Associations between low-density lipoprotein cholesterol and haemorrhagic stroke

OBJECTIVE To investigate the associations between the blood concentrations of low-density lipoprotein cholesterol(LDL-C)and the clinical features of haemorrhagic stroke.METHODS This study analysed the data from patients with acute haemorrhagic stroke at a comprehensive stroke centre from 2013 to 2018.Patients were stratified into three groups according to their baseline LDL-C levels:<70,70 to<100 and≥100 mg/dL.We used multivariate logistic regression models to analyse the associations between LDL-C and the risks of having severe neurological deficits(National Institute Health Stroke Scale[NIHSS]scores≥15)and unfavourable outcomes(modified Rankin Scale[mRS]scores>2)at discharge.RESULTS Six-hundred and six patients were analysed.Their median age was 58 years.Among the patients,75(12%)patients had LDL-C levels<70 mg/dL,194(32%)patients had LDL-C levels between 70 to<100 mg/dL and the other 337(56%)patients had LDL-C levels≥100 mg/dL.Patients with higher LDL-C levels were less likely to suffer severe neurological deficits(LDL-C:70 to<100 vs.<70 mg/dL,adjusted odds ratio[OR]:0.29,95%CI:0.15–0.57;LDL-C:≥100 vs.<70 mg/dL,adjusted OR=0.27,95%CI:0.15–0.51)and to have unfavourable outcomes at discharge(LDL-C:70 to<100 vs.<70 mg/dL,adjusted OR=0.50,95%CI:0.29–0.87 and LDL-C:≥100 vs.<70 mg/dL,adjusted OR=0.46,95%CI:0.28–0.78).CONCLUSIONS An LDL-C level<70 mg/dL was independently associated with severe neurological deficits of haemorrhagic stroke and may increase the risks of unfavourable outcomes at discharge.

Rationale and Study Design for a Single-Arm Phase Ila Study Investigating Feasibility of Preventing Ischemic Cerebrovascular Events in High-Risk Patients with Acute Non-disabling Ischemic Cerebrovascular Events Using Remote Ischemic Conditioning

Background：Acute minor ischemic stroke （AMIS） or transient ischemic attack （TIA） is a common cerebrovascular event with a considerable high recurrence.Prior research demonstrated the effectiveness of regular long-term remote ischemic conditioning （RIC） in secondary stroke prevention in patients with intracranial stenosis.We hypothesized that RIC can serve as an effective adjunctive therapy to pharmacotherapy in preventing ischemic events in patients with AMIS/TIA.This study aimed to investigate the feasibility,safety,and preliminary efficacy of daily RIC in inhibiting cerebrovascular/cardiovascular events after AMIS/TIA.Methods：This is a single-arm,open-label,multicenter Phase IIa futility study with a sample size of 165.Patients with AMIS/TIA receive RIC as an additional therapy to secondary stroke prevention regimen.RIC consists of five cycles of 5-min inflation （200 mmHg） and 5-min deflation of cuffs on bilateral upper limbs twice a day for 90 days.The antiplatelet strategy is based on individual physician＇s best practice：aspirin alone,clopidogrel alone,or combination of aspirin and clopidogrel.We will assess the recurrence rate of ischemic stroke/TIA within 3 months as the primary outcomes.Conclusions：The data gathered from the study will be used to determine whether a further large-scale,multicenter randomized controlled Phase Ⅱ trial is warranted in patients with AMIS/TIA.Trial Registration：ClinicalTrials.gov,NCT03004820;https：//www.clinicaltrials.gov/ct2/show/NCT03004820.

Clinical Features of Patients with Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders

Background： Neuromyelitis optica spectrum disorder （NMOSD） was long believed to be an aggressive form of multiple sclerosis （MS）. This study aimed to describe the clinical features of patients with MS and NMOSD to assist in differential diagnoses in clinical practice. Methods： Data including the patients＇ serum and cerebrospinal fluid （CSF） tests, image findings, and clinical information from 175 patients with MS or NMOSD at Xuanwu Hospital, Capital Medical University from November 2012 to May 2014 were collected and analyzed retrospectively. An enzyme-linked immunosorbent assay was performed to detect the myelin oligodendrocyte glycoprotein （MOG） autoantibodies in CSF and serum. Cell-based assays were used to detect aquaporin-4-antibody （AQP4-Ab）. The Chi-square test was used to compare the categorical variables. Wilcoxon rank sum test was peribrmed to analyze the continuous variables. Results： Totally 85 MS patients （49%） and 90 NMOSD patients （51%） were enrolled, including 124 （71%） women and 51 （29%） men. Fewer MS patients （6%） had autoinamune diseases compared to NMOSD （19%） （x2= 6.9, P 〈 0.01 ）. Patients with NMOSD had higher Expanded Disability Status Scale scores （3.5 [3]） than MS group （2 [2]） （x2= -3.69, P 〈 0.01）. The CSF levels of white cell count and protein in both two groups were slightly elevated titan the normal range, without significant difference between each other. Positivity of serum AQP4-Ab in NMOSD patients was higher than that in MS patients （MS： 0, NMOSD： 67%; x2= 63.9, P 〈 0.01 ）. Oligoclonal bands in CSF among NMOSD patients were remarkably lower than that among MS （MS： 59%, NMOSD： 20%; x2= 25.7, P 〈 0.01）. No significant difference of MOG autoantibodies was found between the two groups. Conclusion： The different CSF features combined with clinical, magnetic resonance imaging, and serum characteristics between Chinese patients with MS and NMOSD could assist in the differential diagnosis.

Microstructure Variation of Pellets Containing Ferrous Dust during Carbonation Consolidation

The carbonation and microstructure characteristics of pellets containing ferrous dusts were investigated during carbonation consolidation at differem reaction temperatures and CO2 partial pressures. The results indicated that green pellets had loose and network supporting structure with initial strength, and large cracks and pores existed in the pellets. The carbonation reaction was controlled by interracial chemical reaction at the initial fast stage, which limited diffusion and thus caused the reaction rate to decrease. With increasing reaction temperature and CO2 partial pressure, the conversion rates of CaO and the number of microcrystalline CaCO3 particles increased, and the volume expansion of CaCO3 led to a decrease in the open porosity, average pore size and specific surface area of the pellets. Micro pores were occluded, and the number of smaller pores （diameter less than 50 nm） increased, thereby resulting in the more compact and uniform structure of carbonated pellets. Simuhaneously, the dense structure prevented CO2 diffusion into the product layer, affecting the increase in carbonation conversion rate.