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

Partial dehulling increases the energy content and nutrient digestibility of barley in growing pigs

Objective The hull attached to the barley kernel can be mechanically removed thus reducing the fiber content of the barley. This experiment was carried out to evaluate the effects of partial dehulling on the nutrient digestibility as well as the digestible energy (DE) and metabolizable energy (ME) content of barley in pigs. Methods Two hulled barley samples (high fiber barley [HF] and low fiber barley [LF]) with either high or low fiber contents were obtained from the Hubei and Jiangsu Provinces of China. A portion of the two barleys was mechanically dehulled (dehulled high fiber barley [DHF] and dehulled low fiber barley [DLF]). Thirty barrows (initial BW = 31.5±3.2 kg) were assigned to one of five diets in a randomized complete block design. The five diets consisted of 96.9% corn, HF, LF, DHF, or DLF supplemented with 3.1% minerals and vitamins. Each diet was fed to six barrows housed in individual metabolism crates for a 10-d acclimation period followed by a 5-day total but separate collection of feces and urine. Results The daily loss of gross energy (GE) in feces was lower (p<0.01) for pigs fed DHF than for those fed HF. The daily N intake and fecal N loss were lowest (p<0.01) for pigs fed the corn diet. The DE and ME as well as the apparent total tract digestibility (ATTD) of dry matter, GE, organic matter, neutral detergent fiber (NDF) and acid detergent fiber (ADF) of DHF or DLF were higher (p<0.01) than the values in HF and LF, respectively while the values except the ATTD of NDF and ADF in DLF were higher (p<0.01) than the values in DHF and were comparable to corn. Conclusion The DE and ME contents as well as the ATTD of nutrients in both DHF and DLF barley were improved compared with the HF and LF barley. Moreover, the nutritive value of DLF barley was comparable to the yellow-dent corn used in the study

Effects of dietary valine:lysine ratio on the performance, amino acid composition of tissues and mRNA expression of genes involved in branched-chain amino acid metabolism of weaned piglets

Objective The goal of this study was to investigate the effects of dietary standard ileal digestible (SID) valine:lysine ratios on performance, intestinal morphology, amino acids of liver and muscle, plasma indices and mRNA expression of branched-chain amino acid (BCAA) metabolism enzymes. Methods A total of 144 crossbred pigs (Duroc×Landrace×Large White) weaned at 28±4 days of age (8.79±0.02 kg body weight) were randomly allotted to 1 of 4 diets formulated to provide SID valine:lysine ratios of 50%, 60%, 70%, or 80%. Each diet was fed to 6 pens of pigs with 6 pigs per pen (3 gilts and 3 barrows) for 28 days. Results Average daily gain increased quadratically (p<0.05), the villous height of the duodenum, jejunum and ileum increased linearly (p<0.05) as the SID valine:lysine ratio increased. The concentrations of plasma α-keto isovaleric and valine increased linearly (p<0.05), plasma aspartate, asparagine and cysteine decreased (p<0.05) as the SID valine:lysine ratio increased. An increase in SID lysine:valine levels increased mRNA expression levels of mitochondrial BCAA transaminase and branched-chain α-keto acid dehydrogenase in the longissimus dorsi muscle (p<0.05). Conclusion Using a quadratic model, a SID valine:lysine ratio of 68% was shown to maximize the growth of weaned pigs which is slightly higher than the level recommended by the National Research Council [6]

Comparative energy content and amino acid digestibility of barley obtained from diverse sources fed to growing pigs

Objective Two experiments were conducted to determine the content of digestible energy (DE) and metabolizable energy (ME) as well as the apparent ileal digestibility (AID) and standardized ileal digestibility (SID) of crude protein (CP) and amino acids (AA) in barley grains obtained from Australia, France or Canada. Methods In Exp. 1, 18 growing barrows (Duroc×Landrace×Yorkshire; 31.5±3.2 kg) were individually placed in stainless-steel metabolism crates (1.4×0.7×0.6 m) and randomly allotted to 1 of 3 test diets. In Exp. 2, eight crossbred pigs (30.9±1.8 kg) were allotted to a replicate 3×4 Youden Square designed experiment with three periods and four diets. Two pigs received each diet during each test period. The diets included one nitrogen-free diet and three test diets. Results The relative amounts of gross energy (GE), CP, and all AA in the Canadian barley were higher than those in Australian and French barley while higher concentrations of neutral detergent fiber, acid detergent fiber, total dietary fiber, insoluble dietary fiber and β-glucan as well as lower concentrations of GE and ether extract were observed in the French barley compared with the other two barley sources. The DE and ME as well as the SID of histidine, isoleucine, leucine and phenylalanine in Canadian barley were higher (p<0.05) than those in French barley but did not differ from Australian barley. Conclusion Differences in the chemical composition, energy content and the SID and AID of AA were observed among barley sources obtained from three countries. The feeding value of barley from Canada and Australia was superior to barley obtained from France which is important information in developing feeding systems for growing pigs where imported grains are used

Dietary maifanite supplementation did not affect the apparent total tract digestibility of calcium and phosphorus in growing pigs

Objective This study was conducted to determine the effects of dietary maifanite supplementation and fecal collection method on the apparent total tract digestibility (ATTD) of calcium (Ca) and phosphorus (P) and blood parameters in growing pigs. Methods Thirty-six growing barrows (Duroc×Landrace×Yorkshire; 27.0±2.6 kg) were allotted to six dietary treatments with 6 pigs per treatment according to body weight in a completely randomized design. The experimental treatments were: i) Low Ca+cornstarch (2.25%), ii) Low Ca+maifanite (2.25%), iii) Medium Ca+cornstarch (1.42%), iv) Medium Ca+maifanite (1.42%), v) High Ca+cornstarch (0.64%), and vi) High Ca+maifanite (0.64%). Feces were collected by the total collection (TC) and indicator method (IM). At the beginning and the end of the experiment, blood samples were collected from each pig. Results For the TC method, there were no difference in Ca intake, fecal Ca output, Ca retention and the ATTD of Ca between cornstarch and maifanite diets at the same dietary Ca level. However, urinary Ca excretion was lower (p = 0.01) in pigs fed low Ca diets without maifanite supplementation compared with other dietary treatments. Dietary maifanite supplementation had no effect on the P metabolism in growing pigs. For the IM method, there was no difference in Ca digestibility between cornstarch and maifanite diets at the same dietary Ca level. The ATTD of P was greater (p<0.01) in pigs fed the high Ca diet with maifanite supplementation compared with the high Ca diet with cornstarch treatment. Dietary inclusion of maifanite had no effect on blood parameters in growing pigs. Conclusion Dietary maifanite supplementation had no effect on the ATTD of Ca and P and serum parameters in growing pigs. The IM resulted in lower digestibility values than the TC method

Evaluation of energy digestibility and prediction of digestible and metabolisable energy in sunflower seed meal fed to growing pigs

The experiment was conducted to determine the chemical composition, digestible energy (DE), metabolisable energy (ME) and the apparent total tract digestibility (ATTD) in sunflower seed meal (SFSM) and to develop reasonable prediction equations for estimating energy digestibility based on chemical composition of these meals for growing pigs. Ten SFSMs were collected and 66 crossbred barrows (initial body weight=36.43±5.25 kg) were randomly allocated to one of eleven diets. The basal diet was based on corn and soybean meal which contained 82.2% corn, 14.8% de-hulled soybean meal and 3% premix. The test diets contained 30% SFSM at the expense of corn and soybean meals. The experiment comprised a 7-d adaptation period followed by a 5-d collection period of faecal matter and urine. On a dry matter (DM) basis, the content of crude protein, neutral and acid detergent fibre, and gross energy (GE) ranged from 29.33 to 39.09%, 38.15 to 55.40%, 24.59 to 37.34% and 18.65 to 21.50 MJ/kg, respectively. The concentration of DE and ME ranged from 10.51 to 12.47 MJ/kg and 10.26 to 12.16 MJ/kg of DM, respectively. The DE values and ATTD of GE among the ten SFSMs significantly differed (P10%) among the ten SFSMs (DM). The results of DE, ME and prediction equations could be applied to evaluate the energy digestibility of SFSM in growing pigs

Hippolachnin A, a New Antifungal Polyketide from the South China Sea Sponge <i>Hippospongia lachne</i>

Hippolachnin A (<b>1</b>), a polyketide possessing an unprecedented carbon skeleton with a four-membered ring, was isolated from the South China Sea sponge <i>Hippospongia lachne</i>. The structure was elucidated using MS and NMR spectroscopic analyses, and the absolute configuration was determined using a calculated ECD method. Hippolachnin A demonstrated potent antifungal activity against three pathogenic fungi, <i>Cryptococcus neoformans</i>, <i>Trichophyton rubrum</i>, and <i>Microsporum gypseum</i>, with a MIC value of 0.41 μM for each fungus