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According to the research progress in recent years, "Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018" has greatly revised and supplemented the criteria for the diagnosis and treatment of acute ischemic stroke. Based on the new clinical research evidence published in the past four years, this paper interprets the revisions and supplements of the guidelines 2018. [ABSTRACT FROM AUTHOR]

1-Naphthylamine (1NA), which is harmful to human and aquatic animals, has been used widely in the manufacturing of dyes, pesticides, and rubber antioxidants. Nevertheless, little is known about its environmental behavior and no bacteria have been reported to use it as the growth substrate. Herein, we describe a pathway for 1NA degradation in the isolate Pseudomonas sp. strain JS3066, determine the structure and mechanism of the enzyme NpaA1 that catalyzes the initial reaction, and reveal how the pathway evolved. From genetic and enzymatic analysis, a five gene-cluster encoding a dioxygenase system was determined to be responsible for the initial steps in 1NA degradation through glutamylation of 1NA. The γ-glutamylated 1NA was subsequently oxidized to 1,2-dihydroxynaphthalene which was further degraded by the well-established pathway of naphthalene degradation via catechol. A glutamine synthetase-like (GS-like) enzyme (NpaA1) initiates 1NA glutamylation, and this enzyme exhibits a broad substrate selectivity toward a variety of anilines and naphthylamine derivatives. Structural analysis revealed that the aromatic residues in the 1NA entry tunnel and the V201 site in the large substrate-binding pocket significantly influence NpaA1's substrate preferences. The findings enhance understanding of degrading polycyclic aromatic amines, and will also enable the application of bioremediation at naphthylamine contaminated sites., Competing Interests: SZ, SD, TL, MM, DL, JS, NZ No competing interests declared, (© 2024, Zhang, Deng et al.)

Objective: To investigate the hypoglycemic characteristics of hospitalized elderly patients with type 2 diabetes mellitus (T2DM)., Methods: From January, 2014 to December, 2015, the data of 58 565 blood measurements using a standard blood glucose monitoring system (BGMS) were collected from 1187 cases of patients with type 2 diabetes during hospitalization in the Department of Endocrinology, Guangdong General Hospital (Guangzhou, China). Stratified analyses were conducted by dividing the patients into 3 age groups, namely <45 years group (128 cases), 45-64 years group (594 cases), and ≥65 years group (465 cases). The incidence and time distribution of hypoglycemia in these patients were compared among the 3 age groups., Results: The risk of hypoglycemia increased with age. Compared with those below 45 years of age, the patients beyond or equal to 65 years had a significantly increased hypoglycemic density (0.95% vs 0.40%, P<0.001), a higher proportion of patients with hypoglycemia (28.17% vs 10.94%, P<0.001), and greater patient-days with hypoglycemia (4.48% vs 1.76%, P<0.001). In the elderly patients, hypoglycemia occurred most frequently before dawn, at which time the hypoglycemic density was 2.66% in patients ≥65 years of age, significantly higher than that in patients below 45 years (1.09%, P<0.05) and between 45 and 64 years (1.90%, P<0.05); the proportion of patients with hypoglycemia was also significantly higher in the elderly patients (14.57%) than in those below 45 years (3.77%, P<0.02) and between 45 and 64 years (9.42%, P<0.02). The proportion of patients with recurrent hypoglycemia (≥2 times) was significantly higher in patients ≥65 years (13.33%) than in younger patients (2.34% in <45 years group and 9.43% in 45-64 years group, P<0.05)., Conclusion: The hypoglycemic risk in hospitalized elderly patients with T2DM is significantly higher than that in younger patients, especially before dawn and in terms of recurrent hypoglycemia. Clinicians should develop differential blood glucose monitoring and management strategies for these elderly patients to improve the clinical safety.

Objective: To investigate the risk factors, pathogenesis, cause of death, and outcome of different stroke subtypes., Methods: The relevant data, including demographics, baseline risk factors, cause of death, and 1-year case fatality, were analyzed among 1913 consecutive hospitalized patients with ischemic and hemorrhagic stroke, 599 (31.3%) with intracerebral hemorrhage (ICH) and 1314 with ischemic stroke (68.7%), including 209 cases (15.9%) of total anterior circulation infarction (TACI), 417 cases (31.7%) of partial anterior circulation infarction (PACI), and 186 cases (14.2%) of posterior circulation infarctions (POCI), and 502 cases (38.2%) of lacunar infarctions (LACI), 1098 males and 815 females, aged 64 +/- 13 (14-98)., Results: Multivariate analysis showed that when age and sex were adjusted, atrial fibrillation was the independent predictive factor of TACI [odds ratio (OR) = 1.42, 95% CI = 1.25-2.31), hypertension and alcohol intake were the independent predictive factor LACI (OR = 1.24, 95% CI = 1.02-2.18; 0R = 1.12, 95% CI = 1.03-3.04) and ICH (OR = 1.84, 95% CI = 1.31-3.02; OR = 1.04, 95% CI = 1.01-4.13). A negative association was observed between hypertension and TACI (OR = 0.62, 95% CI = 0.34-0.72), atrial fibrillation and LACI (OR = 0.46, 95% CI = 0.26-0.82), and ICH and diabetes (OR = 0.56, 95% CI = 0.42-0.76). As compared to LACI, TACI and ICH significantly increased the risk of 1-year mortality (OR = 6.21, 95% CI = 2.86-8.42; OR = 5.86; 95% CI = 2.46-8.52)., Conclusions: Stroke subtypes have different risk factor profile, causes and outcome. Information on determinants of the clinical syndromes may impact on the prevention and acute phase interventions.