HC； January 1, 2010 to June 1, 2010) health insurance databases. Baseline characteristics, health care resource utilization, and costs were compared between adults with T2DM initiating injectable therapy with insulin glargine pen versus liraglutide. Follow-up outcomes, including glycated hemoglobin A1c (A1C), hypoglycemia, health care utilization, and costs, were assessed. RESULTS At baseline, almost one in three liraglutide patients (OI, n = 363； HC, n = 521) had A1C <7.0%, while insulin glargine patients (OI, n = 498； HC, n = 1,188) had poorer health status, higher A1C (insulin glargine: 9.8% and 9.1% versus liraglutide: 7.9% and 7.7%, OI and HC, respectively, both P < 0.001), and were less likely to be obese (insulin glargine: 10.8% and 9.2% versus liraglutide: 17.4% and 18.8%, OI and HC, respectively, both P < 0.01). The percentage of patients experiencing a hypoglycemic event was numerically higher for insulin pen use for both cohorts (OI 4.4% versus 3.0%； HC 6.2% versus 2.3%). During follow-up, in the insulin glargine cohort, annualized diabetes-related costs remained unchanged ($8,344 versus $7,749 OI, and $7,094 versus $7,731 HC), despite a significant increase in pharmacy costs, due to non-significant decreases in medical costs, while the liraglutide cohort had a significant increase in annualized diabetes-related costs ($4,510 versus $7,731 OI, and $4,136 versus $7,111 HC； both P < 0.001) due to a non-significant increase in medical costs coupled with a significant increase in pharmacy costs. CONCLUSION These descriptive data identified differences in demographic and baseline clinical characteristics among patients initiating injectable therapies. The different health care utilization and cost patterns warrant further cost-effectiveness analysis.

Speech intelligibility tests are conducted on hearing-impaired people for the purpose of evaluating the performance of a hearing device under varying listening conditions and device settings or algorithms. The speech reception threshold (SRT) is typically defined as the signal-to-noise ratio (SNR) at which a subject scores 50% correct on a speech intelligibility test. An SRT is conventionally measured with an adaptive procedure； in which the SNR of successive sentences is adjusted based on the subject's scores on previous sentences. The SRT can be estimated as the mean of a subset of the SNR levels； or by fitting a psychometric function. A set of SRT results is typically analyzed with a repeated measures analysis of variance. We propose an alternative approach for analysis； a zero-and-one inflated beta regression model； in which an observation is a single sentence score rather than an SRT. A parametrization of the model is defined that allows efficient maximum likelihood estimation of the parameters. Fitted values from this model； when plotted against SNR； are analogous to a mean psychometric function in the traditional approach. Confidence intervals for the fitted value curves are obtained by parametric bootstrap. The proposed approach was applied retrospectively to data from two studies that assessed the speech perception of cochlear implant recipients using different sound processing algorithms under different listening conditions. The proposed approach yielded mean SRTs for each condition that were consistent with the traditional approach； but were more informative. It provided the mean psychometric curve of each condition； revealing differences in slope； i.e. differential performance at different parts of the SNR spectrum. Another advantage of the new method of analysis is that results are stated in terms of differences in percent correct scores； which is more interpretable than results from the traditional analysis.

ObjectivesRecent studies reported that 24-hour ambulatory blood pressure variability (ABPV) was associated with lacunar infarction and white matter hyperintensities (WMH). However, the relationship between ABPV and enlarged perivascular spaces (EPVS) has not been investigated. Thus, our study aimed to investigate whether ABPV is associated with EPVS by 24-hour ambulatory blood pressure monitoring (ABPM).DesignWe conducted this study as a cross-sectional study.SettingsThe study was based on patients who presented for physical examinations in our hospital from May 2013 to June 2016.ParticipantsPatients with both brain MRI scans and 24-hour ABPM were included and patients with acute stroke, a history of severe stroke and some other severe diseases were excluded. A total of 573 Chinese patients were prospectively enrolled in this study.Primary and secondary outcome measuresEPVS in basal ganglia (BG) and white matter (WM) were identified on MRI and classified into three categories by the severity. WMH were scored by the Fazekas scale. Coefficient of variation (CV) and SD were considered as metrics of ABPV. Spearman correlation analysis and ordinal logistic regression analysis were used to assess the relationship between ABPV and EPVS.ResultsThere were statistical differences among the subgroups stratified by the severity of EPVS in BG in the following ABPV metrics: SD and CV of systolic blood pressure (SBP), CV of diastolic blood pressure (DBP) in 24 hours, daytime and nighttime and SD of DBP in nighttime. The above ABPV metrics were positively associated with the degree of EPVS. The association was unchanged after adjusting for confounders. Spearman correlation analysis showed ABPV was not related to the degree of EPVS in the WM.ConclusionABPV was independently associated with EPVS in BG after controlling for blood pressure, but not in the WM. Pathogenesis of EPVS in BG and WM might be different.