Impacts of stress hyperglycemia ratio on early neurological deterioration and functional outcome after endovascular treatment in patients with acute ischemic stroke.

Background and Purpose: Hyperglycemia has been associated with unfavorable outcome of acute ischemic stroke, but this association has not been verified in patients with endovascular thrombectomy treatment. This study aimed to assess the impact of stress hyperglycemia ratio on early neurological deterioration and favorable outcome after thrombectomy in patients with acute ischemic stroke. Methods: Stroke patients with endovascular thrombectomy in two comprehensive centers were enrolled. Early neurological deterioration was defined as ≥4 points increase of National Institutes of Health Stroke Scale (NIHSS) at 24 hours after endovascular procedure. Favorable outcome was defined as modified Rankin Scale (mRS) score of 0-2 at 90 days of stroke onset. Multivariate regression analysis was used to identify the predictors for early neurological deterioration and favorable outcome. Results: Among the 559 enrolled, 74 (13.2%) patients developed early neurological deterioration. The predictors for early neurological deterioration were high stress hyperglycemia ratio at baseline (OR =5.77; 95% CI, 1.878-17.742; P =0.002), symptomatic intracranial hemorrhage (OR =4.90; 95% CI, 2.439-9.835; P <0.001) and high NIHSS score after 24 hours (OR =1.11; 95% CI, 1.071-1.151; P <0.001). The predictors for favorable outcome were stress hyperglycemia ratio (OR =0.196, 95% CI, 0.077-0.502; P =0.001), age (OR =0.942, 95% CI, 0.909-0.977; P =0.001), NIHSS score 24 hours after onset (OR =0.757, 95% CI =0.693-0.827; P <0.001), groin puncture to recanalization time (OR =0.987, 95% CI, 0.975-0.998; P =0.025), poor collateral status before treatment (ASITN/SIR grade 0-3, OR =62.017, 95% CI, 25.920-148.382; P <0.001), successful recanalization (mTICI 2b or 3, OR =7.415, 95% CI, 1.942-28.313; P =0.001). Conclusion: High stress hyperglycemia ratio may be related to early neurological deterioration and decreased likelihood of favourable outcomes after endovascular thrombectomy in patients with acute ischemic stroke.

Effect of Cu on the Microstructure and Mechanical Properties of a Low-Carbon Martensitic Stainless Steel.

Reversed austenite is of vital importance in low-carbon martensitic stainless steel because it improves impact toughness. However, a proper amount of reversed austenite is obtained by tempering at a critical temperature, which reduces the strength of the steel. Therefore, how to improve strength-toughness matching is an important problem. Copper (Cu) is an effective strengthening element in steels. However, there is little in-depth discussion on the role of Cu on the microstructure and mechanical properties of low-carbon martensite steel. In this work, the effect of different Cu content on the reversed austenite formation, tensile strength, and impact toughness of a low-carbon martensitic stainless steel (0Cr13Ni4Mo) was systematically investigated through use of a transmission electron microscope (TEM), transmission Kikuchi diffraction (TKD), atom probe tomography (APT), and other characterization methods and mechanical property tests. The results showed that the addition of Cu decreased the phase transition temperatures of martensite and austenite and increased the volume fraction of the reversed austenite. APT results indicated that Cu-rich clusters first formed with alloying elements such as ferrum (Fe) and nickel (Ni) and then grew to be precipitates through rejection of the alloying elements. The Ni atoms diffused towards the interface between the precipitates and the martensite matrix, which provided heterogeneous nucleation sites for the reversed austenite. Cu precipitations strengthened tensile strength during tempering. However, it generated temper brittleness in the steel at a tempering temperature of 450 °C, resulting in the impact energy of the 3Cu-steel being only 7 J. A good combination with higher tensile strength (863 MPa) and ductility (192 J) was obtained when tempering at 600 °C in the presence of Cu-rich precipitates and a sufficient volume fraction of the reversed austenite. The results provide guidance for the design of steels with reversed austenite and Cu and promote the development of high-strength and high-toughness steels.