Hemorrhagic Score Research Articles

Association Between Anatomic and Clinical Indicators of Injury Severity After Moderate-Severe Traumatic Brain Injury: A Pilot Study Using Multiparametric Magnetic Resonance Imaging.

This study sought to identify whether an anatomical indicator of injury severity as measured by multiparametric magnetic resonance imaging (MRI) including magnetic resonance elastography (MRE), is predictive of a clinical measure of injury severity after moderate-severe traumatic brain injury (TBI). Nine individuals who were admitted to acute inpatient rehabilitation after moderate-to-severe TBI completed a comprehensive MRI protocol prior to discharge from rehabilitation, which included conventional MRI with diffusion tensor imaging (DTI). Of those, five of nine also underwent brain MRE to measure the brain parenchyma stiffness. Clinical severity of injury was measured by the length of post-traumatic amnesia (PTA). MRI-assessed non-hemorrhage contusion score and hemorrhage score, DTI-measured white matter fractional anisotropy, and MRE-measured lesion stiffness were all assessed. A higher hemorrhagic score was significantly associated with a longer length of PTA (p = 0.026). Participants with a longer PTA tended to have a higher non-hemorrhage contusion score and softer contusion lesions than the contralateral control side, although the small sample size did not allow for assessment of a significant association. To our knowledge, this is the first report applying MRI/MRE imaging protocol to quantitate altered brain anatomy after moderate-severe TBI and its association with PTA, a known clinical predictor of post-acute outcome. Future larger studies could lead to the development of prediction models that integrate clinical data with anatomical (MRI), structural (DTI), and mechanical (MRE) changes caused by TBI, to inform prognosis and care planning.

Correlation between IPSET-t risk at diagnosis and subsequent hemorrhage in patients with essential thrombocythemia; a single institution experience.

Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by an increased risk of thrombotic and hemorrhagic events, that represent the leading causes of mortality and morbidity. Currently, while thrombotic risk is assessed through the IPSET-t and r-IPSET scores, there is no specific prognostic tool used to predict hemorrhagic risk in ET. The aim of the study was to define incidence and risk factors connected to hemorrhagic events by retrospectively analyzing 308 ET patients diagnosed between 1996 and 2022 at the Division of Hematology of Udine and treated according to the current international guidelines. According to molecular status, 193 patients (62.7%) were JAK2 mutated, 66 (21.4%) had a CALR mutation, 14 (4.5%) had a MPL mutation, 21 patients (6.8%) were "triple negative," and 14 patients (4.5%) were not evaluable. According to IPSET-t score, 49.7% patients were at high, 24.3% at intermediate, and 26.0% at low-risk, respectively. Twelve (3.9%) patients experienced bleeding at ET diagnosis, while 24 (7.8%) had at least one hemorrhagic event during follow-up at a median time of 103 months (range: 1-309). Forty hemorrhagic events were totally recorded and defined as minor in 22 cases, moderate in 11 cases, and severe in 7 cases. Cumulative incidence (CI) of hemorrhage at 10 and 20 years was 6.0% and 12.0%, respectively. A statistically significant correlation between hemorrhagic risk and IPSET-t score emerged: 10 years hemorrhage CI was 3.2% for low-risk, 2.9% for intermediate-risk, and 9.8% for high-risk patients, respectively (p=0.002). We found no correlation between hemorrhagic risk and gender or mutational status. Results of our study highlight the validity of IPSET-t score in predicting individual hemorrhagic risk among ET patients, suggesting a possible role of IPSET-t scoring system as a global evaluator for vascular events in ET patients.

Clinical outcome vis-à-vis the intracerebral hemorrhagic score among patients with intracerebral hypertensive hemorrhage

Clinical outcome vis-à-vis the intracerebral hemorrhagic score among patients with intracerebral hypertensive hemorrhage

Research Note: Effect of increasing fat supplementation in diets on productive performance, egg quality, and fatty liver incidence in laying hens throughout the entire laying cycle

This study aimed to investigate the effect of increasing fat supplementation in diets on productive performance, egg quality, and fatty liver incidence in laying hens during the entire laying cycle. A total of three hundred eighty-four 18-wk-old Hy-Line Brown laying hens were randomly allotted to 1 of 3 dietary treatments with 8 replicates for a 52-wk feeding trial. Each replicate comprised 16 consecutive cages with 1 hen per cage. The experimental diets were prepared by supplementing 0, 1.5, or 3.0% tallow to a basal diet, but all nutrients and energy in 3 diets were formulated to be equalized according to the recommended nutrient and energy concentrations at each phase of laying hens. Results indicated that increasing fat supplementation in diets decreased (linear, P < 0.01) feed conversion ratio (FCR) by increased egg mass (linear, P < 0.05) but decreased feed intake (linear and quadratic, P < 0.05) in laying hens during overall periods. Increasing fat supplementation in diets decreased (linear and quadratic, P < 0.05) egg yolk color during overall periods. Increasing fat supplementation in diets had no effects on liver color and hemorrhagic score measured at 60 wk (phase 3) and 70 wk of age (phase 4) without affecting hepatic fat concentrations during overall periods. However, the relative abdominal fat weight in laying hens was increased (linear and quadratic, P < 0.05) during overall periods by increasing fat supplementation in diets. In conclusion, increasing fat supplementation up to 3.0% in diets improves FCR with no impacts on fatty liver incidence and economics in laying hens throughout the entire laying cycle.

LncRNA MIR4435-2HG suppression regulates macrophage M1/M2 polarization and reduces intestinal inflammation in mice with ulcerative colitis

ObjectiveTo explore the effect and potential mechanism of LncRNA MIR4435-2HG on macrophage polarization and intestinal inflammation in ulcerative colitis (UC).MethodsRAW264.7 macrophage cells stimulated with lipopolysaccharide (LPS) were co-cultured with Caco-2 cells to establish an inflammatory model of UC in vitro. Balb/c mice were orally administered dextran sulfate sodium (DSS) to establish an in vivo UC model. Flow cytometry and immunohistochemical (IHC) analyses were performed to assess the levels of surface phenotype markers. RT-qPCR and enzyme-linked immunosorbent assay (ELISA) were performed to measure the levels of inflammatory cytokines. Western blotting was used to analyze expression of the tight junction protein zona occludens 1 (ZO-1) and the key proteins of the JAK1/STAT1 signaling pathway (Janus kinase-1(JAK1), p-JAK1, signal transducer and activator of transcription 1 (STAT1), p-STAT1.ResultsIn in vitro experiments, we found that inhibition of MIR4435-2HG was able to decrease the levels of CD68, iNOS, IL-6, and TEER, and increase the levels of CD206, Arg-1, IGF-1, and ZO-1. Meanwhile, inhibition of MIR4435-2HG significantly suppressed the levels of p- JAK1 and p- STAT1. In addition, we further demonstrated by in vivo experiments that inhibition of MIR4435-2HG significantly attenuated intestinal inflammation in mice, as evidenced by increased body weight, increased colon length and weight, decreased fecal scores, hemorrhagic scores, and DAI scores, and amelioration of colonic injury, and decreased inflammatory factors.ConclusionsMIR4435-2HG suppression inhibits macrophage M1 polarization while promoting M2 polarization, thereby alleviating intestinal inflammation in mice with ulcerative colitis through JAK1/STAT1 signaling.

Prothrombin consumption as an indicator of hemorrhagic phenotype in mild platelet function disorders.

The bleeding risk of patients with mild platelet function disorders is difficult to assess and their phenotype remains ill-explored. This study was designed to establish a comprehensive biological phenotype of patients with mild platelet function disorders. Twenty patients were included with persistent abnormal light transmission aggregometry (LTA). The ISTH bleeding assessment tool (ISTH-BAT) was assessed to identify laboratory analyses associated with an abnormal hemorrhagic score. The majority of patients had defects that might affect Gαi protein signaling pathways or minor abnormalities. No LTA nor flow cytometry parameters were associated with an above-normal hemorrhagic score. However, prothrombin consumption, which corresponds to the ratio of serum residual factor II to plasma residual factor II, was significantly higher (p = .006) in the abnormal ISTH-BAT group (mean = 14%, SD = 6) compared with the normal ISTH-BAT group (mean = 8%, SD 4). Prothrombin consumption was significantly associated with ISTH-BAT score (r = .5287, IC 95% 0.0986-0.7924, p = .0165). In this group of patients, there was an association between a pathological bleeding score and increased prothrombin consumption. This test could be used as an additional indicator of platelet function abnormality liable to be related to bleeding risk.

Assessment of prognostic ability of intracerebral hemorrhage score with special reference to a tribal population

Background: Stroke is the second leading cause of death worldwide. Intracerebral hemorrhage (ICH) accounts for 10% of all strokes, and about 35–45% of patients die within the 1st month. The scarcity of robust data on the validity and utility of the ICH score on the Indian population in a resource-poor health facility is a compelling factor for more study in this field, especially among the tribal population in this region. ICH score is a simple, easy-to-calculate prognostic indicator of hemorrhagic score. Aims and Objectives: The aim of this study is to estimate the prognostic significance of ICH score (both modified and the original) in hemorrhagic stroke in terms of mortality and morbidity and to analyze associated risk factors like mortality, morbidity, and motor recovery of hemorrhagic stroke in tribal and non-tribal population. Materials and Methods: The study was institution-based observational and prospective study of 120 new-onset hemorrhagic stroke cases diagnosed by clinical and radiological evaluation admitted in this medical college during the period of study. Along with history, clinical examination and CT scan brain guided ICH scoring is done, follow-up at the end of 1 week and at the 5th week including physical performance assessment and reviewing of records and certificates. P&lt;0.05 was considered statistically significant. Results: The patients with modified ICH score 0 had 100% improvement whereas the improvement was seen in 54.84% of patients with scores 1 and 2. A total 50% of patients with scores 3 and 4 improved significantly. The incidence of hypertension was more in non-tribal population (70.45%) than total tribal population (56.25%) of study and Compared to non-tribal population (23.86%), tribals had more history of addiction (40.63%). Conclusion: Both the ICH Scores, modified and the original, were practical and valid predicting mortality in our setup. However, the modified one was more accurate and pragmatic in our study.

Inhibition of Salvianolic Acid B and Ginsenoside Rg1 on Hemorrhagic Transformation after Stroke

Abstract Objective Application of recanalization on stroke patients is not only limited with time window, but also accompanied with the risk of hemorrhagic transformation. In present study, the effects of salvianolic acid B and ginsenoside Rg1 combination (SalB/Rg1) on time window and hemorrhagic transformation against ischemic stroke was evaluated on middle cerebral artery occlusion (MCAO) mice. Methods The protection and time window of SalB/Rg1 were estimated through infarct volume, neurobehavioral deficits, and histomorphological examination. The prohibition of SalB/Rg1 against hemorrhagic transformation was detected on MCAO mice stimulated with dextrose and reperfusion. Hemorrhagic transformation was assessed by the Heidelberg Bleeding Classification. The mechanism of SalB/Rg1 against hemorrhagic transformation was identified by immunofluorescence staining and in situ gelatin zymography. Results First, SalB/Rg1 significantly reduced infarct volume and improved neurobehavior in a dose-dependent manner. Then, the protective time window up to 9 hours was detected for SalB/Rg1 against stroke. Both the dose-dependent efficiency and longtime protection of SalB/Rg1 were further identified based on cytoarchitecture through histopathological stain. Second, SalB/Rg1 downregulated hemorrhagic score, infarct volume, and abnormal neurobehavior. Finally, the inhibition of SalB/Rg1 against hemorrhagic transformation was found to accompany with its protection on the integrity of neurovascular unit. Around the edge area of infarction, SalB/Rg1 attenuated the astrocyte activation, maintained the abundance of junction protein (claudin-5) between endothelial cells, considerably decreased matrix metallopeptidase 9 activity through in situ gelatin zymography. Conclusion SalB/Rg1 is a promising strategy for further development against stroke, especially against hemorrhagic transformation.

Involvement of sympathetic nerve activation in acupoint application induced improvement of gastric ulcer and motility in rats with gastric ulcer

To observe the effect of mustard oil application at "Liangmen" (ST21) on gastric ulcer (GU) and gastric motility and its association with the sympathetic nerve activity in rats with GU, so as to provide experimental basis for improvement of GU by acupoint application. Thirty-nine male SD rats were randomly divided into control (n=7), model, acupoint application (AA), medication (guanethidine, an adrenergic sympathetic antagonist) and AA+medication groups (n=8 in each of the latter 4 groups). The GU model was made by applying acetic acid-immersed filter paper onto the gastric antrum. For rats of the AA and AA+medication groups, 50% mustard oil was applied to left ST21 for 10 min, once a day, for 9 consecutive days. Rats of the medication and AA+medication groups received intraperitoneal injection of guanethidine solution (40 mg/kg) beginning from the modeling day on, once a day for 10 consecutive days. The rat's body weight of each group was recorded on the 0th, 1st, 3rd, 7th and 9th day. The intragastric peristaltic wave frequency and the myoelectrical activity (frequency of slow waves, and integration of fast waves) of the gastric smooth muscle were recorded by using PowerLab data acquisition system. The gastric ulcer area was measured after the rats were executed, and histopathological changes of gastric antrum tissues (histopathological score including epithelial cell injury, submucosal edema, hemorrhagic injury, inflammatory cell infiltration score) were observed after H.E. staining. Compared with the control group, the body weight ratio, frequency of gastric peristaltic waves and slow wave frequency of gastric smooth muscle were significantly decreased (P<0.001, P<0.05), while the ulcer area, total histopathological score, epithelial cell injury score, submucosal edema score, hemorrhagic injury score and inflammatory cell infiltration score were significantly increased in the model group (P<0.05, P<0.001). Relevant to the model group, the AA group had a significant increase in the body weight ratio, frequency of gastric peristaltic waves, slow wave frequency, integration of fast waves (P<0.05, P<0.001), and a considerable decrease in the ulcer area, total histopathological score, epithelial cell injury score, submucosal edema score, hemorrhagic injury score and inflammatory cell infiltration score (P<0.05, P<0.001), and the medication group has a significantly decrease in the frequency of gastric peristaltic waves (P<0.05). In comparison with the AA group, the body weight ratio, frequency of gastric peristaltic waves and slow wave frequency of gastric smooth muscle in both medication and AA+medication groups, and the integration of fast waves in the medication group were obviously lower (P<0.05, P<0.001, P<0.01), whereas the levels of ulcer area, total pathological score, submucosal edema score, hemorrhagic injury score and inflammatory cell infiltration score in both medication and AA+medication groups, and the epithelial cell injury score in medication group were significantly higher (P<0.05, P<0.001). Application of mustard oil at acupoint ST21 can effectively remit GU caused by acetic acid and regulate gastric rhythmic contraction, which was mediated by sympathetic nerve.

Predictive Factors for Hemorrhagic Transformation in Acute Ischemic Stroke in the REAL-World Clinical Practice.

Few data exists on predictive factors of hemorrhagic transformation (HT) in real-world acute ischemic stroke patients. The aims of this study were: (i) to identify predictive variables of HT (ii) to develop a score for predicting HT. We retrospectively analyzed the clinical, radiographic, and laboratory data of patients with acute ischemic stroke consecutively admitted to our Stroke Unit along two years. Patients with HT were compared with those without HT. A multivariate logistic regression analysis was performed to identify independent predictors of HT on CT scan at 24 hours to develop a practical score. The study population consisted of 564 patients with mean age 77.5±11.8 years. Fifty-two patients (9.2%) showed HT on brain CT at 24 hours (4.9% symptomatic). NIHSS score ≥8 at Stroke Unit admission (3 points), cardioembolic etiology (2 points), acute revascularization by systemic thrombolysis and/or mechanical thrombectomy (1 point), history of previous TIA/stroke (1 point), and major vessel occlusion (1 point) were found independent risk factors of HT and were included in the score (Hemorrhagic Transformation Empoli score (HTE)). The predictive power of HTE score was good with an AUC of 0.785 (95% CI: 0.749-0.818). Compared with 5 HT predictive scores proposed in the literature (THRIVE, SPAN-100, MSS, GRASPS, SITS-SIC), the HTE score significantly better predicted HT. NIHSS score ≥8 at Stroke Unit admission, cardioembolism, urgent revascularization, previous TIA/stroke, and major vessel occlusion were independent predictors of HT. The HTE score has a good predictive power for HT. Prospective studies are warranted.

A Clinical Study of 50 Partially Edentulous Patients with Fixed Partial Denture Restorations to Compare Clinical Parameters and Changes in Gingival Sulcus Width After Displacement with 2 Different Gingival Retraction Cord Materials (Cotton and Polymer).

BACKGROUND The present study aimed to compare the clinical performance and gingival sulcus width changes in partially edentulous patients using cotton and polymer gingival retraction cords. MATERIAL AND METHODS Fifty partially edentulous patients were divided into 2 groups (Gp C and Gp P) and were subjected to single crown/fixed partial denture treatment. Clinical parameters, including plaque index scores, placement time, and hemorrhage control scores, were assessed. Gingival sulcus width changes before and after retraction were evaluated using individual type 4 dental stone dies observed under an optical microscope. Statistical analysis was performed using dependent/independent t tests. RESULTS The mean placement time, hemorrhage control time, and hemorrhagic scores were lower in Gp P than in Gp C, indicating better clinical performance of polymer-based retraction cord. Both groups showed an increase in sulcus width after retraction, but Gp P had a significantly higher sulcus width (690.03±45.37) compared to Gp C (471.38±28.13). The mean difference in sulcus width between baseline and after retraction was also significantly higher in Gp P (525.84 micrometers) than in Gp C (309.11 micrometers). CONCLUSIONS The present study shows that polymer-based cords produce more sulcus width and have better clinical performance compared to cotton-based gingival retraction cords. These results suggest that the use of polymer-based retraction cords can improve the quality of dental impressions in partially edentulous patients.

Abstract Number: LBA16 Does Intracranial Hemorrhage Associated with Tenecteplase Occur Exclusively Within the Stroke Burden?

Introduction As IV tenecteplase (TNK) is becoming an alternative to IV alteplase in acute ischemic stroke (AIS), establishing the incidence of intracranial hemorrhage (ICH) complications is important. Given the higher fibrin specificity of TNK as compared to alteplase, our aim was to distinguish hemorrhage within the stroke burden versus spontaneous ICH in patients with AIS with TNK‐associated ICH. Methods Retrospective chart review of patients presenting from February 2020 to January 2022 with anterior circulation AIS to our comprehensive stroke center who received TNK was performed to evaluate for associated ICH. ECASS‐3 criteria was used to define hemorrhagic transformation and ICH score was used for primary, spontaneous ICH. Fisher exact test statistic was used to evaluate for significant differences in ASPECTS score, medium versus versus large vessel occlusion, angiographic recanalization, IV eptifibatide use, pre‐morbid antiplatelet use, and association with symptomatic versus asymptomatic hemorrhage. A benchmark less than 5% symptomatic ICH incidence was set based on historical alteplase rates within our network. Social science statistics software was used for data analysis. Results Out of 77 subjects who received TNK, 20.7% (n = 16) developed ICH, 9.1% (n = 7) of which were symptomatic ICH with a temporally‐related increase in NIHSS of at least 4 or greater. Seven subjects (43.75%) were male. Mean age was 73.38 (95% CI 65.92, 80.83). Median initial NIHSS was 16, 95% CI [11.74, 21.51]. Median ASPECTS was 9, 95% CI [8.74, 9.89]. Two subjects developed spontaneous, primary ICH (n = 1 symptomatic ICH, n = 1 non‐symptomatic ICH) in the absence of hemorrhagic transformation of ischemic stroke. No significant difference between subjects with asymptomatic hemorrhage versus symptomatic hemorrhage was found when comparing ASPECTS &gt; = 7 versus &lt; 7 (Fisher value = 1), angiographic recanalization (Fisher value = 1), use of IV eptifibatide (Fisher value = 1), pre‐morbid antiplatelet use (Fisher value = 0.13), or medium vessel occlusion (Fisher value = ‐0.63). Conclusions Expected rates of hemorrhagic transformation were higher in tenecteplase than our historical benchmark rate for alteplase. Spontaneous hemorrhage unrelated to ischemic stroke area were seen in 2 subjects without known hematological disorders. Larger, prospective studies are needed to validate safety of tenecteplase in real world settings.

COVID-19 infections and vaccination in patients with hereditary hemorrhagic telangiectasia – a cohort study

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant orphan disease, leading to malformations of blood vessels. Regarding the pandemic, both, the course of COVID-19 infection and the response to the vaccination and its pos- sible side effects, such as increased bleeding episodes, are still poorly investigated. Methodology: Retrospective single-center cohort study at the Department of Otolaryngology / Head &amp; neck Surgery (University Hospital of Zurich, Switzerland) between February 14th and March 21th 2022. Among the 32 eligible adult patients with HHT, we collected patient- and disease-specific characteristics. The course of a COVID-19 infection including severity of the disease and symptoms were noted. We assessed changes in the Hereditary Hemorrhagic Telangiectasia Epistaxis Severity Score (HHT-ESS) before and after vaccination. Results: Out of the 32 patients, 5 patients suffered a COVID-19 infection, thereby mainly experiencing loss of taste and smell and cough. No significant change of the HHT-ESS before and after vaccination was observed. The median HHT-ESS before and after the vaccination was 4.06. Conclusions: There was no significant change in bleeding severity (HHT-ESS) before and after COVID-19 vaccination. Based on these findings, the vaccination for HHT patients does not seem to worsen the further course of the disease. The overall symptoms, risks and complications after Sars-CoV-2 vaccination and infection seem to be comparable to the general population.

Administration of recombinant human thrombopoietin is associated with alleviated thrombocytopenia in adult intensive care unit patients with pneumonia: A single-center retrospective study.

Background: Recombinant human thrombopoietin (rhTPO) is reported to stimulate platelet production and increase peripheral platelet counts; it is primarily used to manage chemotherapy-induced thrombocytopenia and idiopathic thrombocytopenic purpura. However, the effect of rhTPO in patients with pneumonia and thrombocytopenia remains uncertain. Objective: To assess the association of rhTPO and platelet counts in ICU patients with pneumonia and thrombocytopenia. Materials and Methods: A retrospective cohort study was performed in the ICU department, Nanfang Hospital, Southern Medical University, Guangzhou, China. From January 2016 to April 2021, patients with pneumonia and thrombocytopenia were allocated to two groups—the rhTPO and no-rhTPO groups—according to whether they received rhTPO treatment or not during their ICU stay. Demographical and clinical data were collected and analyzed using statistical software; p < 0.05 was considered statistically significant. Results: Out of 327 patients, 149 were in the rhTPO group and 178 were in the no-rhTPO group. Within the first 7 days, platelet counts increased more for patients in the rhTPO group compared with those in the no-rhTPO group (99.21 ± 102.613 vs. 2.08 ± 43.877, p = 0.000). The clinical recovery rate of platelets increased within 7 days (65.8 vs. 18.5%, p = 0.000) and, after 7 days of enrollment, hemorrhagic scores decreased more apparently in the rhTPO group (2.81 ± 2.856 vs. 1.16 ± 2.123, p = 0.000). Further, bleeding events ceased in 66.7% of the patients in the rhTPO group compared with 37.3% of the patients in the no-rhTPO group (p = 0.000). Less red-blood-cells transfusions were needed in the rhTPO group (3.639 ± 4.630 vs. 5.818 ± 6.858, p = 0.009). Furthermore, through logistic regression, rhTPO administration was found to be an independent indicator that affected the platelet recovery rate within 7 days. Conclusion: This study finds that rhTPO administration is associated with increased platelet counts, alleviated bleeding, and reduced blood transfusion. For patients with pneumonia and thrombocytopenia, rhTPO may be an effective therapeutic drug; however, more RCT trails are needed to confirm our observation.

Predictive Power of Hemorrhagic Transformation Scores in Real Life Stroke Patients Undergone to Urgent Reperfusion: A Brief Report

Introduction and aim: Hemorrhagic transformation (HT) is the most feared complication in acute phase of ischemic stroke. Predicting HT is of utmost importance in clinical practice. In the latest years a lot of HT prediction scores have been proposed, but their comparison in real life lack. Therefore, the aim of our study was to provide information about this topic. Materials and Methods: We retrospectively calculated THRIVE, SPAN-100, MSS score, SITS-ICH and GRASPS scores in patients consecutively admitted in our Stroke Unit along two years. To evaluate their predictive power, the area under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve was calculated. Results: Study population was composed by ninety-one patients (51.6% females) with mean age 80.1 ± 11.3 years. Seventy-four (81.3%) patients undergone to systemic intravenous alteplase, seven (7.7%) to mechanical thrombectomy, ten (11%) to systemic intravenous alteplase plus mechanical thrombectomy. Eighteen patients (19.7%) presented HT. MSS score was the best prognosticator of HT, however the predictive power of the five analyzed score was low, ranging from and none of the score resulted significantly superior to the others. Conclusion: Our real-life study showed a low predictive power of a lot of HT prediction scores. Further prospective studies are warranted.

Angong Niuhuang Wan reduces hemorrhagic transformation and mortality in ischemic stroke rats with delayed thrombolysis: involvement of peroxynitrite-mediated MMP-9 activation

BackgroundHemorrhagic transformation (HT) is a common complication of delayed tissue plasminogen activator (t-PA) treatment for ischemic stroke. Peroxynitrite plays an important role in the breakdown of blood–brain barrier (BBB) and the development of HT. We tested the hypothesis that Angong Niuhuang Wan (AGNHW), a traditional Chinese medicinal formula, could be used in conjunction with t-PA to protect the BBB, minimize HT, and improve neurological function by suppressing peroxynitrite-mediated matrix metalloproteinase-9 (MMP-9) activation.MethodsWe first performed quality control study and chemical identification of AGNHW by using UPLC. In animal experiments, male Sprague–Dawley rats were subjected to 5 h of middle cerebral artery occlusion (MCAO) followed by 19 h of reperfusion plus t-PA infusion (10 mg/kg) at 5 h of cerebral ischemia. AGNHW (257 mg/kg) was given orally at 2 h after MCAO. Hemorrhagic transformation was measured using hemorrhagic scores and hemoglobin levels in ischemic brains. Evans blue leakage was utilized to assess the severity of the blood–brain barrier (BBB) damage. The modified neurologic severity score (mNSS) test was used to assess neurological functions. Peroxynitrite and superoxide was detected by using fluorescent probes. MMP-9 activity and expression were examined by gelatin zymography and immunostaining. The antioxidant effects were also studied by using brain microvascular endothelial b.End3 cells exposed to 5 h of oxygen and glucose deprivation (OGD) plus 5 h of reoxygenation with t-PA treatment (20 µg/ml).ResultsAGNHW significantly reduced the BBB damage, brain edema, reduced hemorrhagic transformation, enhanced neurological function, and reduced mortality rate in the ischemic stroke rats with t-PA treatment. AGNHW reduced peroxynitrite and superoxide in vivo and in vitro and six active chemical compounds were identified from AGNHW with peroxynitrite scavenging activity. Furthermore, AGNHW inhibited MMP-9 activity, and preserved tight junction protein claudin-5 and collagen IV in the ischemic brains.ConclusionAGNHW could be a potential adjuvant therapy with t-PA to protect the BBB integrity, reduce HT, and improve therapeutic outcome in ischemic stroke treatment via inhibiting peroxynitrite-mediated MMP-9 activation.Graphical

Untangling the difficult interplay between ischemic and hemorrhagic risk: The role of risk scores.

BACKGROUNDBleedings are an independent risk factor for subsequent mortality in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention. This represents a hazard equivalent to or greater than that for recurrent ACS. Dual antiplatelet therapy (DAPT) represents the cornerstone in the secondary prevention of thrombotic events, but the benefit of such therapy is counteracted by the increased hemorrhagic complications. Therefore, an early and individualized patient risk stratification can help to identify high-risk patients who could benefit the most from intensive medical therapies while minimizing unnecessary treatment complications in low-risk patients. AIMTo review existing literature and gain better understanding of the role of ischemic and hemorrhagic risk scores in patients with ischemic heart disease (IHD). METHODSWe used a combination of terms potentially used in literature describing the most common ischemic and hemorrhagic risk scores to search in PubMed as well as references of full-length articles.RESULTSIn this review we briefly describe the most important ischemic and bleeding scores that can be adopted in patients with IHD, focusing on GRACE, CHA2DS2-Vasc, PARIS CTE, DAPT, CRUSADE, ACUITY, HAS-BLED, PARIS MB and PRECISE-DAPT score. In the second part of this review, we try to define a possible approach to the IHD patient, using the most suitable scores to stratify patient risk and decide the most appropriate patient treatment. CONCLUSIONIt becomes evident that risk scores by themselves can’t be the solution to balance the ischemic/bleeding risk of an IHD patient. Instead, some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD.

Hemorrhagic dot score as a follow up marker in psoriasis on treatment: A prospective observational study.

Psoriasis assessment tools in use presently lack reproducibility and are cumbersome to use. An easily reproducible, objective tool with ability to maintain visual records for follow up is hence desirable. We conducted a study with the aim to assess dermoscopic changes in psoriasis while on treatment by recording the number of hemorrhagic dots (Hemorrhagic Dot Score-HDS) in a representative plaque and comparing it to the PASI score. A longitudinal prospective study was conducted between October 2018 to March 2020 in a dermatology centre of a tertiary hospital on cases of chronic plaque psoriasis on treatment over 6months, assessed at baseline and thereafter monthly for 6 months. Hundred consenting patients of chronic plaque psoriasis were assessed, clinically, PASI and dermoscopically. HDS and other dermoscopic features were noted at every visit. ANOVA and F test of testing of equality of Variance; effect size in terms of Cohen were used to report the strength of an apparent relationship. Percentage improvement in the mean PASI scores and HDS and percentage improvement of mean was found significant in each month on follow up. Systemic therapy as compared to topical therapy showed higher effect size of 6.1 and 1.7, respectively. Hemorrhagic dot score can be used as an objective, definite assessment tool correlating with clinical severity of psoriasis with more accuracy which shows changes early following institution of therapy.

Hemorrhagic risk scores in hospitalized patients with acute coronary syndrome: can they (only) predict bleeding events?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute coronary syndrome (ACS) is a life-threatening condition and its therapeutic approach increases the risk of important bleeding events which are associated with a worse prognosis. Along with hemorrhagic events, a drop on hemoglobin level not related to bleeding or the development of anemia could have a negative impact on prognosis. Both CRUSADE and PARIS bleeding risk scores are used to evaluate and to stratify the risk of major bleeding in ACS. However their actual predictive value has been questioned and validity of these scores in predicting in-hospital mortality (IHM) is not established. Objectives To evaluate the actual prognostic value of CRUSADE and PARIS bleeding scores in ACS patients during their hospitalization stay. Methods Retrospective single center cohort study including 103 hospitalized patients after an acute ST-segment elevation myocardial infarction (STEMI) regardless of its reperfusion strategy. In-hospital major hemorrhagic events (IHMHE), considered intracerebral hemorrhage, those resulting in hemodynamic compromise or requiring a blood transfusion, were assessed. Data on hemoglobin levels (HL) at hospital admission and at the time of hospital discharge were also collected and a composite endpoint (CE) of IHMHE and a drop in HL ≥ 3g/dL were elaborated. Both scores were calculated for each patient, its predictive value and their impact on IHM were determined. Results Out of 103 patients enrolled, the median age was 58.15 ± 12.6 years and 85.4% were male. Two IHMHE occurred, twenty patients (19.4%) had anemia at the time of hospital discharge and 16 of these patients (15.5%) were not anemic at the time of hospital admission. Nine (8.7%) patients had a drop in their HL of at least 3g/dL. The five bleeding risk categories defined by CRUSADE investigators were used, with 48 (46.6%) patients in the very low risk category, 9 (8.7%) and 6 (5.8%) in the high and very high risk category, respectively. Hospitalization length stay was 5.6 ± 4.1 days with an overall in-hospital mortality (IHM) of 5.8%. Receiver operating characteristic curve (ROC) analysis showed that CRUSADE score had an excellent discriminatory power for the CE (AUC 0.927, 95% CI 0.854-1.000) and the PARIS score had an acceptable discriminatory value (AUC 0.775, 95% CI 0.616-0.935). Both CRUSADE and PARIS bleeding scores also had prognostic value in evaluating IHM (AUC 0.929, 95% CI 0.856-1.000 and AUC 0.788, 95% CI 0.634-0.942, respectively). No specific and independent predictors of IHMHE were found, neither related to individual characteristics nor to therapeutic approach. Conclusion The presenting study showed that CRUSADE and PARIS scores still have discriminatory power to assess CE and to assess IHM in ACS patients. Their addition to stratification tools could be of interest.

An evaluation of bird weight and diet nutrient density during early lay on ISA Brown performance, egg quality, bone characteristics, and liver health at 50 weeks of age

This study compared the impact of a higher nutrient density (HND) or lower nutrient density (LND) diet fed during early lay to either heavier weight (HW) or lighter weight (LW) ISA Brown hens. At 18 wk of age (WOA) pullets (n = 240) were evenly assigned to either HW (n = 120) or LW (n = 120). Sixty birds from each weight group were then randomized to either the HND or LND diet treatments which were fed from 18 to 24 WOA inclusive. At 25 WOA the LND diet replaced the HND diet. All hens remained on LND diet to 50 WOA. Hen performance was measured from 18 to 50 WOA. Femur and liver health were evaluated at 50 WOA. Egg quality was assessed from 46 to 50 WOA. The 18 WOA HW hens had higher BW, cumulative egg production, cumulative feed intake (CFI), and cumulative egg mass (CEM) to both 24 and 50 WOA (P < 0.01). At 24 WOA the HND diet also generated higher BW (P < 0.001), CEM (P < 0.001) and lower cumulative feed conversion ratio (CFCR) (P < 0.01), the latter being sustained to 50 WOA (P < 0.01). At 50 WOA CFCR of LW birds was lower than HW birds (P < 0.01). Egg weight (EW), yolk diameter, and percent yolk weight were higher (P < 0.05) in the HW birds with the highest albumen to yolk ratio in LW birds (P < 0.05). Egg shape index was higher in LND diet fed birds (P < 0.01) while LW hens had higher shell phosphorus (P < 0.05). Body weight and diet nutrient density interacted on femoral diameter and cortical thickness being higher (P < 0.01) in LW birds fed HND than LW birds fed LND diets. Fatty liver hemorrhagic scores (P < 0.05) and liver lipid peroxidase (P < 0.001) at 50 WOA were higher in HW and LND diet treatments. Concurrently HW birds had the highest CFI and EW while CFCR and liver health were superior in LW and the HND diet treatment.