Advancing Solid Oxide Fuel Cell Performance: Enhanced Electrochemical Properties of Pr1-xCaxBaFe2O5+δ Nanofiber Cathodes via Ca Doping.

The double perovskite oxide PrBaFe2O5+δ has great potential as a cathode material for solid oxide fuel cells (SOFCs). However, the electrochemical characteristics of Fe-based double perovskites are relatively inferior. To improve its electrochemical performance, Ca is investigated to partially replace Pr, forming Pr1-xCaxBaFe2O5+δ (PCBFx, x = 0.0-0.3) by an electrospinning technique. The PCBFx nanofibers exhibited a crystalline structure characterized by orthorhombic symmetry and space group P4/mmm. Furthermore, these PCBFx nanofibers displayed exceptional chemical compatibility with the Sm0.2Ce0.8O1.95 (SDC) electrolyte when sintered at a temperature of 900 °C for 5 h. The X-ray photoelectron spectroscopy (XPS) analysis reveals a progressive increase in the Fe4+ concentration as the Ca doping level rises. The polarization resistances (Rp) of the PCBF00, PCBF01, PCBF02, and PCBF03 nanofiber cathodes were 0.103, 0.079, 0.056, and 0.048 Ω cm2 at 750 °C. In the meantime, doping Ca increases the peak power density of the single cell by 46%, from 762.80 (PCBF00) to 1114.85 (PCBF03) mW cm-2 at 750 °C. The results demonstrate that PCBF03 double perovskite nanofibers exhibit great potential as cathode materials for SOFCs.

Dual-Channel Surface Waves Directional Radiation with Customizable Intensity and Switchable Pattern.

Achieving the conversion from surface waves (SWs) to propagating waves has captivated long-standing interest, and various ingenious metasurfaces benefiting from the powerful control capability for electromagnetic waves are able to realize efficient SWs directional radiation. Nevertheless, most existing schemes still suffer from the bottlenecks of single radiation channel, uncontrollable radiation intensity, and immutable radiation pattern, which immensely hinder their practical application in high-integration intelligent devices. Herein, a series of appealing strategies are proposed to achieve the dual-channel SWs directional radiation with customizable radiation intensity and switchable radiation pattern. The dual-channel SWs radiation metadevice based on the phase modulation metasurface is designed to directionally radiate SWs in left-handed circular polarized channel and right-handed circular polarized channel and possesses the broadband frequency scanning characteristic. More strikingly, the intensity-customizable dual-channel SWs radiation metadevice loaded with lumped resistors can control the realized gain of two circular polarized radiation beams, and the pattern-switchable dual-channel SWs radiation metadevice loaded with PIN diodes can dynamically adjust the radiation direction of the radiation beams. Numerous simulations and experiments of the proof-of-concept prototypes with modular design corroborate the theoretical predictions. Our methodology shows unprecedented flexibility in regulating SWs directional radiation and has enormous potential in engineering applications.

Broadband 2D phase-gradient metasurface for linearly-polarized waves by suppressing Lorentz resonance of meta-atoms.

Metasurfaces have exhibited versatile capacities of controlling electromagnetic (EM) waves due to the high degree of freedom of designing artificially engineered meta-atoms. For circular polarization (CP), broadband phase gradient metasurfaces (PGMs) can be realized based on P-B geometric phase by rotating meta-atoms; while for linear polarization (LP), realization of broadband phase gradients has to resort to P-B geometric phase during polarization conversion and polarization purity has to be sacrificed for broadband properties. It is still challenging to obtain broadband PGMs for LP waves without polarization conversion. In this paper, we propose the design of 2D PGMs by combining the inherently wideband geometric phases and non-resonant phases of meta-atom, under the philosophy of suppressing Lorentz resonances that usually bring about abrupt phase changes. To this end, an anisotropic meta-atom is devised which can suppress abrupt Lorentz resonances in 2D for both x- and y-polarized waves. For y-polarized waves, the central straight wire is in perpendicular to electric vector Ein of incident waves, Lorentz resonance cannot be excited although the electrical length approaches or even exceeds half a wavelength. For x-polarized waves, the central straight wire is in parallel with Ein, a split gap is opened on the center of the straight wire so as to avoid Lorentz resonance. In this way, the abrupt Lorentz resonances are suppressed in 2D and the wideband geometric phase and the gradual non-resonant phase are left for broadband PGM design. As a proof of concept, a 2D PGM prototype for LP waves was designed, fabricated and measured in microwave regime. Both simulated and measured results show that the PGM can achieve broadband beam deflection for reflected waves for both x- and y-polarized waves in broadband, without changing the LP state. This work provides a broadband route to 2D PGMs for LP waves and can be readily extended to higher frequencies such as terahertz and infrared regimes.

Deep-Learning-Empowered Holographic Metasurface with Simultaneously Customized Phase and Amplitude.

Metasurfaces with simultaneously and independently controllable amplitude and phase have provided a higher degree of freedom in manipulating electromagnetic (EM) waves. Compared with phase- or amplitude-only modulation, the capability of simultaneously controlling the phase and amplitude of EM waves can enable holography with a higher resolution. However, this drastically increases the design complexity of holographic metasurfaces, and the design process is usually quite time-consuming. In this paper, we propose an inverse design of meta-atoms that can simultaneously and independently tailor the phase and amplitude of transmitted waves using customized deep ResNet while eliminating the coupling of parameters. To demonstrate the design method, two holographic metasurfaces were designed using the trained network without the need for parameter sweeping, which will significantly enhance design efficiency. Prototypes were fabricated and measured. Both the simulated and measured results show that high-resolution holography is obtained, which sufficiently verifies the reliability of the design method. Our work paves the way for the intelligent design of metasurfaces and can also be applied to the design of other artificial materials or surfaces.

Large-angle broadband transmission of electromagnetic waves through dielectric plates by embedding meta-atoms.

In many practical applications, dielectric electromagnetic (EM) windows are usually under large-angle incidence of EM waves rather than normal incidence. To guarantee normal operation of devices inside, high transmission must be maintained under large incident angles, especially for TE-polarized waves. In this work, we propose a method of achieving broadband transmission of TE-polarized waves under large incident angles by embedding meta-atoms within dielectric plates. To this end, long metallic wires and S-shaped structures are embedded in the original dielectric plate, the former of which will dilute the effective permittivity due to plasma oscillation and the latter will increase the effective permeability due to induced strong current loops under large incident angles. In this way, two consecutive transmission peaks can be generated, forming a broad transmission band under large incident angles. A proof-of-principle Ku-band prototype was designed, fabricated, and measured to verify this strategy. Both simulated and measured results show that the prototype can operate in the whole Ku-band under incident angle [60°, 85°] for TE-polarized waves, with significantly enhanced transmission. This work provides an effective method of enhancing large-angle transmission of EM waves and may find applications in radar, communications and others.

Five-Year Outcomes After Endovascular Treatment for Large Vessel Occlusion Stroke.

Background: The long-term outcomes of acute large vessel occlusion (LVO) in anterior circulation treated by endovascular treatment (EVT) remains to be determined. The aim of this study was to assess the 5-year outcomes of patients with LVO who underwent EVT. Methods: This study was an observational, nationwide registry of consecutive patients with acute LVO who received EVT in 28 comprehensive stroke centers in China. The primary outcome was the proportion of favorable outcome [modified Rankin Scale score (mRS) 0-2] at 5 years. Secondary outcomes included proportions of patients with excellent outcome (mRS 0-1), all-cause mortality and risk of stroke recurrence at 5 years. Results: A total of 807 patients were included into the study and had 90-day follow-up data, 657 patients had 5-year follow-up data. At 90 days, 218 patients (27.0%) had an excellent outcome, 349 patients (43.2%) had a favorable functional outcome. 199 patients (24.7%) died. At 5 years, 190 patients (28.9%) had an excellent outcome, 261 patients (39.7%) had a favorable functional outcome, 317 patients (48.2%) died and 129 (28.2%) had stroke recurrence. Because of missing 5-year follow-up data, among available 269 patients who achieved functional independence at 90 days, 208 (77.3%) maintained favorable outcome, 19 (7.1%) had disability (mRS 3-5) and 42 (15.6%) died at 5 years. Furthermore, among available 189 patients with mRS 3-5 at 90 days, 53 (28.0%) patients achieved favorable functional outcome, 60 (31.7%) patients maintained unfavorable functional outcome and 76 (40.2%) patients died within 5 years. Multivariate analyses identified that younger age [odds ratio (OR): 0.96; 95% CI, 0.93-0.99; P = 0.009], lower mRS at 90 days (OR: 0.15; 95% CI, 0.10-0.23; P < 0.001) and absence of stroke recurrence (OR: 0.001; 95% CI, 0.000-0.006; P < 0.001) were significantly associated with favorable outcome at 5 years. Advanced age (OR: 1.06, 95% CI, 1.04-1.08; P < 0.001), higher mRS at 90 days (OR: 0.84; 95% CI, 0.73-0.98; P = 0.021) and atrial fibrillation (OR: 1.63; 95% CI, 1.02-2.60; P = 0.04) were independent factors for stroke recurrence. Conclusion: Our results indicated that the beneficial effect of EVT in patients with acute LVO can be sustained during the course of at least 5 years. Reducing the risk of stroke recurrence by anticoagulation for atrial fibrillation may be a crucial strategy to improve long-term outcome.

Single-Layer Achiral Metasurface with Independent Amplitude-Phase Control for Both Left-Handed and Right-Handed Circular Polarizations.

Amplitude-phase control for circular polarized (CP) waves is experiencing a research upsurge in electromagnetics owing to the kaleidoscopic electromagnetic responses and promising application prospects of circular polarizations, and chiral metasurfaces are more facile to achieve a series of intriguing chiral phenomena than natural materials. However, it is difficult for most existing chiral metasurfaces to independently tailor the amplitude and phase of left-handed circular polarized and right-handed circular polarized waves at the same frequency as they suffer the drawbacks of large thickness, multiple layers, and complex structure. Herein, an innovative strategy of single-layer achiral metasurfaces of thickness 0.13λ0 is proposed to independently and simultaneously manipulate the amplitude and phase of orthogonal CP waves. As a proof of concept, an amplitude and phase controlled dual-channel meta-hologram is designed to reconstruct diverse images with high fidelity under orthogonal CP illumination, and the simulated and experimental results collectively validate the availability of our methodology. Significantly, the meta-hologram is also applicable to full polarization states according to the decomposition of electromagnetic waves. The inspiring design of single-layer achiral metasurfaces provides a simple and effective approach to explore chiral effects, and they possess enormous application potential in multitudinous microwave devices.

Transmission enhancement of a half-wave wall under extreme angles by synergy of double lorentz resonances.

The a half-wave wall is usually adopted as the transparent window for electromagnetic (EM) waves ranging from microwave to optical regimes. Due to the interference nature, the bandwidth of the half-wave wall is usually quite narrow, especially under extreme angles for TE-polarized waves. It is usually contradictory to expand the bandwidth and to keep high transmission. To overcome this contradiction, we propose to extend the transmission bandwidth of half-wave walls under extreme angles by introducing Lorentz-type resonances using metasurfaces. The impedance of the half-wave wall is firstly analyzed. To improve the impedance matching, the impedance below and above the half-wave frequency should be increased. To this end, metallic wires and I-shaped structures are incorporated into the half-wave wall as the mid-layer. Due to the Lorentz-type resonance of the metallic wire, effective permittivity below the half-wave frequency can be reduced while that above the half-wave frequency can be increased due to Lorentz-type resonance of the I-shaped structures, both under large incident angles. In this way, the impedance matching, and thus the transmission, can be improved within an extended band. A proof-of-principle prototype was designed, fabricated, and measured to verify this strategy. Both simulated and measured results show that the prototype can operate in 14.0-19.0GHZ under incident angle [70°, 85°] with significant transmission enhancement for TE-polarized waves. This work provides an effective method of enhancing the transmission of EM waves and may find applications in radomes, IR windows, and others.

Basilar artery on computed tomography angiography score and clinical outcomes in acute basilar artery occlusion.

OBJECTIVES: This study aimed to evaluate the safety and efficacy of mechanical thrombectomy (MT) in patients with acute basilar artery occlusion (BAO) based on the baseline Basilar Artery on Computed Tomography Angiography (BATMAN) score. METHODS: We selected patients from the BASILAR study and analyzed the effects and safety of standard medical therapy (SMT) and MT for patients with documented BATMAN scores. The patients were subgrouped according to their BATMAN score (0-3, 4-6, and 7-10). The primary outcome was a favorable functional outcome (modified Rankin Scale [mRS] ≤ 3) and mortality after 90 days. RESULTS: This study included 828 patients: 337 with poor BATMAN scores (0-3), 386 with moderate BATMAN scores (4-6), and 105 with good BATMAN scores (7-10). MT was associated with favorable functional outcomes in the poor (adjusted odds ratio [aOR], 11.96; 95% confidence interval [CI], 2.58-55.43; P = 0.002), moderate (aOR, 4.66; 95% CI, 2.11-10.28; P < .001), and good (aOR, 7.71; 95% CI, 2.20-27.02; P = 0.001) BATMAN score subgroups. MT was also associated with low mortality rates in the poor (aOR, 0.10; 95% CI, 0.04-0.27; P < 0.001) and moderate (aOR, 0.31; 95% CI, 0.16-0.57; P = 0.002) BATMAN score subgroups. The BATMAN score was significantly associated with favorable outcomes in both the SMT (aOR, 1.44; 95% CI, 1.08-1.93; P = 0.014) and MT (aOR, 1.31; 95% CI, 1.20-1.44; P < 0.001) groups. CONCLUSION: Higher BATMAN scores were associated with improved prognosis and lower mortality rates after 3 months. MT was associated with improved outcomes in patients with low BATMAN scores despite their worse overall outcomes. UNIQUE IDENTIFIER: ChiCTR1800014759, 2018/02/03.

Quasi-omnidirectional retroreflective metagrating for TE-polarized waves based on wave-vector reversions.

Structuring elements of gratings brings more freedom in manipulating diffraction waves, e.g., retroreflection using diffraction orders other than the 0th order. Most retroreflective metagratings (RMs) can achieve retroreflection only under one particular direction, limiting their applications. In this paper, we propose a quasi-omnidirectional RM based on wave-vector reversion for TE-polarized waves. The metagrating element is composed of four rotationally-symmetric sub-elements, which is composed of one probe and two directors on its two sides. The substrate-air-metal layer can reverse kz while directors can reverse kx. Therefore, the wave-vector k of reflected waves can be completely reversed by the sub-element, providing necessary momentum for retroreflection. The -2nd diffraction order of the metagrating is tailored to channel out waves with reversed k, leading to retroreflection. Due to the element's four-fold rotational symmetry, retroreflection can be achieved along four directions, covering all of the four quarters of azimuth angle. We demonstrate prototypes in Ku band, and the average backscattering enhancement compared with a metal plane with the same area (SAMP) along the four directions reaches up to 31.3 dB with incident angle 50.0° at 15.0 GHz. Both simulated and measured results verify our design. This work provides another perspective on retroreflection and may find applications in retroreflective functional devices.

Extended Thrombolysis In Cerebral Infarction (eTICI) grade 2c: a potential angiographic target for endovascular treatment in acute basilar artery occlusion?

BACKGROUND: Higher extended Thrombolysis In Cerebral Infarction (eTICI) grades are associated with better clinical outcomes after endovascular treatment (EVT) for proximal intracranial occlusion of the anterior circulation. However, the relationship between eTICI grade and outcomes after EVT in patients with acute basilar artery occlusion (BAO) remains unclear. We aimed to explore which eTICI category was the cut-off correlating with better clinical outcomes in patients with BAO undergoing EVT. METHODS: We included patients treated via EVT from the BASILAR study. Multivariable logistic regression analyses were performed to assess the impact of eTICI grades on 90-day favorable functional outcomes, defined as a modified Rankin Scale (mRS) score of 0-3. Other outcomes were functional independence (mRS 0-2), all-cause mortality, and symptomatic intracranial hemorrhage. RESULTS: Among 647 patients treated with EVT, 127 (19.6%), 128 (24.5%), 110 (21.1%), and 282 (54%) patients achieved eTICI grades of 0-2a, 2b, 2c, and 3, respectively. Compared with eTICI grades 0-2a, higher rates of favorable functional outcomes (adjusted OR (aOR) 2.96, 95% CI 1.33 to 6.57, and aOR 7.40, 95% CI 3.63 to 15.09, respectively) were observed for grades 2c and 3, not 2b (aOR 1.93, 95% CI 0.86 to 4.36). The risks of mortality and symptomatic intracranial hemorrhage were also lower for eTICI grades 2c and 3 than for grades 0-2a. CONCLUSIONS: An eTICI grade of 2c/3 may be a target for successful reperfusion after EVT in patients with acute BAO; however, further studies with larger sample sizes and clinical trials are needed.

Quasi-continuous linear phase-gradient metamaterial based on conformal spoof surface plasmon polaritons.

In this work, we propose a method of achieving quasi-continuous linear phase gradient for transmitted waves based on conformal spoof surface plasmon polariton (SSPP). To this end, a SSPP structure with high transmission is firstly designed as the unit cell of the metamaterial. To obtain the phase gradient, SSPP structures are arranged delicately in a way that they are conformal to the brachistochrone curve. In this way, quasi-continuous linear Pancharatnam-Berry (PB) phase profile can be realized strictly along one of the two transverse directions. To verify this idea, a dual-band transmissive metamaterial operating in X and Ku band was designed, fabricated and measured. Due to the phase gradient imparted by the conformal SSPP structures, high-efficiency anomalous refraction can be realized within the two bands. Different from the general PGM, the phase gradient of the conformal SSPP structure allows us to achieve the desired anomalous refraction angle without reconstructing the PB phase. Both the simulation and measurement results are well consistent with theoretical predictions. This work provides another strategy of achieving anomalous refraction and may find applications in beam steering, digital beam forming, etc.

Endovascular intervention for basilar artery occlusion in the elderly.

BACKGROUND: To date, few data have been reported on clinical outcomes following interventions in elderly populations with acute basilar artery occlusion. Using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study (BASILAR), we evaluated the efficacy and safety of intervention and determined predictors of outcomes among elderly patients in China. METHODS: Patients from January 2014 to May 2019 were dichotomized into elderly (75 years or older) and nonelderly patients (under 75 years). Pearson's Chi-square test and multivariate logistic regression were performed to assess 90-day favorable functional outcome (defined as a modified Rankin scale score of 0-3), mortality and symptomatic intracranial hemorrhage between intervention and conservative cohorts in elderly patients. RESULTS: Among the 829 patients in the BASILAR, 182 patients aged 75 years or older were analyzed. These patients were divided into intervention (127 patients) and conservative (55 patients) cohorts. Compared with the conservative cohort, the intervention cohort presented more frequently with a favorable functional outcome (28.3% versus 12.7%; p = 0.023) and with a decreased mortality (54.3% versus 76.4%; p = 0.005). There was no difference in symptomatic intracranial hemorrhage (4.7% versus 0, p = 0.235). Multivariate analysis indicated that intervention was associated with favorable functional outcome (adjusted odds ratio, 0.262; 95% confidence interval, 0.088-0.778, p = 0.016) and lower mortality (adjusted odds ratio, 0.257; 95% confidence interval, 0.109-0.606, p = 0.002). In the intervention cohort, initial National Institutes of Health Stroke Scale (NIHSS) score and occlusion site were associated with functional outcome, and initial NIHSS score and recanalization were associated with mortality. CONCLUSIONS: Although the overall outcome following intervention was worse with age, intervention was more effective and safer than conservative treatment for elderly Chinese patients with basilar artery occlusion. Predictors of desirable outcome in elderly patients undergoing intervention included lower initial NIHSS score, occlusion site and successful recanalization.Clinical Trial Registration-URL: http://www.chictr.org. Unique identifier: ChiCTR-1800014759.

Single-layer metasurface for ultra-wideband polarization conversion: bandwidth extension via Fano resonance.

In this paper, we propose a method of designing ultra-wideband single-layer metasurfaces for cross-polarization conversion, via the introduction of Fano resonances. By adding sub-branches onto the unit cell structure, the induced surface currents are disturbed, leading to coexistence of both bright and dark modes at higher frequencies. Due to the strong interaction between the two modes, Fano resonance can be produced. In this way, five resonances in all are produced by the single-layer metasurface. The first four are conventional and are generated by electric and magnetic resonances, whereas the fifth one is caused by Fano resonance, which further extends the bandwidth. A prototype was designed, fabricated and measured to verify this method. Both the simulated and measured results show that a 1:4.4 bandwidth can be achieved for both x- and y-polarized waves, with almost all polarization conversion ratio (PCR) above 90%. This method provides an effective alternative to metasurface bandwidth extension and can also be extended to higher bands such as THz and infrared frequencies.

Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke: The DEVT Randomized Clinical Trial.

Importance: For patients with large vessel occlusion strokes, it is unknown whether endovascular treatment alone compared with intravenous thrombolysis plus endovascular treatment (standard treatment) can achieve similar functional outcomes. Objective: To investigate whether endovascular thrombectomy alone is noninferior to intravenous alteplase followed by endovascular thrombectomy for achieving functional independence at 90 days among patients with large vessel occlusion stroke. Design, Setting, and Participants: Multicenter, randomized, noninferiority trial conducted at 33 stroke centers in China. Patients (n = 234) were 18 years or older with proximal anterior circulation intracranial occlusion strokes within 4.5 hours from symptoms onset and eligible for intravenous thrombolysis. Enrollment took place from May 20, 2018, to May 2, 2020. Patients were enrolled and followed up for 90 days (final follow-up was July 22, 2020). Interventions: A total of 116 patients were randomized to the endovascular thrombectomy alone group and 118 patients to combined intravenous thrombolysis and endovascular thrombectomy group. Main Outcomes and Measures: The primary end point was the proportion of patients achieving functional independence at 90 days (defined as score 0-2 on the modified Rankin Scale; range, 0 [no symptoms] to 6 [death]). The noninferiority margin was -10%. Safety outcomes included the incidence of symptomatic intracerebral hemorrhage within 48 hours and 90-day mortality. Results: The trial was stopped early because of efficacy when 234 of a planned 970 patients had undergone randomization. All 234 patients who were randomized (mean age, 68 years; 102 women [43.6%]) completed the trial. At the 90-day follow-up, 63 patients (54.3%) in the endovascular thrombectomy alone group vs 55 (46.6%) in the combined treatment group achieved functional independence at the 90-day follow-up (difference, 7.7%, 1-sided 97.5% CI, -5.1% to ∞)P for noninferiority = .003). No significant between-group differences were detected in symptomatic intracerebral hemorrhage (6.1% vs 6.8%; difference, -0.8%; 95% CI, -7.1% to 5.6%) and 90-day mortality (17.2% vs 17.8%; difference, -0.5%; 95% CI, -10.3% to 9.2%). Conclusions and Relevance: Among patients with ischemic stroke due to proximal anterior circulation occlusion within 4.5 hours from onset, endovascular treatment alone, compared with intravenous alteplase plus endovascular treatment, met the prespecified statistical threshold for noninferiority for the outcome of 90-day functional independence. These findings should be interpreted in the context of the clinical acceptability of the selected noninferiority threshold. Trial Registration: Chinese Clinical Trial Registry: ChiCTR-IOR-17013568.

DEVT: A randomized, controlled, multicenter trial of direct endovascular treatment versus standard bridging therapy for acute stroke patients with large vessel occlusion in the anterior circulation - Protocol.

BACKGROUND: Eight randomized controlled trials have consistently shown that endovascular treatment plus best medical treatment improves outcome after acute anterior proximal intracranial large vessel occlusion strokes. Whether intravenous thrombolysis prior to endovascular treatment in patients with anterior circulation, large vessel occlusion is of any additional benefits remains unclear. OBJECTIVE: This study compares the safety and efficacy of direct endovascular treatment versus intravenous recombinant tissue-type plasminogen activator bridging with endovascular treatment (bridging therapy) in acute stroke patients with intracranial internal carotid artery or middle cerebral artery-M1 occlusion within 4.5 h of symptom onset. METHODS AND DESIGN: The DEVT study is a randomized, controlled, multicenter trial with blinded outcome assessment. This trial uses a five-look group-sequential non-inferiority design. Up to 194 patients in each interim analysis will be consecutively randomized to direct endovascular treatment or bridging therapy group in 1:1 ratio over three years from about 30 hospitals in China. OUTCOMES: The primary end-point is the proportion of independent neurological function defined as modified Rankin scale score of 0 to 2 at 90 days. The primary safety measure is symptomatic intracerebral hemorrhage at 48 h and mortality at 90 days. TRIAL REGISTRY NUMBER: ChiCTR-IOR-17013568 (www.chictr.org.cn).

Polarization-independent multi-channel retroreflective metasurfaces based on extraordinary optical diffraction.

Retroreflection can be achieved by phase gradient imparted by super-cells of metasurfaces. Nevertheless, in most cases, retroreflection can only be achieved for one specific polarization. In this paper, we propose an alternative design strategy and reveal that a polarization-independent multi-channel metasurface based on extraordinary optical diffraction (EOD) can achieve high-efficient retroreflection. A unary unit cell, instead of binary unit cells, is employed to canalize impinging EM waves along targeted diffraction channels. Under oblique incidence, only the -1st diffraction order is maintained and the 0th order and others are suppressed through structural design while the reflection is unaffected under normal incidence. In this way, we can achieve retroreflection in three channels. A proof-of-principle prototype was designed, fabricated and measured to verify this design strategy. The prototype can operate at 20.0 GHz under the incident angle of ±48.6° and 0° with the efficiency of retroreflection about 90%. Both the simulated and measured results show an excellent performance of retroreflection along the three channels, regardless of the polarization state of incident waves. This method offers a fast implementation for retrodirective characteristics with facile planar fabrication and can also be easily extended to THz or optical regimes.

Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry.

Importance: Several randomized clinical trials have recently established the safety and efficacy of endovascular treatment (EVT) of acute ischemic stroke in the anterior circulation. However, it remains uncertain whether patients with acute basilar artery occlusion (BAO) benefit from EVT. Objective: To evaluate the association between EVT and clinical outcomes of patients with acute BAO. Design, Setting, and Participants: This nonrandomized cohort study, the EVT for Acute Basilar Artery Occlusion Study (BASILAR) study, was a nationwide prospective registry of consecutive patients presenting with an acute, symptomatic, radiologically confirmed BAO to 47 comprehensive stroke centers across 15 provinces in China between January 2014 and May 2019. Patients with acute BAO within 24 hours of estimated occlusion time were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. Main Outcomes and Measures: The primary outcome was the improvement in modified Rankin Scale scores (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days across the 2 groups assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. The secondary efficacy outcome was the rate of favorable functional outcomes defined as modified Rankin Scale scores of 3 or less (indicating an ability to walk unassisted) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage and 90-day mortality. Results: A total of 1254 patients were assessed, and 829 patients (of whom 612 were men [73.8%]; median [interquartile] age, 65 [57-74] years) were recruited into the study. Of these, 647 were treated with standard medical treatment plus EVT and 182 with standard medical treatment alone. Ninety-day functional outcomes were substantially improved by EVT (adjusted common odds ratio, 3.08 [95% CI, 2.09-4.55]; P < .001). Moreover, EVT was associated with a significantly higher rate of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 4.70 [95% CI, 2.53-8.75]; P < .001) and a lower rate of 90-day mortality (adjusted odds ratio, 2.93 [95% CI, 1.95-4.40]; P < .001) despite an increase in symptomatic intracerebral hemorrhage (45 of 636 patients [7.1%] vs 1 of 182 patients [0.5%]; P < .001). Conclusions and Relevance: Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.

Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial.

BACKGROUND: Previous randomised trials have shown an overwhelming benefit of mechanical thrombectomy for treating patients with stroke caused by large vessel occlusion of the anterior circulation. Whether endovascular treatment is beneficial for vertebrobasilar artery occlusion remains unknown. In this study, we aimed to investigate the safety and efficacy of endovascular treatment of acute strokes due to vertebrobasilar artery occlusion. METHODS: We did a multicentre, randomised, open-label trial, with blinded outcome assessment of thrombectomy in patients presenting within 8 h of vertebrobasilar occlusion at 28 centres in China. Patients were randomly assigned (1:1) to endovascular therapy plus standard medical therapy (intervention group) or standard medical therapy alone (control group). The randomisation sequence was computer-generated and stratified by participating centres. Allocation concealment was implemented by use of sealed envelopes. The primary outcome was a modified Rankin scale (mRS) score of 3 or lower (indicating ability to walk unassisted) at 90 days, assessed on an intention-to-treat basis. The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial haemorrhage, device-related complications, and other severe adverse events. The BEST trial is registered with ClinicalTrials.gov, NCT02441556. FINDINGS: Between April 27, 2015, and Sept 27, 2017, we assessed 288 patients for eligibility. The trial was terminated early after 131 patients had been randomly assigned (66 patients to the intervention group and 65 to the control group) because of high crossover rate and poor recruitment. In the intention-to-treat analysis, there was no evidence of a difference in the proportion of participants with mRS 0-3 at 90 days according to treatment (28 [42%] of 66 patients in the intervention group vs 21 [32%] of 65 in the control group; adjusted odds ratio [OR] 1·74, 95% CI 0·81-3·74). Secondary prespecified analyses of the primary outcome, done to assess the effect of crossovers, showed higher rates of mRS 0-3 at 90 days in patients who actually received the intervention compared with those who received standard medical therapy alone in both per-protocol (28 [44%] of 63 patients with intervention vs 13 [25%] of 51 with standard therapy; adjusted OR 2·90, 95% CI 1·20-7·03) and as-treated (36 [47%] of 77 patients with intervention vs 13 [24%] of 54 with standard therapy; 3·02, 1·31-7·00) populations. The 90-day mortality was similar between groups (22 [33%] of 66 patients in the intervention vs 25 [38%] of 65 in the control group; p=0·54) despite a numerically higher prevalence of symptomatic intracranial haemorrhage in the intervention group. INTERPRETATION: There was no evidence of a difference in favourable outcomes of patients receiving endovascular therapy compared with those receiving standard medical therapy alone. Results might have been confounded by loss of equipoise over the course of the trial, resulting in poor adherence to the assigned study treatment and a reduced sample size due to the early termination of the study. FUNDING: Jiangsu Provincial Special Program of Medical Science.

Clinical efficacy of tirofiban combined with a Solitaire stent in treating acute ischemic stroke.

This study explores the safety and effect of acute cerebral infarction treatment by microcatheter injection of tirofiban combined with a Solitaire AB stent and/or stent implantation. Emergency cerebral angiograms showing the responsible vascular occlusion of 120 acute cerebral infarction patients who underwent emergency endovascular thrombectomy were included in the study. These patients were randomly divided into two groups using the random number table method: treatment group (n=60) that received thrombectomy (with cerebral artery stents) combined with intracerebral injection of tirofiban and control group (n=60) that only received thrombectomy (with cerebral artery stents alone). The baseline data, cerebral angiography before and after surgery, hospitalization, and follow-up results of patients in these two groups were compared. Furthermore, the incidence of major adverse cerebrovascular events of these two groups was compared (90-day modified Rankin scale, a score of 0-2 indicates a good prognosis). The difference between baseline clinical data and brain angiography between these two groups was not statistically significant. Patients in the treatment group had a higher prevalence of thrombolysis in cerebral infarction grade 2b/3 than patients in the control group (88.3% (53/60) vs 66.7% (40/60), P=0.036). Moreover, the National Institutes of Health Stroke Scale scores 7 days after surgery and the 90-day prognosis were all better for the patients who received tirofiban (P=0.048 and P=0.024). Mechanical thrombectomy with Solitaire AB stents in combination with the injection of tirofiban through a microcatheter appears to be safe and effective for the endovascular treatment of acute ischemic stroke.