Outcomes and risk factors for infection after endovascular treatment in patients with acute ischemic stroke.

AIMS: Infection is a common complication following acute ischemic stroke (AIS) and significantly contributes to poor functional outcomes after stroke. This study aimed to investigate the effects of infection after endovascular treatment (post-EVT infection) on clinical outcomes and risk factors in patients with AIS. METHODS: We retrospectively analyzed AIS patients treated with endovascular treatment (EVT) between January 2016 and December 2022. A post-EVT infection was defined as any infection diagnosed within 7 days after EVT. The primary outcome was functional independence, defined as a modified Rankin scale (mRS) score of 0-2 at 90 days. A multivariable logistic regression analysis was conducted to determine independent predictors of post-EVT infection and the associations between post-EVT infection and clinical outcomes. RESULTS: A total of 675 patients were included in the analysis; 306 (45.3%) of them had post-EVT infections. Patients with post-EVT infection had a lower rate of functional independence than patients without infection (31% vs 65%, p = 0.006). In addition, patients with post-EVT infection achieved less early neurological improvement (ENI) after EVT (25.8% vs 47.4%, p < 0.001). For safety outcomes, the infection group had a higher incidence of any intracranial hemorrhage (23.9% vs 15.7%, p = 0.01) and symptomatic intracranial hemorrhage (10.1% vs 5.1%, p = 0.01). Unsuccessful recanalization (aOR 1.87, 95% CI 1.11-3.13; p = 0.02) and general anesthesia (aOR 2.22, 95% CI 1.25-3.95; p = 0.01) were identified as independent predictors for post-EVT infection in logistic regression analysis. CONCLUSION: AIS patients who develop post-EVT infections are more likely to experience poor clinical outcomes. Unsuccessful recanalization and general anesthesia were independent risk factors for the development of post-EVT infection.

Half-life determination of the ground state decay of 167Tm and 168Tm.

Precise determination of half-lives of 167Tm and 168Tm are important for their application in nuclear medicine diagnostics, nuclear forensics, and other nuclear data measurements. We produced 167Tm and 168Tm sources using an α-particle beam bombarded 165Ho target and a series purification steps. A series of 173 measurements was performed over a period of 44 days using a high-purity germanium (HPGe) detector to track the count rate change as a function of time by following the 207.8 keV and 531.5 keV γ-lines to determine the radioactive decay half-life of 167Tm. The measurement of half-life of 168Tm ground state has been performed using the same HPGe γ-ray spectrometer to observe γ-lines at 198.3 keV, 816.0 keV, 184.3 keV, 741.4 keV and 914.9 keV. Weighted least-squares fits of exponential decay curves were performed for the dataset of each γ-ray emission, with final determined half-lives of 9.250(15) d and 93.41(12) d for 167Tm and 168Tm, respectively. The uncertainty budgets are presented and discussed in detail. Our result of 167Tm half-life is consistent with the Evaluated Nuclear Structure Data File (ENSDF) recommended half-life of 9.25(2) d. The outcome of 168Tm half-life determination is longer than the ENSDF recommended half-life of 93.1(2) d. Further independent measurements would be ideal to resolve the discrepancy.

Frequency comb generation via synchronous pumped χ(3) resonator on thin-film lithium niobate.

Resonator-based optical frequency comb generation is an enabling technology for a myriad of applications ranging from communications to precision spectroscopy. These frequency combs can be generated in nonlinear resonators driven using either continuous-wave (CW) light, which requires alignment of the pump frequency with the cavity resonance, or pulsed light, which also mandates that the pulse repetition rate and cavity free spectral range (FSR) are carefully matched. Advancements in nanophotonics have ignited interest in chip-scale optical frequency combs. However, realizing pulse-driven on-chip Kerr combs remains challenging, as microresonator cavities have limited tuning range in their FSR and resonance frequency. Here, we take steps to overcome this limitation and demonstrate broadband frequency comb generation using a χ(3) resonator synchronously pumped by a tunable femtosecond pulse generator with on-chip amplitude and phase modulators. Notably, employing pulsed pumping overcomes limitations in Kerr comb generation typically seen in crystalline resonators from stimulated Raman scattering.

CSF1R inhibition reprograms tumor-associated macrophages to potentiate anti-PD-1 therapy efficacy against colorectal cancer.

PD-1 blockade therapy has made great breakthroughs in treatment of multiple solid tumors. However, patients with microsatellite-stable (MSS) colorectal cancer (CRC) respond poorly to anti-PD-1 immunotherapy. Although CRC patients with microstatellite instability (MSI) or microsatellite instability-high (MSI-H) can benefit from PD-1 blockade therapy, there are still some problems such as tumor recurrence. Tumor-associated macrophages (TAMs), most abundant immune components in tumor microenvironment (TME), largely limit the therapeutic efficacy of anti-PD-1 against CRC. The CSF1/CSF1R pathway plays a key role in regulating macrophage polarization, and blocking CSF1R signaling transduction may be a potential strategy to effectively reprogram macrophages and remodel TME. Here, we found that increasing expression of CSF1R in macrophages predicted poor prognosis in CRC cohort. Furthermore, we discovered a novel potent CSF1R inhibitor, PXB17, which significantly reprogramed M2 macrophages to M1 phenotype. Mechanically, PXB17 significantly blocked activation of PI3K/AKT/mTORC1 signaling, resulting in inhibition of cholesterol biosynthesis. Results from 3D co-culture system suggested that PXB17-repolarized macrophages could induce infiltration of CD8+ T lymphocytes in tumors and improve the immunosuppressive microenvironment. In vivo, PXB17 significantly halted CRC growth, with a stronger effect than PLX3397. In particular, PXB17 potently enhanced therapeutic activity of PD-1 mAb in CT-26 (MSS) model and prevented tumor recurrence in MC-38 (MSI-H) model by promoting formation of long-term memory immunity. Our study opens a new avenue for CSF1R in tumor innate and adaptive anti-tumor immunomodulatory activity and suggests that PXB17 is a promising immunotherapy molecule for enhancing the efficacy of PD-1 mAb or reducing tumor recurrence of CRC.

Sub-Gluteus Maximus Fascial Plane and Perineural Hydrodissection as Novel Treatment for Posterior Femoral Cutaneous Nerve Entrapment.

ABSTRACT: Posterior femoral cutaneous nerve (PFCN) entrapment due to overuse is rarely reported in the literature, and treatment is limited. Conventional treatment includes focused rehabilitation exercises, computed tomography-guided or magnetic resonance (MR)-guided nerve blocks, MR-guided cryoablation, and surgical decompression, but data for treatment validation and efficacy are lacking. Sub-gluteus maximus fascial plane and perineural hydrodissection may offer an effective alternative treatment for PFCN entrapment, especially given reports of successful cases with similar procedural techniques in other anatomical locations and structures.

The role of murine M1 macrophages from different sources in unilateral ureteral obstruction.

Introduction: The unilateral ureteral obstruction (UUO) model is the most extensively used model to investigate chronic renal fibrosis. Macrophages play a critical role in the UUO model. We aimed to analyze the phenotype of macrophages from different sources activated in vitro and explore the role of M1 macrophages from various sources in UUO. Material and methods: C57BL/6 mice were randomly allocated to five different groups (n = 5 per group): the sham-operated control group, PBS-treated (UUO + PBS) group, bone marrow-derived M1 macrophage-treated (UUO + BM1) group, peritoneal M1 macrophage-treated (UUO + PM1) group, and splenic M1 macrophage-treated (UUO + SPM1) group. After M1 macrophages were injected into the tail vein of UUO-treated mice, renal fibrosis indexes were determined using HE, Masson staining, and α-SMA. Results: Compared to those in the UUO + PBS group, the pathological changes were much more severe in the UUO + BM1, UUO + PM1, and UUO + SPM1 groups. Compared to that in the UUO + PBS group, UUO + BM1 group, and UUO + SPM1 group, the collagen area in the UUO + PM1 group was higher at post-UUO day 5 (p < 0.01). The expression of α-SMA in the UUO + PM1 group was higher than that in the UUO + PBS group, UUO + BM1 group, and UUO + SPM1group (p < 0.001). Conclusions: The M1 macrophages cultured in vitro were reinjected into mice and aggravated kidney injury and fibrosis. Compared with BM1 and SPM1, PM1 demonstrated a stronger effect on inducing renal injury and fibrosis.

Cutoff value of IC50 for drug sensitivity in patient-derived tumor organoids in colorectal cancer.

Patient-derived tumor organoids (PDTOs) have the potential to be used to predict the patient response to chemotherapy. However, the cutoff value of the half-maximal inhibition concentration (IC50) for PDTO drug sensitivity has not been validated with clinical cohort data. We established PDTOs and performed a drug test in 277 samples from 242 CRC patients who received FOLFOX or XELOX chemotherapy. After follow-up and comparison of the PDTO drug test and final clinical outcome results, the optimal IC50 cutoff value for PDTO drug sensitivity was 43.26 µmol/L. This PDTO drug test-defined cutoff value could predict patient response with 75.36% sensitivity, 74.68% specificity, and 75% accuracy. Moreover, this value distinguished groups of patients with significant differences in survival benefit. Our study is the first to define the IC50 cutoff value for the PDTO drug test to effectively distinguish CRC patients with chemosensitivity or nonsensitivity and predict survival benefits.

Use of Carbon Nanoparticles to Improve the Efficiency of Harvesting Lymph Nodes in Rectal Cancer.

BACKGROUND: The accurate determination of lymph node status in patients with rectal cancer requires harvesting a certain number of lymph nodes. This study investigated whether using carbon nanoparticles (CNs) could improve the efficiency of harvesting lymph nodes in rectal cancer patients. MATERIALS AND METHODS: Data from patients with rectal cancer treated with radical resection were collected from Nanfang Hospital between January 2014 and June 2021. Patients in the CN group received a CN suspension 1 day before surgery, which was endoscopically injected around the tumor. A 1:1 case-matched study was performed using the propensity score. The efficiency of harvesting lymph nodes was investigated by comparing the number of total nodes, total time, and percentage of nodes <5 mm in size between the CN and non-CN groups. RESULTS: A total of 768 patients were included, with 246 patients who underwent CN injection and 522 patients who did not. After matching, 246 pairs of patients were analyzed. After matching, the number of total nodes of each sample was significantly higher in the CN group than in the non-CN group ( P <0.001). The total time for node detection ( P <0.001) was significantly shorter in the CN group. The percentage of nodes <5 mm in size was increased significantly in the CN group ( P <0.001). Among patients with clinical staging I/II, the difference in positive LNs was significant (21.79% vs. 11.95%, P =0.029). CONCLUSIONS: The application of CNs improved the efficiency of harvesting lymph nodes during rectal cancer surgery.

Prevalence of preoperative deep vein thrombosis in long bone fractures of lower limbs: a systematic review and meta-analysis.

BACKGROUND: There is a paucity of data regarding the prevalence of preoperative deep vein thrombosis (DVT) in patients with long bone (including femur, tibia and fibula) fractures of the lower limbs. We performed a meta-analysis to address the issue. METHODS: Electronic databases, including PubMed, EMBASE, the Web of Science, the Cochrane Library, the VIP database, CNKI, and the Wanfang database, were systematic searched for original articles that reported the prevalence of preoperative DVT in long bone fractures of the lower limbs from January 2016 to September 2021. The prevalence of preoperative DVT was pooled using random-effects models, and subgroups were established according to study type, detection method, sample size and fracture site. RESULTS: Twenty-three articles reporting on 18,119 patients were eligible. The overall pooled preoperative DVT prevalence was 24.1% (95% CI 19.3-28.8%). In different subgroups, the preoperative DVT prevalences were 18.2-27.3%, 15.2-28.6%, 23.1-24.9%, 18.2-26.0% and 23.2-23.4% for different study designs, sample sizes, age groups, detection methods and fracture sites, respectively. CONCLUSIONS: Despite the heterogeneity among studies, this systematic review suggests that the prevalence of preoperative DVT, which may seriously affect the prognosis of patients, is high. Therefore, greater efforts should be devoted to the improvement of screening and prevention strategies for preoperative DVT in lower-extremity long bone fractures. LEVEL OF EVIDENCE: Level III. Trial Registration The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42022324706.

Activation of Sphingomyelin Phosphodiesterase 3 in Liver Regeneration Impedes the Progression of Colorectal Cancer Liver Metastasis Via Exosome-Bound Intercellular Transfer of Ceramides.

BACKGROUND & AIMS: The machinery that prevents colorectal cancer liver metastasis (CRLM) in the context of liver regeneration (LR) remains elusive. Ceramide (CER) is a potent anti-cancer lipid involved in intercellular interaction. Here, we investigated the role of CER metabolism in mediating the interaction between hepatocytes and metastatic colorectal cancer (CRC) cells to regulate CRLM in the context of LR. METHODS: Mice were intrasplenically injected with CRC cells. LR was induced by 2/3 partial hepatectomy (PH) to mimic the CRLM in the context of LR. The alteration of corresponding CER-metabolizing genes was examined. The biological roles of CER metabolism in vitro and in vivo were examined by performing a series of functional experiments. RESULTS: Induction of LR augmented apoptosis but promoted matrix metalloproteinase 2 (MMP2) expression and epithelial-mesenchymal transition (EMT) to increase the invasiveness of metastatic CRC cells, resulting in aggressive CRLM. Up-regulation of sphingomyelin phosphodiesterase 3 (SMPD3) was determined in the regenerating hepatocytes after LR induction and persisted in the CRLM-adjacent hepatocytes after CRLM formation. Hepatic Smpd3 knockdown was found to further promote CRLM in the context of LR by abolishing mitochondrial apoptosis and augmenting the invasiveness in metastatic CRC cells by up-regulating MMP2 and EMT through promoting the nuclear translocation of ß-catenin. Mechanistically, we found that hepatic SMPD3 controlled the generation of exosomal CER in the regenerating hepatocytes and the CRLM-adjacent hepatocytes. The SMPD3-produced exosomal CER critically conducted the intercellular transfer of CER from the hepatocytes to metastatic CRC cells and impeded CRLM by inducing mitochondrial apoptosis and restricting the invasiveness in metastatic CRC cells. The administration of nanoliposomal CER was found to suppress CRLM in the context of LR substantially. CONCLUSIONS: SMPD3-produced exosomal CER constitutes a critical anti-CRLM mechanism in LR to impede CRLM, offering the promise of using CER as a therapeutic agent to prevent the recurrence of CRLM after PH.

Development and validation of a collagen signature to predict the prognosis of patients with stage II/III colorectal cancer.

The tumor, nodes and metastasis (TNM) classification system provides useful but incomplete prognostic information and lacks the assessment of the tumor microenvironment (TME). Collagen, the main component of the TME extracellular matrix, plays a nonnegligible role in tumor invasion and metastasis. In this cohort study, we aimed to develop and validate a TME collagen signature (CSTME) for prognostic prediction of stage II/III colorectal cancer (CRC) and to compare the prognostic values of "TNM stage + CSTME" with that of TNM stage alone. Results indicated that the CSTME was an independent prognostic risk factor for stage II/III CRC (hazard ratio: 2.939, 95% CI: 2.180-3.962, p < 0.0001), and the integration of the TNM stage and CSTME had a better prognostic value than that of the TNM stage alone (AUC(TNM+CSTME) = 0.772, AUC TNM = 0.687, p < 0.0001). This study provided an application of "seed and soil" strategy for prognosis prediction and individualized therapy.

Dystonia-like behaviors and impaired sensory-motor integration following neurotoxic lesion of the pedunculopontine tegmental nucleus in mice.

Introduction: The pedunculopontine nucleus (PPTg) is a vital interface between the basal ganglia and cerebellum, participating in modulation of the locomotion and muscle tone. Pathological changes of the PPTg have been reported in patients and animal models of dystonia, while its effect and mechanism on the phenotyping of dystonia is still unknown. Methods: In this study, a series of behavioral tests focusing on the specific deficits of dystonia were conducted for mice with bilateral and unilateral PPTg excitotoxic lesion, including the dystonia-like movements evaluation, different types of sensory-motor integrations, explorative behaviors and gait. In addition, neural dysfunctions including apoptosis, neuroinflammation, neurodegeneration and neural activation of PPTg-related motor areas in the basal ganglia, reticular formations and cerebellum were also explored. Results: Both bilateral and unilateral lesion of the PPTg elicited dystonia-like behaviors featured by the hyperactivity of the hindlimb flexors. Moreover, proprioceptive and auditory sensory-motor integrations were impaired in bilaterally lesioned mice, while no overt alterations were found for the tactile sensory-motor integration, explorative behaviors and gait. Similar but milder behavioral deficits were found in the unilaterally lesioned mice, with an effective compensation was observed for the auditory sensory-motor integration. Histologically, no neural loss, apoptosis, neuroinflammation and neurodegeneration were found in the substantia nigra pars compacta and caudate putamen (CPu) following PPTg lesion, while reduced neural activity was found in the dorsolateral part of the CPu and striatal indirect pathway-related structures including subthalamic nucleus, globus pallidus internus and substantia nigra pars reticular. Moreover, the neural activity was decreased for the reticular formations such as pontine reticular nucleus, parvicellular reticular nucleus and gigantocellular reticular nucleus, while deep cerebellar nuclei were spared. Conclusion: In conclusion, lesion of the PPTg could elicit dystonia-like behaviors through its effect on the balance of the striatal pathways and the reticular formations.

RNAi-mediated CrebA silencing inhibits reproduction and immunity in Locusta migratoria manilensis.

Locusta migratoria manilensis is a major agricultural pest that causes severe direct and indirect damage to several crops. Thus, to provide a theoretical foundation for pest control, the role of CrebA in the reproduction and immune regulation of L. migratoria was investigated. CrebA is a bZIP transcription factor that critically regulates intracellular protein secretion. In this study, CrebA was widely expressed in the brain, fat body, integument, midgut, and reproductive tissues of different maturity stages of adult locusts, especially in the female fat body. RNA interfering (RNAi)-mediated silencing of CrebA inhibited locusts ovarian development, and key reproduction gene expressions, Vgs, VgRs, Chico, and JHAMT were downregulated. After the locusts were injected with Micrococcus luteus or Escherichia coli, M. luteus activated lysozyme expression, while the E. coli activated both phenol oxidase cascade and lysozyme expression. Furthermore, both bacteria stimulated the upregulation of the antimicrobial peptide genes DEF3 and DEF4. However, CrebA silencing is fatal to locusts infection with E. coli, with a mortality rate of up to 96.3%, and resulted in a significant decrease in the expression of DEF3 and DEF4 and changes in the activities of phenol oxidase and lysozyme of locusts infected by bacteria. Collectively, CrebA may be involved in diverse biological processes, including reproduction and immunity. CrebA inhibited locusts reproduction by regulating JH signaling pathway and inhibits the expression of immune genes TLR6, IMD, and AMPs. These results demonstrate CrebA seems to play a crucial role in reproduction and innate immunity.

Sub-1 Volt and high-bandwidth visible to near-infrared electro-optic modulators.

Integrated electro-optic (EO) modulators are fundamental photonics components with utility in domains ranging from digital communications to quantum information processing. At telecommunication wavelengths, thin-film lithium niobate modulators exhibit state-of-the-art performance in voltage-length product (VπL), optical loss, and EO bandwidth. However, applications in optical imaging, optogenetics, and quantum science generally require devices operating in the visible-to-near-infrared (VNIR) wavelength range. Here, we realize VNIR amplitude and phase modulators featuring VπL's of sub-1 V ⋅ cm, low optical loss, and high bandwidth EO response. Our Mach-Zehnder modulators exhibit a VπL as low as 0.55 V ⋅ cm at 738 nm, on-chip optical loss of ~0.7 dB/cm, and EO bandwidths in excess of 35 GHz. Furthermore, we highlight the opportunities these high-performance modulators offer by demonstrating integrated EO frequency combs operating at VNIR wavelengths, with over 50 lines and tunable spacing, and frequency shifting of pulsed light beyond its intrinsic bandwidth (up to 7x Fourier limit) by an EO shearing method.

Automatic Detection of Small Sample Apple Surface Defects Using ASDINet.

The appearance quality of apples directly affects their price. To realize apple grading automatically, it is necessary to find an effective method for detecting apple surface defects. Aiming at the problem of a low recognition rate in apple surface defect detection under small sample conditions, we designed an apple surface defect detection network (ASDINet) suitable for small sample learning. The self-developed apple sorting system collected RGB images of 50 apple samples for model verification, including non-defective and defective apples (rot, disease, lacerations, and mechanical damage). First, a segmentation network (AU-Net) with a stronger ability to capture small details was designed, and a Dep-conv module that could expand the feature capacity of the receptive field was inserted in its down-sampling path. Among them, the number of convolutional layers in the single-layer convolutional module was positively correlated with the network depth. Next, to achieve real-time segmentation, we replaced the flooding of feature maps with mask output in the 13th layer of the network. Finally, we designed a global decision module (GDM) with global properties, which inserted the global spatial domain attention mechanism (GSAM) and performed fast prediction on abnormal images through the input of masks. In the comparison experiment with state-of-the-art models, our network achieved an AP of 98.8%, and a 97.75% F1-score, which were higher than those of most of the state-of-the-art networks; the detection speed reached 39ms per frame, achieving accuracy-easy deployment and substantial trade-offs that are in line with actual production needs. In the data sensitivity experiment, the ASDINet achieved results that met the production needs under the training of 42 defective pictures. In addition, we also discussed the effect of the ASDINet in actual production, and the test results showed that our proposed network demonstrated excellent performance consistent with the theory in actual production.

Half-life determination of 111Ag.

111Ag is a radionuclide that can be generated by neutron capture on 110Pd and whose decay properties and production feasibility make it a potential therapeutic agent against arthritis. Due to the discrepancies of recent published values of the half-life of 111Ag with previous published works which are not thoroughly documented for detailed experiment procedures and uncertainty budgets evaluation, an independent redetermination of the 111Ag half-life value is required. In this work, a solid 111Ag source was prepared and repeatedly measured in a high purity Germanium (HPGe) detector to determine its half-life. In total, more than fifty measurements were performed over a period of 26.3 days, corresponding to ∼3.5 half-lives of 111Ag. The experimental method and corresponding uncertainty budget are presented. The result of 7.419(15) days is consistent with the recently published value, 7.423(13) days, by Collins et al. and deviates by 0.418% from the currently recommended value 7.45(1) days. A new recommend half-life value of 7.437(7) days was determined utilizing all available experimental values by a power-moderated mean (PMM) method.

Determination of the half-life of 161Tb.

161Tb has potential applications in targeted radionuclide therapy and nuclear forensic science. However, the half-lives of 161Tb in previous studies show a discrepancy. In this study, 161Tb samples were produced by irradiating 160Gd2O3 with thermal neutron flux. A series of procedures were applied to extract a pure 161Tb solution and three solid samples were prepared. The half-life of 161Tb has been measured with a high-purity germanium (HPGe) detector. The time-dependency of the 161Tb activity was followed by assessing the count rate of their characteristic gamma-ray emissions at 48.9 keV and 74.6 keV over a period of 33-43 days. The experiment and uncertainty budget are discussed in detail. Different uncertainty propagation equations were applied for random uncertainties, medium-frequency deviations and potential systematic errors. The result for the 161Tb half-life of 6.967 (11) d was determined by the weighted mean of half-lives from three samples, which confirms that the half-life is longer than the of the current evaluated half-life of 6.89 (2) d. From all available quoted experimental values, a recommended half-life of 6.934 (14) d was determined by the power-moderated method (PMM). Based on recent four published half-life values, a half-life of 161Tb of 6.9582 (33) d was determined by the PMM analysis.

How to Avoid Misdiagnosing Spontaneous Cervical Spinal Epidural Hematoma as Ischemic Stroke: 3 Case Reports and Literature Review.

When spontaneous cervical spinal epidural hematoma (SCEH) presents with hemiparesis, it can be misdiagnosed with ischemic stroke (IS), and the treatment of IS such as thrombolysis may deteriorate the symptoms of patients with SCEH, leading to worse sequelae or even death. We reported 3 SCEH patients who were initially suspected as IS in our center between Jun 2020 and April 2022 and analyzed their clinical characteristics together with 48 patients reported in the literature from Jan 1995 to April 2022. Two of the 3 SCEH patients had neck symptoms, while none of them presented cranial nerve symptoms. Cranial computed tomography (CT) scans were negative; however, abnormal signals in the cervical spinal canal were observed during cranial computed tomography angiography (CTA) and subsequent cervical CT confirmed the diagnosis of SCEH. All of them avoid mistreatment with recombinant tissue plasminogen activator (rt-PA). Subsequently, we analyzed the clinical characteristics of a total of 51 patients. Thirteen of them developed symptoms during activity. Neck pain was an important sign of SCEH because 35 patients had neck pain or neck discomfort. Sensory impairment was reported in a small proportion of patients (11/51), which varied a lot in the patients. Some special manifestations highly suggested spinal cord lesions and provided evidence for the early differential diagnosis of SCEH and stroke, but the incidence of which was quite low: ipsilateral Horner syndrome in 2 patients, Brown-Séquard syndrome in 2 cases, and Lhermitte's sign in 1 case. Only a minority (8/51) of the patients were correctly diagnosed at the emergency unit using cervical CT. Six patients were correctly diagnosed when performing CTA. A large portion of the cases (21/51) were first misdiagnosed as IS, but no responsible lesions were found on cranial magnetic resonance imaging (MRI), and subsequent cervical MRI confirmed the diagnosis. Sixteen patients were diagnosed with SCEH after the deterioration of symptoms. A total of 13 patients received rt-PA, and 10 of them had symptoms aggravation after thrombolysis. For patients with acute onset of hemiparesis but without cranial nerve symptoms, especially those accompanied by clinical features such as neck pain, ipsilateral Horner syndrome, Brown-Séquard syndrome, and Lhermitte's sign, SCEH should be highly suspected rather than stroke. Careful differential diagnosis should be performed with a comprehensive medical history and thorough physical examination. Cervical CT scan is a reasonable choice for quick differential diagnosis prior to administering potentially harmful therapy, especially rt-PA.