Mitochondrial myopathy without extraocular muscle involvement: a unique clinicopathologic profile
Yan LinJiayin WangHong RenXiaotian MaWei WangYing ZhaoZhihong XuShuangwu LiuWenqing WangXuebi XuBin WangDandan ZhaoDongdong WangWei LiFuchen LiuYuying ZhaoJian‐Qiang LuChuanzhu YanKunqian Ji
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We have demonstrated in a multicenter cohort that the COVID-19 pandemic has led to a delay in intravenous thrombolysis (IVT) among stroke patients. Whether this delay contributes to meaningful short-term outcome differences in these patients warranted further exploration. We conducted a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers across 7 U.S states. Patients admitted prior to the COVID-19 pandemic (1/1/2019–02/29/2020) were compared to patients admitted during the early pandemic (3/1/2020–7/31/2020). Multivariable logistic regression was used to estimate the effect of IVT delay on discharge to hospice or death, with treatment delay on admission during COVID-19 included as an interaction term. Of the 676 thrombolysed patients, the median age was 70 (IQR 58–81) years, 313 were female (46.3%), and the median NIHSS was 8 (IQR 4–16). Longer treatment delays were observed during COVID-19 (median 46 vs 38 min, p = 0.01) and were associated with higher in-hospital death/hospice discharge irrespective of admission period (OR per hour 1.08, 95% CI 1.01–1.17, p = 0.03). This effect was strengthened after multivariable adjustment (aOR 1.15, 95% CI 1.07–1.24, p < 0.001). There was no interaction of treatment delay on admission during COVID-19 (pinteraction = 0.65). Every one-hour delay in IVT was also associated with 7% lower odds of being discharged to home or acute inpatient rehabilitation facility (aOR 0.93, 95% CI 0.89–0.97, p < 0.001). Treatment delays observed during the COVID-19 pandemic led to greater early mortality and hospice care, with a lower probability of discharge to home/rehabilitation facility. There was no effect modification of treatment delay on admission during the pandemic, indicating that treatment delay at any time contributes similarly to these short-term outcomes.
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Objective To investigate the diagnosis value of minimum exercise test of lactic acid and pyruvic acid(METLP) for mitochondrial myopathy.Methods METLP were applied in 21 patients with mitochondrial myopathy,6 patients with other myopathy and 14 patients without myopathy.All of them were diagnosed by muscle biopsy.The results of METLP were analyzed.Results The abnormal results of METLP were found in 18(85.7%) patients with mitochondrial myopathy,including 12 cases had 2 or more abnormal indexes.The mainly abnormal index was the value of lactic acid post-exercise/ pyruvic acid pre-exercise(L2/P1) 17.The abnormal results of METLP were found in 6(100%) patients with other myopathy.Most of them showed a high concentration of lactic acid post-aerobic exercise(L2),and sustainable to after rest,or even more higher(L3).3(21.4%)patients without myopathy showed abnormal results of METLP.Conclusions In all the indexes of METLP,the value of L2/P1 is the reliable index for diagnosis mitochondrial myopathy or no-myopathy;the value of L3/L2 is the most important index in differential diagnosis of mitochondrial myopathy and other myopathy.METLP plays a certain role in the diagnosis of the mitochondrial myopathy,but the clinical and pathological data ought to be combined.
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