Challenges and opportunities in the islet transplantation microenvironment: a comprehensive summary of inflammatory cytokine, immune cells, and vascular endothelial cells.

It is now understood that islet transplantation serves as a ß-cell replacement therapy for type 1 diabetes. Many factors impact the survival of transplanted islets, especially those related to the microenvironment. This review explored microenvironmental components, including vascular endothelial cells, inflammatory cytokines, and immune cells, and their profound effects on post-islet transplantation survival rates. Furthermore, it revealed therapeutic strategies aimed at targeting these elements. Current evidence suggests that vascular endothelial cells are pivotal in facilitating vascularization and nutrient supply and establishing a new microcirculation network for transplanted islets. Consequently, preserving the functionality of vascular endothelial cells emerges as a crucial strategy to enhance the survival of islet transplantation. Release of cytokines will lead to activation of immune cells and production and release of further cytokines. While immune cells hold undeniable significance in regulating immune responses, their activation can result in rejection reactions. Thus, establishing immunological tolerance within the recipient's body is essential for sustaining graft functionality. Indeed, future research endeavors should be directed toward developing precise strategies for modulating the microenvironment to achieve higher survival rates and more sustained transplantation outcomes. While acknowledging certain limitations inherent to this review, it provides valuable insights that can guide further exploration in the field of islet transplantation. In conclusion, the microenvironment plays a paramount role in islet transplantation. Importantly, we discuss novel perspectives that could lead to broader clinical applications and improved patient outcomes in islet transplantation.

Double boron-oxygen-fused polycyclic aromatic hydrocarbons: skeletal editing and applications as organic optoelectronic materials.

An efficient one-pot strategy for the facile synthesis of double boron-oxygen-fused polycyclic aromatic hydrocarbons (dBO-PAHs) with high regioselectivity and efficient skeletal editing is developed. The boron-oxygen-fused rings exhibit low aromaticity, endowing the polycyclic aromatic hydrocarbons with high chemical and thermal stabilities. The incorporation of the boron-oxygen units enables the polycyclic aromatic hydrocarbons to show single-component, low-temperature ultralong afterglow of up to 20 s. Moreover, the boron-oxygen-fused polycyclic aromatic hydrocarbons can also serve as ideal n-type host materials for high-brightness and high-efficiency deep-blue OLEDs; compared to single host, devices using boron-oxygen-fused polycyclic aromatic hydrocarbons-based co-hosts exhibit dramatically brightness and efficiency enhancements with significantly reduced efficiency roll-offs; device 9 demonstrates a high color-purity (Commission International de l'Eclairage CIEy = 0.104), and also achieves a record-high external quantum efficiency (28.0%) among Pt(II)-based deep-blue OLEDs with Commission International de l'Eclairage CIEy < 0.20; device 10 achieves a maximum brightnessof 27219 cd/m2 with a peak external quantum efficiency of 27.8%, which representes the record-high maximum brightness among Pt(II)-based deep-blue OLEDs. This work demonstrates the great potential of the double boron-oxygen-fused polycyclic aromatic hydrocarbons as ultralong afterglow and n-type host materials in optoelectronic applications.

A Word-Level Adversarial Attack Method Based on Sememes and an Improved Quantum-Behaved Particle Swarm Optimization.

The goal of textual adversarial attack methods is to replace some words in an input text in order to make the victim model misbehave. This article proposes an effective word-level adversarial attack method based on sememes and an improved quantum-behaved particle swarm optimization (QPSO) algorithm. The sememe-based substitute method, which uses the words sharing the same sememes as the substitutes of the original words, is first employed to form the reduced search space. Then, an improved QPSO algorithm, called historical information-guided QPSO with random drift local attractor (HIQPSO-RD), is proposed to search the reduced search space for adversarial examples. The HIQPSO-RD introduces historical information into the current mean best position of the QPSO, for the purpose of improving the convergence speed of the algorithm, by enhancing its exploration ability and preventing the premature convergence of the swarm. The proposed algorithm uses the random drift local attractor technique to make a good balance between its exploration and exploitation, so that the algorithm can find a better adversarial attack example with low grammaticality and perplexity (PPL). In addition, it employs a two-stage diversity control strategy to enhance the search performance of the algorithm. Experiments on three natural language processing (NLP) datasets, with three commonly used nature language processing models as victim models, show that our method achieves higher attack success rates but lower modification rates than the state-of-the-art adversarial attack methods. Moreover, the results of human evaluations show that adversarial examples generated by our method can better maintain the semantic similarity and grammatical correctness of the original input.

Short-term and long-term effects of Sanming healthcare system reform on drug-related expenditures for rural patients with cancer in public hospitals: an interrupted time series analysis using segmented regression model in China.

OBJECTIVES: To assess the effects of 'Sanming model' on drug-related expenditures. DESIGN: Interrupted time series analysis with two time points was conducted to analyse the effects of 'Sanming model' using segmented regression model. SETTING: Two hundred and eighty public hospitals in Fujian province in China. PARTICIPANTS: A total of 777 171 inpatients and 792 743 outpatients with cancer who participated in New Rural Cooperative Medical Scheme (NRCMS) were included. INTERVENTIONS: 'Sanming model' was issued by Sanming government in February 2013 and spread to other cities in Fujian province in January 2015. PRIMARY OUTCOME MEASURES: Four drug-related expenditure variables. RESULTS: Among inpatients, total drug expenditures and drug expenditures covered by NRCMS dropped instantly after the reform in all hospitals. Although there was insignificant change during the short-term reform period, the total drug expenditures and drug expenditures covered by NRCMS decreased at the rate of ¥20.3 (p=0.0099) and ¥18.8 (p=0.0341) per capita month-to-month during the long-term reform period in Sanming hospitals, respectively. Among outpatients, total drug expenditures and drug expenditures covered by NRCMS decreased at the rate of ¥20.8 (p=0.0335) and ¥18.4 (p=0.0242) per capita month-to-month during the short-term reform period in Sanming hospitals, respectively. However, the downward trend did not continue into the long term. The significant decreases in trend of drug expenditures uncovered by NRCMS were only observed after the reform in provincial hospitals. The ratio of drug expenditures to inpatient (outpatient) expenditures decreased after the reform in all hospitals. CONCLUSIONS: 'Sanming model' had long-term effect in reducing total drug expenditures, drug ratio and drug expenditures covered by NRCMS for rural inpatients with cancer and only short-term positive effect for outpatients. However, there was limited effect of 'Sanming model' on drug expenditures uncovered by NRCMS. 'Sanming model' still needs to accumulate experiences and improves the reform measures dynamically.

Effects of irrigation and nitrogen application on soil water and nitrogen distribution and water-nitrogen utilization of wolfberry in the Yellow River Irrigation Region of Gansu Province, China.

To address the problems of extensive field management, low productivity, and inefficient water and fertilizer utilization in wolfberry (Lycium barbarum L.) production, an appropriate water and nitrogen regulation model was explored to promote the healthy and sustainable development of the wolfberry industry. Based on a field experiment conducted from 2021 to 2022, this study compared and analyzed the effects of four irrigation levels [75%-85% θf (W0, full irrigation), 65%-75% θf (W1, slight water deficit), 55%-65% θf (W2, moderate water deficit), and 45%-55% θf (W3, severe water deficit)] and four nitrogen application levels [0 kg·ha-1 (N0, no nitrogen application), 150 kg·ha-1 (N1, low nitrogen application), 300 kg·ha-1 (N2, medium nitrogen application), and 450 kg·ha-1 (N3, high nitrogen application)] on soil water distribution, soil nitrate nitrogen (NO3 --N) migration, yield, and water-nitrogen use efficiency of wolfberry. The soil moisture content of the 40-80 cm soil layer was higher than those of 0-40 cm and 80-120 cm soil layer. The average soil moisture content followed the order of W0 > W1 > W2 > W3 and N3 > N2 > N1 > N0. The NO3 --N content in the 0-80 cm soil layer was more sensitive to water and nitrogen regulation, and the cumulative amount of NO3 --N in the soil followed the order of W0 > W1> W2 > W3 and N3 > N2 > N1 > N0 during the vegetative growth period. There was no evidently change in soil NO3 --N accumulation between different treatments during the autumn fruit. The yield of wolfberry under the W1N2 treatment was the highest (2623.09 kg·ha-1), which was 18.04% higher than that under the W0N3 treatment. The average water consumption during each growth period of wolfberry was the highest during the full flowering period, followed by the vegetative growth and full fruit periods, and the lowest during the autumn fruit period. The water use efficiency reached a peak value of 6.83 kg·ha-1·mm-1 under the W1N2 treatment. The nitrogen uptake of fruit and nitrogen fertilizer recovery efficiency of fruit first increased and then decreased with increasing irrigation and nitrogen application. The treatment of W1N2 obtained the highest nitrogen uptake of fruit and nitrogen recovery efficiency of fruit, which were 63.56 kg·ha-1 and 8.17%, respectively. Regression analysis showed that the yield and water-nitrogen use efficiency of wolfberry improved when the irrigation amount ranged from 315.4 to 374.3 mm, combined with nitrogen application amounts of 300.0 to 308.3 kg·ha-1. Additionally, the soil NO3 --N residue was reduced, making it an optimal water and nitrogen management model for wolfberry planting. The present findings contribute novel insights into the production of wolfberry with saving water and reducing nitrogen, which helps to improve the level of wolfberry productivity in the Yellow River irrigation region of Gansu Province and other areas with similar climate.

Novel Optimization Design Methods of Highly Loaded Compressor Cascades Considering Endwall Effect.

The endwall effect has a great impact on the aerodynamic performance of compressor blades. Based on three conventional near-endwall blade modeling methods of bowed blade, endbend blade and leading-edge strake blade (LESB), two combined optimization design methods of highly loaded blades have been developed considering the endwall effect in the current study, i.e., the bowed blade combined with the LESB (bowed LESB blade) and the endbend blade combined with the LESB (endbend LESB blade). Optimization designs were conducted for a compressor cascade with low solidity by using the two combined modeling methods and the three conventional modeling methods, and the optimization results were compared and analyzed in detail. The results showed that the five optimization modelling methods could all improve the performance for the original cascade, and the optimized cascade with the bowed LESB modeling method has the best aerodynamic performance. The total pressure loss of the optimal bowed LESB cascade was only 40.3% of that in the original cascade while reducing the solidity of the original cascade from 1.53 to 1.25 and keeping the static pressure rise and diffusion factor at the same level as the original one. Among the optimal cascades, the radial migration height of the low-energy fluid and the corresponding vortex have great effects on the aerodynamic performance, and the optimal bowed LESB cascade is superior to the other optimal cascades in this aspect.

Regulatory relationships of demographic, clinical characteristics and quality of care for heart failure patients in southern China.

OBJECTIVE: Quality of care for Chinese patients with heart failure was substandard. This study aimed to ascertain the characteristics related to quality of care to narrow the gap. METHODS: Data from 2064 heart failure patients between 1 January 2012 and 31 December 2015 at a hospital in Fujian Province were analyzed. The Bayesian network was used to assess the regulatory relationships between demographic and clinical characteristics and compliance with quality indicators. RESULTS: The compliance with quality indicators ranged from 42.5% to 90.2%. The compliance with recommended doses for medications all reached or was close to 100% except indapamide. Residence place, hypertension, troponin, B-type natriuretic peptide, heart rate, lung disease, number of emergency treatments (ETs) and ejection fraction directly regulated the compliance, and gender, age, medical payment methods, myocardiopathy, coronary heart disease and arrhythmia indirectly regulated the compliance in the Bayesian network. The lower compliance was found in patients under ET, patients with abnormal testing indicators, patients without specific comorbidities and patients under the New Rural Cooperative Medical Scheme or self-paying. Patients with lung disease and those who lived in urban areas had a longer length of stay. CONCLUSIONS: The compliance with medication indicators for heart failure was suboptimal, but recommended doses were prescribed to patients who received medications. A series of strategies should be developed to improve the quality of care, such as expanding the scope and depth of knowledge of guidelines and clinical pathways, integrating the reminder and quality assessment model into the hospital medical record information system, paying more attention to the vulnerable population and improving the medical security system.

Highly Efficient Phosphorescent Tetradentate Platinum(II) Complexes Containing Fused 6/5/6 Metallocycles.

A series of neutral tetradentate Pt(II) complexes with fused 6/5/6 metallocycles and biphenyl (bp)-containing ligands have been designed and synthesized. All bridging atoms adopt nitrogens designed as an acridinyl group (Ac), an aza acridinyl group (AAc), and an aza carbazolyl group (ACz), which can effectively tune their LUMO energy levels. Their HOMO energy levels can be well-controlled through molecular modifications on the bp moieties with electron-donating and electron-withdrawing groups. These molecular modifications also have profound effects on the electrochemical and photophysical properties and photostabilities of the Pt(II) complexes. The ground-states and excited states are systematically studied by density functional theory (DFT), time-dependent density functional theory (TD-DFT), and natural transition orbital (NTO) calculations. All the Pt(II) complexes exhibit admixed 3(LC/MLCT) characters in T1 states with various proportions, which are strongly structure-dependent. These 6/5/6 Pt(II) complexes demonstrate high quantum efficiencies in dichloromethane solutions (ΦPL = 27-51%) and in doped PMMA films (ΦPL = 36-52%) at room temperature with short luminescence lifetimes of 1.6-9.5 µs and 7.6-9.0 µs, respectively. They emit green light with dominant peaks of 512-529 nm in solutions and 512-524 nm in doped PMMA films, respectively. Importantly, Pt(bp-2) exhibits highly stable emission colors with the same dominant peaks at 512 nm in various matrixes and also demonstrates a long photostability lifetime, LT80, at 80% of initial luminance, of 190 min, which is doped in polystyrene films (5 wt %) excited by UV light of 375 nm at 500 W/m2. These studies indicate that these 6/5/6 Pt(II) complexes can act as good phosphorescent emitters for OLED applications and should provide a viable route for the development of efficient and stable Pt(II)-based phosphorescent emitters.

Computational Exploration of Chiral Iron Porphyrin-Catalyzed Asymmetric Hydroxylation of Ethylbenzene Where Stereoselectivity Arises from π-π Stacking Interaction.

The mechanism and origins of stereoselectivity of chiral iron porphyrin-catalyzed asymmetric hydroxylation of ethylbenzene were explored with density functional theory. The hydrogen atom abstraction is the rate- and stereoselectivity-determining step. In good agreement with experimental results, the formation of the (R)-1-phenylethanol product is found to be the most favorable pathway. The transition state of hydrogen atom abstraction which leads to the (S)-1-phenylethanol product is unfavorable by 1.7 kcal/mol compared to the corresponding transition state which leads to the (R)-1-phenylethanol product. Enantioselectivity arises from an attractive π-π stacking interaction between the phenyl group of ethylbenzene substrate and the naphthyl group of the porphyrin ligand.

Metal-Assisted Delayed Fluorescent Pd(II) Complexes and Phosphorescent Pt(II) Complex Based on [1,2,4]Triazolo[4,3-a]pyridine-Containing Ligands: Synthesis, Characterization, Electrochemistry, Photophysical Studies, and Application.

The synthesis and photophysical characterization of a series of tetradentate cyclometalated M(tzpPh-O-CzPy-R) complexes and their analogues are reported, where M is palladium or platinum and a tetradentate cyclometalating ligand contains tzpPh (3-phenyl-[1,2,4]triazolo[4,3-a]pyridine) and CzPy (carbazolylpyridine) moieties linked with an oxygen atom. Variations of the σ-electron-donating group R on the ligand significantly affect the photophysical properties of the complexes. By using the strong electron-withdrawing tzp portion as an acceptor and the carbazole portion as a donor, a series of Pd(II)-based metal-assisted delayed fluorescence (MADF) materials was developed. Electrochemical analysis demonstrates the irreversible reduction process occurs on the tzp ring and the irreversible oxidation process mainly occurs on the metal-phenyl moiety. This is in agreement with the HOMO and LUMO distributions by the DFT calculations, which also shows that the Pt(II) complex has more metal orbital character than those of the Pd(II) complexes. Most of the Pd(II) complexes reported here are highly emissive at 77 K in 2-MeTHF with luminescent lifetimes in the millisecond range (τ = 1.96-2.36 ms) and λmax = 488-499 nm; however, the luminescent lifetimes are shortened to the microsecond range (τ = 26.7-152.9 µs in solution and 57.0-109.9 µs in thin film respectively) at room temperature. The quantum efficiency of the Pd(II) complexes can be increased by more than 8-fold through structure modification with σ-donating groups on the ligand. Especially, the Pd(tzp-3) has a small ΔEST of 0.228 eV and exhibits strong typical MADF in PMMA film. The Pt(II) complex Pt(tzp-2) exhibits high thermal stability (ΔT0.5% = 440 °C) and high quantum efficiency (Φ = 50.1%) in dichloromethane solution with τ of 15.8 µs. The Pt(tzp-2) based bright green OLED achieved a peak EQE of 8.7% and a maximum brightness of 28280 cd/m2 using an unoptimized device structure.

Preexisting dual antiplatelet treatment increases the risk of post-thrombolysis intracranial hemorrhage in Chinese stroke patients.

OBJECTIVE: Previous studies have shown conflicting results on the use of antiplatelet (AP) agent and its risk of symptomatic intracerebral hemorrhage (sICH) following thrombolysis for acute ischemic stroke. Our study was to explore the safety of intravenous (IV) thrombolysis in Chinese stroke patients who were on AP prior to stroke. METHODS: Data were collected from the thrombolysis implementation and monitor of acute ischemic stroke in China (TIMS-China) registry. Symptomatic ICH defined per SITS-MOST (safe implementation of treatments in stroke-monitoring study), ECASS II (second European-Australasian acute stroke study), and NINDS (National Institute of Neurological Disorders and Stroke) criteria, 90-day functional outcome, and 7-day and 90-day mortalities were compared between the stroke patients who were on mono and dual AP therapy. RESULTS: A total of 157 (14.2%) patients received at least one AP drug within 24 hours before thrombolysis. Patients with preexisting dual AP treatment had higher rate of sICH (14.3% (2/14) per SITS-MOST, 21.4% (3/14) per ECASS II definitions) than those on no AP treatment. No significant difference was found in the rate of sICH or 7-day or 90-day mortalities between the groups on aspirin (ASA) alone and on no AP treatment. DISCUSSION: The risk of developing sICH is low when thrombolysis is given to patients who are on ASA alone. However, there is potential increased risk of sICH if a patient is on dual AP treatment.

Cost-effectiveness of thrombolysis within 4.5 hours of acute ischemic stroke in China.

BACKGROUND: Previous economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA) is cost-effective for acute ischemic stroke. The present study aimed to determine the cost-effectiveness of tPA treatment in China, the largest developing country. METHODS: A combination of decision tree and Markov model was developed to determine the cost-effectiveness of tPA treatment versus non-tPA treatment within 4.5 hours after stroke onset. Outcomes and costs data were derived from the database of Thrombolysis Implementation and Monitor of acute ischemic Stroke in China (TIMS-China) study. Efficacy data were derived from a pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Costs and quality-adjusted life-years (QALYs) were compared in both short term (2 years) and long term (30 years). One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. RESULTS: Comparing to non-tPA treatment, tPA treatment within 4.5 hours led to a short-term gain of 0.101 QALYs at an additional cost of CNY 9,520 (US$ 1,460), yielding an incremental cost-effectiveness ratio (ICER) of CNY 94,300 (US$ 14,500) per QALY gained in 2 years; and to a long-term gain of 0.422 QALYs at an additional cost of CNY 6,530 (US$ 1,000), yielding an ICER of CNY 15,500 (US$ 2,380) per QALY gained in 30 years. Probabilistic sensitivity analysis showed that tPA treatment is cost-effective in 98.7% of the simulations at a willingness-to-pay threshold of CNY 105,000 (US$ 16,200) per QALY. CONCLUSIONS: Intravenous tPA treatment within 4.5 hours is highly cost-effective for acute ischemic strokes in China.

Risk factors of dilated Virchow-Robin spaces are different in various brain regions.

BACKGROUND AND PURPOSE: Few studies have reported on the risk factors of dilated Virchow-Robin Spaces (dVRS) in large samples of ischemic stroke patients. Little evidence exists regarding the relationship between dVRS and etiologic subtype of ischemic stroke or lacune. We aimed to investigate the risk factors associated with the severity of dVRS in a large sample of ischemic stroke patients. METHODS: We consecutively enrolled 1,090 patients who experienced an ischemic stroke within the past seven days and underwent a 3.0 T MRI scan in the Chinese IntraCranial AtheroSclerosis Study (ICAS). Clinical data and cranial MRI information of patients included age, sex, vascular risk factors, dVRS, leukoaraiosis, lacune, and etiologic subtype of ischemic stroke. Analyses were performed regarding the risk factors associated with the severity of dVRS by univariate analysis and multivariable ordinal logistic regression analysis. RESULTS: Through multivariable ordinal logistic regression analysis, age, the severity of leukoaraiosis, lacune, admission National Institutes of Health Stroke Scale (NIHSS) ≤3, and the severity of dVRS in the white matter (WM) and hippocampus (Hip) were correlated with the severity of dVRS in basal ganglia (BG); male, history of hypertension, admission NIHSS ≤3, and the severity of dVRS in BG and Hip were correlated with the severity of dVRS in WM; female, the severity of leukoaraiosis, admission NIHSS >3, small artery occlusion subtype of ischemic stroke, and the severity of dVRS in BG and WM were correlated with the severity of dVRS in Hip. CONCLUSION: dVRS is an indicator of cerebral small vessel diseases such as leukoaraiosis and lacune. However, the risk factors of dVRS differ in various brain regions.

Effect of in-hospital medical complications on case fatality post-acute ischemic stroke: data from the China National Stroke Registry.

BACKGROUND: In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke. In this prospective work, the China National Stroke Registry Study, we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke. METHODS: From September 2007 to August 2008, we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China. Medical complications, case fatality and other information recorded at baseline, during hospitalisation, and at 3, 6, and 12 months after stroke onset. Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke. RESULTS: There were 39 741 patients screened, 14 526 patients with acute ischemic stroke recruited, and 11 560 ischemic stroke patients without missing data identified during the 12-month follow-up. Of the 11 560 ischemic patients, 15.8% (1826) had in-hospital medical complications. The most common complication was pneumonia (1373; 11.9% of patients), followed by urinary tract infection and gastrointestinal bleeding. In comparison with patients without complications, stroke patients with complications had a significantly higher risk of death during their hospitalization, and at 3, 6 and 12 months post-stroke. Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period (adjusted OR = 6.946; 95%CI 5.181 to 9.314), at 3 months (adjusted OR = 3.843; 95%CI 3.221 to 4.584), 6 months (adjusted OR = 3.492; 95%CI 2.970 to 4.106), and 12 months (adjusted OR = 3.511; 95%CI 3.021 to 4.080). Having multiple complications strongly increased the death risk of patients. CONCLUSION: Short-term and long-term outcomes of acute stroke patients are affected by in-hospital medical complications.

[A survey of neurological medical care resources in grade II suburban and urban hospitals in Beijing].

OBJECTIVE: To survey the current availability of expertise in diagnosis and treatment of neurological diseases in grade II hospitals (primary hospitals) in Beijing. METHODS: Observation, personal in-depth interview and structured questionnaire methods were conducted to survey the status of neurology health care system. RESULTS: From June to August 2005, 66 grade II suburban and urban hospitals in Beijing of China were investigated. There were 66 grade II hospitals in Beijing (suburban 34; urban 32). Cerebrovascular disease was the most common disease. Accounting for 84% of the hospitalized cases in inpatients neurology departments. In urban areas, the proportion of grade II and grade III hospitals (referral hospitals) was 58:60, but in suburban and rural areas, the proportion was 48:6. In suburban and rural areas. Only 64.7% of the hospitals could provide urokinase treatment, 26.5% could provide recombinant tissue plasminogen activator (rt-PA) treatment and 58.8% had standardized operation protocol. CONCLUSIONS: The grade II hospitals in suburban areas have heavy grave responsibility to deal with cerebrovascular disease, but these hospitals are in lack of specialists, diagnostic equipment and stroke treatment protocols and could not satisfy the medical demand. It is suggested that in the grade II hospitals in suburban areas of Beijing, strengthening personnel training, establishing primary stroke center and setting up telestroke emergency care systems are urgently needed.

[The effect of percutaneous transluminal stenting for vertebrobasilar ischemia on sleep apnea hypopnea syndrome].

OBJECTIVE: To evaluate the relationship between vertebrobasilar ischemia (VBI) and sleep apnea hypopnea syndrome (SAHS) and the effect of percutaneous transluminal stenting for VBI on the clinical parameters of SAHS. METHODS: Twenty patients with VBI were included for clinical history, physical examination with sleep quentionnaires and scored by the Epworth Sleepiness Scale (ESS). Polysomnographic (PSG) studies were performed before and after vascular stenting for VBI. The relationship among clinical factors, the incidence and characteristics of SAHS were analyzed. The changes of apnea hypopnea index (AHI), longest apnea duration (LAD), the total time of apnea and hypopnea (AH%), the lowest arterial saturation (LSaO(2)) and oxygen desaturation index (ODI(4)) before and after vascular stenting were compared. RESULTS: PSG studies were performed in 20 cases of VBI. SAHS was confirmed in 17 of the 20 patients, including mild (10/20), moderate (3/20) and severe (4/20), all were of obstructive. Before stenting therapy, AHI was 11.3/h (6.3 - 23.6)/h, but was 5.0/h (1.6 - 12.7)/h after therapy. LAD was (31.5 +/- 18.6) s vs (19.5 +/- 12.4) s, LSaO2 was (83.6 +/- 7.1)% vs (86.1 +/- 3.3)%, the AH% was [2.3 (0.6% - 9.8)%] vs [6.9% (2.6 - 14.3)%], ODI(4) was 10.1/h (5.3 - 29.0)/h vs 5.8/h (2.7 - 17.0)/h, respectively before and after stenting. AHI, LAD and ODI(4) were significantly decreased and LSaO(2) was increased after stenting for VBI. CONCLUSION: This series of patients with cerebravascular ischemia caused by vertebrobasilar artery stenosis had a high prevalence of obstructive sleep apnea. Vertebrobasilar vascular stenting was shown to be a reliable method of decreasing the degree of sleep-disordered breathing and hypoxia for SAHS patients with vertebrobasilar artery stenosis.