A Review of Artificial Intelligence in the Rupture Risk Assessment of Intracranial Aneurysms: Applications and Challenges.

Intracranial aneurysms (IAs) are highly prevalent in the population, and their rupture poses a significant risk of death or disability. However, the treatment of aneurysms, whether through interventional embolization or craniotomy clipping surgery, is not always safe and carries a certain proportion of morbidity and mortality. Therefore, early detection and prompt intervention of IAs with a high risk of rupture is of notable clinical significance. Moreover, accurately predicting aneurysms that are likely to remain stable can help avoid the risks and costs of over-intervention, which also has considerable social significance. Recent advances in artificial intelligence (AI) technology offer promising strategies to assist clinical trials. This review will discuss the state-of-the-art AI applications for assessing the rupture risk of IAs, with a focus on achievements, challenges, and potential opportunities.

Early Brain Injury and Neuroprotective Treatment after Aneurysmal Subarachnoid Hemorrhage: A Literature Review.

Early brain injury (EBI) subsequent to subarachnoid hemorrhage (SAH) is strongly associated with delayed cerebral ischemia and poor patient prognosis. Based on investigations into the molecular mechanisms underlying EBI, neurovascular dysfunction resulting from SAH can be attributed to a range of pathological processes, such as microvascular alterations in brain tissue, ionic imbalances, blood-brain barrier disruption, immune-inflammatory responses, oxidative stress, and activation of cell death pathways. Research progress presents a variety of promising therapeutic approaches for the preservation of neurological function following SAH, including calcium channel antagonists, endothelin-1 receptor blockers, antiplatelet agents, anti-inflammatory agents, and anti-oxidative stress agents. EBI can be mitigated following SAH through neuroprotective measures. To enhance our comprehension of the relevant molecular pathways involved in brain injury, including brain ischemia-hypoxic injury, neuroimmune inflammation activation, and the activation of various cell-signaling pathways, following SAH, it is essential to investigate the evolution of these multifaceted pathophysiological processes. Facilitating neural repair following a brain injury is critical for improving patient survival rates and quality of life.

Correction: Liu et al. A Predictive Model for the Risk of Posterior Circulation Stroke in Patients with Intracranial Atherosclerosis Based on High Resolution MRI. Diagnostics 2022, 12, 812.

Errors occurred in the number of patients in the posterior circulation ischemic stroke (PCIS) group and non-PCIS group described in the original publication [...].

A Predictive Model for the Risk of Posterior Circulation Stroke in Patients with Intracranial Atherosclerosis Based on High Resolution MRI.

Intracranial vertebrobasilar atherosclerosis is the main cause of posterior circulation ischemic stroke. We aimed to construct a predictive model for the risk of posterior circulation ischemic stroke in patients with posterior circulation atherosclerosis based on high-resolution MRI (HR-MRI). A total of 208 consecutive patients with posterior circulation atherosclerosis confirmed by HR-MRI, from January 2020 to July 2021, were retrospectively assessed. They were assigned to the posterior circulation stroke (49 patients) and non-posterior circulation stroke group (159 patients) based on clinical presentation and diffusion-weighted imaging (DWI). Demographic data, risk factors of atherosclerosis, laboratory findings, and imaging characteristics were extracted from electronic health records. Plaque features were investigated by HR-MRI. Fifty-three clinical or imaging features were used to derive the model. Multivariable logistic regression analysis was employed to construct the prediction model. The nomogram was evaluated for calibration, differentiation, and clinical usefulness. Plaque enhancement, plaque irregular surface morphology, artery location of plaque, and dorsal quadrant of plaque location were significant predictors for posterior circulation stroke in patients with intracranial atherosclerosis. Subsequently, these variables were selected to establish a nomogram. The model showed good distinction (C-index 0.830, 95% CI 0.766-0.895). The calibration curve also showed excellent consistency between the prediction of the nomogram and the observed curve. Decision curve analysis further demonstrated that the nomogram conferred significantly high clinical net benefit. The nomogram calculated from plaque characteristics in HR-MRI may accurately predict the posterior circulation stroke occurrence and be of great help for stratification of stroke decision making.

Psychological impact on COVID-19 patients during the outbreak in China: A case-control study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has caused widespread panic due to its highly infectious and pandemic transmission. We aimed to evaluate the psychological impact of the COVID-19 outbreak on infected subjects in China. METHODS: This case-control, survey-based study assessed the psychological status of COVID-19 patients and non-infected controls from February 10 to March 18, 2020, in China. Sex, age, education years, marital status, jobs, annual household income, living status, and geographic origin were matched between the two groups. The main outcome measures included anxiety, depression, insomnia, help-seeking behaviors, and treatment for mental problems. RESULTS: A total of 326 patients and 1304 (1:4 ratio) matched non-infected controls were enrolled. Compared with controls, patients had higher scores on the Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9 (PHQ-9), and Insomnia Severity Index (ISI) (all p<0.01). Patients had higher rate of any mental problems (62.6% vs 42.5%, p<0.01), anxiety (27.3% vs 12.2%, p<0.01), depression (26.7% vs 14.6%, p<0.01), suicidal ideation (16.0% vs 10.7%, p<0.01), and insomnia (57.7% vs 36.7%, p<0.01). Among the subjects with mental problems, the proportion of seeking help (15.2% vs 6.9%, p<0.01) and receiving treatment (11.3% vs 4.3%, p<0.01) was higher in patients than controls. CONCLUSIONS: Our study showed a higher prevalence of mental problems in COVID-19 patients compared to controls, suggesting a great psychological impact of COVID-19 infection. Our findings highlighted the urgent need for psychological assistance for COVID-19 patients.

A High Resolution MRI Study of the Relationship Between Plaque Enhancement and Perforator Stroke after Stenting for Symptomatic Vertebrobasilar Artery Stenosis.

BACKGROUND AND PURPOSE: Perforator stroke is one of the most common complications of vertebrobasilar arterial stenting. We investigated whether perforator stroke after vertebrobasilar arterial stenting is associated with plaque enhancement in patients with severe vertebrobasilar artery stenosis. METHODS: We studied patients with symptomatic vertebrobasilar arterial stenosis who underwent stenting from January 2017 to July 2020. Patients who underwent high resolution magnetic resonance imaging were recruited among them. Demographic data, risk factors of atherosclerosis, procedure details, and characteristics of imaging were extracted from electronic health records and imaging data. Plaque features were investigated by high resolution magnetic resonance imaging. RESULTS: 136 patients were enrolled in this study, 39 of whom fulfilled the inclusion criteria. 18 patients (46.2%) had obvious plaque enhancement among the 39 patients, and 21 (53.8%) had plaque non-enhancement. 21 patients (53.8%) had diffuse distribution, and 22 patients (56.4%) had irregular plaques surface. Patients were divided into plaque enhanced and plaque non-enhanced groups according to the degree of plaque enhancement. Clinical characteristics and other plaque features were similar between two groups. Procedure-related perforator stroke was identified in 4 patients (10.3%). Patients with plaque enhancement were more likely to have perforator stroke after stenting compared with those with plaque non-enhancement (22.2% versus 0%, P = 0.037). CONCLUSIONS: Plaque enhancement in high resolution magnetic resonance imaging may be associated with perforator stroke after vertebrobasilar artery stenting.

Mental Health and Psychological Responses During the Coronavirus Disease 2019 Epidemic: A Comparison Between Wuhan and Other Areas in China.

OBJECTIVE: This study aimed to compare the mental health and psychological responses in Wuhan, a severely affected area, and other areas of China during the coronavirus disease 2019 (COVID-19) epidemic. METHODS: This cross-sectional study was conducted on February 10-20, 2020. A set of online questionnaires was used to measure mental health and responses. A total of 1397 participants from Wuhan (age, 36.4 ± 10.7 years; male, 36.1%) and 2794 age- and sex-matched participants from other areas of China (age, 35.9 ± 9.9 years; male, 39.0%) were recruited. RESULTS: Compared with their counterparts, participants from Wuhan had a significantly higher prevalence of any mental health problems (46.6% versus 32.2%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.65-2.17), anxiety (15.2% versus 6.2%; adjusted OR = 2.65, 95% CI = 2.14-3.29), depression (18.3% versus 9.7%; adjusted OR = 2.11, 95% CI = 1.74-2.54), suicidal ideation (10.5% versus 7.1%; adjusted OR = 1.60, 95% CI = 1.28-2.02), and insomnia (38.6% versus 27.6%; adjusted OR = 1.70, 95% CI = 1.48-1.96). Participants from Wuhan had a slightly higher rate of help-seeking behavior (7.1% versus 4.2%; adjusted OR = 1.76, 95% CI = 1.12-2.77) but similar rate of treatment (3.5% versus 2.7%; adjusted OR = 1.23, 95% CI = 0.68-2.24) for mental problems than did their counterparts. In addition, compared with their counterparts, participants from Wuhan gave higher proportions of responses regarding "fearful" (52% versus 36%, p < .001), "discrimination against COVID-19 cases" (64% versus 58%, p = .006), "strictly comply with preventive behaviors" (98.7% versus 96%, p = .003), and "fewer living and medical supplies" (<2 weeks: 62% versus 57%, p = .015). CONCLUSIONS: The COVID-19 epidemic has raised enormous challenges regarding public mental health and psychological responses, especially in the highly affected Wuhan area. The present findings provide important information for developing appropriate strategies for the prevention and management of mental health problems during COVID-19 and other epidemics.

The mental health of frontline and non-frontline medical workers during the coronavirus disease 2019 (COVID-19) outbreak in China: A case-control study.

BACKGROUND AND OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a new infectious disease with high transmissibility and morbidity. It has caused substantial mental distress to medical professionals. We aimed to compare the psychological impact of the COVID-19 outbreak between frontline and non-frontline medical workers in China. METHODS: This case-control study recruited 1173 frontline and 1173 age- and sex-matched non-frontline medical workers during the COVID-19 outbreak (February 11 to 26, 2020). A set of online questionnaires were used to measure mental problems (i.e., anxiety, insomnia, and depressive symptoms), and help-seeking behavior and treatment for these mental problems. RESULTS: Frontline medical workers had higher rates of any mental problem (52.6% vs. 34.0%, adjusted OR=1.88, 95% CI=1.57-2.25), anxiety symptoms (15.7% vs. 7.4%, adjusted OR=1.95, 95% CI=1.46-2.61), depressed mood (marginally insignificant; 14.3% vs. 10.1%, adjusted OR=1.32, 95% CI=0.99-1.76) and insomnia (47.8% vs. 29.1%, adjusted OR=1.96, 95% CI=1.63-2.36) than non-frontline medical workers. No significant difference was observed in terms of suicidal ideation (12.0% vs. 9.0%, adjusted OR=1.25, 95% CI=0.92-1.71), help-seeking (4.5% vs. 4.5%, adjusted OR=1.00, 95% CI=0.53-1.87) or treatment (3.4% vs. 2.3%, adjusted OR=1.38, 95% CI=0.54-3.52) for mental problems. LIMITATIONS: The case-control nature of the data precludes causal inferences, and there is a possibility of bias related to self-reports. CONCLUSIONS: Frontline medical workers had more mental problems but comparable help-seeking behaviors and treatment for these problems than non-frontline medical workers. These findings highlight the timely mental support and intervention for medical workers, especially for those on the frontline.

The Protective Effect of Adiponectin-Transfected Endothelial Progenitor Cells on Cognitive Function in D-Galactose-Induced Aging Rats.

Aging is a multifactorial process involving the cumulative effects of inflammation, oxidative stress, and mitochondrial dynamics, which can produce complex structural and biochemical alterations to the nervous system and lead to dysfunction of microcirculation, blood-brain barrier (BBB), and other problems in the brain. Long-term injection of D-galactose (D-gal) can induce chronic inflammation and oxidative stress, accelerating aging. The model of accelerated aging with long-term administration of D-gal have been widely used in anti-aging studies, due to the increase of chronic inflammation and decline of cognition that similarity with natural aging in animals. However, despite extensive researches in the D-gal-induced aging rats, studies on their microvasculature remain limited. Endothelial progenitor cells (EPCs), which are precursors to endothelial cells (ECs), play a significant role in the repair and regeneration process of endogenous blood vessel, and adiponectin (APN), a protein derived from adipocyte, has many effects on protective vascular endothelium and anti-inflammatory. Recently, many studies have shown that APN can promote improvements in cognitive function. Under these circumstances, we investigated the neuroprotective effect of the APN-transfected EPC (APN-EPC) treatment on rats after administration with D-gal and explored the likely underlying mechanisms. Compared to model group for D-gal administration, better cognitive function and denser microvessels were significantly found in the APN-EPC treatment group, and indicated APN-EPC treatment in aging rats could improve the cognitive dysfunction and microvessel density. The level of proinflammatory cytokines IL-1ß, IL-6, and TNF-α, activated astrocytes and apoptosis rate were significantly reduced in the APN-EPC group compared with the model group, showed that APN-EPCs alleviated the neuroinflammation in aging rats. In addition, the APN-EPC group inhibited the decrease of BBB-related proteins claudin-5, occludin, and Zo-1 in aging rats and attenuated BBB dysfunction significantly. These results of our study indicated that APN-EPC treatment in D-gal-induced aging rats have a positive effect on improving cognitive and BBB dysfunction, increasing angiogenesis, and reducing neuroinflammation and apoptosis rate. This research suggests that cell therapy via gene modification may provide a safe and effective approach for the treatment of age-related neurogenerative diseases.