Writing Group for the BASILAR Group IMPORTANCE Several randomized clinical trials have recently established the safety and efficacy of endovascular treatment (EVT) of acute ischemic stroke in the anterior circulation. However, it remains uncertain whether patients with acute basilar artery occlusion (BAO) benefit from EVT.OBJECTIVE To evaluate the association between EVT and clinical outcomes of patients with acute BAO. DESIGN, SETTING, AND PARTICIPANTSThis nonrandomized cohort study, the EVT for Acute Basilar Artery Occlusion Study (BASILAR) study, was a nationwide prospective registry of consecutive patients presenting with an acute, symptomatic, radiologically confirmed BAO to 47 comprehensive stroke centers across 15 provinces in China between January 2014 and May 2019. Patients with acute BAO within 24 hours of estimated occlusion time were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. MAIN OUTCOMES AND MEASURESThe primary outcome was the improvement in modified Rankin Scale scores (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days across the 2 groups assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. The secondary efficacy outcome was the rate of favorable functional outcomes defined as modified Rankin Scale scores of 3 or less (indicating an ability to walk unassisted) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage and 90-day mortality.RESULTS A total of 1254 patients were assessed, and 829 patients (of whom 612 were men [73.8%]; median [interquartile] age, 65 [57-74] years) were recruited into the study. Of these, 647 were treated with standard medical treatment plus EVT and 182 with standard medical treatment alone. Ninety-day functional outcomes were substantially improved by EVT (adjusted common odds ratio, 3.08 [95% CI, 2.09-4.55]; P < .001). Moreover, EVT was associated with a significantly higher rate of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 4.70 [95% CI,; P < .001) and a lower rate of 90-day mortality (adjusted odds ratio, 2.93 [95% CI, 1.95-4.40]; P < .001) despite an increase in symptomatic intracerebral hemorrhage (45 of 636 patients [7.1%] vs 1 of 182 patients [0.5%]; P < .001).CONCLUSIONS AND RELEVANCE Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.
Epidemiological studies have indicated that the consumption of fruits and vegetables is associated with a reduced risk for the development of chronic diseases, such as cardiovascular disease and cancer. Phytochemicals, including phenolics and flavonoids, are suggested to be the major bioactive compounds contributing to the health benefits of fruits and vegetables. Onions are a major source of dietary flavonoids; however, there may exist varietal differences in composition, concentration, and beneficial activities. To characterize these differences, shallots and 10 onion (Allium cepa L.) varieties commonly available in the United States (Western Yellow, Northern Red, New York Bold, Western White, Peruvian Sweet, Empire Sweet, Mexico, Texas 1015, Imperial Valley Sweet, and Vidalia) were evaluated for total phenolic and flavonoid contents and antioxidant and antiproliferative activities. Shallots contained the highest total phenolic content (114.7 +/- 10.0 mg/100 g of sample) among the varieties tested, with a 6-fold difference observed when compared to the variety with the lowest phenolic content (Vidalia, p < 0.05). Western Yellow onion variety exhibited the highest total flavonoid content (69.2 +/- 3.7 mg/100 g of onion) of the varieties tested, with an 11-fold difference when compared to the variety with the lowest flavonoid content (Western White, p < 0.05). Shallots exhibited the highest total antioxidant activity (45.5 +/- 2.1 micromol of vitamin C equiv/g of onion), followed by Western Yellow, New York Bold, Northern Red, Mexico, Empire Sweet, Western White, Peruvian Sweet, Texas 1015, Imperial Valley Sweet, and Vidalia. For all varieties, both total phenolic and flavonoid contents were strongly correlated with total antioxidant activity (R (2) = 0.9668, p < 0.05; and R (2) = 0.7033, p < 0.05, respectively). The proliferation of HepG(2) and Caco-2 cells was significantly inhibited in a dose-dependent fashion after exposure to the Western Yellow, shallots, New York Bold, and Northern Red extracts, with Western Yellow, shallots, and New York Bold exhibiting the highest antiproliferative activity against HepG(2) cells and New York Bold and Western Yellow exhibiting the highest antiproliferative activity against Caco-2 cells. However, the varieties of Western White, Peruvian Sweet, Empire Sweet, Mexico, Texas 1015, Imperial Valley Sweet, and Vidalia demonstrated weak antiproliferative activity against both HepG(2) and Caco-2 cells. These results may influence consumers toward purchasing onion varieties exhibiting greater potential health benefits and may significantly affect future breeding efforts to enhance onion nutritional qualities.
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