Synergistic insights: the integrated role of CT/CTP and clinical parameters in hemorrhagic transformation prediction.

BACKGROUND: Acute ischemic stroke presents significant challenges in healthcare, notably due to the risk and poor prognosis associated with hemorrhagic transformation (HT). Currently, there is a notable gap in the early clinical stage for a valid and reliable predictive model for HT. METHODS: This single-center retrospective study analyzed data from 224 patients with acute ischemic stroke due to large vessel occlusion. We collected comprehensive clinical data, CT, and CTP parameters. A predictive model for HT was developed, incorporating clinical indicators alongside imaging data, and its efficacy was evaluated using decision curve analysis and calibration curves. In addition, we have also built a free browser-based online calculator based on this model for HT prediction. RESULTS: The study identified atrial fibrillation and hypertension as significant risk factors for HT. Patients with HT showed more extensive initial ischemic damage and a smaller ischemic penumbra. Our novel predictive model, integrating clinical indicators with CT and CTP parameters, demonstrated superior predictive value compared to models based solely on clinical indicators. CONCLUSIONS: The research highlighted the intricate interplay of clinical and imaging parameters in HT post-thrombectomy. It established a multifaceted predictive model, enhancing the understanding and management of acute ischemic stroke. Future studies should focus on validating this model in broader cohorts, further investigating the causal relationships, and exploring the nuanced effects of these parameters on patient outcomes post-stroke.

Clinical outcomes after endovascular thrombectomy in different triage methods.

Objective: The purpose of this study was to evaluate the effectiveness and safety of drip and ship (DS) for acute ischemic stroke (AIS) by comparing three treatment strategies: 1) patients seen at a primary stroke center, started on emergency intravenous thrombolysis and then transported to a comprehensive stroke center (drip and ship, DS); 2) patients immediately transferred to comprehensive stroke center without starting intravenous thrombolysis, for mechanical thrombectomy (non-drip and ship, non-DS); and 3) patients admitted directly to the comprehensive stroke center for assessment and subsequent bridging thrombolysis (mothership, MS). Methods: We retrospectively reviewed the data of patients that underwent mechanical thrombectomy for AIS from November 2020 to May 2022 at our institution. Patients were divided into three groups: DS, non-DS, and MS. Time course, multimodal CT features and clinical results were compared among the three groups. Results: The study included 62 patients, with 19, 18, and 25 patients in DS, non-DS, and MS groups, respectively. Baseline characteristics did not differ among the three groups. The DS group had a significantly longer median onset to groin time than the MS group (395 min vs 244 min; P < 0.001), a significantly shorter onset to primary stroke center time than the non-DS group (90 min vs 463 min; P < 0.001), and a longer primary stroke center to groin puncture time than the non-DS group (277 min vs 162 min; P = 0.002). The onset to needle time was longer in the MS group than the DS group (151.2 min vs 111.8 min; P = 0.041). The intravenous thrombolysis to puncture time was shorter in the MS group compared with DS (56 min vs 278 min; P < 0.001). No significant differences were present among groups in post-operative variables measured. Conclusions: DS is a safe and effective method, with no increased risk of postoperative complications or death compared to non-DS and MS methods. The study provides a reference for the selection of transport modes for AIS patients.

Efficacy and safety of a neurointerventional operation robotic assistance system in cerebral angiography.

BACKGROUND: At present, neurointerventional surgery requires angiographers to perform operations in the digital subtraction angiography (DSA) room. Ionising radiation and chronic joint damage are still unavoidable for angiographers. Therefore, we researched and developed a neurointerventional robot-assisted system, which is operated by angiographers in an operating room outside the DSA room. We have conducted a prospective, multicentre, randomised controlled trial to evaluate the safety and efficacy of a robot-assisted system in human cerebral angiography. In the future, this research will provide a platform for the research and development of an intelligent surgical system and bring revolutionary progress in neurointerventional surgery. METHODS: From December 2020 to December 2021, 260 patients were enrolled from three medical centres, who were randomly and equally divided into a robot-assisted system group and a clinical routine cerebral angiography group. The success rate of angiography, the rate of the catheter reaching the target vessel, the operation time, X-ray radiation exposure and the incidence of related adverse events were compared between the two groups. RESULTS: A total of 257 patients completed this trial; baseline characteristics of the two groups did not differ significantly. The success rate of angiography in both the control group and the experimental group was 100%. The rate of the catheter reaching the target vessel was 99.23% and 100.00% in the control and experimental groups, respectively. For the control versus experimental groups, the angiographic operation time was 48.59±25.60 min versus 47.94±27.49 min, respectively; the X-ray radiation dose was 735.01±554.77 mGy versus 821.65±705.45 mGy, respectively; and the incidence of adverse events was 23.44% versus 22.48%, respectively. No statistical differences were present between the two groups. CONCLUSION: The robot-assisted surgical system is more convenient for cerebral angiography and is as safe and effective as the traditional cerebral angiography.

Clinical outcome and prognostic factors of patients with non-traumatic angiography-negative subarachnoid hemorrhage.

Purpose: The cause of spontaneous subarachnoid hemorrhage (SAH) is unknown in 10% of cases. The aim of this study was to demonstrate the characteristics of patients with angiography-negative subarachnoid hemorrhage (anSAH) and to analyze factors influencing the clinical outcome in patients suffering from anSAH. Methods: A retrospective cohort of 75 patients with anSAH [26 perimesencephalic (pmSAH) and 49 non-perimesencephalic SAH (npmSAH)] admitted between January 2016 and June 2022 was included. We analyzed demographic, clinical data and 6-month functional outcomes. Enter regression analysis was performed to identify factors associated with outcomes. Results: Unfavorable outcome was achieved in 10 of 75 patients (13.3%). Unfavorable outcome was associated with senior adults (p = 0.008), Hijdra cistern score (HCS) elevation (p = 0.015), long-time lumbar cistern continuous drainage (LCFD; p = 0.029) and hydrocephalus (p = 0.046). The only significant risk factor for unfavorable outcome after npmSAH was the HCS (OR 1.213 (95%CI 1.007-1.462), p = 0.042). Conclusion: Our study provides valuable information on both SAH patterns and functional outcome in patients suffering from anSAH and should be taken into consideration during management of these patients.

Taurine promotes axonal sprouting via Shh-mediated mitochondrial improvement in stroke.

PURPOSE: Motor function is restored by axonal sprouting in ischemic stroke. Mitochondria play a crucial role in axonal sprouting. Taurine (TAU) is known to protect the brain against experimental stroke, but its role in axonal sprouting and the underlying mechanism are unclear. METHODS: We evaluated the motor function of stroke mice using the rotarod test on days 7, 14, and 28. Immunocytochemistry with biotinylated dextran amine was used to detect axonal sprouting. We observed neurite outgrowth and cell apoptosis in cortical neurons under oxygen and glucose deprivation (OGD), respectively. Furthermore, we evaluated the mitochondrial function, adenosine triphosphate (ATP), mitochondrial DNA (mtDNA), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PCG-1α), transcription factor A of mitochondria (TFAM), protein patched homolog 1 (PTCH1), and cellular myelocytomatosis oncogene (c-Myc). RESULTS: TAU recovered the motor function and promoted axonal sprouting in ischemic mice. TAU restored the neuritogenesis ability of cortical neurons and reduced OGD-induced cell apoptosis. TAU also reduced reactive oxygen species, stabilized mitochondrial membrane potential, enhanced ATP and mtDNA content, increased the levels of PGC-1α, and TFAM, and restored the impaired levels of PTCH1, and c-Myc. Furthermore, these TAU-related effects could be blocked using an Shh inhibitor (cyclopamine). CONCLUSION: Taurine promoted axonal sprouting via Shh-mediated mitochondrial improvement in ischemic stroke.

Ferroptosis related genes are regulated by methylation and predict the prognosis of glioblastoma patients.

Background: Glioblastoma multiforme (GBM) is the most aggressive type of primary brain tumor. Ferroptosis is a form of cell death that is involved in regulating the biological behavior of tumors, and could become a promising potential biomarker in tumor diagnosis and treatment. Methods: We used the expression of ferroptosis related genes in the Cancer Genome Atlas (TCGA) and Chinese Glioma Cooperative Group (CGCG) datasets to construct a prognostic prediction model and verified the expression by real-time polymerase chain reaction (RT-qPCR). Using TCGA genomic and epigenetic data, we analyzed the factors that regulate the expression of these ferroptosis related genes. Results: We used 15 ferroptosis related genes related to the prognosis of GBM to establish a prognostic predictive risk model. The area under the curve (AUC) of this model was 0.907, which had good utility in predicting the prognosis of GBM, and could be used as an independent prognostic indicator for GBM patients. We verified the expression of these risk genes by RT-qPCR in 30 independent pairs of tumors and adjacent tissues. Genomic and epigenetic analysis of risk genes found that the expressions of these genes were mainly regulated by methylation, not copy number variation in GBM. Conclusions: The ferroptosis related characteristics proposed in this study can potentially predict the prognosis of GBM patients, and these prognostic-related genes are generally regulated by methylation.

The Application of "Stilted Building" Technique in the Embolization of Aneurysms with Secondary Branches.

OBJECTIVE: Many intracranial aneurysms often have branch arteries, and it is especially important to protect them during embolization. The purpose of the present study was to evaluate the curative effect and safety of the "stilted building" technique. METHODS: 25 patients with intracranial aneurysms with branch arteries that have been treated by coil embolization with the "stilted building" technique were retrospectively reviewed. Clinical follow-up was performed after endovascular treatment. RESULTS: All 25 patients successfully underwent aneurysm embolization. During the operation, the ruptured sac and most of the body of the aneurysm were embolized using the "stilted building" technique. Immediate imaging showed that the blood flow to the branch arteries from the neck or sidewall of the aneurysm was unobstructed. The mRS scores of the 25 patients during the follow-up period were mRS 0 for twenty-one patients, mRS 1 for three patients, and mRS 6 for one patient. No aneurysms recurred among the patients who completed the follow-up. CONCLUSIONS: In an aneurysm with a branch artery, when a balloon or stent cannot be effectively used to protect the branch artery, the use of "stilted building" embolization can achieve good therapeutic effects, and the short-term follow-up results are satisfactory; the technique can effectively protect branch arteries originating from aneurysms.

Optimal control of a delayed smoking model with immigration.

In this paper, we formulate a smoking model with delay and immigration, and the possibility of optimal controls both over the susceptible and heavy problem smoker subjects is assumed. The existence of the optimal control pair is also proved. We derive the optimality condition via the Pontryagin's maximum principle with delay and obtain the existence of the optimal solution. Numerical simulation is given. Numerical simulations are made to support the main results.

DnaJ homolog subfamily A member1 (DnaJ1) is a newly discovered anti-apoptotic protein regulated by azadirachtin in Sf9 cells.

BACKGROUND: Azadirachtin, one of the most promising botanical insecticides, has been widely used for pest control. Azadirachtin induces apoptosis in insect cell lines, including Sf9, SL-1 and BTI-Tn-5B1-4. Mitochondrial and lysosomal pathways are likely involved in the azadirachtin-induced apoptosis, however, detailed molecular mechanisms remain largely undefined. RESULTS: Azadirachtin-induced apoptosis in Sf9 cells was verified by morphological observation, Hoechst 33258 staining, and a Caspase-3-based analysis. Comparative two-dimensional gel electrophoresis (2-DE) coupled with a linear ion trap quadrupole (LTQ)-MS/MS analysis identified 12 prominent, differentially expressed proteins following azadirachtin treatment. These differentially expressed genes are involved in regulating cytoskeleton development, signal transduction, gene transcription, and cellular metabolism. Knockdown gene expression of a gene encoding a DnaJ homolog enhanced apoptosis induced by azadirachtin in Sf9 cells. CONCLUSION: Azadirachtin treatment induces apoptosis in Sf9 cells and affects expression of multiple genes with functions in cytoskeleton development, signal transduction, gene regulation, and cellular metabolisms. Azadirachtin induces apoptosis at least partially by down-regulation of Sf-DnaJ in Sf9 cells.

Value of High-frequency Ultrasound in the Diagnosis of Supinator Syndrome.

Objective To evaluate the diagnostic value of high-frequency ultrasound in the diagnosis of supinator syndrome (SD). Methods Ten patients with supinator syndrome (SD group) and 20 healthy volunteers (control group) underwent ultrasonographic examination. Axial and long-axis views of the radial nerve were taken where the nerves enters the supinator muscle entrance. The maximum transverse diameter and anteroposterior diameter were also measured. Results High-frequency ultrasound clearly revealed the images and course of radial nerve deep branch in two groups. The SD group had swollen nerves and the maximum transverse diameter and anteroposterior diameter were (3.50?0.39)mm and (4.30?0.47)mm,respectively,which were significantly larger than in the control group [(1.10?0.17)mm,t=-29.67,P=0.00;(1.00?0.16)mm,t=-36.72,P=0.00). The causes (including synovial cyst nearby and radial artery recurrent branch) of nerve entrapment were revealed directly in 4 patients in SD group. Conclusions High-frequency ultrasound can clearly display the radial nerve deep branch around the elbow joint. SD patients have swollen nerves at the entrance of the supinator muscle,where the diameters of these nerves are abnormally enlarged.

Solid pseudopapillary tumors of the pancreas: Findings from routine screening sonographic examination and the value of contrast-enhanced ultrasound.

BACKGROUND: Solid pseudopapillary tumors (SPTs) are rare neoplasms of the pancreas. We describe the features of these small tumors identified on routine screening sonographic (US) examination and the potential value of using contrast-enhanced ultrasound (CEUS) scanning. METHODS: We retrospectively reviewed records from 17 patients who had undergone screening via US examination at Peking University Third Hospital between January 2000 and June 2011. Each of these patients had been confirmed by a pathologist to have an SPT. Six patients had undergone CEUS prior to surgery. We recorded all features on both gray-scale US and CEUS. RESULTS: All patients (4 men and 13 women; ages 23-35 years; mean age, 27.2 years) were initially screened by US. The largest mass identified was 5.0 cm in diameter (mean diameter, 4.2 cm), and most tumors showed homogeneous hypoechogenicity. A hyperechoic rim was detected in four masses. CEUS showed peripheral-rim hyperenhancement in the arterial phase of all six masses. CONCLUSIONS: Routine screening US examinations are capable of identifying small (<5.0 cm) SPTs. These screening examinations allow diagnosis on the basis of typical imaging features, such as a homogeneously hypoechoic mass with a hyperechoic rim. CEUS shows greater detail of the rim and cystic areas in the tumor, which significantly improves the proper diagnosis.

Analysis of an SEIR epidemic model with saturated incidence and saturated treatment function.

The dynamics of SEIR epidemic model with saturated incidence rate and saturated treatment function are explored in this paper. The basic reproduction number that determines disease extinction and disease survival is given. The existing threshold conditions of all kinds of the equilibrium points are obtained. Sufficient conditions are established for the existence of backward bifurcation. The local asymptotical stability of equilibrium is verified by analyzing the eigenvalues and using the Routh-Hurwitz criterion. We also discuss the global asymptotical stability of the endemic equilibrium by autonomous convergence theorem. The study indicates that we should improve the efficiency and enlarge the capacity of the treatment to control the spread of disease. Numerical simulations are presented to support and complement the theoretical findings.

High-intensity focused ultrasound treatment of late-stage pancreatic body carcinoma: optimal tumor depth for safe ablation.

Objective criteria are currently not available for assessing the extent of ablation by high-intensity focused ultrasound (HIFU). A retrospective review was conducted in Chinese patients with late-stage pancreatic body carcinoma treated with 1 h/d intermittent HIFU at a single center. Clinical and procedure-related characteristics were examined in relation to tumor posterior depth. Clinically, tumor ablation was negatively correlated with posterior tumor depth, with a 1-cm increase in depth decreasing ablation by 30.7%. At a computed tomography (CT)-determined 7-cm posterior tumor depth (considered the critical value for the procedure), ablation sensitivity and specificity were 77.8% and 72.7%, respectively. Tumor ablation >30% in patients with a CT-determined posterior tumor depth ≤7 cm was 9.333 times better than that in patients with a CT-determined posterior tumor depth >7 cm. Adverse effects did not affect the efficacy of HIFU. Tumors with posterior depths <7 cm may effectively be treated with HIFU-induced ablation with minimal adverse events.

Risk factors for dural arteriovenous fistula intracranial hemorrhage.

To our knowledge, the risk factors for intracranial hemorrhage from dural arteriovenous fistula (DAVF) have not been systematically described, due to the complexity of their anatomy and low incidence. We performed this retrospective study to investigate the DAVF factors predicting intracranial hemorrhage. A 10year database of 144 consecutive patients with DAVF was reviewed. Data collected and analyzed were demographics, morphologic features of DAVF, sex, age, fistula flow rate, arterial supply, lesion location, and venous drainage pattern. Linear univariate and multivariate logistic regression analyses were used to evaluate the association between influencing factors and hemorrhage. A first linear univariate analysis was performed for all influencing factors, and showed that sex, lesion location, and venous drainage pattern were statistically significant in predicting intracranial hemorrhage (p<0.05). Secondary multivariate logistic regression analysis with sex, lesion location, and venous drainage pattern showed that only venous drainage pattern was statistically significant in predicting intracranial hemorrhage (p<0.05). Therefore, venous drainage pattern, particularly the cortical venous drainage, significantly predicts intracranial hemorrhage from DAVF. Both sex and lesion location may be confounding factors in predicting intracranial hemorrhage from DAVF, while the other factors may not be associated with hemorrhage.

Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy.

Primary liver cancer and liver metastases are among the most frequent malignancies worldwide, with an increasing number of new cases and deaths every year. Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy. This synopsis outlines the first clinical practice guidelines for ultrasound-guided percutaneous microwave ablation therapy for hepatic malignancy, which was created by a joint task force of the Society of Chinese Interventional Ultrasound. The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment, as well as proposing the criteria for the treatment candidates.

[Multiple factors related with intracranial hemorrhage of dural arteriovenous fistula: clinical analysis].

OBJECTIVE: To discuss the relevant predicative factors of dural arteriovenous fistula (dAVF) in intracranial hemorrhage. METHODS: A total of 144 consecutive patients with dAVFs were recruited for a retrospective analysis from 1996 to 2006. The relevant factors of gender, age, fistula flow rate, arterial supply, lesion and venous drainage pattern were analyzed to evaluate the outcome of intracranial hemorrhage. RESULTS: Univariate analysis showed that gender, lesion and venous drainage pattern were statistical significant for intracranial hemorrhage of DAVF (P < 0.05). However, only venous drainage pattern was significant in the predication of intracranial hemorrhage (P < 0.05). CONCLUSION: Only venous drainage pattern is significant in the predication of dural arteriovenous fistulas in intracranial hemorrhage. Both gender and lesion may be confounding factors.

Correlation between ultrasound reflection intensity and tumor ablation ratio of late-stage pancreatic carcinoma in HIFU therapy: dynamic observation on ultrasound reflection intensity.

The minimally invasive high-intensity focused ultrasound (HIFU) therapy is thermal ablation treatment for late-stage pancreatic carcinoma with widely recognized safety and effectiveness, but there are currently no instant assessment methods for its ablation effect. It is vital to find a real-time high-sensitive assessment method. This research aims to dynamically observe the variation rules of ultrasound reflection intensity, analyze the correlation between ultrasound reflection intensity and tumor ablation ratio, and find out the value of ultrasound reflection intensity in prognosis of HIFU ablation effect. HIFU intermittent therapies were retrospectively analyzed for 31 subjects with late-stage pancreatic carcinoma from March 2007 to December 2009 in the study. The variation rules of the ultrasound reflection intensity during HIFU therapy were summarized and the correlation between ultrasound reflection intensity and tumor ablation ratio was analyzed based on the tumor ablation ratio indicated by CT scanning. The conclusion is that variation of ultrasound reflection intensity can be used for initial assessment of tumor ablation in HIFU therapy and early prognosis of overall HIFU ablation, providing important clinical basis for improving safety and effectiveness of HIFU therapy. Ultrasound can work as a real-time imaging instrument for observation of HIFU ablation effect in treating late-stage pancreatic carcinoma.

Degradation of 3-phenoxybenzoic acid by a Bacillus sp.

3-Phenoxybenzoic acid (3-PBA) is of great environmental concern with regards to endocrine disrupting activity and widespread occurrence in water and soil, yet little is known about microbial degradation in contaminated regions. We report here that a new bacterial strain isolated from soil, designated DG-02, was shown to degrade 95.6% of 50 mg·L(-1) 3-PBA within 72 h in mineral salt medium (MSM). Strain DG-02 was identified as Bacillus sp. based on the morphology, physio-biochemical tests and 16S rRNA sequence. The optimum conditions for 3-PBA degradation were determined to be 30.9°C and pH 7.7 using response surface methodology (RSM). The isolate converted 3-PBA to produce 3-(2-methoxyphenoxy) benzoic acid, protocatechuate, phenol, and 3,4-dihydroxy phenol, and subsequently transformed these compounds with a q(max), K(s) and K(i) of 0.8615 h(-1), 626.7842 mg·L(-1) and 6.7586 mg·L(-1), respectively. A novel microbial metabolic pathway for 3-PBA was proposed on the basis of these metabolites. Inoculation of strain DG-02 resulted in a higher degradation rate on 3-PBA than that observed in the non-inoculated soil. Moreover, the degradation process followed the first-order kinetics, and the half-life (t(1/2)) for 3-PBA was greatly reduced as compared to the non-inoculated control. This study highlights an important potential application of strain DG-02 for the in situ bioremediation of 3-PBA contaminated environments.

[Application of intraoperative spinal ultrasonography in thoracic spinal decompressive operations].

OBJECTIVE: To investigate the feasibility and clinical value of intraoperative ultrasonography (IOUS) in thoracic spinal decompression surgery. METHODS: Ten patients with confirmed thoracic spinal stenosis underwent thoracic spinal decompression in our center from August 2009 to December 2010. The appearance of the compressed section of spinal cord was observed with IOUS. Before and after the decompression operation, the diameters of dural sac and the spinal cord were recorded respectively. The location and nature of the compression-causing mass were confirmed. RESULTS: IOUS clearly showed the shape of the normal and the compressed sections of dural sac and spinal cord. In the 14 thoracic spinal cord sections of these 10 patients, the anteroposterior diameter, horizontal diameter, and their ratio were bigger than those before decompression. The values of anteroposterior diameter and anteroposterior/horizontal diameter ratio showed significant differences(the P value of dural sac anteroposterior diameter comparison was 0.008, which of spinal cord was 0.007; the P values of these two structures ratio comparison were both 0.002 before and after decompression), while the horizontal diameter presented no significant differences (the P values of both structures were 0.270 and 0.195 respectively before and after decompression). CONCLUSIONS: IOUS can clearly show the morphological changes of the dural sac and spinal cord before and after the decompression. In addition, it helps surgeons to locate and specify the nature of the compression-causing mass on the ventral side of dural sac. Furthermore, IOUS can suggest whether the decompression is sufficient in a real-time manner.