A Rubik's Cube-Inspired Pedagogical Tool for Teaching and Learning Engineering Ethics.

To facilitate engineering students' understanding of engineering ethics and support instructors in developing course content, this study introduces an innovative educational tool drawing inspiration from the Rubik's Cube metaphor. This Engineering Ethics Knowledge Rubik's Cube (EEKRC) integrates six key aspects-ethical theories, codes of ethics, ethical issues, engineering disciplines, stakeholders, and life cycle-identified through an analysis of engineering ethics textbooks and courses across the United States, Singapore, and China. This analysis underpins the selection of the six aspects, reflecting the shared and unique elements of engineering ethics education in these regions. In an engineering ethics course, the EEKRC serves multiple functions: it provides visual support for grasping engineering ethics concepts, acts as a pedagogical guide for both experienced and inexperienced educators in course design, offers a complementary assessment method for evaluating students learning outcomes, and assists as a reference for students engaging in ethical analysis.

Realizing Near-Unity Photoluminescence Efficiency in Antimony-Doped Indium-Based Halides Induced by Strong Electron-Phonon Coupling.

Exploring a zero-dimensional (0D) hybrid halide with a large Stokes shift and efficient broad-band emission is highly desirable due to its enormous potential for solid-state lighting (SSL) application. However, it is still challenging to develop a highly emissive 0D hybrid halide with low toxicity and remarkable stability. Herein, we developed a novel indium-based metal halide A5In2Cl16·4H2O (A = doubly protonated 1,4-diaminobutane) whose inorganic octahedrons are completely isolated by the organic cations to form the 0D structure. Experimental and theoretical studies confirmed that Sb-doped A5In2Cl16·4H2O exhibits broad yellow emission with a photoluminescence quantum yield (PLQY) of up to 98%. The intense yellow emission can be attributed to the radiative recombination of triplet self-trapped excitons (STEs) in [SbCl6]3- octahedrons caused by the strong electron-phonon coupling. Benefiting from the excellent stability and photoluminescence performance, A5In2Cl16·4H2O:15%Sb was used as the yellow phosphor to prepare a white-light-emitting diode (WLED) device with a color rendering index of 87.8 and a luminous efficiency of up to 36.18 lm/W, demonstrating its potential in SSL applications. This work provides a guidance for developing environmentally friendly, efficient, and stable ultraviolet (UV)-excited broad-band emission materials.

Bioresponsive and transformable coacervate actuated by intestinal peristalsis for targeted treatment of intestinal bleeding and inflammation.

Developing an oral in situ-forming hydrogel that targets the inflamed intestine to suppress bleeding ulcers and alleviate intestinal inflammation is crucial for effectively treating ulcerative colitis (UC). Here, inspired by sandcastle worm adhesives, we proposed a water-immiscible coacervate (EMNs-gel) with a programmed coacervate-to-hydrogel transition at inflammatory sites composed of dopa-rich silk fibroin matrix containing embedded inflammation-responsive core-shell nanoparticles. Driven by intestinal peristalsis, the EMNs-gel can be actuated forward and immediately transform into a hydrogel once contacting with the inflamed intestine to yield strong tissue adhesion, resulting from matrix metalloproteinases (MMPs)-triggered release of Fe3+ from embedded nanoparticles and rearrangement of polymer network of EMNs-gel on inflamed intestine surfaces. Extensive in vitro experiments and in vivo UC models confirmed the preferential hydrogelation behavior of EMNs-gel to inflamed intestine surfaces, achieving highly effective hemostasis, and displaying an extended residence time ( > 48 h). This innovative EMNs-gel provides a non-invasive solution that accurately suppresses severe bleeding and improves intestinal homeostasis in UC, showcasing great potential for clinical applications.

An Ionization-Based Aerosol Sensor and Its Performance Study.

In recent years, with the rapid development of new energy vehicles, the safety issues of lithium-ion batteries have attracted attentions from all sectors of society. Research has found that during the thermal runaway process of lithium-ion batteries, aerosol emissions usually occur earlier than other gases. Accurate and timely measurement of these aerosol concentrations can help to warn the power battery pack fires. However, existing aerosol sensors are unable to meet the requirements of real-time monitoring and high precision. This article proposes an ionization mechanism based aerosol sensor that works at principles of field emission, field charging and gas discharge, and investigates its static and dynamic response characteristics. The sensor is manufactured and assembled using Microelectro Mechanical Systems processing technology. The sensor exhibits superior performances in terms of range, sensitivity, nonlinearity, repeatability, response time, and other aspects. The study provides a new solution for current aerosol detection with great potential for application.

High-efficiency color-tunable ultralong room-temperature phosphorescence from organic-inorganic metal halides via synergistic inter/intramolecular interactions.

Materials exhibiting highly efficient, ultralong and multicolor-tunable room-temperature phosphorescence (RTP) are of practical importance for emerging applications. However, these are still very scarce and remain a formidable challenge. Herein, using precise structure design, several novel organic-inorganic metal-halide hybrids with efficient and ultralong RTP have been developed based on an identical organic cation (A). The original organic salt (ACl) exhibits red RTP properties with low phosphorescence efficiency. However, after embedding metals into the organic salt, the changed crystal structure endows the resultant metal-halide hybrids with excellent RTP properties. In particular, A2ZnCl4·H2O exhibits the highest RTP efficiency of up to 56.56% with a long lifetime of up to 159 ms. It is found that multiple inter/intramolecular interactions and the strong heavy-atom effect of the rigid metal-halide hybrids can suppress molecular motion and promote the ISC process, resulting in highly stable and localized triplet excitons followed by highly efficient RTP. More crucially, multicolor-tunable fluorescence and RTP achieved by tuning the metal and halogen endow these materials with wide application prospects in the fields of multilevel information encryption and dynamic optical data storage. The findings promote the development of phosphorescent metal-halide hybrids for potential high-tech applications.

On-chip integrated metasystem for spin-dependent multi-channel color holography.

On-chip integrated metasurface driven by in-plane guided waves is of great interests in various light-field manipulation applications such as colorful augmented reality and holographic display. However, it remains a challenge to design colorful multichannel holography by a single on-chip metasurface. Here we present metasurfaces integrated on top of a guided-wave photonic slab that achieves multi-channel colorful holographic light display. An end-to-end scheme is used to inverse design the metasurface for projecting off-chip preset multiple patterns. Particular examples are presented for customized patterns that were encoded into the metasurface with a single-cell meta-atom, working simultaneously at RGB color channels and for several different diffractive distances, with polarization dependence. Holographic images are generated at 18 independent channels with such a single-cell metasurface. The proposed design scheme is easy to implement, and the resulting device is viable for fabrication, promising plenty of applications in nanophotonics.

Synthesis and fabrication of magnetically separable phosphate-modified magnetic chitosan composites for lead(II) selective removal from wastewater.

To address the urgent need for efficient removal of lead-containing wastewater and reduce the risk of toxicity associated with heavy-metal wastewater contamination, materials with high removal rates and easy separation must be developed. Herein, a novel organic-inorganic hybrid material based on phosphorylated magnetic chitosan (MSCP) was synthesized and applied for the selective removal of lead (II) from wastewater. From the characterization and the experimental results can be obtained that the magnetic saturation strength of MSCP reaches 14.65 emu/g, which can be separated quickly and regenerated readily, and maintains high adsorption performance even after 5 cycles, indicating that the adsorbent possesses good magnetic separation performance and durability. Also, MSCP showed high selective adsorption performance for lead in the multiple metal ions coexistence solutions at pH 6.0 and room temperature, with an adsorption coefficient SPb-MSCP of 78.85%, which was much higher than that of MSC (the SPb-MSC was 11.59%). Additionally, in the single lead system, the sorption characteristics of Pb(II) on MSCP and MCP had obvious pH-responsiveness, and their adsorption capacity increased with the increase of solution pH, reaching the maximal values of 80.19 and 72.68 mg/g, respectively. It is noteworthy that the acid resistance of MSCP with an inert layer coated on the core is significantly improved, with almost no iron leaching from MSCP over the entire acidity range, while MCP has 7.63 mg/g of iron leaching at pH 1.0. Significantly, MSCP exhibited a maximum adsorption capacity of 102.04 mg/g, which matches the Langmuir model at pH 6.0 and 298.15 K, and points to the pseudo-second-order kinetics of the chemisorption process of Pb(II) on MSCP. These findings highlight the great potential of MSCP for Pb(II) removal from aqueous solution, making it a promising solution for Pb(II) contamination in wastewater.

Sr-Incorporated Bioactive Glass Remodels the Immunological Microenvironment by Enhancing the Mitochondrial Function of Macrophage via the PI3K/AKT/mTOR Signaling Pathway.

The repair of critical-sized bone defects continues to pose a challenge in clinics. Strontium (Sr), recognized for its function in bone metabolism regulation, has shown potential in bone repair. However, the underlying mechanism through which Sr2+ guided favorable osteogenesis by modulating macrophages remains unclear, limiting their application in the design of bone biomaterials. Herein, Sr-incorporated bioactive glass (SrBG) was synthesized for further investigation. The release of Sr ions enhanced the immunomodulatory properties and osteogenic potential by modulating the polarization of macrophages toward the M2 phenotype. In vivo, a 3D-printed SrBG scaffold was fabricated and showed consistently improved bone regeneration by creating a prohealing immunological microenvironment. RNA sequencing was performed to explore the underlying mechanisms. It was found that Sr ions might enhance the mitochondrial function of macrophage by activating PI3K/AKT/mTOR signaling, thereby favoring osteogenesis. Our findings demonstrate the relationship between the immunomodulatory role of Sr ions and the mitochondrial function of macrophages. By focusing on the mitochondrial function of macrophages, Sr2+-mediated immunomodulation sheds light on the future design of biomaterials for tissue regenerative engineering.

Polyimide/Ag2WO4 Z-Scheme Heterojunction for Efficient Photocatalytic Degradation of Tetracycline.

It is of great significance to construct a Z-scheme heterojunction for improving solar light harvesting and achieving efficient separation of photogenerated carriers and then enhancement of the photocatalytic performance of semiconductor photocatalysts. Herein, the direct Z-scheme PI/Ag2WO4 heterojunction was designed and prepared according to the band edge potentials of the semiconductor. Due to the fact that the Z-scheme structure not only endowed the PI/Ag2WO4 composites with efficient separation of photogenerated electron-hole pairs but also reserved the redox ability of the valence band and conduction band of monophase catalysts, the 50% PI/Ag2WO4 heterojunction exhibited excellent photocatalytic activity, which were 2.9 and 1.5 times those of the PI and Ag2WO4 photocatalysts, respectively. The photocatalytic reaction mechanism of PI/Ag2WO4 composites was confirmed by the results of TEM, UV-vis, XPS, and EPR experiments. This work provides a feasible strategy to design high-performance photocatalysts in the field of practice purification of wastewater.

"Internet+Nursing Service" Mobile Apps in China App Stores: Functionality and Quality Assessment Study.

Background: As the Chinese society ages and the concern for health and quality of life grows, the demand for care services in China is increasing. The widespread use of internet technology has greatly improved the convenience and efficiency of web-based services. As a result, the Chinese government has been implementing "Internet+Nursing Services" since 2019, with mobile apps being the primary tools for users to access these services. The quality of these apps is closely related to user experience and the smooth use of services. Objective: This study aims to evaluate the functionality, services, and quality of "Internet+Nursing Service" apps; identify weaknesses; and provide suggestions for improving service programs and the research, development, improvement, and maintenance of similar apps. Methods: In December 2022, two researchers searched for "Internet+Nursing Service" apps by applying the search criteria on the Kuchuan mobile app monitoring platform. After identifying the apps to be included based on ranking criteria, they collected information such as the app developer, app size, version number, number of downloads, user ratings, and number and names of services. Afterward, 5 trained researchers independently evaluated the quality of the apps by using the Chinese version of the user version of the Mobile App Rating Scale (uMARS-C). The total uMARS-C score was based on the average of the five evaluators' ratings. Results: A total of 17 "Internet+Nursing Service" apps were included. Among these, 12 (71%) had been downloaded more than 10,000 times, 11 (65%) had user ratings of 4 or higher, the median app size was 62.67 (range 22.71-103; IQR 37.51-73.47) MB, 16 (94%) apps provided surgical wound dressing change services, 4 (24%) covered first-tier cities, and only 1 (6%) covered fourth-tier cities. The median total uMARS-C score was 3.88 (range 1.92-4.92; IQR 3.71-4.05), which did not correlate with app store user ratings (r=0.003; P=.99). The quality of most apps (11/17, 65%) was average. Most apps (12/17, 71%) were rated as "good" or above (≥4 points) in terms of information quality, layout, graphics, performance, and ease of use; however, the vast majority of apps were rated as "fair" or even "poor" (<4 points) in terms of credibility (14/17, 82%) and demand (16/17, 94%). Conclusions: "Internet+Nursing Service" apps need to broaden their service coverage, increase service variety, and further optimize their service structure. The overall quality of these apps is generally poor. App developers should collaborate with medical professionals and communicate with target users before launching their products to ensure accurate content, complete functionality, and good operation that meets user needs.

Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke: The MARVEL Randomized Clinical Trial.

Importance: It is uncertain whether intravenous methylprednisolone improves outcomes for patients with acute ischemic stroke due to large-vessel occlusion (LVO) undergoing endovascular thrombectomy. Objective: To assess the efficacy and adverse events of adjunctive intravenous low-dose methylprednisolone to endovascular thrombectomy for acute ischemic stroke secondary to LVO. Design, Setting, and Participants: This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 82 hospitals in China, enrolling 1680 patients with stroke and proximal intracranial LVO presenting within 24 hours of time last known to be well. Recruitment took place between February 9, 2022, and June 30, 2023, with a final follow-up on September 30, 2023. Interventions: Eligible patients were randomly assigned to intravenous methylprednisolone (n = 839) at 2 mg/kg/d or placebo (n = 841) for 3 days adjunctive to endovascular thrombectomy. Main Outcomes and Measures: The primary efficacy outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores (range, 0 [no symptoms] to 6 [death]). The primary safety outcomes included mortality at 90 days and the incidence of symptomatic intracranial hemorrhage within 48 hours. Results: Among 1680 patients randomized (median age, 69 years; 727 female [43.3%]), 1673 (99.6%) completed the trial. The median 90-day modified Rankin Scale score was 3 (IQR, 1-5) in the methylprednisolone group vs 3 (IQR, 1-6) in the placebo group (adjusted generalized odds ratio for a lower level of disability, 1.10 [95% CI, 0.96-1.25]; P = .17). In the methylprednisolone group, there was a lower mortality rate (23.2% vs 28.5%; adjusted risk ratio, 0.84 [95% CI, 0.71-0.98]; P = .03) and a lower rate of symptomatic intracranial hemorrhage (8.6% vs 11.7%; adjusted risk ratio, 0.74 [95% CI, 0.55-0.99]; P = .04) compared with placebo. Conclusions and Relevance: Among patients with acute ischemic stroke due to LVO undergoing endovascular thrombectomy, adjunctive methylprednisolone added to endovascular thrombectomy did not significantly improve the degree of overall disability. Trial Registration: ChiCTR.org.cn Identifier: ChiCTR2100051729.

Oxygen Vacancies on NH4 V4 O10 Accelerate Ion and Charge Transfer in Aqueous Zinc-Ion Batteries.

Vanadium-based compounds are identified as promising cathode materials for aqueous zinc ion batteries due to their high specific capacity. However, the low intrinsic conductivity and sluggish Zn2+ diffusion kinetics seriously impede their further practical application. Here, oxygen vacancies on NH4 V4 O10 is reported as a high-performing cathode material for aqueous zinc ion batteries via a facile hydrothermal strategy. The introduction of oxygen vacancy accelerates the ion and charge transfer kinetics, reduces the diffusion barrier of zinc ions, and establishes a stable crystal structure during zinc ion (de-intercalation). As a result, the oxygen vacancy enriched NH4 V4 O10 exhibits a high specific capacity of ≈499 mA h g-1 at 0.2 A g-1 , an excellent rate capability of 296 mA h g-1 at 10 A g-1 and the specific capacity cycling stability with 95.1% retention at 5 A g-1 for 4000 cycles, superior to the NVO sample (186.4 mAh g-1 at 5 A g-1 , 66% capacity retention).

Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion.

BACKGROUND: The effects of the glycoprotein IIb/IIIa receptor inhibitor tirofiban in patients with acute ischemic stroke but who have no evidence of complete occlusion of large or medium-sized vessels have not been extensively studied. METHODS: In a multicenter trial in China, we enrolled patients with ischemic stroke without occlusion of large or medium-sized vessels and with a National Institutes of Health Stroke Scale score of 5 or more and at least one moderately to severely weak limb. Eligible patients had any of four clinical presentations: ineligible for thrombolysis or thrombectomy and within 24 hours after the patient was last known to be well; progression of stroke symptoms 24 to 96 hours after onset; early neurologic deterioration after thrombolysis; or thrombolysis with no improvement at 4 to 24 hours. Patients were assigned to receive intravenous tirofiban (plus oral placebo) or oral aspirin (100 mg per day, plus intravenous placebo) for 2 days; all patients then received oral aspirin until day 90. The primary efficacy end point was an excellent outcome, defined as a score of 0 or 1 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. Secondary end points included functional independence at 90 days and a quality-of-life score. The primary safety end points were death and symptomatic intracranial hemorrhage. RESULTS: A total of 606 patients were assigned to the tirofiban group and 571 to the aspirin group. Most patients had small infarctions that were presumed to be atherosclerotic. The percentage of patients with a score of 0 or 1 on the modified Rankin scale at 90 days was 29.1% with tirofiban and 22.2% with aspirin (adjusted risk ratio, 1.26; 95% confidence interval, 1.04 to 1.53, P = 0.02). Results for secondary end points were generally not consistent with the results of the primary analysis. Mortality was similar in the two groups. The incidence of symptomatic intracranial hemorrhage was 1.0% in the tirofiban group and 0% in the aspirin group. CONCLUSIONS: In this trial involving heterogeneous groups of patients with stroke of recent onset or progression of stroke symptoms and nonoccluded large and medium-sized cerebral vessels, intravenous tirofiban was associated with a greater likelihood of an excellent outcome than low-dose aspirin. Incidences of intracranial hemorrhages were low but slightly higher with tirofiban. (Funded by the National Natural Science Foundation of China; RESCUE BT2 Chinese Clinical Trial Registry number, ChiCTR2000029502.).

The design and clinical application of a new appliance to treat impacted maxillary central incisors.

Maxillary central incisor impaction is one of the most common types of dental anomalies in children. Treatment of impacted central incisors is complicated and challenging given the position of the impacted central incisors, root development, and the complexity of the crown eruption direction. This study aimed to describe the use of a new multifunctional appliance for the treatment of impacted maxillary central incisors. This article reports the use of a novel appliance for the treatment of impacted maxillary central incisors. We describe the cases of two young patients with labial horizontally impacted maxillary central incisors. Both patients were treated using this novel appliance. Therapeutic effects were evaluated by comparing the pretreatment results, posttreatment cone-beam computed tomography images, and posttreatment clinical examination results. At the end of the treatment period using the novel appliance, the impacted central incisors had successfully been properly aligned in the dental arch, and the tooth roots had not resorbed. Both patients exhibited good dental alignment, with restored function and acceptable aesthetics. This article demonstrates that the new appliance was comfortable, convenient, safe, and effective in the treatment of impacted maxillary central incisors and that its clinical use should be promoted in the future.

Time-Dependent Endovascular Treatment Effect According to Collateral Status in Basilar Artery Occlusion.

Prior studies on anterior circulation stroke have demonstrated that the benefits of endovascular treatment (EVT) may be absent in patients with poor collaterals. Our study focused on patients with basilar artery occlusion (BAO) to investigate time-dependent EVT effects according to the posterior circulation collateral score (PC-CS). The BASILAR study was a nationwide prospective Chinese registry of consecutive BAO patients. Patients were divided into groups receiving standard medical therapy alone (SMT group) or SMT plus EVT (EVT group). Restricted cubic spline analyses (RCSA) were performed to explore the nonlinear and linear relationships between EVT time and outcomes for different PC-CS. We included 828 patients with acute BAO. Compared with the poor collateral (PC-CS 0-3), the adjusted odds ratio of favorable outcome was 1.311 in patients with moderate (PC-CS 4-5) (95% CI, 0.781-2.201) and 1.899 with good (PC-CS 6-10) collateral (1.125-3.207) for EVT. RCSA revealed that in patients with PC-CS 0-3, the favorable outcome probability after EVT significantly decreased to 10% within 6 h and stabilized thereafter (Pnonlinearity = 0.035), while in patients with moderate and good collateral, the probability was maintained at approximately 30% and 40% respectively, even beyond 6 h (all Pnonlinearity > 0.05). Among patients with BAO, good collateral circulation was independently associated with improved outcomes along with the usage of thrombectomy. Patients with poor collaterals should receive EVT as early as possible, especially within 6 h of symptom onset, while the time window may be extended in patients with moderate and good collaterals. Unique identifier: ChiCTR1800014759.

Easily attainable and low immunogenic stem cells from exfoliated deciduous teeth enhanced the in vivo bone regeneration ability of gelatin/bioactive glass microsphere composite scaffolds.

Repair of critical-size bone defects remains a considerable challenge in the clinic. The most critical cause for incomplete healing is that osteoprogenitors cannot migrate to the central portion of the defects. Herein, stem cells from exfoliated deciduous teeth (SHED) with the properties of easy attainability and low immunogenicity were loaded into gelatin/bioactive glass (GEL/BGM) scaffolds to construct GEL/BGM + SHED engineering scaffolds. An in vitro study showed that BGM could augment the osteogenic differentiation of SHED by activating the AMPK signaling cascade, as confirmed by the elevated expression of osteogenic-related genes, and enhanced ALP activity and mineralization formation in SHED. After implantation in the critical bone defect model, GEL/BGM + SHED scaffolds exhibited low immunogenicity and significantly enhanced new bone formation in the center of the defect. These results indicated that GEL/BGM + SHED scaffolds present a new promising strategy for critical-size bone healing.

Twenty-four-hour National Institute of Health Stroke Scale predicts short- and long-term outcomes of basilar artery occlusion after endovascular treatment.

Background: The present study aimed to evaluate the prognostic value of the 24-h National Institute of Health Stroke Scale (NIHSS) for short- and long-term outcomes of patients with basilar artery occlusion (BAO) after endovascular treatment (EVT) in daily clinical routine. Methods: Patients with EVT for acute basilar artery occlusion study registry with the 24-h NIHSS, and clinical outcomes documented at 90 days and 1 year were included. The NIHSS admission, 24-h NIHSS, NIHSS delta, and NIHSS percentage change, binary definitions of early neurological improvement [ENI; improvement of 4/(common ENI)/8 (major ENI)/10 (dramatic ENI)] NIHSS points were compared to predict the favorable outcomes and mortality at 90 days and 1 year. The primary outcome was defined as favorable if the modified Rankin Scale (mRS) score was 0-3 at 90 days. Results: Of the 644 patients treated with EVT, the 24-h NIHSS had the highest discriminative ability for favorable outcome prediction [receiver operator characteristic (ROC)NIHSS 24 h area under the curve (AUC): 0.92 (0.90-0.94)] at 90 days and 1 year [(ROCNIHSS 24 h AUC: 0.91 (0.89-0.94)] in comparison to the NIHSS score at admission [ROCNIHSS admission AUC at 90 days: 0.73 (0.69-0.77); 1 year: 0.74 (0.70-0.78)], NIHSS delta [ROCΔ NIHSS AUC at 90 days: 0.84 (0.81-0.87); 1 year: 0.81 (0.77-0.84)], and NIHSS percentage change [ROC%change AUC at 90 days: 0.85 (0.82-0.89); 1 year: 0.82 (0.78-0.86)]. Conclusion: The 24-h NIHSS with a threshold of ≤23 points was the best surrogate for short- and long-term outcomes after EVT for BAO in the clinical routine.

Identification of Patients with Potential Atrial Fibrillation during Sinus Rhythm Using Isolated P Wave Characteristics from 12-Lead ECGs.

Atrial fibrillation (AF) is largely underdiagnosed. Previous studies using deep neural networks with large datasets have shown that screening AF with a 12-lead electrocardiogram (ECG) during sinus rhythm (SR) is possible. However, the poor availability of these trained models and the small size of the retrievable datasets limit its reproducibility. This study proposes an approach to generate explainable features for detecting AF during SR with limited data. We collected 94,224 12-lead ECGs from 64,196 patients from Taipei Medical University Hospital. We selected ECGs during SR from 213 patients before AF diagnosis and randomly selected 247 age-matched participants without AF records as the controls. We developed a signal-processing technique, MA-UPEMD, to isolate P waves, and quantified the spatial and temporal features using principal component analysis and inter-lead relationships. By combining these features, the machine learning models yielded AUC of 0.64. We showed that, even with this limited dataset, the P wave, representing atrial electrical activity, is depicted by our proposed approach. The extracted features performed better than the bandpass filter-extracted P waves and deep neural network model. We provided a physiologically explainable and reproducible approach for classifying patients with AF during SR.

Endovascular treatment for distal basilar artery occlusion stroke.

Background: This study aimed to investigate the clinical outcomes of endovascular treatment (EVT) for distal basilar artery occlusion (BAO) and compare them with the outcomes of standard medical treatment (SMT) in daily clinical practice. Methods: Patients with distal BAO enrolled in the BASILAR study from January 2014 to May 2019 were included. Differences in clinical outcomes were analyzed using Pearson's chi-square test and multivariable logistic regression. Clinical outcomes were evaluated using the modified Rankin Scale (mRS) score at 90 days, the mortality at 90 days, and the occurrence of symptomatic intracranial hemorrhage within 48 h. Results: Among the 267 patients with distal BAO (222 patients in the EVT group and 45 patients in the SMT group), compared with the SMT group, the EVT group was associated with a favorable outcome (mRS 0-3; 40.1 vs. 15.6%; aOR 5.44; 95% CI, 1.68-17.66; P = 0.005) and decreased mortality (44.6 vs. 71.1%, aOR 0.32, 95% CI, 0.13-0.77; P = 0.012). In the EVT group, multivariable analysis showed that the initial National Institutes of Health Stroke Scale (NIHSS) score and posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS) were associated with favorable functional outcomes and mortality. Conclusion: Our study suggests that, compared with SMT, EVT is technically feasible and safe for patients with distal BAO.

Risk score for symptomatic intracranial haemorrhage in patients with acute ischaemic stroke receiving endovascular treatment.

BACKGROUND AND PURPOSE: This study aimed to develop a score to predict the risk for symptomatic intracranial haemorrhage (sICH) associated with endovascular treatment (EVT) in patients with acute ischaemic stroke caused by large vessel occlusions (LVOs) in the anterior circulation. METHODS: Between January 2017 and December 2019, acute stroke patients with anterior circulation occlusion and EVT were retrospectively enroled from 11 comprehensive stroke centres in China. Univariate analyses were performed to compare the factors in patients with or without sICH. The predictive value of parameters associated with sICH was evaluated with multivariate logistic regression, and the score was developed according to the magnitude of regression coefficients. We performed external validation in a retrospective stroke registry of EVT for acute anterior circulation ischaemic stroke in 21 comprehensive stroke centres across 10 provinces in China (ACTUAL). RESULTS: Of the 433 patients, 70 (16.2%) patients had sICH. The preoperative predictive factors of sICH were poor collateral circulation, low baseline ASPECTS, cardioembolic stroke and high serum glucose. Using the OR of preoperative predictive factors (collateral circulation status, baseline ASPECTS, TOAST type and serum glucose) in the multivariable model, we derived the ACTS score. In the derivation cohort, the area under the ROC curve (AUC) was 0.797; in the validation cohort, it was 0.727. CONCLUSION: The ACTS score provides a quick and easy-to-perform scale to predict the risk of sICH in acute anterior circulation stroke patients treated with EVT. This score should be further examined and improved in future prospective studies to increase its precision and applicability before it can be recommended to make clinical decisions regarding the performance of EVT.