Neuro-Interventional Diagnosis and Treatment Using the Right Transradial Approach in Patients with Aberrant Right Subclavian Artery.

OBJECTIVE: To assess the effectiveness and safety of neurological interventions using the right transradial approach (R-TRA) in patients with aberrant right subclavian artery (ARSA). METHODS: We retrospectively analyzed cases that underwent cerebral angiography and interventions at Huangpi District People's Hospital from January 2023 to July 2023. Out of 335 cases, 5 patients with ARSA were identified. RESULTS: All 5 cases underwent diagnostic cerebral angiography via R-TRA. Two of the patients received interventions via R-TRA: 1 underwent right internal carotid artery balloon dilation angioplasty, while another underwent left vertebral artery stenting. No surgery-related complications were observed during these procedures. CONCLUSIONS: R-TRA proves to be a safe and effective option for neuro-interventional surgery in patients with ARSA.

Predicting asymptomatic coronary artery disease in first-ever acute ischemic stroke patients: a cross-sectional study.

Background: It is frequently observed that patients with first-ever acute ischemic stroke (AIS) have a common occurrence of asymptomatic coronary artery disease (CAD). This condition is associated with a poor prognosis. Early detection and recognition of asymptomatic CAD in first-ever AIS patients may optimize the clinical management and ultimately lead to improved outcomes. The aim of this study was to investigate the role of aortic arch plaque (AAP) detected through combined computed tomography angiography (CTA) as an early predictor of asymptomatic CAD in patients with first-ever AIS without prior diagnosis of CAD. Methods: A cross-sectional study was conducted at Xuanwu Hospital, Capital Medical University from January 2019 to December 2021, involving patients with first-ever AIS caused by large arterial atherosclerosis. Patients with a history of recognized cardiovascular disease, nonatherosclerotic arterial stenosis, atrial fibrillation related to cardioembolism, and complete carotid occlusions were excluded. The study utilized a combined coronary and cervicocephalic CTA to evaluate atherosclerosis in the cervicocephalic, aortic, and coronary arteries simultaneously. First-ever AIS patients without prior diagnosis of CAD were divided into 2 groups: 1 with asymptomatic CAD detected through CTA and the other without. Multivariate logistic regression was used to identify independent risk factors associated with the presence of asymptomatic CAD, including aortic arch, cervical and intracranial atherosclerotic characteristics (e.g., vascular stenosis, plaque thickness, extent, and complexity). Results: Among 182 AIS patients, 84 (46.2%) had asymptomatic CAD. Increased aortic arch plaque (AAP) thickness per millimeter [adjusted odds ratio (aOR): 1.26; 95% confidence interval (CI): 1.08-1.47], presence of severe AAP (aOR: 4.24; 95% CI: 1.59-12.03), mixed AAP (aOR: 2.65; 95% CI: 1.09-6.62), and ulcerative AAP (aOR: 11.76; 95% CI: 2.05-222.84) raised the risk of asymptomatic CAD in stroke patients, independent of other factors. The combination of ulcerative AAP, diabetes mellitus, and smoking could predict asymptomatic CAD with an area under the receiver operating characteristic curve (AUC) of 0.71 (95% CI: 0.64-0.79; P<0.001). Ulcerative AAP was found to be more valuable than cervicocephalic atherosclerotic characteristics for predicting asymptomatic CAD in first-ever AIS patients. Conclusions: The presence of ulcerative AAP was associated with asymptomatic CAD in first-ever AIS patients. As an early systemic atherosclerosis feature, ulcerative AAP is probably a more valuable indicator than cervicocephalic atherosclerotic characteristics for predicting asymptomatic CAD in AIS patients.

Ultralow Thermal Conductivity of a Chalcogenide System Pt3Bi4Q9 (Q = S, Se) Driven by the Hierarchy of Rigid [Pt6Q12]12- Clusters Embedded in Soft Bi-Q Sublattice.

Knowledge of structure-property relationships in solids with intrinsic low thermal conductivity is crucial for fields such as thermoelectrics, thermal barrier coatings, and refractories. Herein, we propose a new "rigidness in softness" structural scheme for intrinsic low lattice thermal conductivity (κL), which embeds rigid clusters into the soft matrix to induce large lattice anharmonicity, and accordingly discover a new series of chalcogenides Pt3Bi4Q9 (Q = S, Se). Pt3Bi4S9-xSex (x = 3, 6) achieved an intrinsic ultralow κL down to 0.39 W/(m K) at 773 K, which is considerably low among the Bi chalcogenide thermoelectric materials. Pt3Bi4Q9 contains the rigid cubic [Pt6Q12]12- clusters embedded in the soft Bi-Q sublattice, involving multiple bonding interactions and vibration hierarchy. The hierarchical structure yields a large lattice anharmonicity with high Grüneisen parameters (γ) 1.97 of Pt3Bi4Q9, as verified by the effective scatter of low-lying optical phonons toward heat-carrying acoustic phonons. Consequently, the rigid-soft coupling significantly inhibits heat propagation, exhibiting low acoustic phonon frequencies (∼25 cm-1) and Debye temperatures (ΘD = 170.4 K) in Pt3Bi4Se9. Owing to the suppressed κL and considerable power factor (PF), the ZT value of Pt3Bi4S6Se3 can reach 0.56 at 773 K without heavy carrier doping, which is competitive among the pristine Bi chalcogenides. Theoretical calculations predicted a large potential for performance improvement via proper doping, indicating the great potential of this structure type for promising thermoelectric materials.

GeV4 S8 : a Novel Bimetallic Sulfide for Robust and Fast Potassium Storage.

Potassium-ion batteries (PIBs) have attracted much attention due to their low production cost and abundant resources. Germanium is a promising alloying-type anode with a high theoretical capacity for PIBs, yet suffering significant volume expansion and sluggish potassium-ion transport kinetics. Herein, a rational strategy is formulated to disperse Ge atoms into transition metal V-S sulfide frameworks to form a loosely packed and metallic GeV4 S8 medium. The theoretical prediction shows that GeV4 S8 is conducive to the adsorption and diffusion of K+ . The V-S frameworks provide fast ion/electron diffusion channels and also help to buffer the volume expansion during K+ insertion. In situ and ex situ characterizations manifest that KGe alloy clusters are constrained and dispersed by potassiated VS2 topological structure during discharging, and revert to the original GeV4 S8 after charging. Consequently, as a novel anode for PIBs, GeV4 S8 provides a high specific capacity of ≈400 mAh g-1 at 0.5 C, maintaining 160 mAh g-1 even at 12.5 C and ≈80% capacity after 1000 cycles at 5 C, superior to most of the state-of-the-art anode materials. The proposed strategy of combining alloy and intercalation dual-functional units is expected to open up a new way for high-capacity and high-rate anode for PIBs.

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.

Optical properties of particle dispersed coatings with gradient distribution.

Particle dispersed coatings with gradient distributions, resulting from either gravity or artificial control, are frequently encountered in practical applications. However, most current studies investigating the optical properties of coatings use the uniform model (uniform single layer assumption), overlooking the gradient distribution effects. Given the pervasiveness of gradient distributions and the widespread use of the uniform model, it is imperative to evaluate applicability conditions of the uniform model in practical applications. In this work, we comprehensively investigate the quantitative performance of the uniform model in predicting the infrared optical properties of coatings with gradient distributions of particle volume fraction using the superposition T-matrix method. The results show that the gradient distribution of particle volume fraction has a limited impact on the emissivity properties of T i O 2-PDMS coatings in the midwavelength-infrared (MWIR) and long-wavelength-infrared (LWIR) bands, which validates the uniform model for the gradient coatings with weakly scattering dielectric particles. However, the uniform model can yield significant inaccuracies in estimating the emissivity properties of Al-PDMS coatings with gradient distributions in the MWIR and LWIR bands. To accurately estimate the emissivity of such gradient coatings with the scattering metallic particles, meticulous modeling of the particle volume fraction distribution is essential.

Cerebral hypometabolism mediates the effect of stroke volume on cognitive impairment in heart failure patients.

AIMS: The present study aimed to phenotype the cerebral structural and glucose metabolic alterations in patients with heart failure (HF) using simultaneous positron emission tomography (PET)/magnetic resonance (MR) and to investigate their relationship to cardiac biomarkers and cognitive performance. METHODS AND RESULTS: Forty-two HF patients caused by ischaemic heart disease (mean age 67.2 ± 10.4, 32 males) and 32 age- and sex-matched healthy volunteers (mean age 61.3 ± 4.8, 18 males) were included in this study. Participants underwent simultaneous cerebral fluorine-18 (18 F) fluorodeoxyglucose PET/MR followed by cardiac MR scan, and neuropsychological scores were obtained to assess cognitive performance. The grey matter volume (GMV) and standardized uptake value ratio (SUVR) were calculated to examine cerebral structural and metabolic alterations. Cardiac biomarkers included cardiac MR parameters and cardiac serum laboratory tests. Mediation analysis was performed to explore the associations among cerebral alterations, cardiac biomarkers, and cognitive performance. HF patients demonstrated notable cognitive impairment compared with normal controls (P < 0.001). Furthermore, HF patients exhibited regional brain hypometabolism in the bilateral calcarine cortex, caudate nucleus, thalamus, hippocampus, precuneus, posterior cingulate cortex, lingual and olfactory cortex, and GMV reduction in bilateral thalamus and hippocampus (cluster level at P < 0.05, Gaussian random field correction). The SUVR of the hypometabolic brain regions was correlated with the Montreal Cognitive Assessment (MoCA) scores (r = 0.55, P = 0.038) and cardiac stroke volume (r = 0.49, P = 0.002). Cerebral hypometabolism played a key role in the relationship between the decreased stroke volume and MoCA scores, with a mediation effect of 33.2%. CONCLUSIONS: HF patients suffered cerebral metabolic and structural alterations in regions associated with cognition. The observed correlation between cardiac stroke volume and cognitive impairment underscored the potential influence of cerebral hypometabolism, suggesting that cerebral hypometabolism due to chronic systemic hypoperfusion may significantly contribute to cognitive impairment in HF patients.

Effects of Thermal Boundary Resistance on Thermal Management of Gallium-Nitride-Based Semiconductor Devices: A Review.

Wide-bandgap gallium nitride (GaN)-based semiconductors offer significant advantages over traditional Si-based semiconductors in terms of high-power and high-frequency operations. As it has superior properties, such as high operating temperatures, high-frequency operation, high breakdown electric field, and enhanced radiation resistance, GaN is applied in various fields, such as power electronic devices, renewable energy systems, light-emitting diodes, and radio frequency (RF) electronic devices. For example, GaN-based high-electron-mobility transistors (HEMTs) are used widely in various applications, such as 5G cellular networks, satellite communication, and radar systems. When a current flows through the transistor channels during operation, the self-heating effect (SHE) deriving from joule heat generation causes a significant increase in the temperature. Increases in the channel temperature reduce the carrier mobility and cause a shift in the threshold voltage, resulting in significant performance degradation. Moreover, temperature increases cause substantial lifetime reductions. Accordingly, GaN-based HEMTs are operated at a low power, although they have demonstrated high RF output power potential. The SHE is expected to be even more important in future advanced technology designs, such as gate-all-around field-effect transistor (GAAFET) and three-dimensional (3D) IC architectures. Materials with high thermal conductivities, such as silicon carbide (SiC) and diamond, are good candidates as substrates for heat dissipation in GaN-based semiconductors. However, the thermal boundary resistance (TBR) of the GaN/substrate interface is a bottleneck for heat dissipation. This bottleneck should be reduced optimally to enable full employment of the high thermal conductivity of the substrates. Here, we comprehensively review the experimental and simulation studies that report TBRs in GaN-on-SiC and GaN-on-diamond devices. The effects of the growth methods, growth conditions, integration methods, and interlayer structures on the TBR are summarized. This study provides guidelines for decreasing the TBR for thermal management in the design and implementation of GaN-based semiconductor devices.

Metabolomic Insights into the Mechanisms of Ganoderic Acid: Protection against α-Amanitin-Induced Liver Injury.

α-Amanitin is a representative toxin found in the Amanita genus of mushrooms, and the consumption of mushrooms containing α-Amanitin can lead to severe liver damage. In this study, we conduct toxicological experiments to validate the protective effects of Ganoderic acid A against α-amanitin-induced liver damage. By establishing animal models with different durations of Ganoderic acid A treatment and conducting a metabolomic analysis of the serum samples, we further confirmed the differences in serum metabolites between the AMA+GA and AMA groups. The analysis of differential serum metabolites after the Ganoderic acid A intervention suggests that Ganoderic acid A may intervene in α-amanitin-induced liver damage by participating in the regulation of retinol metabolism, tyrosine and tryptophan biosynthesis, fatty acid biosynthesis, sphingosine biosynthesis, spermidine and spermine biosynthesis, and branched-chain amino acid metabolism. This provides initial insights into the protective intervention mechanisms of GA against α-amanitin-induced liver damage and offers new avenues for the development of therapeutic drugs for α-Amanitin poisoning.

Corrigendum to "Experience and lessons learned from blunt cerebrovascular injuries: A case report" [Heliyon 9 (3) (March 2023) Article e13968].

[This corrects the article DOI: 10.1016/j.heliyon.2023.e13968.].

Diagnostic accuracy of contrast-enhanced dual-energy computed tomography for detecting metastatic lymph nodes in patients with malignant tumors: a systematic review and meta-analysis.

Background: This meta-analysis evaluated the diagnostic accuracy of contrast-enhanced dual-energy computed tomography (DECT) for detecting metastatic lymph nodes in patients with cancer. Methods: PubMed, Embase and Cochrane Library databases were searched for literature published from database inception until September 2022. Only studies that investigated the diagnostic accuracy of DECT for metastatic lymph nodes in patients with malignant tumors and surgically removed metastatic lymph nodes for pathological confirmation were included. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. The threshold effect was determined by calculating Spearman correlation coefficients and summary receiver operating characteristic (SROC) curve patterns. Deeks test was used to assess publication bias. Results: All of the included studies were observational studies. A total of 16 articles involving 984 patients were included (2,577 lymph nodes) in this review. A total of 15 variables were included in the meta-analysis, including 6 individual parameters and 9 combined parameters. Normalized iodine concentration (NIC) in the arterial phase combined with the slope in the arterial phase showed better identification of metastatic lymph nodes. The spearman correlation coefficient was -0.371 (P=0.468), and the SROC curve did not show a "shoulder-arm" shape, suggesting that there was no threshold effect and that heterogeneity was present. The combined sensitivity was 94% [95% confidence interval (CI): 86-98%], the specificity was 74% (95% CI: 52-88%), and the area under the curve was 0.94. The Deeks test suggested no significant publication bias in the included studies (P=0.06). Conclusions: NIC in arterial phase combined with the slope in the arterial phase has some diagnostic value in differentiating between metastatic and benign lymph nodes, but this should be further evaluated in additional studies with rigorous design and high homogeneity.

Experience and lessons learned from blunt cerebrovascular injuries: A case report.

Background: Blunt cerebrovascular injuries are rare and serious complications of trauma that can lead to cerebral vascular dissection or aneurysm. Improving awareness of blunt cerebrovascular injuries and using computed tomography angiography to pre-screen patients at high risk is recommended by current guidelines to prevent the occurrence of ischemic stroke complications. Case description: A 32-year-old male patient was admitted to the hospital following neck trauma accompanied by stroke symptoms. Imaging revealed intimal injury of the right common carotid artery and acute cerebral infarction. After an endarterectomy and repair, the vascular lumen obstruction resolved, blood flow was restored, and the patient's condition stabilized. Conclusion: Blunt cerebrovascular injury has been seriously neglected in clinical practice. Delayed or under-diagnosis of blunt cerebrovascular injury can result large strokes. Standardized treatment protocols, which include the screening and grading of blunt cerebrovascular injury, may reduce the risk of permanent neurological dysfunction, and even death, in patients.

Deep Learning Assisted Optimization of Metasurface for Multi-Band Compatible Infrared Stealth and Radiative Thermal Management.

Infrared (IR) stealth plays a vital role in the modern military field. With the continuous development of detection technology, multi-band (such as near-IR laser and middle-IR) compatible IR stealth is required. Combining rigorous coupled wave analysis (RCWA) with Deep Learning (DL), we design a Ge/Ag/Ge multilayer circular-hole metasurface capable of multi-band IR stealth. It achieves low average emissivity of 0.12 and 0.17 in the two atmospheric windows (3~5 µm and 8~14 µm), while it achieves a relatively high average emissivity of 0.61 between the two atmospheric windows (5~8 µm) for the purpose of radiative thermal management. Additionally, the metasurface has a narrow-band high absorptivity of 0.88 at the near-infrared wavelength (1.54 µm) for laser guidance. For the optimized structure, we also analyze the potential physical mechanisms. The structure we optimized is geometrically simple, which may find practical applications aided with advanced nano-fabrication techniques. Also, our work is instructive for the implementation of DL in the design and optimization of multifunctional IR stealth materials.

Internal carotid artery dissection with different interventions and outcomes: two case reports.

Spontaneous internal carotid artery dissection (ICAD) is a rare disease and an important cause of stroke in young patients. The presentation of ICAD is variable and atypical. We have used three-dimensional T1-weighted volume isotropic turbo spin-echo acquisition to help diagnose ICAD. ICAD should be considered in young patients presenting with relevant symptoms in an emergency setting. We herein report ICAD with an unexplained onset in two patients. Neither had a history of large or small cervical trauma, but both had a history of hypertension. The first patient was a 33-year-old man who presented with upper extremity numbness and mobility impairment, and the second patient was a 40-year-old man with onset of visual impairment. There were no obvious triggers in either case. Both patients were diagnosed with ICAD by blood vessel examination. However, their prognoses differed. The first patient recovered after endovascular therapy, whereas the second patient was successfully managed with medical treatment. ICAD can cause different symptoms depending on where the dissection occurs. Clinicians must be aware of the different clinical manifestations of ICAD, make the correct diagnosis in a timely manner, make appropriate treatment plans according to the patient's condition, and strive for timely recanalization of the blood vessels.

LRRC75A-AS1 Inhibits Chondrogenic Differentiation of Bmscs via Targeting the Mir-140-3p/Wnt/Β-Catenin Pathway.

BACKGROUND: Bone marrow mesenchymal stem cells (BMSCs) are pluripotent cells with the ability to differentiate into adipocytes, chondrocytes, and osteoblasts. BMSCs are widely used in regenerative medicine and cartilage tissue engineering. Role of lncRNA LRRC75A-AS1 (leucine-rich repeat containing 75A antisense RNA 1) in the chondrogenic differentiation of BMSCs was investigated in this study. METHODS: BMSCs were isolated from rat bone marrow and then identified using flow cytometry. Alcian blue staining was used to detect chondrogenic differentiation. The effect of LRRC75A-AS1 on chondrogenic differentiation was assessed by western blot. The downstream target of LRRC75A-AS1 was determined by dual luciferase activity assay. RESULTS: BMSCs were identified with positive CD29 and CD44 staining and negative staining of CD34 and CD45. LRRC75A-AS1 was decreased during the chondrogenic differentiation of BMSCs. Silencing of LRRC75A-AS1 increased collagen II (COL II), aggrecan and SOX9 and promoted chondrogenic differentiation. However, over-expression of LRRC75A-AS1 inhibited chondrogenic differentiation. miR- 140-3p was increased during chondrogenic differentiation and interacted with LRRC75A-AS1. miR-140- 3p bind to wnt3a, and inhibition of miR-140-3p up-regulated wnt3a and nuclear ß- catenin expression. Wnt3a and nuclear ß-catenin were decreased during chondrogenic differentiation. Inhibition of miR-140- 3p attenuated LRRC75A-AS1 deficiency-induced up-regulation of COL II, aggrecan and SOX9. CONCLUSION: LRRC75A-AS1 suppressed chondrogenic differentiation of BMSCs through down-regulation of miR-140-3p and up-regulation of the wnt/ß-catenin pathway.

Taraxasterol inhibits inflammation in osteoarthritis rat model by regulating miRNAs and NF-κB signaling pathway.

Osteoarthritis (OA) has a high incidence rate in the elderly population and is a cause of chronic degenerative joint disease. Current therapeutic approaches to OA are effective but come with some side effects. Therefore, it is urgent to find new safe and effective OA treatments. This study aimed to clarify the function of taraxasterol (TAX) isolated from Taraxacum officinale in the papain-induced rat OA model. We observed that TAX alleviated the typical OA-caused phenomena in the joint. The expression of serum inflammatory mediators such as TNF-α, IL-6, and IL-1ß was also repressed by TAX. In addition, NF-κB signaling pathway was repressed by TAX. Furthermore, two microRNAs: miR-140 and miR-146a were elevated after TAX treatment in OA rat model. Interestingly, several common targets of miR-140 and miR-146a, including HSPA4L, ST5, and ERBB4, were confirmed to be regulated by TAX. Inflammatory response related genes including S100A8, CCL3, A2M, LBP, and CCR1 were repressed by TAX in OA rat model. In summary, TAX inhibits inflammation in osteoarthritis rat model. Inflammatory mediators, NF-κB pathway and miR-140/miR-146a targets mediate the function of TAX.

Neutrophil-to-lymphocyte ratio predicts parenchymal hematoma after mechanical thrombectomy in basilar artery occlusion.

Background: parenchymal hematoma (PH) is a severe complication of endovascular treatment (EVT) for acute basilar artery occlusion (ABAO). This study aimed to evaluate the incidence and predictors of PH after EVT for ABAO. Methods: Using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study, we enrolled patients treated with mechanical thrombectomy from the BASILAR registry. PH was assessed in accordance with the Heidelberg Bleeding Classification. Logistic regression was used to identify predictors of PH. Results: A total of 639 patients were included. Forty-eight patients (7.5%) were diagnosed with PH within 48 h of EVT. Ninety-day mortality was higher in patients with PH compared with those without (81.3 vs. 42.8%, P < 0.001). Favorable neurological outcomes (modified Rankin scale score, 0-3) rates was lower in patients with PH compared with those without (6.3 vs. 34.5%, P < 0.001). With a multivariate analysis, hypertension [odds ratio (OR) = 2.30, 95% confidence interval (CI) 1.04-5.08], pre-treatment National Institutes of Health Stroke Score (NIHSS, >25; OR = 3.04, 95% CI 1.43-6.45), and Neutrophil-to-lymphocyte ratio (NLR, >10; OR = 1.88, 95% CI 1.02-3.48) were associated with PH after EVT. Conclusions: PH occurred at a rate of 7.5% after EVT in patients with ABAO. Hypertension, higher baseline NIHSS, and higher NLR value increase the risk of PH after EVT for ABAO.

Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial.

Importance: Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy. Objective: To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion. Design, Setting, and Participants: This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022. Interventions: Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy. Main Outcomes and Measures: The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours. Results: Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]). Conclusions and Relevance: Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.

OTO-Net: An Automated MRA Image Segmentation Network for Intracranial Aneurysms.

Intracranial aneurysms are local dilations of the cerebral blood vessels; people with intracranial aneurysms have a high risk to cause bleeding in the brain, which is related to high mortality and morbidity rates. Accurate detection and segmentation of intracranial aneurysms from Magnetic Resonance Angiography (MRA) images are essential in the clinical routine. Manual annotations used to assess the intracranial aneurysms on MRA images are substantial interobserver variability for both aneurysm detection and assessment of aneurysm size and growth. Many prior automated segmentation works have focused their efforts on tackling the problem, but there is still room for performance improvement due to the significant variability of lesions in the location, size, structure, and morphological appearance. To address these challenges, we propose a novel One-Two-One Fully Convolutional Networks (OTO-Net) for intracranial aneurysms automated segmentation in MRA images. The OTO-Net uses full convolution to achieve intracranial aneurysms automated segmentation through the combination of downsampling, upsampling, and skip connection. In addition, loss ensemble is used as the objective function to steadily improve the backpropagation efficiency of the network structure during the training process. We evaluated the proposed OTO-Net on one public benchmark dataset and one private dataset. Our proposed model can achieve the automated segmentation accuracy with 98.37% and 97.86%, average surface distances with 1.081 and 0.753, dice similarity coefficients with 0.9721 and 0.9813, and Hausdorff distance with 0.578 and 0.642 on these two datasets, respectively.