The prognostic role of pre-treatment neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in esophageal squamous cell carcinoma treated with concurrent chemoradiotherapy.

PURPOSE: In this study, we retrospectively investigated the prognostic role of pre-treatment neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in esophageal squamous cell carcinoma patients (ESCC) treated with concurrent chemo-radiotherapy (CCRT). METHODS: We retrospectively analyzed the records of 338 patients with pathologically diagnosed esophageal squamous cell carcinoma that underwent concurrent chemo-radiotherapy from January 2013 to December 2017. Univariate and multivariate analyses were used to identify prognostic factors for progression free survival (PFS) and overall survival (OS). RESULTS: The result showed that the thresholds for NLR and PLR were 2.47 and 136.0 by receiver operating characteristic curve. High NLR and PLR were both associated with tumor length (P < 0.05). High NLR and PLR were significantly associated with poor PFS and OS. Multivariate analyses identified NLR, PLR and TNM stage were independent risk factors for PFS and OS. CONCLUSIONS: We show that the pre-treatment NLR and PLR may serve as prognostic indicators for esophageal squamous cell carcinoma treated with concurrent chemo-radiotherapy.

Design of Janus Nanoparticles for Mobility Control in Heterogeneous Reservoirs.

Unfavorable mobility ratios in heterogeneous reservoirs have resulted in progressively poor waterflood sweep efficiency and diminishing production. In order to address this issue, our study has developed amphiphilic-structured nanoparticles aimed at enhancing the microscopic displacement capability and oil displacement efficiency. First, the transport process of Janus nanoparticles in porous media was investigated. During the water flooding, Janus nanoparticle injection, and subsequent water flooding stages, the injection pressure increased in a "stepped" pattern, reaching 0.023, 0.029, and 0.038 MPa, respectively. Second, emulsification effects and emulsion viscosity experiments demonstrated that the amphiphilic structure improved the interaction at the oil-water interface, reducing the seepage resistance of the oil phase through emulsification. In porous media, Janus nanoparticles transported with water exhibit 'self-seeking oil' behavior and interact with the oil phase, reducing the viscosity of the oil phase from 19 to 5 mPa·s at 80 °C. Finally, the core model displacement experiment verified the characteristics of Janus nanoparticles in improving the oil-water mobility ratio. Compared with the water flooding stage, the recovery percent increased by 20.8%, of which 13.7% was attributed to the subsequent water flooding stage. Utilizing the asymmetry of the Janus particle structure can provide an effective path to enhanced oil recovery in inhomogeneous reservoirs.

ASCOD phenotyping of acute vertebrobasilar artery occlusion treated by mechanical thrombectomy: insight from the PERSIST registry.

OBJECTIVE: Determining the underlying etiology of acute vertebrobasilar artery occlusion (VBAO) is crucial for selecting an appropriate treatment approach. The authors aimed to investigate the distribution of etiology and the association with functional outcomes in patients with acute VBAO who underwent endovascular treatment in which atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection (ASCOD) phenotyping was used. METHODS: A retrospective study was conducted at 21 centers in China, involving patients with VBAO who received endovascular treatment within 24 hours of the estimated occlusion time. In the ASCOD phenotyping, each phenotype is graded based on the following categories: 1, likely to be causal; 2, uncertain if causal; and 3, unlikely to be causal. The authors defined a single possible cause as a cause graded 1 in a single domain, and multiple possible causes were graded 1 or 2 regardless of overlap. The primary outcome was unfavorable outcome (modified Rankin Scale [mRS] score of 3-6) at 90 days. The secondary outcomes included shift of mRS score at 90 days, 90-day mortality, successful reperfusion, and National Institutes of Health Stroke Scale score at 24 hours. Multivariable regression analysis was used to assess the association between etiological subtypes and functional outcomes. Multivariate competing-risk regression analysis was performed to analyze the association between etiological subtypes and the risk of recurrent stroke. RESULTS: A total of 577 patients were included in this study. Of these, 521 (90%) had a single possible cause. The most common etiology was A1 (382 cases, 73%), followed by C1 (111 cases, 21%) and O1 (28 cases, 5%-in this study the other causes and dissection subtypes were categorized under the umbrella term of "O" causes). Similar patterns were observed in the multiple possible causes. In the baseline characteristics of the cohort, as rescue therapy, stenting was more frequently used in patients in the A1 group than in the C1 group (53.2% vs 41.7%; p < 0.01). The proportion of atherosclerosis-type etiology increased when the occlusion was located more proximally (p < 0.01). Compared to the A1 group, patients in the C1 group had a lower incidence of unfavorable outcome (OR 0.42, 95% CI 0.24-0.73), which was less likely to shift to a worse mRS score (OR 0.60, 95% CI 0.39-0.91). The O1 subtype was not associated with unfavorable outcome (OR 1.35, 95% CI 0.46-4.01), whereas patients with the O1 subtype were more likely to shift to worse mRS score (OR 2.39, 95% CI 1.09-5.25) and to have a higher 90-day mortality rate (OR 2.60, 95% CI 1.07-6.31). Furthermore, there was no significant association between single etiological subtypes and stroke recurrence within 1 year. CONCLUSIONS: The most common etiology in patients with VBAO was atherosclerosis, followed by cardiac pathology and other. Compared to the A1 subgroup, the C1 subgroup showed better functional outcomes, whereas the O1 subgroup showed worse outcomes. Additionally, there was no statistically significant difference in the recurrence risk.

Microwave ablation combined with percutaneous vertebroplasty for treating painful non-small cell lung cancer with spinal metastases under real-time temperature monitoring.

PURPOSE: To retrospectively study the therapeutic effect and safety performance of the combination strategies of the computed tomography (CT)-guided microwave ablation (MWA) and percutaneous vertebroplasty (PVP) as a treatment for painful non-small cell lung cancer (NSCLC) with spinal metastases. MATERIALS AND METHODS: A retrospective review included 71 patients with 109 vertebral metastases who underwent microwave ablation combined with percutaneous vertebroplasty by the image-guided and real-time temperature monitoring. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry Disability Index (ODI) scores before treatment and during the follow-up period. RESULTS: Technical success was achieved in all patients. The mean pre-procedure VAS score and morphine doses were 6.6 ± 1.8 (4-10) and 137.2 ± 38.7 (40-200) mg, respectively. The mean VAS scores and daily morphine doses at 24 h and 1, 4, 12, and 24 weeks postoperatively were 3.3 ± 1.9 and 73.5 ± 39.4 mg; 2.2 ± 1.5 and 40.2 ± 29.8 mg; 1.7 ± 1.2 and 31.3 ± 23.6 mg; 1.4 ± 1.1 and 27.3 ± 21.4 mg; and 1.3 ± 1.1 and 24.8 ± 21.0 mg, respectively (all P < 0.001). ODI scores significantly decreased (P < 0.05). Minor cement leakage occurred in 51 cases (46.8%), with one patient having a grade 3 neural injury. No local tumor progression was observed by follow-up imaging. CONCLUSIONS: MWA combined with PVP can significantly relieve pain and improve patients' quality of life, which implied this is an effective treatment option for painful NSCLC with spinal metastases. Additionally, its efficacy should be further verified through the mid- and long-term studies.

Occurrence Mechanism of the Abnormal Gelation Phenomenon of High Temperature Cementing Slurry Induced by a Polycarboxylic Retarder.

The class G oil well cement is a type of special cement that can be subjected to a high temperature formation environment. It was found that the class G cement tail slurry with a low polycarboxylic retarder dosage (usually ≤1% by weight of cement) was more prone to cause the abnormal gelation phenomenon (AGP) than the lead slurry with a high retarder dosage at a high temperature (usually when T ≥ 120 °C). This study aimed at the occurrence mechanism of this unfavorable phenomenon that seriously endangers the cementing security. Results showed that the abnormal gelatinous region underwent premature hydration; namely, the calcium hydroxide and calcium silicate hydrate (C-S-H) content were all higher than the nongelatinous region, while the copolymer content was the opposite. Correspondingly, the theory of "premature hydration and crystal nucleation" was proposed to explain the abnormal gelation mechanism of a cementing tail slurry with an insufficient retarder dosage. Furthermore, a novel functionalized copolymer retarder "PAIANS" was synthesized to alleviate the AGP.

Preparation of a Polycarboxylate Superplasticizer with Different Monomer Regulations and Its Effect on Fluidity, Rheology, and Strength of Cement.

Polycarboxylate superplasticizers (PCEs) are indispensable functional ingredients in modern construction, and their usage is extensive. Herein, a polyether macromonomer (VPEG) with high reactivity was used to prepare VAPCEs with different interfacial adsorption properties (acid-ether ratio) at low temperatures and reacted in 30 min. The effects of various VAPCEs on the fluidity, rheology, and strength of cement were investigated with a w/c (water/cement) ratio of 0.35. Results showed that VAPCE-3 (acid-ether ratio is 3) exhibited the best dispersion, and the fluidity of cement slurry with VAPCE-3 (280 mm) is 278.38% higher than that of the control sample (74 mm). The reason is summarized as VAPCE-3 having good adsorption performance on the surface of cement particles and having a large steric hindrance between particles. The compressive strength of cement with VAPCE-3 was enhanced by 8.29% compared with pure cement in 3 days of curing age due to its densification on microstructure and lowest R orientation index of calcium hydroxide. With the amount of acrylic acid in VAPCE increasing, the flexural strength enhanced because a more cross-linking network was formed with Ca2+ in cement with the increase of COO- content in VAPCEs.

Predictors and prognosis of early neurological outcomes on patients with Vertebrobasilar artery occlusion undergoing endovascular treatment.

BACKGROUND: This research explored the factors influencing early neurological outcomes (ENO) in patients who had vertebrobasilar artery occlusion (VBAO) and received endovascular treatment (EVT), as well as examining the causal influence of ENO on the prognosis of VBAO patients. METHODS: A retrospective review was carried out on patients from 65 Chinese stroke centers, all within 24 hours of the estimated occlusion time. ENO includes early neurological improvement (ENI) and early neurological deterioration (END), defined as a decrease or an increase of at least 4 points in NIHSS score between baseline and 24 hours after EVT. Death within 24 hours after EVT also consider as END. END was further divided into explainable END and unexplainable END (unEND). Independent predictors of ENO and the association between ENO and outcomes in patients with VBAO were determined using center-adjusted analyses. The study developed a multivariate logistic regression model to examine the comparative risk of unEND versus explainable END on the clinical outcomes in VBAO patients. RESULTS: A total of 2257 patients were included. Glasgow Coma Scale (GCS) (OR 1.16, 95% CI 1.03-1.30) and successful reperfusion (OR 1.15, 95% CI 1.02-1.30) were associated with ENI. Baseline NIHSS (OR 0.60, 95% CI 0.53-0.68), successful reperfusion (OR 0.79, 95% CI 0.71-0.89) and puncture to reperfusion time (OR 1.17, 95% CI 1.03-1.33) were associated with END. When examining three-month prognostic indexes, both END and ENI were found to be linked to the three-month outcomes, but in opposite directions. A subgroup analysis of END suggested that unexplained END typically demonstrated a more favorable prognosis compared to explained END, although the prognosis remained generally unfavorable. CONCLUSIONS: ENO, whether they manifested as early improvement or deterioration, were linked to the prognosis of VBAO patients undergoing EVT. The outcomes after unEND were more favorable than those following explained END.

Metabolic Engineering of Escherichia coli for High-Titer Biosynthesis of 3'-Sialyllactose.

3'-Sialyllactose (3'-SL) is among the foremost and simplest sialylated breast milk oligosaccharides. In this study, an engineered Escherichia coli for high-titer 3'-SL biosynthesis was developed by introducing a multilevel metabolic engineering strategy, including (1) the introduction of precursor CMP-Neu5Ac synthesis pathway and high-performance α2,3-sialyltransferase (α2,3-SiaT) genes into strain BZ to achieve de novo synthesis of 3'-SL; (2) optimizing the expression of glmS-glmM-glmU involved in the UDP-GlcNAc and CMP-Neu5Ac synthesis pathways, and constructing a glutamine cycle system, balancing the precursor pools; (3) analysis of critical intermediates and inactivation of competitive pathway genes to redirect carbon flux to 3'-SL biosynthesis; and (4) enhanced catalytic performance of rate-limiting enzyme α2,3-SiaT by RBS screening, protein tag cloning. The final strain BZAPKA14 yielded 9.04 g/L 3'-SL in a shake flask. In a 3 L bioreactor, fed-batch fermentation generated 44.2 g/L 3'-SL, with an overall yield and lactose conversion of 0.53 g/(L h) and 0.55 mol 3'-SL/mol, respectively.

Expectations for employing Escherichia coli Nissle 1917 in food science and nutrition.

As a promising probiotic strain, Escherichia coli Nissle 1917 (EcN) has been demonstrated to confer beneficial effects on intestinal health, immune function, and pathogen prevention. Additionally, EcN has also been widely studied due to its clear genomic information, tractable gene regulation, and simple growth conditions. This review summarizes the various applications potential of EcN in food science and nutrition, including inflammation prevention, tumor-targeting therapy, antibacterial agents for food, and nutrient production with a focus on specific case studies. Moreover, we highlight the major challenges of employing EcN in food science and nutrition, including regulatory approval, stability during food processing, and consumer acceptance. Finally, we conclude with a discussion on perspectives related to employing EcN in food science and nutrition.

Rescue stenting after failure of endovascular thrombectomy for acute vertebrobasilar artery occlusion: data from the PERSIST registry.

BACKGROUND: Among acute vertebrobasilar artery occlusion (VBAO) patients, successful reperfusion is a strong predictor of favorable outcomes. However, failed reperfusion (FR) with endovascular thrombectomy (EVT) in VBAO was observed to occur in 18-50% of cases. We aim to evaluate the safety and efficacy of rescue stenting (RS) for VBAO after failed EVT. METHODS: Patients with VBAO who received EVT were enrolled retrospectively. Propensity score matching was performed as the primary analysis to compare the outcomes between patients with RS and FR. Furthermore, a comparison between using the self-expanding stent (SES) and balloon-mounted stent (BMS) in the RS group was also conducted. The primary and secondary outcomes were defined as a 90-day modified Rankin Scale (mRS) score 0-3, and a 90-day mRS score 0-2, respectively. Safety outcomes included all-cause mortality at 90 days and symptomatic intracranial hemorrhage (sICH). RESULTS: The RS group showed a significantly higher rate of 90-day mRS score 0-3 (46.6% vs 20.7%; adjusted OR (aOR) 5.06, 95% CI 1.88 to 13.59, P=0.001) and a lower rate of 90-day mortality (34.5% vs 55.2%; aOR 0.42, 95% CI 0.23 to 0.90, P=0.026) than the FR group. The rates of 90-day mRS score 0-2 and sICH were not significantly different between the RS group and FR group. There were no differences in all outcomes between SES and BMS groups. CONCLUSIONS: RS appeared to be a safe and effective rescue approach in patients with VBAO who failed EVT, and there was no difference between using SES and BMS.

Janus membrane with asymmetric wettability for efficient oil/water separation.

The rapid development of society and industry as well as the frequent occurrence of oil spills cause the shortage of fresh water resources, which not only affects human safety and life, but also impedes the world-wide sustainable development. To address these challenges, novel membrane materials with unique wettability properties have gained significant attention, particularly in the field of oil/water separation. In this research, we modified the hydrophobic PET fabric to achieve superhydrophilic characteristics using impregnation method. Subsequently, we electrospun hydrophobic PVDF fibers onto the superhydrophilic fabric surface, and PVDF/Ca10(PO4)6(OH)2@PET Janus membrane with asymmetric wettability was obtained. The membrane has an excellent unidirectional liquid transport capacity, and can effectively separate heavy oil or light oil, the separation efficiency is more than 90 %. The results also show that the Janus membrane can be used under alkaline conditions and has satisfactory tensile resistance and re-use performance. This work provides a new idea for Janus membrane design and effectively improves the application potential of the Janus membrane in the field of oil/water separation.

Water-Adaptive Microcapsules with a Brittle-Ductile-Brittle Transition Based on an O/W/O Emulsion for the Self-Healing of Cementitious Materials.

Cementitious materials inevitably develop cracks, posing a serious threat to the long-term security of infrastructure, especially in the complex underground environment of cementing engineering. Microcapsules are facing the problem of encapsulated structure damage during the mixing and breaking difficultly during self-healing when applied in cementitious materials, resulting in the decline of self-healing efficiency. Herein, the calcium alginate water-adaptive microcapsules (CaAlg-NS/E-51) were prepared via an O/W/O emulsion, and the water adaptability of the shell was applied to achieve a rapid brittle-ductile transition by absorbing water. The water adaptability of the microcapsule is conducive to resisting shear stress during stirring due to the decreased elastic modulus and the increased ductility of the shell when it absorbs water. Meanwhile, the water-bearing shell loses water and becomes brittle during dry curing, making it prone to fracture when self-healing. In the self-healing measurement, the self-healing efficiency of cementitious specimens with microcapsules absorbing water for 10 min improved by 234.9 and 60.0% at 1 and 7 days, respectively, compared with those containing dry microcapsules, owing to the water adaptability of the shell.

Clinical outcomes of radioactive seed brachytherapy and microwave ablation in inoperable stage I non-small cell lung cancer.

This study assessed the efficacy and safety of radioactive iodine-125 seed ablation brachytherapy (RSABT) in comparison to microwave ablation therapy (MWAT) for treating inoperable stage I non-small cell lung cancer (NSCLC). We conducted a retrospective analysis of data from stage I NSCLC patients who underwent CT-guided RSABT or MWAT. The primary outcomes measured were progression-free survival (PFS), overall survival (OS), and the occurrence of adverse events. Of the patients included in the study, 71 underwent RSABT and 105 received MWAT. The median follow-up time for these groups was 47.4 months and 60 months, respectively. The PFS rates at 1-year, 3-year, and 5-year for the RSABT group were 87.3%, 72.6%, and 65.8%, while for the MWAT group, they were 89.5%, 69.3%, and 43.7%, respectively (P = 0.011). The OS rates at 1-year, 3-year, and 5-year for the RSABT group were 97.2%, 78.1%, and 66.1%, and for the MWAT group, they were 99%, 75.8%, and 55%, respectively (P = 0.112). Upon multivariate analysis, the treatment modality was identified as an independent predictor of PFS (P = 0.008). Additionally, both sex and T stage were found to be independent predictors of both PFS and OS (P < 0.05). Adverse events, such as pneumothorax, occurred in 50% of the MWAT group and 39% of the RSABT group (P = 0.313). The incidence of pleural effusion was 44% in the MWAT group compared to 14% in the RSABT group (P < 0.001). Needle bleeding was observed in 32% of the RSABT group and 5% of the MWAT group (P < 0.001). We conclude RSABT demonstrates promising efficacy and safety in the treatment of stage I NSCLC. However, further studies are essential to validate these preliminary findings.

CeO2@CuS@PDA-FA as targeted near-infrared PTT/CDT therapeutic agents for cancer cells.

Single tumor treatment method usually has some defects, which makes it difficult to achieve good therapeutic effect. The ingenious combination of multiple tumor treatment methods on a single nanoplatform to achieve multifunctional treatment can effectively improve the efficiency of treatment. The targeted modification of nanomaterials can augment the precision of nanotherapeutic drugs in tumor treatment. Herein, a multifunctional nanoplatform (CeO2@CuS@PDA-FA) based on cerium dioxide nanoparticles engineered with copper sulfide (CeO2@CuS) has been constructed for synergistic photothermal therapy (PTT) and chemodynamic therapy (CDT). The CeO2@CuS were coated using polydopamine (PDA), and the modification of PDA surface by folic acid, in order to achieve the targeted effect for tumors. The localized hyperthermia induced by PTT can further improve the CDT efficiency of the nanoplatform, leading to a PTT/CDT synergistic effect. The nanoplatform possessed the capability of cancer cell-targeted and achieved better therapeutic efficacyin vitro. This work provided a new strategy for combined multifunctional theranostic platform and shows strong potential in practical applications.

Mechanism underlying the effect of MnO2 nanosheets for A549 cell chemodynamic therapy.

MnO2 nanosheets (MnO2NSs) were synthesized by one-step method, and MnO2NSs were applied to A549 cell chemodynamic Therapy (CDT). The cytotoxicity, redox ability, and reactive oxygen species production of MnO2NSs have been investigated, and differences in cell metabolism during CDT were determined using liquid chromatography-mass spectrometry (LC-MS/MS). In addition, the metabolites of A549 lung cancer cells affected by MnO2NSs treatment are identified; metabolite differences were identified by PCA, PLS-DA, orthogonal PLS-DA, and other methods; and these differences were analyzed using non-targeted metabolomics. We found that A549 cells which were treated by MnO2NSs have 17 different metabolites and 9 metabolic pathways that varied markedly. Owing to their unique composition, structure, and physicochemical properties, MnO2NSs and their composites have become a favored type of nanomaterial used for CDT in cancer therapy. This work provides insights into the mechanism underlying the effects of MnO2NSs on the tumor microenvironment of A549 lung cancer cells, effectively making up for the deficiency of the study on cellular mechanism of CDT-induced apoptosis of cancer cells. It could aid the development of cancer CDT treatment strategies and help improve the use of nanomaterials in the clinical field.

Metabolomics analysis of MnO2 nanosheets CDT for breast cancer cells and mechanism of cytotoxic action.

Chemodynamic therapy (CDT) has received more and more attention as an emerging therapeutic strategy, especially transition metals with Fenton or Fenton-like activity have good effects in CDT research, manganese dioxide nanosheets (MnO2 NSs) and their complexes have become one of the most favored nanomaterials in CDT of tumors. CDT is mainly based on the role of reactive oxygen species (ROS) in tumor treatment, which have clear chemical properties and produce clear chemical reactions. However, their mechanism of interaction with cells has not been fully elucidated. Here, we performed CDT on mouse breast cancer cells (4T1) based on MnO2 NSs, extracted the metabolites from the 4T1 cells during the treatment, and analyzed the differences in metabolites by using high-resolution liquid chromatography-mass spectrometry (LC-MS). Untargeted metabolomics studies were conducted using the relevant data. This study mainly explored the changes in MnO2 NSs on the metabolite profile of 4T1 cells and their potential impact on tumor therapy, in order to determine the mechanism of action of MnO2 NSs in the treatment of breast cancer. The results of the study showed the presence of 11 different metabolites in MnO2 NSs CDT for 4T1 tumor cells, including phosphoserine, sphingine, phosphocholine, and stearoylcarnitine. These findings provide a deeper understanding of breast cancer treatment, and are beneficial for the further research and clinical application of CDT.

A Janus membrane doped with carbon nanotubes for wet-thermal management.

In a human skin-fibrous fabric-external environment, fibrous materials, as the "second skin" of the human body, provide comfort against the wet and heat effectively. Fibrous materials protect human health and guarantee work efficiency in various outdoor or inner scenes. Personal wet-thermal management based on fibrous materials can regulate comfort in a facile manner with low or zero energy consumption, which has become a potential development area. However, realizing synergistic management of the wet and heat effectively and conveniently is a challenge in the development and production of fibrous materials. We designed and fabricated a Janus fibrous membrane composed of 3-(trimethoxysilyl)propyl methacrylate (TMSPMA)-modified hydrophobic cotton gauze and electrospun carbon nanotubes (CNTs)-doped cellulose acetate (CA) hydrophilic fibrous membrane. Taking advantage of asymmetric wettability along its thickness direction, the Janus fibrous membrane, acting as a "liquid diode", could transport sweat/moisture from human skin to the external environment unidirectionally, which endowed a dry surface on human skin, avoiding "stickiness", and realizing wet management. Doped CNTs had good photothermal-conversion capacity, so the Janus membrane exhibited excellent heating capacity for passive radiation, so excellent synergistic wet-thermal management was obtained. The Janus membrane could be a candidate for diverse applications of fibrous membranes. Our data provide new ideas for the design and fabrication of fibrous membranes with remarkable wet-thermal management.

Effects of Hybrid Graphene Oxide-Nanosilica on Calcium Silicate Hydrate in the Simulation Environment and Cement.

This research aims to investigate the synergistic reinforcing mechanisms of chemically combined graphene oxide and nanosilica (GO-NS) in the structure of calcium silicate hydrate (C-S-H) gels compared with physically combined GO/NS. The results confirmed that the NS chemically deposited on the GO surface formed a coating to keep GO from aggregation, while the connection between GO and NS in GO/NS was too weak to prevent GO from clumping, making GO-NS better dispersed than GO/NS in pore solution. When applied to cement composites, the incorporation of GO-NS enhanced the compressive strength by 27.3% after 1-day hydration compared to that of the plain sample. This is because that GO-NS generated multiple nucleation sites at early hydration, reduced the orientation index of calcium hydroxide (CH), and increased the polymerization degree of C-S-H gels. GO-NS acted as the platforms for the growing process of C-S-H, enhancing its interface bonding strength with C-S-H and increasing the connection degree of the silica chain. Furthermore, the well-dispersed GO-NS was prone to insert in C-S-H and induced deeper cross-linking, thereby refining the microstructure of C-S-H. All these effects on hydration products resulted in the mechanical improvement of cement.

Effect of INR on Outcomes of Endovascular Treatment for Acute Vertebrobasilar Artery Occlusion.

Endovascular treatment (EVT) has been proven to be the standard treatment for acute vertebrobasilar artery occlusion (VBAO). This study aimed to analyze the effects of international normalized ratio (INR) indicators on outcomes in patients with acute VBAO treated with EVT. Dynamic data on INR in patients with VBAO who received endovascular treatment (EVT) at 65 stroke centers in China were retrospectively enrolled. Outcome measures included the modified Rankin Scale (mRS) score at 90 days and 1 year and symptomatic intracranial hemorrhage (sICH). The associations between elevated INR (INR > 1.1), INR variability (time-weighted variance of INR changes), and various clinical outcomes were analyzed in all patients and subgroups stratified by oral anticoagulation (OAC) by mixed logistic regression analysis. A total of 1825 patients met the study criteria, of which 1384 had normal INR and 441 had elevated INR. Multivariate analysis showed that elevated INR was significantly associated with poor functional outcomes (mRS 4-6) at 90 days (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.08-1.72) and 1 year (OR 1.32, 95% CI 1.05-1.66), but was not associated with an increased risk of sICH (OR 1.00, 95% CI 0.83-1.20). Similar associations exist between INR variability and poor functional outcomes at 90 days (OR 2.17, 95% CI 1.09-4.30), 1 year (OR 2.28, 95% CI 1.16-4.46), and sICH (OR 1.11, 95% CI 0.93-1.33). Subgroup analyses further revealed that elevated INR and INR variability remained associated with poor functional outcomes in patients not receiving oral anticoagulation (OAC) therapy, while no significant associations were observed in OAC-treated patients, regardless of whether they were on warfarin or direct oral anticoagulants. Elevated INR and INR variability in VBAO patients treated with EVT were associated with poor functional outcomes. The mechanism underlying the association between elevated INR and poor functional outcomes might be attributed to the fact that elevated INR indirectly reflects the burden of comorbidities, which could independently worsen outcomes. These findings underscore the importance of a comprehensive and dynamic evaluation of INR levels in the management of VBAO patients receiving EVT, providing valuable insights for optimizing patient outcomes.

CT-based and CTA-based posterior circulation ASPECTS in acute basilar artery occlusion: An Agreement Study.

BACKGROUND AND PURPOSE: The purpose of the present study was to evaluate the agreement on pc-ASPECTS (posterior circulation Acute Stroke Prognosis Early Computed Tomography Scores) based on non-contrast CT (NCCT) and CT angiography (CTA) source images in patients with acute basilar artery occlusion (BAO). METHODS: We prospectively enrolled consecutive patients with acute BAO from January 2022 to August 2022 at The First Affiliated Hospital of University of Science and Technology of China. The NCCT and CTA were scored independently by 15 raters during 2 different reading sessions at least 3 weeks apart. The pc-ASPECTS based on NCCT and CTA were analyzed on the full scale or were dichotomized (0-6 versus 7-10, 0-7 versus 8-10 and 0-8 versus 9-10). The level of agreement was measured using Fleiss κ Statistics. RESULTS: The median (IQR) CT-based pc-ASPECTS was 8 (6.75-9). The interrater agreement for CT-based pc-ASPECTS (κ=0.133 [0.132-0.133]) and CTA-based pc-ASPECTS (κ=0.204 [0.203-0.204]) was slight for all raters. Dichotomizations obtaining the highest concordance for the CT-based pc-ASPECTS (0-6 versus 7-10) and the CTA-based pc-ASPECTS (0-8 versus 9-10) failed to increase the interrater agreement to a substantial level (κ=0.350 [0.348-0.351] and 0.396 [0.395-0.398], respectively). Intrarater agreement for global CT-based pc-ASPECTS was less than substantial for the 14/15 raters and reached the level of substantial for the 3/15 raters with dichotomization. CONCLUSIONS: Agreement between clinicians assessing CT-based and CTA-based pc-ASPECTS cannot be sufficient to make reproducible clinical decisions and assessments. The dichotomization failed to improve interrater and intrarater agreement to the level of substantial.