The impact of COVID-19 pandemic on treatment delay and short-term neurological functional prognosis for acute ischemic stroke during the lockdown period.

Background: Preventive strategies implemented during the COVID-19 pandemic may negatively influence the management of patients with acute ischemic stroke (AIS). Nowadays, studies have demonstrated that the pandemic has led to a delay in treatment among patients with AIS. Whether this delay contributes to meaningful short-term outcome differences warranted further exploration. Objective: The objective of this study was to evaluate the impacts of the COVID-19 pandemic on treatment delay and short-term outcomes of patients with AIS treated with IVT and MT. Methods: Patients admitted before (from 11/1/2019 to 1/31/2020) and during the COVID-19 pandemic (from 2/1/2020 to 3/31/2020) were screened for collecting sociodemographic data, medical history information, and symptom onset status, and comparing the effect of treatment delay. The patients treated with IVT or MT were compared for delay time and neurological outcomes. Multivariable logistic regression was used to estimate the effect of treatment delay on short-term neurological prognosis. Results: In this study, 358 patients receiving IVT were included. DTN time increased from 50 min (IQR 40-75) before to 65 min (IQR 48-84), p = 0.048. 266 patients receiving MT were included. The DTP was 120 (112-148) min vs. 160 (125-199) min before and during the pandemic, p = 0.002. Patients with stroke during the pandemic had delays in treatment due to the need for additional PPE (p < 0.001), COVID-19 screening processes (p < 0.001), multidisciplinary consultation (p < 0.001), and chest CT scans (p < 0.001). Compared with pre-COVID-19, during the pandemic, patients had a higher likelihood of spontaneous intracranial hemorrhage after IVT (OR: 1.10; 95% CI, 1.03-1.30) and a lower likelihood of mRS scores 0-2 at discharge (OR: 0.90; 95% CI, 0.78-0.99). In logistic regression analysis, high NIHSS score at admission, increasing age, worse pre-admission mRS, large vessel occlusion, admission during the lockdown period, and low mTICI grade after MT were associated with an mRS ≥ 3. Conclusion: The COVID-19 pandemic has had remarkable impacts on the management of AIS. The pandemic might exacerbate certain time delays and play a significant role in early adverse outcomes in patients with AIS.

A Low-cost Mobile System with Multi-AR Guidance for Brain Surgery Assistance.

Surgical operation especially brain surgery requires comprehensive understanding on the surrounding area of the surgical path. Augmented Reality (AR) technology provided an effective way to increase the surgeon's perception on the plan. However, current applications were hindered by the expensive hardware and limited guidance information. In this paper, an AR system especially designed for brain surgery was proposed, which featured in low-cost system components and multi-AR guidance. A light-weight AR glasses was utilized together with normal mobile phone to provide mobile AR to the surgeon. A web-based application was implemented for compatibility of various mobile devices. Multi-AR information was designed for surgical guidance, including planned operation path, dangerous areas, and three quantitative guidance metrics. Patient's specific 3D model was reconstructed based on CT images, and the phantom was utilized to evaluate the effectiveness of the system. The experimental results indicated that the assistance of the multi-AR guidance outperformed the results of with no AR guidance at all and with virtual path guidance only. As a result, our system could help the operator to perform the operation tasks easier.Clinical Relevance- This proposed method provided a potential way for brain surgery with multiple AR guidance information with the assistance of a low-cost AR system, which may improve the surgeon's cognition on the surgical site.

Delayed Stroke Treatment during COVID-19 Pandemic in China.

BACKGROUND: Social distance, quarantine, pathogen testing, and other preventive strategies implemented during CO-VID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS). OBJECTIVE: The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of AIS in China. METHODS: This study included patients with AIS admitted in 2 hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 pandemic outbreak (January 31, 2020, as officially announced by the Chinese government) were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and compared for pre- (measured as onset-to-door time [ODT]) and posthospital delay (measured as door-to-needle time [DNT]). The influencing factors for delayed treatment (indicated as onset-to-needle time >4.5 h) were analyzed with multivariate logistic regression analysis. RESULTS: A total of 252 patients were included, of which 153 (60.7%) were enrolled before and 99 (39.3%) after the COVID-19 pandemic. ODT increased from 202 min (interquartile range [IQR] 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (p = 0.001). DNT increased from 50 min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (p = 0.048). The proportion of patients with intravenous thrombolysis in those with AIS was decreased significantly after the pandemic (15.4% vs. 20.1%; p = 0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms, small artery occlusion, and transported by other means than ambulance were associated with delayed treatment. CONCLUSIONS: COVID-19 pandemic has remarkable impacts on the management of AIS. Both pre- and posthospital delays were prolonged significantly, and proportion of patients arrived within the 4.5-h time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.

Identification of hub genes and signaling pathways related to gastric cells infected by Helicobacter pylori.

BACKGROUND: Helicobacter pylori is a pathogen involved in several gastroduodenal diseases, whose infection mechanisms have not been completely confirmed. To study the specific mechanism of gastropathy caused by H. pylori, we analyzed the gene microarray of gastric mucosa and gastric cells infected by H. pylori through bioinformatics analysis. METHODS: We downloaded GSE60427 and GSE74492 from the Gene Expression Omnibus (GEO) database, screened differentially expressed genes (DEGs), and identified the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) through R software. The Search Tool for the Retrieval of Interacting Genes (STRING) was applied to establish a protein-protein interaction (PPI) network and Cytoscape was used to identify the top seven hub genes. Besides, we also constructed the gene-microRNA(gene-miRNA) interaction through the miRTarBase v8.0 database by using the NetworkAnalyst tool. RESULTS: One hundred and fifteen DEGs were screened out, with 54 genes up-regulated and 61 genes down-regulated, among which seven hub genes, including "IGF1R," "APOE," "IRS1," "ATF3," "LCN2," "IL2RG," and "PI3," were considered as the main regulatory proteins in gastric cells when infected by H. pylori. CONCLUSION: In this study, hub genes and related signal enrichment pathways of gastropathy infected by H. pylori were analyzed through bioinformatics analysis based on the GSE60427 and GSE74492 datasets.

Preprocedural Neutrophil to Albumin Ratio Predicts In-Stent Restenosis Following Carotid Angioplasty and Stenting.

BACKGROUND AND PURPOSE: In-stent restenosis (ISR) is unfavorable to the long-term efficacy of carotid angioplasty and stenting (CAS). Inflammation plays a critical role in the development of ISR. The aim of the study was to investigate whether neutrophil to albumin ratio (NAR) is a predictor of ISR in patients undergoing CAS. METHODS: We retrospectively recruited patients who underwent CAS. These patients were divided into restenosis group and nonrestenosis group. NAR was examined prior to the CAS procedure. Clinical and radiographic assessments were performed at 6 months and annually after the procedure. ISR was defined as greater than or equal to 50% stenosis in the treated lesion. Cox regression was used to identify predictors of ISR following CAS. RESULTS: During a mean follow-up period of 14.6 months, a total of 459 treated arteries (in 427 participants) were enrolled, among which 72 (15.7%) developed ISR. On multivariate analysis, baseline NAR greater than or equal to13.4, residual stenosis, lesion length, and baseline glucose level were associated with ISR (hazard ratio 1.94[95% confidence interval (CI), 1.08-3.49], 1.09[95% CI, 1.07-1.12], 1.04[95% CI, 1.01-1.06], and 1.01[95% CI, 1.00-1.02], respectively). CONCLUSION: Elevated preprocedural NAR may be a predictor of ISR in patients undergoing CAS.

Biharmonic volumetric mapping using fundamental solutions.

We propose a biharmonic model for cross-object volumetric mapping. This new computational model aims to facilitate the mapping of solid models with complicated geometry or heterogeneous inner structures. In order to solve cross-shape mapping between such models through divide and conquer, solid models can be decomposed into subparts upon which mappings is computed individually. The biharmonic volumetric mapping can be performed in each subregion separately. Unlike the widely used harmonic mapping which only allows C0 continuity along the segmentation boundary interfaces, this biharmonic model can provide C1 smoothness. We demonstrate the efficacy of our mapping framework on various geometric models with complex geometry (which are decomposed into subparts with simpler and solvable geometry) or heterogeneous interior structures (whose different material layers can be segmented and processed separately).