Does MRI add value in selecting patients for thrombectomy beyond the 6 h window? A matched-control analysis.

Background: Controversy exists regarding the need of advanced imaging for patient selection in the extended window. Aims: To analyze the effect of initial imaging modalities on clinical outcomes of patients underwent MT in the extended window. Methods: This was a retrospective analysis of a prospective registry, the Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke (ANGEL-ACT) registry which was conducted at 111 hospitals between November 2017 and March 2019 in China. Primary study cohort and Guideline like cohort were identified, in each cohort, two imaging modalities for patient selection in 6 to 24 h window were defined: (1) NCCT ± CTA, (2) MRI. Guideline-like cohort were further screened based on key features of the DAWN and DEFUSE 3 trials. The primary outcome was 90 day mRS. The safety outcomes were sICH, any ICH and 90-day mortality. Results: After adjusting for covariates, there were no significant differences in 90 day mRS or any safety outcomes between two imaging modalities groups in both cohorts. All outcome measures of mixed-effects logistic regression model were consistent with propensity score matching model. Conclusion: Our results indicate that patients presented with anterior large vessel occlusion in the extended time window can potentially benefit from MT even in the absence of MRI selection. This conclusion needs to be verified by the prospective randomized clinical trials.

Prognostic value of pretreatment diffusion-weighted imaging score for acute basilar artery occlusion with successful endovascular recanalization.

PURPOSE: The aim of this study is to test the prognostic value of a diffusion-weighted imaging (DWI) score in acute basilar artery occlusion (ABAO) with successful recanalization. METHODS: The DWI-based pons-midbrain and thalamus (PMT) score was developed to assess posterior circulation infarcts. We test its prognostic value and compare it with other two established scales, the DWI-based posterior circulation acute stroke prognosis Early CT score (PC-ASPECTS) and brain stem score (BSS). A retrospective cohort of consecutive ABAO patients with pretreatment magnetic resonance imaging and successful recanalization (defined as modified Thrombolysis in Cerebral Infarction 2b-3) were analyzed. A favorable outcome was defined as a 90-day modified Rankin Scale (mRS) score of 2 or less. The prognostic performance of three scales was estimated by receiver operating characteristic (ROC) curve analyses. RESULTS: One hundred and sixteen eligible patients (mean age, 59.1 ± 11.7 [standard deviation]; 96 [82.8%] man) were included and evaluated. Between favorable (mRS ≤ 2) and unfavorable groups, the baseline PMT score (median [interquartile range], 3 [1-4] versus 6 [5-8]; P < 0.001) differs significantly. ROC curve analyses showed the PMT score had the best prognostic value for favorable outcome (area under the curve, PMT versus BSS versus PC-ASPECTS = 0.80 versus 0.72 versus 0.68, P = 0.010). Multivariate logistic regression analyses showed baseline National Institute of Health stroke scale (OR, 0.90 [95%CI, 0.86-0.95], P = 0.004) and PMT score < 5 (OR, 17.83 [95%CI, 3.91-81.19], P < 0.001) were independent prognostic factors of favorable outcome. CONCLUSIONS: The PMT score seems to predict clinical outcome of ABAO patients with successful recanalization.

Deconstruction of Clinical Treatment of Pneumonia and Respiratory Tract Infection Based on MRI Molecular Imaging.

Pneumonia is a major research core topic in the medical field, and clinical trials of pneumonia and respiratory tract infection have been ongoing. The purpose of this study was to investigate the clinical efficacy and safety of Shuanghuanghua granules in the treatment of pneumonia and respiratory tract infection based on NMR molecular imaging, and to lay a foundation for the development of new drugs. In this paper, 126 patients were randomly divided into the control group, the treatment group 1, the and treatment group 2, and were given Fengreganmao granules, Shuanghuanghua granules (ultrafine preparation), and Shuanghuanghua granules (extract preparation), respectively. The main symptom scores, sign scores, antipyretic time, and virus content before and after treatment were recorded. Statistical analysis was carried out on this basis. The experiment showed that the body temperature of the subjects in the three groups before treatment was: control group (37.59 ± 0.78), treatment group 1 (37.8 ± 0.81), and treatment group 2 (37.6 ± 0.76). After treatment, the body temperature of subjects in the three groups was: control group (36.67 ± 0.71), treatment group 1 (36.49 ± 0.43), and treatment group 2 (36.19 ± 0.25). Experiments show that Shuanghuanghua granules can significantly reduce the nasal virus, adenovirus, parainfluenza virus, etc. in the patient's body. And it can shorten the antipyretic time of patients and has good clinical application. In addition, this study gave full play to the role of MRI molecular imaging and provided ideas and references for the clinical treatment of pneumonia and respiratory tract infection.

Formulation and Physicochemical and Biological Characterization of Etoposide-Loaded Submicron Emulsions with Biosurfactant of Sophorolipids.

Etoposide (ETO), a traditional anticancer chemotherapeutic agent, is commercialized in oral soft gelatin capsules and non-aqueous parenteral solutions form. Novel formulation application and new excipients exploration are needed to improve the water-solubility and comfort of the drug administration. In the present study, novel etoposide-loaded submicron emulsions (ESE) with the biosurfactants of acidic sophorolipid (ASL) and lactonic sophorolipid (LSL) instead of the chemical surfactant of Tween-80 were prepared and characterized. Firstly, parameters of medium-chain triglyceride: long-chain triglyceride (MCT:LCT), lecithin concentration, homogenization pressure and cycle, and type and concentration of surfactants were investigated to optimize the formation of ESEs. Then the physicochemical properties, antitumor activity, stability, and security of ESEs were compared. The results showed that ASL performed the best properties and activities than Tween-80 and LSL in ESE formation. ASL-ESE showed higher drug loading capacity, slower release rate, and significantly increased antitumor activity against ovarian cancer cell line A2780 via apoptosis than Tween-ESE and commercial ETO injection. Besides, both ASL-ESE and Tween-ESE caused no hemolysis, and the safe dose of ASL was 2.14-fold that of Tween-80 in the hemolysis test, making ASL more reliable for drug delivery applications. Furthermore, ASL-ESE exhibited equivalent long-term and autoclaving stability to Tween-ESE. These results thus suggested the excellent competences of ASL in ESE formation, efficacy enhancement, and safety improvement.

Time to Endovascular Reperfusion and Outcome in Acute Ischemic Stroke : A Nationwide Prospective Registry in China.

PURPOSE: The benefit of endovascular reperfusion therapy for acute ischemic stroke is highly time-dependent but the relation of delays in workflow with outcomes and the key determinants of delays remain uncertain. This study aimed to evaluate the association between faster endovascular therapy and outcomes in a Chinese population with acute ischemic stroke. METHODS: Patients treated with endovascular therapy within 7 h due to anterior large vessel occlusion were enrolled in the ANGEL-ACT registry. Time intervals from hospital arrival to arterial puncture (door-to-puncture), hospital arrival to reperfusion (door-to-reperfusion) and puncture-to-reperfusion were recorded. The outcomes included modified Rankin Scale (mRS) scores 0-1, 0-2, mortality at 3 months, substantial reperfusion, and symptomatic intracranial hemorrhage (sICH). RESULTS: Of 932 patients receiving endovascular therapy (mean age 65.1 years, 60.1% male), the median door-to-puncture, door-to-reperfusion, and puncture-to-perfusion times were 110min (interquartile range, IQR 72-155min), 200min (IQR, 149-260min), and 76min (IQR, 50-118min). Of the patients 87.4% achieved substantial reperfusion and 9.6% had sICH. The mRS 0-1, 0-2, and mortality at 3 months were 39.8%, 43.2%, and 16.4%. Faster door-to-reperfusion and puncture-to-reperfusion were associated with higher likelihood of mRS 0-1, mRS 0-2, and lower rate of sICH. There was a trend of improved mRS, lower mortality, and fewer ICH with shorter door-to-puncture time; however, most differences were not statistically significant. CONCLUSION: Among patients with acute ischemic stroke in routine clinical practice, shorter time to reperfusion was associated with better outcome after endovascular therapy. Standardized workflows and training in endovascular treatment techniques should be promoted nationally to reduce in-hospital delays.

Achieving Partial Nitrification-Anammox Process Dependent on Microalgal-Bacterial Consortia in a Photosequencing Batch Reactor.

Partial nitrification coupled with anammox (PN/A) process is an energy-efficient approach for nitrogen removal from low C/N wastewater. In this study, PN/A was achieved with optimal oxygen supply from a green microalga, Chlorella sorokiniana. The PN process was first initiated within 35 days, and the following algae-intensified PN then reached the steady state within the next 32 days. The dissolved oxygen (DO) concentration was gradually maintained at 0.6 mg L-1 via adjusting the photoperiod to 6-h light/18-h dark cycles, when the accumulation ratio of NO2 --N and the removal ratio of NH4 +-N were both more than 90%. The nitrogen removal capability of anammox was acclimated via elevating the individual effluent NH4 +-N and NO2 --N levels from 100 to 200, to 300 mg L-1. After acclimation, the removal rates of NH4 +-N and total nitrogen (TN) reached more than 70 and 80%, respectively, and almost all the NO2 --N was removed. Then, the algae-intensified PN/A, algammox biofilm system, was successfully started up. When the NH4 +-N level increased from 100 to 300 mg L-1, the TN removal varied between 78 and 82%. In the photosequencing bioreactor, C. sorokiniana, ammonia-oxidizing bacteria (AOB), and anammox coexisted with an illumination of 200 µmol m-2 s-1 and a 6-h light/18-h dark cycles. The DO levels ranged between 0.4 and 0.5 mg L-1. In addition, the microbial community analysis by Illumina MiSeq sequencing showed that the dominant functional bacteria in the algae-intensified PN/A reactors included Nitrosomonas (AOB) and Candidatus Brocadia (anammox), while Nitrospira and Nitrobacter (nitrite oxidizing bacteria), together with Denitratisoma (denitrifier) were largely inhibited. Further studies are required to optimize the microalgal-bacterial consortia system to achieve superior nitrogen removal rates under controllable conditions.

A comparison between different endovascular treatment strategies for acute large vessel occlusion due to intracranial artery atherosclerosis: data from ANGEL-ACT Registry.

PURPOSE: The aim of our study is to compare the characteristics and clinical outcomes among the different endovascular treatment (EVT) strategies for large vessel occlusion underlying intracranial atherosclerosis (ICAS-LVO) in a recent nationwide registry. METHODS: Patients with isolated ICAS-LVO were enrolled in our analysis and were categorized into three groups: first-line mechanical thrombectomy (MT) with rescue angioplasty and/or stenting (MT + RS), direct angioplasty and/or stenting without thrombectomy (DA), and MT alone. Baseline and periprocedural characteristics, successful recanalization, and 90-day functional outcomes were compared. RESULTS: Of 396 patients with isolated ICAS-LVO in our study, successful recanalization was achieved in 94.5%, 100%, and 90.9% of patients in the MT + RS, DA, and MT groups, respectively. The 90-day functional independence in the three groups was 50.8%, 59.0%, and 45.1%. The main efficacy and safety outcomes showed no significant differences among the groups. First-pass recanalization (FPR) was more observed in the MT group (43.4%), the recanalization rate per attempt in the MT group gradually decreased until the fourth attempt, and further maneuvers showed recanalization rates of ≈0% per attempt. MT + RS (adjusted odds ratio [aOR] 0.10, p < 0.0001) and DA (aOR 0.18, p = 0.0013) were associated with lower FPR rate than MT alone in the multivariable logistic regression. CONCLUSIONS: The technical feasibility and favorable outcomes of several EVT strategies for ICAS-LVO were established in our study. First-line MT with a bailout angioplasty is a reasonable option for ICAS-LVO, and DA is an effective option for the cases when ICAS-LVO is strongly suspected before EVT procedure.