Predicting the recurrence of spontaneous intracerebral hemorrhage using a machine learning model.

Background: Recurrence can worsen conditions and increase mortality in ICH patients. Predicting the recurrence risk and preventing or treating these patients is a rational strategy to improve outcomes potentially. A machine learning model with improved performance is necessary to predict recurrence. Methods: We collected data from ICH patients in two hospitals for our retrospective training cohort and prospective testing cohort. The outcome was the recurrence within one year. We constructed logistic regression, support vector machine (SVM), decision trees, Voting Classifier, random forest, and XGBoost models for prediction. Results: The model included age, NIHSS score at discharge, hematoma volume at admission and discharge, PLT, AST, and CRP levels at admission, use of hypotensive drugs and history of stroke. In internal validation, logistic regression demonstrated an AUC of 0.89 and precision of 0.81, SVM showed an AUC of 0.93 and precision of 0.90, the random forest achieved an AUC of 0.95 and precision of 0.93, and XGBoost scored an AUC of 0.95 and precision of 0.92. In external validation, logistic regression achieved an AUC of 0.81 and precision of 0.79, SVM obtained an AUC of 0.87 and precision of 0.76, the random forest reached an AUC of 0.92 and precision of 0.86, and XGBoost recorded an AUC of 0.93 and precision of 0.91. Conclusion: The machine learning models performed better in predicting ICH recurrence than traditional statistical models. The XGBoost model demonstrated the best comprehensive performance for predicting ICH recurrence in the external testing cohort.

Conjugated backbone optimization of an all-fused-ring acceptor for efficient and stable organic solar cells.

Three all-fused-ring acceptors with different conjugated backbone are designed as acceptor materials for organic solar cells. It is found that the horizontally extended conjugation of all-fused-ring acceptors leads to better photovoltaic performance compared to the vertically extended analogue. The results provide a guideline for designing high-performance and stable all-fused-ring acceptor materials.

Unsupervised Machine Learning Revealed that Repeat Transcranial Magnetic Stimulation is More Suitable for Stroke Patients with Statin.

INTRODUCTION: Repeat transcranial magnetic stimulation (rTMS) demonstrates beneficial effects for stroke patients, though its efficacy varies due to the complexity of patient conditions and disease progression. Unsupervised machine learning could be the optimal solution for identifying target patients for transcranial magnetic stimulation treatment. METHODS: We collected data from ischaemic stroke patients treated with rTMS. Unsupervised machine learning methods, including K-means and Hierarchical Clustering, were used to explore the clinical characteristics of patients suitable for rTMS. We then utilized a prospective observational cohort to validate the effect of selected characteristics. For the validated cohort, outcomes included the presence of motor evoked potentials (MEP), favorable functional outcomes (FFO), and changes in the Fugl-Meyer Assessment (FMA) at 3 and 6 months. RESULTS: Hierarchical clustering methods revealed that patients in the better prognosis group were more likely to take statins. The validated cohort was grouped based on statin intake. Patients taking statins exhibited a higher rate of MEP (p = 0.006), a higher rate of FFO at 3 months (p = 0.003) and 6 months (p = 0.021), and a more significant change in FMA (p < 0.001) at both 3 and 6 months. Statin intake was associated with FFO and changes in FMA at 3 and 6 months. This relationship persisted across all subgroups for FMA changes and some FFO subgroups. CONCLUSION: Stroke patients undergoing rTMS treatment taking statins exhibited greater MEP, FFO, and changes in FMA. Statin intake was associated with a better prognosis in these patients.

The machine learning methods to analyze the using strategy of antiplatelet drugs in ischaemic stroke patients with gastrointestinal haemorrhage.

BACKGROUND: For ischaemic stroke patients with gastrointestinal haemorrhage, stopping antiplatelet drugs or reducing the dose of antiplatelet drugs was a conventional clinical therapy method. But not a study to prove which way was better. And the machinery learning methods could help to obtain which way more suit for some patients. METHODS: Data from consecutive ischaemic stroke patients with gastrointestinal haemorrhage were prospectively collected. The outcome was a recurrent stroke rate, haemorrhage events, mortality and favourable functional outcome (FFO). We analysed the data using conventional logistic regression methods and a supervised machine learning model. We used unsupervised machine learning to group and analyse data characters. RESULTS: The patients of stopping antiplatelet drugs had a lower rate of bleeding events (p = 0.125), mortality (p = 0.008), rate of recurrence of stroke (p = 0.161) and distribution of severe patients (mRS 3-6) (p = 0.056). For Logistic regression, stopping antiplatelet drugs (OR = 2.826, p = 0.030) was related to lower mortality. The stopping antiplatelet drugs in the supervised machine learning model related to mortality (AUC = 0.95) and FFO (AUC = 0.82). For group by unsupervised machine learning, the patients of better prognosis had more male (p < 0.001), younger (p < 0.001), had lower NIHSS score (p < 0.001); and had a higher value of serum lipid level (p < 0.001). CONCLUSIONS: For ischemic stroke patients with gastrointestinal haemorrhage, stopping antiplatelet drugs had a better prognosis. Patients who were younger, male, with lesser NIHSS scores at admission, with the fewest history of a medical, higher value of diastolic blood pressure, platelet, blood lipid and lower INR could have a better prognosis.

Molecular Stacking and Aggregation Optimization of Photoactive Layer through Solid Additive Enables High-Performance Organic Solar Cells.

Regulating molecular packing and aggregation of photoactive layer is a critical but challenging issue in developing high-performance organic solar cells. Herein, two structurally similar analogues of anthra[2,3-b : 6,7-b']dithiophene (ADT) and naphtho[1,2-b : 5,6-b']dithiophene (NDT) are developed as solid additive to exploit their effect in regulating the molecular aggregation and π-stacking of photoactive layer. We clarify that the perpendicular arrangements of NDT can enlarge the molecular packing space and improve the face-on stacking of Y6 during the film formation, favoring a more compact and ordered long-range π-π stacking in the out-of-plane direction after the removal of NDT under thermal annealing. The edge-to-face stacked herringbone-arrangement of ADT along with its non-volatilization under thermal annealing can induce the coexistence of face-on and edge-on stacking of blend film. As a result, the NDT treatment shows encouraging effect in improving the photovoltaic performance of devices based on various systems. Particularly, a remarkable PCE of 18.85 % is achieved in the PM6 : L8-BO-based device treated by NDT additive, which is a significant improvement with regard to the PCE of 16.41 % for the control device. This work offers a promising strategy to regulate the molecular packing and aggregation of photoactive layer towards significantly improved performance and stability of organic solar cells.

The unsupervised machine learning to analyze the use strategy of statins for ischaemic stroke patients with elevated transaminase.

BACKGROUND AND PURPOSE: Statins could elevate hepatic transaminase in ischemic stroke patients. There needed to be more evidence on which method stopped statins or adjusting the dose of statins was better for patients. And no evidence showed which way more suit for some patients. METHODS: We collected ischaemic stroke patients with elevated hepatic transaminase when they take statins. The outcome was a recurrent stroke rate, transaminase value after stopping or adjusted, mortality, and favorable functional outcome (FFO). We compare outcome events between the stopped group and the adjustment group. We grouped all patients by unsupervised machine learning and analyzed data characters by the different groups. RESULTS: The patients stopping statins had a higher stroke recurrence and rate of FFO (mRS 0-2), a lower mean value of transaminase, and mortality. By difference unsupervised machine learning group, the km2 group had the lowest stroke recurrence (p = 0.046), lowest mortality (p = 0.049), and highest FFO (p = 0.023). The patients of the km2 group were younger (p < 0.001), more male (p < 0.001), had lesser National Institutes of Health Stroke Scale (NIHSS) scores (p < 0.001), and had slightly higher values of blood pressure (p = 0.002). The group of unsupervised machine learning could improve models' performance. CONCLUSION: For ischemic patients with elevated hepatic transaminase, stopping statins temporarily was a better choice of treatment strategy. These patients who were younger, male, with a lesser NIHSS score at admission and a slightly higher blood lipid value at admission, could have had a better prognosis.

Major intracranial arterial stenosis influence association between baseline blood pressure and clinical outcomes after thrombolysis in ischemic stroke patients.

BACKGROUND: This study aimed to investigate the relationship between baseline blood pressure (BP) and clinical outcomes after thrombolysis for acute ischemic stroke (AIS) in different intracranial arterial stenosis subgroups. METHODS: AIS patients from multicenter with intravenous thrombolysis were retrospectively enrolled from January 2013 to December 2021. We categorized participants into severe (≥ 70%) and nonsevere (< 70%) stenosis of major intracranial arteries subgroups. The primary outcome was unfavorable functional outcome defined as 3-month modified Rankin Scale (mRS) ≥2. The association coefficients between baseline BP and functional outcomes were estimated in general linear regression model. The interactive effect was tested to determine the influence of intracranial arterial stenosis on the association between BP and clinical outcomes. RESULTS: A total of 329 patients were included. Severe subgroup was detected in 151 patients with average age of 70.5. Association between baseline diastolic BP (DBP) and unfavorable functional outcome in intracranial artery stenosis subgroups was significantly different (p for interaction < .05). In nonsevere subgroup, higher baseline DBP was associated with higher risk of unfavorable outcome (OR 1.11, 95% CI 1.03 to 1.20, p = .009) compared with severe subgroup (OR 1.02, 95% CI 0.97 to 1.08, p = .341). Besides, intracranial artery stenosis also modified association between baseline systolic BP (SBP) and 3-month death (p for interaction < .05). In severe subgroup, higher baseline SBP was associated with decreased 3-month death risk (OR 0.88, 95% CI 0.78 to 1, p = .044) compared with nonsevere subgroup (OR 1, 95% CI 0.93 to 1.07, p = .908). CONCLUSIONS: The major intracranial artery state modulates association between baseline BP and 3-month clinical outcomes after intravenous thrombolysis.

Reduced bimolecular charge recombination in efficient organic solar cells comprising non-fullerene acceptors.

Bimolecular charge recombination is one of the most important loss processes in organic solar cells. However, the bimolecular recombination rate in solar cells based on novel non-fullerene acceptors is mostly unclear. Moreover, the origin of the reduced-Langevin recombination rate in bulk heterojunction solar cells in general is still poorly understood. Here, we investigate the bimolecular recombination rate and charge transport in a series of high-performance organic solar cells based on non-fullerene acceptors. From steady-state dark injection measurements and drift-diffusion simulations of the current-voltage characteristics under illumination, Langevin reduction factors of up to over two orders of magnitude are observed. The reduced recombination is essential for the high fill factors of these solar cells. The Langevin reduction factors are observed to correlate with the quadrupole moment of the acceptors, which is responsible for band bending at the donor-acceptor interface, forming a barrier for charge recombination. Overall these results therefore show that suppressed bimolecular recombination is essential for the performance of organic solar cells and provide design rules for novel materials.

Morphology Optimization of the Photoactive Layer through Crystallinity and Miscibility Regulation for High-performance Polymer Solar Cells.

On the premise of strongly crystalline materials involved, it is a challenge to control the phase separation of bulk-heterojunction donor/acceptor active layer to fabricate high-performance polymer solar cells (PSCs). Herein, we develop a molecular design strategy of the third component to synthesize three guest materials (namely BTPT, BTP-Th, and BTP-2Th) to address this issue. We investigate and reveal the effect of crystallinity and miscibility of the third component in controlling the phase separation of Y6-derivatives-based blend film. As a result, a remarkable power-conversion efficiency of 18.53 % is obtained in the ternary PSC based on PTQ10 : m-BTP-PhC6 with BTP-Th as the third component, which is a significant improvement with regard to the efficiency of 17.22 % for the control binary device. Our study offers a molecular design strategy to develop a third component for building ternary PSCs in terms of crystallinity and miscibility regulation.

Low-dose statins improve prognosis of patients with ischaemic stroke undergoing intra-arterial thrombectomy: A prospective cohort study.

BACKGROUND: High-dose statins are recommended as preventive drugs in guidelines for patients with ischaemic stroke undergoing thrombectomy. Not only in clinical practice but also based on large-scale studies, low-dose statins have been widely used and demonstrated to be efficient in Asian populations. However, it remains unknown whether a low-dose statin is related to the prognosis of patients with thrombectomy. Can low-dose statins reduce the risk of bleeding at the same time? METHODS: We prospectively collected data from patients with acute ischaemic stroke undergoing intra-arterial thrombectomy. Efficacy outcomes were National Institutes of Health Stroke Scale (NIHSS) score improvement at 7 days after admission and a favourable functional outcome (FFO) at 90 days. Safety outcomes were rates of in-hospital haemorrhage events and death within 2 years. RESULTS: We included 256 patients in this study. Compared with the control group, the low-dose statin group had a higher NIHSS improvement rate at 7 days, a higher FFO rate at 90 days and a lower death rate within 2 years. The low-dose statin group had a lower percentage of gastrointestinal haemorrhage. Statin use was significantly related to an improved NIHSS score (p = 0.028, OR = 1.773) at 7 days and FFO (P < 0.001, OR = 2.962) at 90 days and to lower death rates (P = 0.025, or = 0.554) within 2 years. CONCLUSION: In Asian acute ischaemic stroke patients with intra-arterial thrombectomy, low-dose statin use was significantly related to NIHSS improvement at 7 days, FFO at 90 days and decreased death rates within 2 years.

Molecular Optimization on Polymer Acceptor Enables Efficient All-Polymer Solar Cell with High Open-Circuit Voltage of 1.10 V.

Currently, rational design of polymer acceptors is desirable but there is still a challenge to develop high-performance all-polymer solar cells (all-PSCs). In this work, brominated thienyl-fused malononitrile-based monomer is employed to copolymerize with indacenodithiophene (IDT) and benzodithiophene (BDT)-based linking units to develop two polymerized small molecule acceptors (PSMAs) PIDT and PBDT, respectively, for all-PSCs. The two PSMAs show similar absorption edges, while PBDT shows a slightly higher lowest unoccupied molecular orbital (LUMO) energy level than PIDT. Benefitted from the relatively high LUMO levels of the two polymer acceptors, notable open-circuit voltage (Voc ) values over 1.0 V are achieved when using them as acceptor to blend with PTQ10 as polymer donor. Particularly, the all-PSC based on PTQ10:PIDT demonstrates a power conversion efficiency of 10.19%, with an outstanding Voc of 1.10 V benefitted from the higher LUMO energy level of PIDT acceptor. The results demonstrate a feasible strategy to design PSMAs by selecting appropriate linking units for increasing the Voc and improving the efficiency of all-PSCs.

Statin pretreatment combined with intravenous thrombolysis for ischemic stroke patients: A meta-analysis.

PURPOSE: For ischemic stroke patients, thrombolysis therapy combined statins might have a better benefit. But difference studies had a debate. The meta-analysis wants to make clear about whether statins could increase effect of therapy or decrease side effect for these patients. METHODS OBJECTIVES: To evaluate the effect and safety about using statins in ischemic stroke patients receiving thrombolysis. DATA SOURCES: Databases including PubMed, Web of Science, Embase and Cochrane Library. ELIGIBILITY CRITERIA: original observational cohort studies. PARTICIPANTS: ischemic stroke patients receiving thrombolysis. INTERVENTIONS: pretreatment statins. APPRAISAL AND SYNTHESIS METHODS: forest plot to show pooled results; I-squared test to evaluate the heterogeneity. RESULTS: Of 87 selected, 8 were eligible. The 8 studies included 10,344 patients (with statins: 2048; without statins: 8296). For clinical recovery at 24 h, pooled OR (odds ratios) was 1.82 (95% CI: 1.49-2.21). For excellent outcome, pooled OR was 1.03 (95% CI: 0.80-1.12). For favorable outcome, pooled OR was 0.99 (95% CI: 0.85-1.16). For ICH (intracranial hemorrhage), pooled OR was 1.16 (95% CI: 0.97-1.40). For sICH (symptomatic intracranial hemorrhage), pooled OR was 1.40 (95% CI: 1.02-1.91). For mortality, overall pooled OR was 0.96 (95% CI: 0.74-1.25). CONCLUSION: In conclusion, the meta-analysis found that for ischemic stroke patients receiving thrombolysis, pretreatment statins were related to a better clinical recovery and a lower short-term mortality. Pretreatment statins had no significant relationship with mRS at 90 days and ICH. Pretreatment high dose statins may be related to the occurrence of sICH.

Volatilizable Solid Additive-Assisted Treatment Enables Organic Solar Cells with Efficiency over 18.8% and Fill Factor Exceeding 80.

Controlling the self-assembling of organic semiconductors to form well-developed nanoscale phase separation in the bulk-heterojunction active layer is critical yet challenging for building high-performance organic solar cells (OSCs). Particularly, the similar anisotropic conjugated structures between nonfullerene acceptors and p-type organic semiconductor donors raise more complexity on manipulating their aggregation toward appropriate phase separation. Herein, a new approach to tune the morphology of photoactive layer is developed by utilizing the synergistic effect of dithieno[3,2-b:2',3'-d]thiophene (DTT) and 1-chloronaphthalene (CN). The volatilizable solid additive DTT with high crystallinity can restrict the over self-assembling of nonfullerene acceptors during the film casting process, and then allowing the refining of phase separation and molecular packing with the simultaneous volatilization of DTT under thermal annealing. Consequently, the PTQ10:m-BTP-PhC6:PC71 BM-based ternary OSCs processed by the dual additives of CN and DTT record a notable power-conversion efficiency of 18.89%, with a remarkable FF of 80.6%.

Statin Treatment in the Acute Phase and the Risk of Post-stroke Pneumonia: A Retrospective Cohort Study.

Background: We aimed to investigate the impact of statin treatment in the acute phase on the risk and severity of post-stroke pneumonia because of the uncertain effects of statins on post-stroke pneumonia. Methods: Consecutive cases of acute ischemic stroke (AIS) between January 2014 and February 2019 were retrospectively analyzed. Additionally, the association of statin treatment in the acute phase with the risk and severity of post-stroke pneumonia was estimated with logistic regression. We registered the present study in the Chinese Clinical Trial Registry (ChiCTR 2000032838). Results: Of the 1,258 enrolled patients, no significant difference was observed in post-stroke pneumonia risk between the two groups (with/without statin treatment in the acute phase) after propensity score matching (35.1 vs. 27.9%, p = 0.155). We did not find statin treatment in the acute phase to significantly increase the risk of post-stroke pneumonia both before and after matched analysis [odds ratio (OR) = 1.51, 95% confidence interval (CI) = 0.85-2.67, p = 0.157; OR = 1.57, 95% CI = 0.77-3.18, p = 0.213, respectively]. In the 271 patients with post-stroke pneumonia, no significant difference was found in its severity between two groups (19.6 vs. 19.4%, p = 0.964). No significant association was found between statin treatment and post-stroke pneumonia severity (OR = 0.95, 95% CI = 0.39-2.31, p = 0.918). Conclusions: There appeared to be no additional benefits of statin treatment in the acute phase for post-stroke pneumonia reduction among AIS patients. Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR2000032838.

Indacenodithiophene-based small-molecule donor with strong crystallinity for efficient organic solar cells.

Two indacenodithiophene (IDT)-based small-molecule analogues (IDBT and IDBT-Cl) are designed as donor materials for organic solar cells. Relative to the amorphous IDBT-Cl, the IDBT with strong crystallinity shows overall better photovoltaic performance when blended with a Y6 acceptor. The results demonstrate the great potential of IDT units in designing efficient small-molecule donors.

Association of Aortic Stiffness and Cognitive Decline: A Systematic Review and Meta-Analysis.

Background: Increased aortic stiffness has been found to be associated with cognitive function decline, but the evidence is still under debate. It is of great significance to elucidate the evidence in this debate to help make primary prevention decisions to slow cognitive decline in our routine clinical practice. Methods: Electronic databases of PubMed, EMBASE, and Cochrane Library were systematically searched to identify peer-reviewed articles published in English from January 1, 1986, to March 16, 2020, that reported the association between aortic stiffness and cognitive function. Studies that reported the association between aortic pulse wave velocity (PWV) and cognitive function, cognitive impairment, and dementia were included in the analysis. Results: Thirty-nine studies were included in the qualitative analysis, and 29 studies were included in the quantitative analysis. The aortic PWV was inversely associated with memory and processing speed in the cross-sectional analysis. In the longitudinal analysis, the high category of aortic PWV was 44% increased risk of cognitive impairment (OR 1.44; 95% CI 1.24-1.85) compared with low PWV, and the risk of cognitive impairment increased 3.9% (OR 1.039; 95% CI 1.005-1.073) per 1 m/s increase in aortic PWV. Besides, meta-regression analysis showed that age significantly increased the association between high aortic PWV and cognitive impairment risk. Conclusion: Aortic stiffness measured by aortic PWV was inversely associated with memory and processing speed and could be an independent predictor for cognitive impairment, especially for older individuals.

Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis.

BACKGROUND: For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding. METHODS: Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years. RESULTS: The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS < = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001). CONCLUSION: For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

The diagnostic reliability and validity of noninvasive imaging modalities to assess leptomeningeal collateral flow for ischemic stroke patients: A systematic review and meta-analysis.

ABSTRACT: Leptomeningeal collateral flow (LMF) is associated with infarct area and clinical outcome for ischemic stroke patients. Although LMF can be detected by multiple imaging methods, but their diagnostic performance is uncertain.The aim of this study was to evaluate the diagnostic validity or reliability of noninvasive image methods in assessing LMF.Databases included PubMed, Web of Science, Embase, and Cochrane Library.Original observational cohort studies.Ischemic stroke patients.Different noninvasive image methods to assess LMF.Newcastle-Ottawa Scale to evaluate the quality of the studies; forest plot to show pooled results; I2 and Egger test to evaluate the heterogeneity and publication bias.Thirty of the 126 selected studies were eligible. For CT angiography, the interobserver agreement ranged from 0.494 to 0.93 and weighted kappa was 0.888; for patients receiving thrombolysis or endovascular treatment, 0.68 to 0.91; 0.494 to 0.89 for the 2-point system, 0.60 to 0.93 for the 3-point system, 0.68 to 0.87 for the system of >4 points; area under the curve (AUC) was 0.78. For perfusion computed tomography (CTP), the interobserver agreement ranged from 0.724 to 0.872; for patients receiving thrombolysis or endovascular treatment, 0.74 to 0.872; 0.724 for the 2-point system, 0.783 to 0.953 for the 3-point system; the intraobserver agreement was 0.884; AUC was 0.826. For MRI-fluid attenuated inversion recovery (FLAIR), the interobserver agreement ranged from 0.58 to 0.86; for patients receiving thrombolysis or endovascular treatment, 0.75 to 0.86; 0.86 for the two-point system, 0.77 to 0.87 for the system of more than 5 points; AUC was 0.82.No pooled data of CTP and FLAIR. The difference cohort study had difference bias. The unpublished data were not included.CT angiography is a good tool for assessing LMF. CTP shows a good validity and reliability, but its diagnostic value needs more evidence. FLAIR is a good modality to assess LMF. These image methods had better validity and reliability to evaluate LMF of patients receiving thrombolysis or endovascular treatment than all ischemic stroke patients.

Efficacy and safety of endovascular treatment for patients with acute intracranial atherosclerosis-related posterior circulation stroke: a systematic review and meta-analysis.

The benefit of endovascular treatment (EVT) for patients with intracranial atherosclerosis-related large vessel occlusion (ICAS-LVO) in posterior circulation stroke (PCS) is inconsistent. This systematic review and meta-analysis were conducted to estimate the effect of ICAS-LVO in PCS treated by EVT. A systematic review was completed, tracking studies from their date of inception until February 2020. Clinical studies which compared outcomes after EVT for ICAS-LVO and non-ICAS-LVO in PCS were included. Data were synthesized and interpreted from meta-analysis. A total of 688 patients (352 ICAS-LVO and 336 non-ICAS-LVO) in the eight studies were included. The successful reperfusion rate (odds ratio [OR], 0.58; 95% confidence intervals [95% CIs], 0.37-0.93; P = 0.02) was lower in PCS with ICAS-LVO than non-ICAS-LVO. And for other clinical outcomes, there were no differences between both groups. Moreover, there were no statistical differences of any clinical outcome among subgroups stratified by nations and target vessel occlusion location. With respect to patients' characteristics, age (mean difference [MD], -2.75; 95% CI, -4.62--0.88; P = 0.004), pc-Alberta Stroke Program Early CT Score (MD, -0.49; 95% CI, -0.94--0.05; P = 0.03), distributions of sex (male) (OR, 2.34; 95% CI, 1.53-3.56; P < 0.001), prior or current smoking (OR, 1.85; 95% CI, 1.12-3.07; P = 0.02), hypertension (OR, 2.06; 95% CI, 1.32-3.22; P = 0.002), coronary artery disease (OR, 0.27; 95% CI, 0.11-0.66; P = 0.004) and general anesthesia (OR, 2.89; 95% CI, 1.54-5.45; P = 0.001) were statistically different between both groups. In conclusion, more targeted assessments are warranted for patients with ICAS-LVO-related PCS during clinical strategies, and the benefit of EVT for PCS with ICAS-LVO deserves further research.

Low-dose statin pretreatment improves function and prognosis of recurrent ischemic stroke patients.

BACKGROUND: Statins are effective in improving the prognosis of stroke patients. In clinical practice, low-dose statins are often administered to stroke patients in Asian countries but their effects on the prognosis of recurrent ischemic stroke patients are still unclear. METHODS: Data of consecutive recurrent ischemic stroke patients were prospectively collected. The National Institutes of Health Stroke Scale (NIHSS) of admission and discharge and the modified Rankin scale (mRs) of 90 days after stroke onset were adopted to evaluate primary outcomes. Secondary outcomes included the subgroup analysis. RESULTS: Among 219 patients (mean age 65.41 ± 11.58 years), 150 (68.5%) were male. The low-dose statin group had a higher percentage of milder stroke at admission (p < 0.001) and discharge (p < 0.001), and favorable functional outcome at 90 days (p < 0.001). Univariable regression analysis showed that the use of low-dose statins was inversely associated with higher discharge NIHSS [odds ratio (OR) = 0.36, p = 0.009] and higher mRs at 90 days (OR = 0.230, p < 0.001). Multivariable logistic regression analysis revealed that low-dose statins also had a significantly inverse association with higher mRs at 90 days (OR = 0.098, p = 0.049). According to subgroup analysis, a significant effect was found in the good-persistency subgroup (NIHSS score at discharge: OR = 0.051, p = 0.004; mRs score at 3 months: OR = 0.053, p = 0.005), but not in the poor-persistency subgroup. CONCLUSION: Low-dose statin pretreatment alleviated stroke severity and improved functional outcomes of recurrent stroke patients.