BACKGROUND Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe disease occurring several weeks after severe acute respiratory syndrome coronavirus 2 infection. It develops in adults with inflammation of different organs including the gastrointestinal tract, heart, kidneys, skin and hematopoietic system. CASE SUMMARY We present a 58-year-old Chinese man diagnosed with MIS-A. His chief complaints were fever, generalized fatigue and anorexia, accompanied with rashes on his back. Further examination showed cardiac, renal and liver injury. He had melena and gastroscopy indicated esophageal ulcer and severe esophagitis. Repeated blood and sputum culture did not show growth of bacteria or fungi. Antibiotic treatment was stopped due to unsatisfactory performance. His condition improved after prednisone and other supportive treatment. CONCLUSION Gastrointestinal involvement in MIS-A is not uncommon. Intestinal involvement predominates, and esophageal involvement is rarely reported. Esophageal ulcer with bleeding could also be a manifestation of MIS-A.

BACKGROUND:The C-reactive protein-to-albumin ratio (CAR) is a novel prognostic biomarker of systemic inflammation and nutritional status. The association between CAR and the long-term outcome of spontaneous intracerebral hemorrhage (ICH) remains unclear. METHODS:From January 2014 to September 2016, 497 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. According to the CAR quartiles, patients were classified into four groups (Q1-Q4). Logistic regression was applied to analyze the relationship between different CAR levels and main outcome (90-day and 1-year mRS 4-6). Restricted cubic splines and receiver operating characteristic (ROC) curves of CAR for poor clinical outcomes were assessed. RESULTS:In the multivariate logistic regression model, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q2, Q3, and Q4 group for 90-day mRS score of 4-6 were 3.64 (1.61-8.23), 3.83 (1.67-8.77), and 8.91 (3.85-20.64). In terms of 1-year mRS score of 4-6, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q3 and Q4 group were 3.31 (1.33-8.22) and 6.87 (2.81-16.78). CONCLUSIONS:A high CAR level was associated with a high risk of long-term adverse prognosis in patients with ICH, and the risk of ICH poor outcome increased steadily with CAR rising in a certain range, and maintained in a high level thereafter.

AbstractObjectiveThe association between gait speed and adverse outcomes after stroke has not been fully illustrated. This study aimed to explore the association of gait speed on long‐term outcomes in minor stroke or transient ischemic attack (TIA).MethodsWe performed a longitudinal study with acute minor stroke or TIA based on a subgroup of the Third China National Stroke Registry data. The gait speed was evaluated using a 10‐meter walking test at discharge and 3 months after the stroke onset. The primary outcomes were poor functional outcomes at 1 year, defined by a modified Rankin Score (mRS) of 2–6. Additional outcomes included all‐cause death, ambulate dependency (mRS score 4–6), cognitive impairment (Montreal Cognitive Assessment <26), stroke recurrence, and composite vascular events.ResultsThe study sample included a total of 1542 stroke patients with a median age of 60 (53–68). At 1‐year follow‐up, 140 (9.20%) patients experienced poor functional outcomes. Faster gait speed at discharge was associated with lower incidence of poor functional outcome (OR = 0.89; 95% CI, 0.84–0.94), cognitive impairment (OR = 0.93; 95% CI, 0.89–0.96), ischemic stroke recurrence (HR = 0.92; 95% CI, 0.87–0.98), and composite vascular events (HR =0.94; 95% CI, 0.89–0.99) at 1 year. Faster gait speed at 3 months was associated with lower incidence of poor functional outcome (OR = 0.90; 95% CI, 0.85–0.95), ambulate dependency (OR = 0.86; 95% CI, 0.77–0.97), and cognitive impairment (OR = 0.92; 95% CI, 0.88–0.95) at 1 year.InterpretationOur findings indicated that slow gait speed after minor stroke or TIA may be an independent predictor for long‐term poor outcomes. Gait speed may be considered as a vital sign during follow‐up in post‐stroke patients.

BACKGROUND The evidence on use of supplementary titanium cable cerclage (TCC) in treating femoral subtrochanteric fractures (FSF) remains scarce. Therefore, this study aimed to investigate the potential therapeutic effects for FSF patients using TCC. MATERIAL AND METHODS A retrospective study of 68 FSF patients treated by a long intramedullary (IM) nailing with (Observation group, n=41) or without (Control group, n=27) TCC was conducted from January 2020 to December 2021. The primary outcome measure was time to postoperative full weight-bearing. Secondary outcome measures were operation time, intraoperative blood loss, number of blood transfusions needed, varus angle loss, excellent and good rate of fracture reduction, Harris score, and survival rate. RESULTS Patients were followed up for 13 to 36 months. The excellent and good rate of fracture reduction was 100% in the Observation group versus 92.6% in the Control group (P=0.013), and the varus angle loss and time to postoperative full weight-bearing in the Observation group were significantly less than in the Control group (P<0.05). The intraoperative blood loss in the Observation group was significantly higher than in the Control group (P<0.001). No differences were noted between groups for Harris scores and survival rates at last follow-up. CONCLUSIONS TCC fixation combined with IM nailing can improve the excellent and good rate of fracture reduction and reduce varus angle loss, as well as shorten the time to full weight-bearing and promote early functional exercise, which offers an effective treatment option for FSF patients who have failed closed reduction.

Objectives:Physical activity is recommended in guidelines for treatment for diabetes, but the association between physical activity and mortality among diabetic patients has not been extensively studied. Methods:Databases were searched from inception to July 10, 2020. Prospective studies were selected to evaluate the association between physical activity and risk for total and cardiovascular diseases (CVD) mortality among diabetic patients. Data were pooled using random-effect model to calculate the relative risks (RRs) with 95% confidence intervals (CIs). Results:We included 16 eligible studies involving with 155,203 diabetic participants and 13,821 cases of death. Our study suggested that physical activity in diabetic patients may decrease risk for all-cause (RR 0.57, 95% CI 0.49-0.67) and CVD mortality (RR 0.55, 95% CI 0.34-0.68). The summary RR for CVD events was 0.65 (95% CI 0.41-1.03). Furthermore, the reductions in all-cause mortality were more significant in diabetic patients with old age (> 60 years) (RR 0.46, 95% CI 0.29 -0.75), higher body mass index (BMI ≥ 28) (RR 0.53, 95% CI 0.42-0.69) and shorter duration of diabetes (RR 0.45, 95% CI 0.24-0.84). Conclusion:Physical activity reduced the risk of total and CVD mortality among patients with diabetes, in particular in diabetic patients with old age (> 60 years), obesity and shorter duration of diabetes.

Background: The neutrophil-to-lymphocyte ratio (NLR) is an index reflecting the overall inflammatory and stress status of patients with major diseases. Many studies associated the NLR with neurological deterioration and a poor prognosis in the spontaneous intracerebral hemorrhage (ICH). However, most previous studies did not further analyze NLR by stratification, and with a relatively small sample size. Besides, the outcome evaluation mostly focused on short-term prognosis or a single timepoint. Methods: Patients' basic characteristics and laboratory examination results, including the NLR were taken at baseline, and data from the 1-year follow-up, including the modified Rankin Scale (mRS) and survival status, was obtained for all patients. Patients included in the study were classified into four groups according to NLR quartiles (Q1-Q4). Logistic regression was used to analyze the relationship between different NLR levels and poor outcomes (mRS 3-5 and mRS 3-6). Results: A total of 594 ICH patients were enrolled. Glasgow Coma Scale (GCS), NIH Stroke Scale (NIHSS) and hematoma volume at first admission were significantly different between different NLR level groups (all P values <0.05). In the multivariate logistic regression model, at the 30-day follow-up, the Q4 (significantly increased NLR) group showed an elevated risk of poor outcomes (OR, 2.37; 95% CI, 1.17-4.83, P=0.02) and functional disability (OR, 2.21; 95% CI, 1.05-4.65, P=0.04). At the 3-month follow-up, the Q4 group still showed an elevated risk of poor outcomes (OR, 2.83; 95% CI, 1.38-5.77, P<0.01) and functional disability (OR, 2.77; 95% CI, 1.28-5.98, P<0.01). At the 1-year follow-up, the Q2 (slightly elevated NLR) group showed significant functional disability (OR, 0.34; 95% CI, 0.16-0.72, P<0.01). Conclusion: A significantly increased NLR may have an impact on the poor outcomes and functional disability of patients with ICH, while a slightly elevated NLR may play a protective role.

BACKGROUND This study investigated the correlations between acute cerebral hemorrhage complicated with stress ulcer bleeding and corresponding indexes, including the Acute Physiology and Chronic Health Evaluation (APACHE) II score, vascular endothelin-1 (ET-1), tumor necrosis factor-alpha (TNF-α), and blood lipid factors. MATERIAL AND METHODS A total of 53 patients with acute cerebral hemorrhage complicated with stress ulcer bleeding were selected as the observation group and 50 patients with simple acute cerebral hemorrhage were selected as the control group. The APACHE II score and the levels of ET-1, TNF-α, and blood lipid factors, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and malondialdehyde (MDA), were detected and the correlations of were analyzed between the 2 groups of patients. RESULTS The blood lipid index TG, APACHE II score, ET-1, TNF-a, renal function indexes [blood urea nitrogen (BUN) and creatinine (Cr)], mortality rate, hemoglobin, and MDA in the observation group were significantly higher than those in the control group, while HDL-C in the observation group was obviously lower than in the control group (p<0.05). The APACHEII score had positive correlations with TG and TNF-α (r=0.8960, r=0.8563, respectively), while it was negatively correlated with TC, HDL-C, LDL-C, and ET-1 (r=-0.909, r=-0.9292, r=-0.8543, and r=-0.8899, respectively) (p<0.001 in all comparisons). APACHEII score, BUN, and Cr were all risk factors. CONCLUSIONS Stress ulcer in patients with acute cerebral hemorrhage is associated with blood lipid changes and inflammation, which provides clues for the diagnosis and treatment of acute cerebral hemorrhage.