[Objective] To study the synergic effect of praziquantel (PZQ) and host acquired immunity on Clonorchis sinensis. [Methods] Acquired immunity to C. sinensis was induced by immunization with crude adult worm antigen (AW Ag) and excretory-secretory antigen (ES Ag) or infection with C. sinensis metacercariae. The effect was assessed by the worm reduction rate compared with the control groups after challenge infection with 50 metacercariae and treated orally with a subcurative dose of praziquantel (50 mg/kg). Significant test was performed by analysis of variance (ANOVA) and Nparl way Kruskal-Wallis test. All calculations were performed by PC-SAS system. [Results] 1. PZQ was more effective against C. sinensis larvae than against adult worms in the control (P＜0. 001), ES Ag (P＜0.01) or crude AW Ag immunization group (P＜0. 001). 2. As compared with the control, the worm reduction rate after challenge infection was significantly higher (P＜0. 001) in ES Ag immunized group (35.60%) and metacercaria infection group (97.5 % ) and less in crude AW Ag group (23.4 %). The PZQ efficacy was significantly enhanced in ES Ag immunized group. [Conclusion] The efficacy of PZQ against C. sinensis could be synergically enhanced in rats by inducing host acquired immunity.

Objective To study the protective immunity and antibody(IgG,IgG1 and IgG2a)response against adult and larva infection of T.spiralis Korean isolate in rats.Methods Fony-six rats were randomly divided into 7 groups.Group A(A1,A2,10 rats)was used for the determination of protective efficacy from adult stage infection,group B (B1,B2,14 rats)was for the protective efficacy from muscle larva stage infection,group C(C1,C2,17 rats)was for challenge control,and group D(5 rats)served as normal control.Rats in groups A,B and C were infected with 1000 T.spiralis muscle larvae,and the infected rats were treated with flubendazole(20 mg/ks,10 d)at day 7(A1,A2) and at day 30(B1,B2).Rats in groups A and B were re-infected with 500 T.spiralis muscle larvae at day 10 after treatment.Rats in groups A1 and B1 were killed at day 7 and day 30 to inspect the reduction of adult worms in the intestines.Rats in groups A2 and B2 were killed at day 30 to detect the reduction of muscle larvae in diaphragms.Rats in groups C and D were killed at the same time,and all rats were bled at the same time.Specific anti-Trichinella IgG,IsG1 and IgG2a were detected by ELISA.Results Adult stage infection induced protective efficacy by 100% against adult stage and by 99.96% against larva stage.Larval stage infection induced protective efficacy by 99.92% against adult stage and 99.89% against muscle larvae.Anti-muscle stage larval ES Ag(IgG 3.0,IgG1 2.2,IgG2a 0.8)and anti-adult crude Ag antibodies(IgG 1.9,IgG1 0.8,IgG2a 0.3) significantly increased in the muscle larval stage infection compared to normal control(IgG 0.5,IgG1 0.1,IgG2a 0.1)and adult stage infection(IgG 0.5,IgG1 0.09,IgG2a 0.09) (P<0.01).Higher specific IgG1 antibody(IgG1 2.2) in larva stage infection was shown than specific IgG2a antibody response(IgG2a 0.8)(P<0.01).Conclusion Protective immunity against both adult and larva worms has been induced from adult and muscle larva stage infections of T.spiralis.

Background: Cancer patients have an increased risk of cardiovascular outcomes and are susceptible to coronavirus disease 2019 (COVID-19) infection. We aimed to assess the cardiovascular safety of COVID-19 vaccination for cancer patients in South Korea. Methods: We conducted a self-controlled case series study using the K-COV-N cohort (2018– 2021). Patients with cancer aged 12 years or older who experienced cardiovascular outcomes were identified. Cardiovascular outcomes were defined as myocardial infarction, stroke, venous thromboembolism (VTE), myocarditis, or pericarditis, and the risk period was 0–28 days after receiving each dose of COVID-19 vaccines. A conditional Poisson regression model was used to calculate the incidence rate ratio (IRR) with 95% confidence interval (CI). Results: Among 318,105 patients with cancer, 4,754 patients with cardiovascular outcomes were included. The overall cardiovascular risk was not increased (adjusted IRR, 0.99 [95% CI, 0.90–1.08]) during the whole risk period. The adjusted IRRs of total cardiovascular outcomes during the whole risk period according to the vaccine type were 1.07 (95% CI, 0.95–1.21) in the mRNA vaccine subgroup, 0.99 (95% CI, 0.83–1.19) in the ChAdOx1 nCoV-19 vaccine subgroup, and 0.86 (95% CI, 0.68–1.10) in the mix-matched vaccination subgroup. However, in the analysis of individual outcome, the adjusted IRR of myocarditis was increased to 11.71 (95% CI, 5.88–23.35) during the whole risk period. In contrast, no increased risk was observed for other outcomes, such as myocardial infarction, stroke, VTE, and pericarditis. Conclusion For cancer patients, COVID-19 vaccination demonstrated an overall safe profile in terms of cardiovascular outcomes. However, caution is required as an increased risk of myocarditis following COVID-19 vaccination was observed in this study.

No abstract available.
Decision Support Techniques* ; Stroke*

BACKGROUND AND PURPOSE: The recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke. METHODS: In total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models. RESULTS: CMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67). CONCLUSIONS: The total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.
Brain ; Cause of Death ; Follow-Up Studies* ; Humans ; Magnetic Resonance Imaging ; Mortality* ; Stroke* ; Stroke, Lacunar

PURPOSE: Infarct core can expand rapidly in acute stroke patients receiving intravenous tissue plasminogen activator (IV t-PA). We investigated changes in the extent of infarct core during IV t-PA treatment, and explored the associative factors of this infarct core expansion in patients with proximal artery occlusion. MATERIALS AND METHODS: We included patients who were considered for sequential intra-arterial therapy (IAT) due to occlusion of intracranial proximal artery after IV t-PA. Patients who had a baseline Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) ≥6 and who underwent two consecutive CT scans before and shortly after IV t-PA infusion were enrolled. Patients were classified into no, moderate, and marked expansion groups based on decreases in ASPECTS (0–1, 2–3, and ≥4, respectively) on follow-up CT. Collateral status was graded using CT angiography. RESULTS: Of the 104 patients, 16 (15.4%) patients showed moderate and 13 (12.5%) patients showed marked infarct core expansion on follow-up CT scans obtained at 71.1±19.1 min after baseline CT scan. Sixteen (15.4%) patients had an ASPECTS value < 6 on the follow-up CT. None of the patients with marked expansion were independent at 3 months. Univariate analysis and ordinal logistic regression analysis demonstrated that the infarct core expansion was significantly associated with collateral status (p < 0.001). CONCLUSION: Among patients who were considered for IAT after IV t-PA treatment, one out of every seven patients exhibited marked expansion of infarct core on follow-up CT before IAT. These patients tend to have poor collaterals and poor outcomes despite rescue IAT.
Administration, Intravenous ; Aged ; Brain Infarction/*diagnostic imaging/*therapy ; Computed Tomography Angiography ; Female ; Fibrinolytic Agents/therapeutic use ; Follow-Up Studies ; Humans ; Male ; *Thrombolytic Therapy ; Tomography, X-Ray Computed/*methods ; Treatment Outcome

Background: and Purpose Nonbacterial thrombotic endocarditis (NBTE) is a cause of stroke in cancer. However, clinical characteristics and outcomes in stroke patients with cancer-associated NBTE are not well known.
Methods: We included consecutive patients with stroke and active cancer over a 9-year period who underwent echocardiography. We retrospectively compared clinical characteristics and presence of metastasis between patients with NBTE, those with cryptogenic etiologies, and those with determined etiologies. We also investigated mortality and stroke events during the 6-month follow-up.
Results: Among the 245 patients, 20 had NBTE, 96 had cryptogenic etiologies, and 129 had determined etiologies. Metastasis was seen in all 20 patients (100%) with NBTE, 69.8% in patients with cryptogenic etiology, and 48.8% in patients with or determined etiology. During the 6-month follow-up, 127 patients (51.8%) developed stroke and/or died (death in 110 [44.9%] and stroke events in 55 [22.4%]). Patients with NBTE showed significantly higher mortality (80%) and stroke occurrence (50%) than those with cryptogenic etiologies (mortality 54.2%, stroke 25.0%, log-rank P=0.006) and determined etiologies (mortality 32.6%, stroke 16.3%, log-rank P<0.001). In a multivariate Cox proportional hazard analysis, the presence of NBTE was independently associated with composite outcomes of mortality and stroke events (hazard ratio, 1.941; 95% confidence interval, 1.052 to 3.690).
Conclusions NBTE should be suspected as a potential cause of stroke in patients with metastatic cancer. Patients with NBTE have a high risk of recurrent stroke and mortality. Future studies are necessary to determine strategies to reduce stroke recurrence in patients with NBTE.

BACKGROUND AND PURPOSE: The benefit of statins in acute stroke remains uncertain. Statins may prevent stroke recurrence during the acute stage of stroke via pleiotropic effects. However, statins may increase the risk of intracerebral hemorrhage. We investigated the effect and safety of rosuvastatin in acute stroke patients. METHODS: This randomized, double-blind, multi-center trial compared rosuvastatin 20 mg and placebo in statin-naive stroke patients who underwent diffusion-weighted imaging (DWI) within 48 hours after symptom onset. The primary outcome was occurrence of new ischemic lesions on DWI at 5 or 14 days. RESULTS: This trial was stopped early after randomization of 316 patients due to slow enrollment. Among 289 patients with at least one follow-up imaging, the frequency of new ischemic lesions on DWI was not different between groups (rosuvastatin: 27/137, 19.7% vs. placebo: 36/152, 23.6%) (relative risk 0.83, 95% confidence interval 0.53-1.30). Infarct volume growth at 5 days (log-transformed volume change, rosuvastatin: 0.2+/-1.0 mm3 vs. placebo: 0.3+/-1.3 mm3; P=0.784) was not different, either. However, hemorrhagic infarction or parenchymal/subarachnoid hemorrhage on gradient-recalled echo magnetic resonance imaging occurred less frequently in the rosuvastatin group (6/137, 4.4%) than the placebo group (22/152, 14.5%, P=0.007). Among 314 patients with at least one dose of study medication, progression or clinical recurrence of stroke tended to occur less frequently in the rosuvastatin group (1/155, 0.6% vs. 7/159, 4.4%, P=0.067). Adverse events did not differ between groups. CONCLUSIONS: The efficacy of rosuvastatin in reducing recurrence in acute stroke was inconclusive. However, statin use was safe and reduced hemorrhagic transformation.
Cerebral Hemorrhage ; Follow-Up Studies ; Hemorrhage ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Infarction ; Magnetic Resonance Imaging ; Random Allocation ; Recurrence ; Stroke* ; Rosuvastatin Calcium