Dual Antiplatelet Therapy vs Alteplase for Patients With Minor Nondisabling Acute Ischemic Stroke

Importance Intravenous thrombolysis is increasingly used in patients with minor stroke, but its benefit in patients with minor nondisabling stroke is unknown. Objective To investigate whether dual antiplatelet therapy (DAPT) is noninferior to intravenous thrombolysis among patients with minor nondisabling acute ischemic stroke. Design, Setting, and Participants This multicenter, open-label, blinded end point, noninferiority randomized clinical trial included 760 patients with acute minor nondisabling stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤5, with ≤1 point on the NIHSS in several key single-item scores; scale range, 0-42). The trial was conducted at 38 hospitals in China from October 2018 through April 2022. The final follow-up was on July 18, 2022. Interventions Eligible patients were randomized within 4.5 hours of symptom onset to the DAPT group (n = 393), who received 300 mg of clopidogrel on the first day followed by 75 mg daily for 12 (±2) days, 100 mg of aspirin on the first day followed by 100 mg daily for 12 (±2) days, and guideline-based antiplatelet treatment until 90 days, or the alteplase group (n = 367), who received intravenous alteplase (0.9 mg/kg; maximum dose, 90 mg) followed by guideline-based antiplatelet treatment beginning 24 hours after receipt of alteplase. Main Outcomes and Measures The primary end point was excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 (range, 0-6), at 90 days. The noninferiority of DAPT to alteplase was defined on the basis of a lower boundary of the 1-sided 97.5% CI of the risk difference greater than or equal to −4.5% (noninferiority margin) based on a full analysis set, which included all randomized participants with at least 1 efficacy evaluation, regardless of treatment group. The 90-day end points were assessed in a blinded manner. A safety end point was symptomatic intracerebral hemorrhage up to 90 days. Results Among 760 eligible randomized patients (median [IQR] age, 64 [57-71] years; 223 [31.0%] women; median [IQR] NIHSS score, 2 [1-3]), 719 (94.6%) completed the trial. At 90 days, 93.8% of patients (346/369) in the DAPT group and 91.4% (320/350) in the alteplase group had an excellent functional outcome (risk difference, 2.3% [95% CI, −1.5% to 6.2%]; crude relative risk, 1.38 [95% CI, 0.81-2.32]). The unadjusted lower limit of the 1-sided 97.5% CI was −1.5%, which is larger than the −4.5% noninferiority margin (P for noninferiority <.001). Symptomatic intracerebral hemorrhage at 90 days occurred in 1 of 371 participants (0.3%) in the DAPT group and 3 of 351 (0.9%) in the alteplase group. Conclusions and Relevance Among patients with minor nondisabling acute ischemic stroke presenting within 4.5 hours of symptom onset, DAPT was noninferior to intravenous alteplase with regard to excellent functional outcome at 90 days. Trial Registration ClinicalTrials.gov Identifier: NCT0366141

Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke

Importance Dual antiplatelet therapy has been demonstrated to be superior to single antiplatelet in reducing recurrent stroke among patients with transient ischemic attack or minor stroke, but robust evidence for its effect in patients with mild to moderate ischemic stroke is lacking. Objective To evaluate whether dual antiplatelet therapy is superior to single antiplatelet among patients with mild to moderate ischemic stroke. Design, Setting, and Participants This was a multicenter, open-label, blinded end point, randomized clinical trial conducted at 66 hospitals in China from December 20, 2016, through August 9, 2022. The date of final follow-up was October 30, 2022. The analysis was reported on March 12, 2023. Of 3065 patients with ischemic stroke, 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were enrolled, after excluding 65 patients who did not meet eligibility criteria or had no randomization outcome. Interventions Within 48 hours after symptom onset, patients were randomly assigned to receive clopidogrel plus aspirin (n = 1541) or aspirin alone (n = 1459) in a 1:1 ratio. Main Outcomes and Measures The primary end point was early neurologic deterioration at 7 days, defined as an increase of 2 or more points in National Institutes of Health Stroke Scale (NIHSS) score, but not as a result of cerebral hemorrhage, compared with baseline. The superiority of clopidogrel plus aspirin to aspirin alone was assessed based on a modified intention-to-treat population, which included all randomized participants with at least 1 efficacy evaluation regardless of treatment allocation. Bleeding events were safety end points. Results Of the 3000 randomized patients, 1942 (64.6%) were men, the mean (SD) age was 65.9 (10.6) years, median (IQR) NIHSS score at admission was 5 (4-6), and 1830 (61.0%) had a stroke of undetermined cause. A total of 2915 patients were included in the modified intention-to-treat analysis. Early neurologic deterioration occurred in 72 of 1502 (4.8%) in the dual antiplatelet therapy group vs 95 of 1413 (6.7%) in the aspirin alone group (risk difference −1.9%; 95% CI, −3.6 to −0.2; P = .03). Similar bleeding events were found between 2 groups. Conclusions and Relevance Among Chinese patients with acute mild to moderate ischemic stroke, clopidogrel plus aspirin was superior to aspirin alone with regard to reducing early neurologic deterioration at 7 days with similar safety profile. These findings indicate that dual antiplatelet therapy may be a superior choice to aspirin alone in treating patients with acute mild to moderate stroke.Trial RegistrationClinicalTrials.gov Identifier: NCT0286900

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Temperature Effect Study on Growth and Survival of Pathogenic Vibrio parahaemolyticus in Jinjiang Oyster (Crassostrea rivularis) with Rapid Count Method

The growth of Vibrio parahaemolyticus (V. parahaemolyticus) in oysters during postharvest storage increases the possibility of its infection in humans. In this work, to investigate the growth or survival profiles in different media, pathogenic V. parahaemolyticus in APW, Jinjiang oyster (JO, Crassostrea rivularis) slurry, and live JO were studied under different temperatures. All the strain populations were counted through our double-layer agar plate (DLAP) method. In APW, the pathogenic V. parahaemolyticus showed continuous growth under 15, 25, and 35°C, while a decline in behavior was displayed under 5°C. The similar survival trend of pathogenic V. parahaemolyticus in JO slurry and live JO was observed under 5, 25, and 35°C, except the delayed growth or decline profile compared to APW. Under 15°C, they displayed decline and growth profile in JO slurry and live JO, respectively. These results indicate the different sensitivity of pathogenic V. parahaemolyticus in these matrices to temperature variation. Furthermore, nonpathogenic V. parahaemolyticus displayed little difference in survival profiles when inoculated in live JO under corresponding temperatures. The results indicate that inhibition or promotion effect could be regulated under different storage temperature for both pathogenic and nonpathogenic strains. Besides, the DLAP method showed the obvious quickness and efficiency during the bacteria count

Temperature Effect Study on Growth and Survival of Pathogenic Vibrio parahaemolyticus in Jinjiang Oyster (Crassostrea rivularis) with Rapid Count Method

The growth of Vibrio parahaemolyticus (V. parahaemolyticus) in oysters during postharvest storage increases the possibility of its infection in humans. In this work, to investigate the growth or survival profiles in different media, pathogenic V. parahaemolyticus in APW, Jinjiang oyster (JO, Crassostrea rivularis) slurry, and live JO were studied under different temperatures. All the strain populations were counted through our double-layer agar plate (DLAP) method. In APW, the pathogenic V. parahaemolyticus showed continuous growth under 15, 25, and 35°C, while a decline in behavior was displayed under 5°C. The similar survival trend of pathogenic V. parahaemolyticus in JO slurry and live JO was observed under 5, 25, and 35°C, except the delayed growth or decline profile compared to APW. Under 15°C, they displayed decline and growth profile in JO slurry and live JO, respectively. These results indicate the different sensitivity of pathogenic V. parahaemolyticus in these matrices to temperature variation. Furthermore, nonpathogenic V. parahaemolyticus displayed little difference in survival profiles when inoculated in live JO under corresponding temperatures. The results indicate that inhibition or promotion effect could be regulated under different storage temperature for both pathogenic and nonpathogenic strains. Besides, the DLAP method showed the obvious quickness and efficiency during the bacteria count

Experimental study on fluid migration mechanism related to Pb-Zn super-enrichment: Implications for mineralisation mechanisms of the Pb-Zn deposits in the Sichuan-Yunnan-Guizhou, SW China

similar to This study focuses on the problem of Pb-Zn super-enrichment, and is based on a new conceptualisation of fluid-rock interactions -> change in fluid properties -> Pb-Zn hydrolysis -> complex instability. Non-magmatic, epigenetic, hydrothermal Pb-Zn deposits in carbonates were used to perform Pb-Zn hydrolysis experiments under normal pressure. Lead-zinc fluid and carbonate interaction experiments, as well as Pb-Zn hydrolysis kinetics experiments during fluid-rock interaction, were performed analyse the roles of pH and fluid-rock interactions in Pb-Zn transport and precipitation, and to investigate the main reasons for the grade disparity between Mississippi Valley-type (MVT) deposits and Pb-Zn deposits found in the Sichuan-Yunnan-Guizhou region of China. Our results show that a pH = 4 is the threshold value for the large-scale hydrolysis of Pb and Zn. When reactions between acidic solutions containing Pb and Zn (pH = 1.0-6.0) and carbonate rocks (i.e., the surrounding rock) reach equilibrium, the final pH of the solution stabilises at 5.2-6.2, which is not associated with the lithology of the surrounding carbonate rocks (dolomite or limestone), crystallite size or the initial pH of the solution, and is negatively correlated with rock particle size. Fluid-rock interactions cause pH to increase, Pb and Zn to partially hydrolysis, and minerals to precipitate, with the maximum precipitation rate reaching similar to 20%. When hydroxide precipitates are mixed with fluids containing reduced S, the precipitates are converted into sulphides. Thus, mineralisation fluid pH, the driving force of fluid migration, Pb-Zn hydrolysis, and fluid-rock interactions combine to restrict the formation of Pb-Zn deposits in carbonates. Among these factors, differences in Pb-Zn hydrolysis are the main causes of disparities among deposit grades. This study not only provides an in-depth consideration of the geochemical behaviour of Pb and Zn in a carbonate-hosted hydrothermal system, but also serves to clarify the mineralisation mechanisms of Pb-Zn deposits in the Sichuan-Yunnan-Guizhou region

VR-10 Thrombospondin-1 Synthetic Polypeptide’s Impact on Rhesus Choroid-Retinal Endothelial Cells

Background/Aims: This study aimed to investigate the effects of the VR-10 TSP-1 synthetic polypeptide on cytokines and the proliferation and migration of endothelial cells, as well as exploring a new method for anti-ocular neoangiogenesis. Methods: We measured the proliferation of RF/6A cells by an MTT assay and investigated the migration of RF/6A cells by a Transwell chamber assay. We examined the mRNA transcript levels of TGF-β2, VEGF, PEDF, Bcl-2 and FasL in RF/6A cells by RT-PCR and evaluated the expression of Fas and caspase-3 proteins in RF/6A cells by western blot analysis. Results: 1. TSP-1 (1 µg/ml) and synthetic peptide VR-10 (0.1 µg/ml, 1 µg/ml and 10 µg/ml) inhibited the proliferation of RF/6A cells in a time and dose-dependent way. 2. TSP-1 and synthetic peptide VR-10 could inhibit the migration of RF/6A cells in a Transwell chamber (P < 0.001). It was demonstrated that 10 µg/ml synthetic peptide VR-10 had the strongest effect. 3. The expression of TGF-β2 mRNA in RF/6A cells increased after treatment with 1 µg/ml TSP-1 (P < 0.0001). However, there was no significant difference between the synthetic peptide VR-10 and the control group (P > 0.05). Expression of PEDF mRNA in RF/6A cells was increased after treatment with 1 µg/ml TSP-1 and synthetic peptide VR-10. We demonstrated that 10 µg/ml synthetic peptide VR-10 had the strongest effect (P < 0.001). There were significant differences between groups (P < 0.001). Expression of TGF-β2 mRNA in RF/6A cells increased after treatment with 1 µg/ml TSP-1 (P = 0.000). There was no significant difference between the synthetic peptide VR-10 and the control group (P > 0.05). PEDF mRNA expression in RF/6A cells decreased after 1 µg/ml TSP-1 and synthetic peptide VR-10 therapy, among which 10 µg/ml synthetic peptide VR-10 demonstrated the strongest effect (P < 0.001). There were significant differences between groups (P < 0.001), except for the 1 µg/ml synthetic peptide VR-10 and 1 µg/ml synthetic peptide VR-10 groups (P = 0.615). 4. Compared with the control group, FasL mRNA expression was significantly increased in the 10 µg/ml synthetic peptide VR-10 treatment group; however, Bcl-2 mRNA expression was decreased. 5. Western blotting showed that RF/6A cells in the control group mainly expressed the 32 kD procaspase-3 forms. For the 10 µg/ml synthetic peptide, VR-10 treatment group, it showed decreased expression of procaspase-3 (32 kD) and concomitant increased expression of its shorter pro apoptotic forms (20 kD). Compared with the control group, Fas protein expression significantly increased in the 10 µg/ml synthetic peptide VR-10 treatment group. Conclusions: Synthetic peptide VR-10 had an inhibitory action on the proliferation and migration of RF/6A cells. VR-10 inhibited angiogenesis by its combined actions, which included up-regulating the expression of an anti-angiogenesis gene, namely, pigment epithelium-derived factor (PEDF), down-regulating the expression of the pro-angiogenic vascular endothelial growth factor (VEGF), and mediated endothelial cell apoptosis

Percutaneous Ventricular Restoration Therapy Using the Parachute Device in Chinese Patients with Ischemic Heart Failure: Three-Month Primary End-point Results of PARACHUTE China Study

Background: The primary cause of ischemic heart failure (HF) is myocardial infarction (MI) resulting in left ventricle (LV) wall motion abnormality secondary to ventricular remodeling. A prospective, nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device (CardioKinetix, Inc., CA, USA) in ischemic HF patients as a result of LV remodeling after anterior wall MI. Methods: Thirty-one patients with New York Heart Association (NYHA) Class II, III ischemic HF, ejection fraction between 15% and 40%, and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014. The Parachute device was implanted through femoral artery. All patients received low-dose aspirin and anticoagulation with warfarin for at least 12 months postdevice implantation. The primary end-point was the assessment of efficacy as measured by the reduction in LV end-systolic volume index (LVESVI) against baseline LVESVI at 3 months postdevice implantation, determined by the echocardiography and measured by echocardiography core laboratory. Quality of life was assessed using EQ-5D and visual analog scale (VAS). For quantitative data comparison, paired t-test (normality data) and signed-rank test (abnormality data) were used; application of signed-rank test was for the ranked data comparison. Results: A change in LVESVI as measured by echocardiography from the preimplant baseline to 3-month postdevice implantation revealed a statistically significant reduction from 77.5 ± 20.0 ml/m2 to 53.1 ± 17.0 ml/m2 (P < 0.0001). The trial met its primary end-point. Of the 31 patients, the procedural success was 96.8%. Overall, NYHA HF class assessment results showed an improvement of more than half a class at 3 months (P < 0.001). Quality of life assessed by the VAS value increased 11.5 points (P < 0.01), demonstrating improvement at 3 months. Conclusion: The favorable outcomes observed in the high-risk patients provide reassuring safety and efficacy data to support adoption of this technology as a therapeutic option for ischemic HF patients. Trial Registration: ClinicalTrials.gov, NCT02240940; https://clinicaltrials.gov/ct2/show/NCT02240940