Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients

Background and Purpose: This study aims to explore the cause and predictive value of hyperchloremia in critically ill stroke patients.Materials and Methods: We conducted a retrospective study of a prospectively collected database of adult patients with first-ever acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) admitted to the neurointensive care unit (NICU) of a university-affiliated hospital, between January 2013 and December 2016. Patients were excluded if admitted beyond 72 h from onset, if they required neurocritical care for less than 72 h, and were treated with hypertonic saline within 72 h or had creatinine clearance less than 15 mL/min.Results: Of 405 eligible patients, the prevalence of hyperchloremia ([Cl−] ≥ 110 mmol/L) was 8.6% at NICU admission ([Cl−]0) and 17.0% within 72 h ([Cl−]max). Thirty-eight (9.4%) patients had new-onset hyperchloremia and 110 (27.1%) had moderate increase in chloride (Δ[Cl−] ≥ 5 mmol/L; Δ[Cl−] = [Cl−]max − [Cl−]0) in the first 72 h after admission, which were found to be determined by the sequential organ failure assessment score in multivariate logistic regression analysis. Neither total fluid input nor cumulative fluid balance had significant association with such chloride disturbance. New-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl−] were both associated with increased odds of 30-day mortality and 6-month poor outcome, although no independent significance was found in multivariate models.Conclusion: Hyperchloremia tends to occur in patients more severely affected by AIS and ICH. Although no independent association was found, new-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl−] were related to poorer outcome in critically ill AIS and ICH patients.Subject terms: clinical studies, intracranial hemorrhage, ischemic stroke, mortality/survival, quality and outcomes

Outcome Prediction by 40-Hz Steady-State Response After Large Hemispheric Infarction

Background and Purpose: The 40-Hz steady state response (SSR) reflects early sensory processing and has the potential to differentiate disease severity. This study aims to evaluate the predictive value of 40-Hz SSRs on the prognosis of patients with large hemispheric infarction (LHI).Methods: We conducted a retrospective study in patients with LHI admitted to the neurological intensive care unit (NICU) of Nanfang Hospital, Southern Medical University, Guangzhou, China, between June 2008 and December 2014. Forty-hertz SSRs were recorded within 72 h of onset and categorized into 3 grades. The correlation between 40-Hz SSR grading and clinical outcome was examined.Results: Of the 97 eligible participants, 41 (42.3%) died within 30 days and 68 (70.1%) exhibited a poor outcome (modified Rankin Scale of 5 and 6) at 90 days after the onset of LHI. We found that 40-Hz SSRs correlated significantly with NIHSS scores at admission and patient outcome. Moreover, Grade III 40-Hz SSR (bilateral sine waves that either disappeared or were not clearly identifiable) had a specificity of 97% and a positive predictive value of 94% in predicting 90-days poor outcome; Grade III 40-Hz SSR also had a specificity of 91% and a positive predictive value of 74% in predicting 30-days mortality.Conclusions: 40-Hz SSR could be used as a simple and specific method in predicting poor prognosis after LHI

Higher Risk of Stroke Is Correlated With Increased Opportunistic Pathogen Load and Reduced Levels of Butyrate-Producing Bacteria in the Gut

Objective: Gut microbiota is a newly identified risk factor for stroke, and there are no large prospective studies linking the baseline gut microbiome to long-term risk of stroke. We present here the correlation between the gut microbiota and stroke risk in people with no prior stroke history.Methods: A total of 141 participants aged ≥60 years without prior history of stroke were recruited and divided into low-risk, medium-risk, and high-risk groups based on known risk factors and whether they were suffering from chronic diseases. The composition of their gut microbiomes was compared using 16S rRNA gene amplicon next-generation-sequencing and Quantitative Insights into Microbial Ecology (QIIME) analysis. Levels of fecal short-chain fatty acids were measured using gas chromatography.Results: We found that opportunistic pathogens (e.g., Enterobacteriaceae and Veillonellaceae) and lactate-producing bacteria (e.g., Bifidobacterium and Lactobacillus) were enriched, while butyrate-producing bacteria (e.g., Lachnospiraceae and Ruminococcaceae) were depleted, in the high-risk group compared to the low-risk group. Butyrate concentrations were also lower in the fecal samples obtained from the high-risk group than from the low-risk group. The concentrations of other short-chain fatty acids (e.g., acetate, propionate, isobutyrate, isovalerate, and valerate) in the gut were comparable among the three groups.Conclusion: Participants at high risk of stroke were characterized by the enrichment of opportunistic pathogens, low abundance of butyrate-producing bacteria, and reduced concentrations of fecal butyrate. More researches into the gut microbiota as a risk factor in stroke should be carried out in the near future

Strategies for synthesizing human milk lacto-N-fucopentaoses oligosaccharides

Lacto-N-fucopentaoses (LNFPs) of type I to V are representative components of human milk oligosaccharides (HMOs) and have garnered increasing attention due to their multi-functional activities. These activities include regulating intestinal flora, resisting pathogen adhesion, and promoting the development and repair of the nervous system. Due to the limited resource of HMOs, artificial synthesis of HMOs can provide an alternative pathway to circumvent this limitation. Currently, LNFPs can be produced using various methods, including biosynthesis, chemical synthesis, and enzymatic synthesis. Currently, emphasis is placed on the last two methods. Chemical synthesis-based methods typically involve strict reaction conditions, cumbersome steps, and low yields. On the other hand, enzymatic synthesis offers several advantages, including mild reaction conditions, high yield, and good selectivity. However, only a few reports have focused on in vivo fermentation as a means to produce LNFPs, despite its cost advantage. In vivo fermentation presents an opportunity to supply the key substrates for fucosyl transfer reactions, namely LNnT and GDP-Fuc, along with the required biosynthesis enzymes. Further exploration of this approach is warranted.This paper aims to review the synthesis methods of LNFPs, their functional activities, and emerging trends in their development. By evaluating the different synthesis approaches, this review seeks to contribute to the advancement of LNFPs production and utilization

Draft genome sequence of extremely acidophilic bacterium Acidithiobacillus ferrooxidans DLC-5 isolated from acid mine drainage in Northeast China

Acidithiobacillus ferrooxidans type strain DLC-5, isolated from Wudalianchi in Heihe of Heilongjiang Province, China. Here, we present the draft genome of strain DLC-5 which contains 4,232,149 bp in 2745 contigs with 57.628% GC content and includes 32,719 protein-coding genes and 64 tRNA-encoding genes. The genome sequence can be accessed at DDBJ/EMBL/GenBank under the accession no. JNNH00000000.1

Structure-immunomodulatory activity relationships of dietary polysaccharides

Polysaccharides are usually composed of more than ten monosaccharide units, which are connected by linear or branched glycosidic bonds. The immunomodulatory effect of natural polysaccharides is one of the most important bioactive function. In this review, molecular weight, monosaccharide (including galactose, mannose, rhamnogalacturonan-I arabinogalactan and uronic acid), functional groups (namely sulfate, selenium, and acetyl groups), types of glycoside bond connection (including 13-1,3-D-glucosyl, alpha-1,4-D-glucosyl, 13-1,4-D-glucosyl, alpha-1,6-D-glucosyl, 13-1,4-D-mannosyl, and 13-1,4-D-Xylopyranosyl), conformation and the branching degrees are systematically identified as their contribution to the immunostimulatory activity of polysaccharides. At present, studies on the structure-activity relationships of polysaccharides are limited due to their low purity and high heterogeneity. However, it is an important step in providing useful guidance for dietary supplements with polysaccharides. The chemical structures and the process of immune responses induced are necessary to be discussed. Polysaccharides may bind with the cell surface receptors to modulate immune responses. This review mainly discusses the structure-activity relationship of dietary polysaccharides

Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study

Background: Generalized convulsive status epilepticus (GCSE) is one of the most challenging life-threatening neurological emergencies. If GCSE becomes super-refractory, it is associated with significant mortality. Although aggressive management of prolonged status epilepticus was conducted, the mortality has not decreased since the late 1990s. Objectives: The present study aimed to explore the risk factors for progression to super-refractory in patients with generalized convulsive status epilepticus (GCSE). Moreover, we illustrated the risk factors for mortality in GCSE patients. Design: An observational retrospective cohort study. Methods: We conducted a retrospective study of patients with GCSE admitted to our neurocritical unit, in Guangzhou, China, from October 2010 to February 2021. The data of sociodemographic information, etiology, laboratory results, treatment, and prognosis were collected and analyzed. Results: A total of 106 patients were enrolled; 51 (48%) of them developed super-refractory status epilepticus (SRSE). Multivariate logistic regression analysis demonstrated that patients with autoimmune encephalitis ( p  = 0.015) and intracranial infection ( p  = 0.019) are likely to progress to SRSE. The in-hospital mortality was 11.8% and 9.1% for patients in the SRSE and non-SRSE groups, respectively ( p  = 0.652). Multivariate logistic regression analysis showed that neutrophil-to-lymphocyte ratios (NLR) at admission were independently associated with in-hospital mortality. Up to 31.4% of SRSE patients and 29.1% of non-SRSE patients died within 6 months after discharge ( p  = 0.798). Multivariate logistic regression analysis showed that plasma exchange (PE) was a protective factor for 6-month mortality. A high NLR at discharge was a risk factor for 6-month mortality. Conclusion: In the current study, about 48% of GCSE patients progressed to SRSE. Regarding etiology, autoimmune encephalitis or intracranial infection was prone to SRSE. No significant differences were observed in the in-hospital and 6-month mortality between SRSE and non-SRSE groups. Multivariate logistic regression analysis showed that NLR at admission and discharge was an independent predictor of in-hospital and 6-month mortality, respectively. Moreover, PE significantly reduced the 6-month mortality

Table_1_Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients.DOCX

<p>Background and Purpose: This study aims to explore the cause and predictive value of hyperchloremia in critically ill stroke patients.</p><p>Materials and Methods: We conducted a retrospective study of a prospectively collected database of adult patients with first-ever acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) admitted to the neurointensive care unit (NICU) of a university-affiliated hospital, between January 2013 and December 2016. Patients were excluded if admitted beyond 72 h from onset, if they required neurocritical care for less than 72 h, and were treated with hypertonic saline within 72 h or had creatinine clearance less than 15 mL/min.</p><p>Results: Of 405 eligible patients, the prevalence of hyperchloremia ([Cl⁻] ≥ 110 mmol/L) was 8.6% at NICU admission ([Cl⁻]₀) and 17.0% within 72 h ([Cl⁻]_max). Thirty-eight (9.4%) patients had new-onset hyperchloremia and 110 (27.1%) had moderate increase in chloride (Δ[Cl⁻] ≥ 5 mmol/L; Δ[Cl⁻] = [Cl⁻]_max − [Cl⁻]₀) in the first 72 h after admission, which were found to be determined by the sequential organ failure assessment score in multivariate logistic regression analysis. Neither total fluid input nor cumulative fluid balance had significant association with such chloride disturbance. New-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl⁻] were both associated with increased odds of 30-day mortality and 6-month poor outcome, although no independent significance was found in multivariate models.</p><p>Conclusion: Hyperchloremia tends to occur in patients more severely affected by AIS and ICH. Although no independent association was found, new-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl⁻] were related to poorer outcome in critically ill AIS and ICH patients.</p><p>Subject terms: clinical studies, intracranial hemorrhage, ischemic stroke, mortality/survival, quality and outcomes.</p