Background and purposeTo date, no large cohort study has investigated the effects of intravenous thrombolysis (IVT) in Chinese patients aged over 80 years who had a stroke. This study aimed to assess the trends in the use of alteplase, the clinical characteristics and the outcomes of Chinese patients aged above 80 years who had an acute ischaemic stroke.MethodsData for this analysis were obtained from the China Stroke Center Alliance programme, a nationwide, multicentre, prospective registry encompassing 1751 hospitals across 31 provinces, covering the period from 1 January 2018 to 14 December 2022. The primary outcome was defined as a modified Rankin Scale (mRS) Score of 0–2 at discharge. Secondary outcomes included an mRS Score of 0–1 and independent ambulation on discharge. Safety outcomes assessed were in-hospital mortality and symptomatic intracranial haemorrhage (sICH).ResultsOut of 30 902 patients over 80 years old who qualified for thrombolysis, 8673 (median age (IQR), 84 (82–87) years) received alteplase treatment. Patients administered alteplase demonstrated improved short-term functional outcomes, such as an mRS Score of 0–2 (adjusted OR (aOR) 1.12, 95% CI, 1.06 to 1.18, p<0.001), an mRS Score of 0–1 (aOR 1.14, 95% CI, 1.08 to 1.19, p<0.001) and independent ambulation at discharge (aOR 1.14, 95% CI, 1.08 to 1.20, p<0.001). Moreover, no significant increase was observed in the risk of in-hospital mortality (aOR 1.12, 95% CI, 0.93 to 1.35; p=0.23). However, the risk of sICH was significantly higher among patients treated with alteplase (aOR 3.22, 95% CI, 2.77 to 3.75; p<0.001).ConclusionsIVT with alteplase in elderly patients who had a stroke resulted in improved short-term functional outcomes without elevating the risk of in-hospital mortality. Nonetheless, this population remains at a higher risk of sICH.

Background/Purpose: No large cohort study has examined intravenous thrombolysis (IVT) in Chinese patients aged > 80 years.We aim to evaluate temporal trends in alteplase use, clinical characteristics, and outcomes in acute ischemic stroke (AIS) patients over 80 years of age in China. Methods: Data were collected from The China Stroke Center Alliance program, which is a nationwide, multicenter, prospective registry at 1751 hospitals in 31 provinces, between January 1, 2018, and December 14, 2022.The primary outcome was a modified Rankin scale score (mRS) of 0-2 at discharge, and the secondary study outcomes were an mRS score 0-1 and independent ambulation at discharge. The safety outcomes included in-hospital mortality and symptomatic intracranial hemorrhage(sICH). Results: Of 212,814 patients eligible for thrombolysis, 30,902 patients were aged > 80 years; among them, 8,673 patients (median [IQR] age, 84 [82-87] years) were treated with alteplase, 52.7% of whom were female (n=4570). The usage rate of alteplase in elderly patients increased from 22.1% in 2018 to 35.7% in 2022, while the rate among younger patients increased from 30.5% in 2018 to 43.3% in 2022. Patients treated with alteplase had better short-term functional outcomes, including mRS scores 0-2 (adjusted OR [aOR] 1.13, 95% CI 1.08-1.19, p<0.001), mRS scores 0-1 (aOR 1.14, 95% CI 1.09-1.20, p<0.001), and independent ambulation at discharge (aOR 1.27, 95% CI 1.19-1.39, p<0.001). Furthermore, there was no increased risk of in-hospital mortality (aOR 0.92, 95% CI 0.79-1.08, p=0.31). However, alteplase was associated with a higher risk of sICH (aOR 2.85, 95% CI 2.48-3.27, p<0.001). Conclusions: Elderly patients receiving IVT with alteplase had better short-term functional outcomes without an increased risk of in-hospital mortality; however, elderly patients are at higher risk of developing symptomatic intracranial hemorrhage.### Competing Interest StatementThe authors have declared no competing interest.### Clinical TrialNA### Funding StatementThis study was supported by grants 2022YFC2504902 and 2022YFC2504904 from the Ministry of Science and Technology of the People?s Republic of China, grant Z200016 from the Beijing Natural Science Foundation, grant 2018000021223ZK03 from Beijing Talents Project, and grants Z201100005620010 and Z211100002921064 from the Beijing Municipal Committee of Science and Technology.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.Not ApplicableThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Ethical approval was obtained from the ethical review board of Beijing Tiantan Hospital (ethical approval number: KY2018-061-02)I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.Not ApplicableI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Not ApplicableI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.Not ApplicableAfter publication of the completed study, data are available upon reasonable request, which will be considered by the corresponding authors based on the information provided by the requester regarding the study and analysis plan.

Objective To investigate the predictive value of myocardial markers [high-sensitivity cardiac troponin I（hs-cTnI）, creatine kinase isoenzyme（CK-MB）, left ventricular ejection fraction（LVEF）]for successful weaning in the patients undergoing extracorporeal cardiopulmonary resuscitation（ECPR）. Methods The clinical data of ECPR patients who received veno-arterial extracorporeal membrane oxygenation（VA-ECMO） treatment in Taihe Hospital of Shiyan City from February 2017 to October 2021 were retrospectively analyzed. According to the weaning outcome, they were divided into successful weaning group（n=26） and failed weaning group（n=36）. Non-parametric test was used to analyze the differences of hs-cTnI, CK-MB and LVEF between the two groups in different times.The parameters with clinical significance and significant difference in univariate analysis were analyzed by binary multivariate Logistic regression analysis. Meanwhile, receiver operating characteristic（ROC） curve was drawn, the area under ROC curve was analyzed, and the sensitivity and specificity of predicting the weaning outcome, optimal cut-off value of myocardial markers were determined. Results 62 ECPR patients treated with VA-ECMO were included in this study with a weaning success rate of 41.9%（26/62）. The CK-MB of the successful weaning group[86（43.5-146.0）U/L] was lower than that of the failed weaning group[618.5（177.8-1225.3）U/L], and the LVEF of the successful weaning group[35%（27.8%-40.5%）]was higher than that of the failed weaning group[29.5%（20.3%-33.8%）]before initiation, and the difference was statistically significant（P＜0.05）.The CK-MB[24.5（17.2-60.5）U/L]and hs-cTnI[4.6（0.9-8.9）ng/mL] of the successful weaning group were lower than those of the failed weaning group CK-MB[759.5（517.8-1520.2）U/L], hs-cTnI[31.7（9.3-75.2）ng/mL], and the LVEF of the successful weaning group[41.5%（33.3%-48.0%）] was higher than that of the failed weaning group[29.0%（19.3%-32.0%）] before weaning, and the difference was statistically significant（P＜0.05）.The hs-cTnI[4.6（0.9-8.9）ng/mL], CK-MB[24.5（17.2-60.5）U/L] before weaning and hs-cTnI[1.5（0.4-3.9）ng/mL], CK-MB（14（9.5-32.75）U/L）after weaning in the successful weaning group decreased compared with hs-cTnI[12.7（1.8-23.3）ng/mL]、CK-MB[86.0（43.5-146.0）U/L]before initiation, and the LVEF[41.5%（33.3%-48.0%）] before weaning and [53.5%（45.8%-56.5%）] after weaning in the successful weaning group increased compared with LVEF[35.0%（27.8%-40.5%）] before initiation, and the difference was statistically significant（P＜0.05）. In the failed weaning group, hs-cTnI[31.7（9.3-75.2）ng/mL] and CK-MB[759.5（517.8-1520.2）U/L] before weaning increased compared with hs-cTnI[12.3（4.2-50.0）ng/mL] and CK-MB[618.5（177.8-1225.3）U/L]before initiation, and the difference was statistically significant（P＜0.05）.Logistic regression analysis showed that CK-MB had the best performance in predicting the weaning outcome, with an AUC value of 0.865, a sensitivity of 80.6% and a specificity of 84.6%. Compared with a single indicator, the combined prediction performance of three myocardial markers was the best, with an AUC value of 0.882, a sensitivity of 80.6% and a specificity of 92.3%. Conclusions The combined application of three myocardial markers（hs-cTnI, CK-MB, LVEF） could improve the predictive performance of weaning outcome in ECPR patients.

Acute organophosphorus pesticide poisoning (AOPP) is fairly common in rural areas of Asia. The symptoms of AOPP are mainly caused by acetylcholine accumulation. According to the clinical characteristics, AOPP symptoms can fall into the following three categories: muscarinic, nicotinic, and central. Death from fatal poisoning is caused by respiratory paralysis, and neurological complications are common. However, no case of intestinal necrosis caused by AOPP has been reported. Hepatic portal vein gas and pneumatosis intestinalis are considered typical and early imaging manifestations of intestinal necrosis. In this article, we describe a very rare case of computed tomography imaging-proven intestinal necrosis caused by AOPP.

To analyze the dynamic changes of serum metabolomics in wasp sting victims, we collected serum from 10 healthy volunteers and 10 patients who had been stung 3 hours, 24 hours, and 72 hours before sample collection. We analyzed the metabolomics by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) techniques and then performed enrichment analysis. A total of 838 metabolites were identified. Serum metabolomics analysis using MetaboAnalyst revealed 289 metabolites that were significantly different among patients in the 3-hour group versus healthy controls (P<0.001). Pathway analysis of those metabolites indicated that those metabolic sets were associated with sphingolipid metabolism. Based on the differences among the control, 3-hour, 24-hour, and 72-hour groups, we classified serum metabolites into different categories. The first and second categories included 297 and 280 metabolites that were significantly different in terms of concentration among healthy controls versus the participants whose sera were analyzed 3 hours, 24 hours, and 72 hours after wasp stings. Pathway analysis of those metabolites indicated that those metabolic sets were associated with thiamine metabolism. The third category included 269 significant metabolites. The fourth category included 28 significant metabolites. Pathway analysis of the metabolites in third and fourth categories indicated that those metabolic sets were associated with phenylalanine, tyrosine, and tryptophan biosynthesis. The fifth category included 31 metabolites, which were not significantly different between the control and 3-hour groups but were higher in concentration in the 24-hour and 72-hour groups. Pathway analysis of the fifth category of significant metabolites identified linoleic acid metabolism. In conclusion, multiple metabolic pathways are associated with wasp stings, and these might provide a basis for exploring mechanisms of wasp sting injury and potential targets for therapy.

Objective: Wasp venom is a potentially important natural drug, but it can cause hypersensitivity reactions. The purpose of the present study was to systematically study the epitopes of wasp venom. Methods: Using a random 12-peptide phage library, we performed antibody-binding epitope panning on ten serum samples from wasp sting victims at 3 h and 4 days after the sting. The panning epitopes were identified by high-throughput sequencing and matched with wasp venom proteins by BLAST. The panned antibody-binding epitopes were verified by ELISA. Results: A total of 35 specific potential wasp venom epitopes in 4 days were identified. Amongst them, twelve peptide epitopes were matched with nine wasp venom proteins, namely, vitellogenin precursor, hexamerin 70b precursor, venom carboxylesterase-6 precursor, MRJP5, major royal jelly protein 8 precursor, venom acid phosphatase Acph-1 precursor, phospholipase A2, venom serine protease 34 precursor, and major royal jelly protein 9 precursor. The changes in serum IgM antibodies induced by wasp venom were confirmed by ELISA based on the 12 peptide epitopes. Conclusion: The nine wasp venom proteins are potential allergens, which should be excluded or modified in the potential biomedical applications of wasp venom.