Background
There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO).
Aim
This meta-analysis aimed to compare time metrics and clinical ...outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours.
Summary of review
Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through 23 February 2021. The primary outcomes were onset to door (OTD), door to imaging, door to puncture (DTP), puncture to recanalization, procedural time, successful recanalization, symptomatic intracranial hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale (mRS) score 0–2), and 90-day mortality. The secondary outcomes were imaging to puncture (ITP), onset to puncture (OTP), onset to recanalization (OTR), door to recanalization (DTR) time, mRS 0–2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14,185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer OTD (WMD 95% CI, 12.83 1.84–23.82 min), DTP (WMD 95% CI, 11.45 5.93–16.97 min), ITP (WMD 95% CI, 10.39 4.61–16.17 min), OTP (WMD 95% CI, 25.30 13.11–37.50 min), OTR (WMD 95% CI, 25.16 10.28–40.04 min), and DTR (WMD 95% CI, 18.02 10.01–26.03 min) time. Significantly lower successful recanalization rate (OR 95% CI, 0.85 0.76–0.95; p = 0.004; I2 = 0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend toward lower OR of good prognosis was witnessed in the off-hour group (OR 95% CI, 0.92 0.84–1.01; p = 0.084; I2 = 0%).
Conclusions
Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend toward worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.
Background and purposeWhether the off-hour effect has an impact on workflow and outcomes of endovascular treatment (EVT) for anterior circulation large vessel occlusion (AC-LVO) remains uncertain. ...This study aimed to compare the characteristics and outcomes of patients who presented or were treated during off-hour versus on-hour in a multi-center registry.MethodsAC-LVO patients from 21 centres were categorised into the off-hour group and the on-hour group. Off-hour (weekends, holidays, and 18:00–7:59 on weekdays) and on-hour (8:00–17:59 on weekdays except for holidays) were defined according to arrival and groin-puncture time points, respectively. Subgroup comparisons between patients both arrived and treated during off-hour (true off-hour) and on-hour (true on-hour) were performed. The primary outcome was the 90-day modified Rankin Scale (mRS) score. Secondary outcomes included favourable outcome (mRS 0–2 at 90 days), EVT-related time metrics, and other clinical outcomes. Ordinary and binary logistic regression and linear regression were taken to adjust for confounding factors.ResultsOf all 698 patients enrolled, 435 (62.3%) and 456 (65.3%) patients were categorised into the off-hour arrival and off-hour puncture group, respectively. Shorter onset to door time (adjusted ß coefficient: −21.56; 95% CI −39.96 to −3.16; p=0.022) was noted in the off-hour arrival group. Ordinal and dichotomous mRS scores at 90 days were comparable between the off-hour group and the on-hour group regardless of off-hour definitions. Other time metrics and outcomes were comparable between the two groups. Of 595 patients both presented and were treated during off-hour or on-hour, 394 patients were categorised into the true off-hour group and 201 into the true on-hour group. Time metrics and clinical outcomes were similar between the true off-hour and the true on-hour group.ConclusionsThe off-hour effect was not significant regarding clinical outcomes and in-hospital workflow in AC-LVO patients receiving EVT in this Chinese multicentre registry.
Crossostephium chinense is a common traditional Chinese medicinal plant used to cure arthralgia and rheumatism. The previous studies mainly focussed on its chemical compositions, with the genetic ...background and resources remaining scarce. Here, we conducted genome skimming for C. chinense, and using these data we not only assembled its complete chloroplast genome, but also reconstructed the phylogenetic relationship between C. chinense and Artemisia. The cp genomes of two C. chinense individuals ranged from 151,024 bp to 151,097 bp in length and had a typical quadripartite structure with a conserved genome arrangement. The cp genome encodes 114 unique genes, consisting of 80 protein-coding genes, 30 tRNA genes, and four rRNA genes, with 19 duplicated genes in the IR regions. Phylogenetic analysis indicates that C. chinense is sister to Artemisia annua and Artemisia fukudo.
Innate immunity is the first line of defense in the human body, and it plays an important role in defending against viral infection. Viruses are identified by different pattern-recognition receptors ...(PRRs) that activate the mitochondrial antiviral signaling protein (MAVS) or transmembrane protein 173 (STING), which trigger multiple signaling cascades that cause nuclear factor-kappaB (NF-kappaB) and interferon regulatory factor 3 (IRF3) to produce inflammatory factors and interferons (IFNs). PRRs play a pivotal role as the first step in pathogen induction of interferon production. Interferon elicits antiviral activity by inducing the transcription of hundreds of IFN-stimulated genes (ISGs) via the janus kinase (JAK)--signal transducer and activator of transcription (STAT) pathway. An increasing number of studies have shown that environmental, pathogen and host factors regulate the IFN signaling pathway. Here, we summarize the mechanisms of host factor modulation in IFN production via pattern recognition receptors. These regulatory mechanisms maintain interferon levels in a normal state and clear viruses without inducing autoimmune disease. Keywords: pattern recognition receptors, interferon-signaling pathway, host factors
Avian influenza A(H5N6) keeps evolving, causing outbreaks in birds and sporadic infections in human. Here, we report a fatal paediatric infection caused by a novel reassortant H5N6 virus. The patient ...was an obese 9‐year‐old girl. She initiated with fever and cough, then developed pneumonia, acute respiratory distress syndrome (ARDS) and respiratory failure. Lower respiratory tract aspirates and anal swabs were serially taken till the patient's death. Viral isolation, genome sequencing and phylogenetic analysis were conducted. A novel reassortant H5N6 virus was isolated from the patient. Except the PA gene, all other 7 genes of the virus belonged to H5N6 genotype A (S4‐like virus). The PA gene was probably obtained from Eurasian waterfowl influenza viruses. The H5N6 virus was consistently detected from the patient's respiratory samples till the 17th day after symptom onset, but not from anal swabs or urine sample by real‐time reverse transcription polymerase chain reaction (RT‐PCR). Significantly elevated (32‐fold) serum antibodies to H5N6 virus were observed during the patient's course of disease. Aside from the identified novel reassortant H5N6 viral strain, obesity, delayed confirmation of aetiology and specific antiviral treatment, and prolonged virus shedding could have contributed to the poor clinical outcome.
By acquiring two sets of tomographic measurements at distinct X-ray spectra, the dual-energy CT (DECT) enables quantitative material-specific imaging. However, the conventionally decomposed material ...basis images may encounter severe image noise amplification and artifacts, resulting in degraded image quality and decreased quantitative accuracy. Iterative DECT image reconstruction algorithms incorporating either the sinogram or the CT image prior information have shown potential advantages in noise and artifact suppression, but with the expense of large computational resource, prolonged reconstruction time, and tedious manual selections of algorithm parameters. To partially overcome these limitations, we develop a domain-transformation enabled end-to-end deep convolutional neural network (DIRECT-Net) to perform high quality DECT material decomposition. Specifically, the proposed DIRECT-Net has immediate accesses to mutual-domain data, and utilizes stacked convolution neural network (CNN) layers for noise reduction and material decomposition. The training data are numerically simulated based on the underlying physics of DECT imaging.The XCAT digital phantom, iodine solutions phantom, and biological specimen are used to validate the performance of DIRECT-Net. The qualitative and quantitative results demonstrate that this newly developed DIRECT-Net is promising in suppressing noise, improving image accuracy, and reducing computation time for future DECT imaging.
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