Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct.

BACKGROUND: The role of endovascular therapy for acute stroke with a large infarction has not been extensively studied in differing populations. METHODS: We conducted a multicenter, prospective, open-label, randomized trial in China involving patients with acute large-vessel occlusion in the anterior circulation and an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower values indicating larger infarction) or an infarct-core volume of 70 to 100 ml. Patients were randomly assigned in a 1:1 ratio within 24 hours from the time they were last known to be well to undergo endovascular therapy and receive medical management or to receive medical management alone. The primary outcome was the score on the modified Rankin scale at 90 days (scores range from 0 to 6, with higher scores indicating greater disability), and the primary objective was to determine whether a shift in the distribution of the scores on the modified Rankin scale at 90 days had occurred between the two groups. Secondary outcomes included scores of 0 to 2 and 0 to 3 on the modified Rankin scale. The primary safety outcome was symptomatic intracranial hemorrhage within 48 hours after randomization. RESULTS: A total of 456 patients were enrolled; 231 were assigned to the endovascular-therapy group and 225 to the medical-management group. Approximately 28% of the patients in both groups received intravenous thrombolysis. The trial was stopped early owing to the efficacy of endovascular therapy after the second interim analysis. At 90 days, a shift in the distribution of scores on the modified Rankin scale toward better outcomes was observed in favor of endovascular therapy over medical management alone (generalized odds ratio, 1.37; 95% confidence interval, 1.11 to 1.69; P = 0.004). Symptomatic intracranial hemorrhage occurred in 14 of 230 patients (6.1%) in the endovascular-therapy group and in 6 of 225 patients (2.7%) in the medical-management group; any intracranial hemorrhage occurred in 113 (49.1%) and 39 (17.3%), respectively. Results for the secondary outcomes generally supported those of the primary analysis. CONCLUSIONS: In a trial conducted in China, patients with large cerebral infarctions had better outcomes with endovascular therapy administered within 24 hours than with medical management alone but had more intracranial hemorrhages. (Funded by Covidien Healthcare International Trading [Shanghai] and others; ANGEL-ASPECT ClinicalTrials.gov number, NCT04551664.).

Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion.

BACKGROUND: Data from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited. METHODS: We conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control). The primary outcome was good functional status, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]), at 90 days. Secondary outcomes included a modified Rankin scale score of 0 to 2, distribution across the modified Rankin scale score categories, and quality of life. Safety outcomes included symptomatic intracranial hemorrhage at 24 to 72 hours, 90-day mortality, and procedural complications. RESULTS: Of the 507 patients who underwent screening, 340 were in the intention-to-treat population, with 226 assigned to the thrombectomy group and 114 to the control group. Intravenous thrombolysis was used in 31% of the patients in the thrombectomy group and in 34% of those in the control group. Good functional status at 90 days occurred in 104 patients (46%) in the thrombectomy group and in 26 (23%) in the control group (adjusted rate ratio, 2.06; 95% confidence interval [CI], 1.46 to 2.91, P<0.001). Symptomatic intracranial hemorrhage occurred in 12 patients (5%) in the thrombectomy group and in none in the control group. Results for the secondary clinical and imaging outcomes were generally in the same direction as those for the primary outcome. Mortality at 90 days was 37% in the thrombectomy group and 55% in the control group (adjusted risk ratio, 0.66; 95% CI, 0.52 to 0.82). Procedural complications occurred in 14% of the patients in the thrombectomy group, including one death due to arterial perforation. CONCLUSIONS: In a trial involving Chinese patients with basilar-artery occlusion, approximately one third of whom received intravenous thrombolysis, endovascular thrombectomy within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical care but was associated with procedural complications and intracerebral hemorrhage. (Funded by the Program for Innovative Research Team of the First Affiliated Hospital of USTC and others; ATTENTION ClinicalTrials.gov number, NCT04751708.).

Boosting the Energy Density of Bowl-Like MnO2@Carbon Through Lithium-Intercalation in a High-Voltage Asymmetric Supercapacitor with "Water-In-Salt" Electrolyte.

Highly concentrated "'water-in-salt"' (WIS) electrolytes are promising for high-performance energy storage devices due to their wide electrochemical stability window. However, the energy storage mechanism of MnO2 in WIS electrolytes-based supercapacitors remains unclear. Herein, MnO2 nanoflowers are successfully grown on mesoporous bowl-like carbon (MBC) particles to generate MnO2/MBC composites, which not only increase electroactive sites and inhibit the pulverization of MnO2 particles during the fast charging/discharging processes, but also facilitate the electron transfer and ion diffusion within the whole electrode, resulting in significant enhancement of the electrochemical performance. An asymmetric supercapacitor, assembled with MnO2/MBC and activated carbon (AC) and using 21 m LiTFSI solution as the WIS electrolyte, delivers an ultrahigh energy density of 70.2 Wh kg-1 at 700 W kg-1, and still retains 24.8 Wh kg-1 when the power density is increased to 28 kW kg-1. The ex situ XRD, Raman, and XPS measurements reveal that a reversible reaction of MnO2 + xLi+ + xe-↔LixMnO2 takes place during charging and discharging. Therefore, the asymmetric MnO2/MBC//AC supercapacitor with LiTFSI electrolyte is actually a lithium-ion hybrid supercapacitor, which can greatly boost the energy density of the assembled device and expand the voltage window.

Effect of endovascular treatment on patients with basilar artery occlusion presenting with different pathologic mechanisms: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to summarize the clinical outcomes of endovascular treatment in patients with basilar artery occlusion (BAO) with different pathologic mechanisms. METHODS: Two independent reviewers searched PubMed/MEDLINE, Embase and Cochrane Library database up to December 2022, patients with different BAO pathological mechanisms (BAO with in situ atherosclerosis vs. embolism alone without vertebral artery steno-occlusion vs. embolism from tandem vertebral artery steno-occlusion) were collected and analyzed. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) to assess the associations between clinical outcomes and BAO pathological mechanisms. RESULTS: A total of 1163 participants from 12 studies were identified. Compared with embolism alone, patients with in situ atherosclerotic BAO had a lower favorable outcome rate (modified Rankin score [mRS] 0-2: 34.5% vs. 41.2%; OR 0.83, 95% CI 0.70-0.98; P = 0.03) and moderate outcome rate (mRS 0-3: 45.8% vs. 55.4%; OR 0.65, 95% CI 0.47-0.90; P = 0.01) at 3 months and a higher risk of mortality (29.9% vs. 27.2%; OR 1.31, 95% CI 0.96-1.79, P = 0.09; adjusted OR 1.46, 95% CI 1.08-1.96). Tandem BAO had a comparable mortality risk to that of in situ atherosclerotic BAO (OR 1.37, 95% CI 0.84-2.22; P = 0.48) or embolism alone (OR 1.44, 95% CI 0.65-3.21; P = 0.43), and there were no significant differences in favorable or moderate outcomes between tandem BAO and each of the other two BAO mechanisms. CONCLUSION: Among BAO patients with endovascular treatment, embolism mechanism had better clinical outcomes than in situ atherosclerosis, and atherosclerotic mechanism was associated with a higher mortality at 3 months. RCTs are needed to further confirm clinical outcomes of BAO by different mechanisms.

Advancing Alzheimer's research: Radiomics visualization of the default mode network in cerebral perfusion imaging.

OBJECTIVE: Alzheimer's disease, an irreversible neurological condition, demands timely diagnosis for effective clinical intervention. This study employs radiomics analysis to assess image features in default mode network cerebral perfusion imaging among individuals with cognitive impairment. METHODS: A radiomics analysis of cerebral perfusion imaging was conducted on 117 patients with cognitive impairment. They were divided into training and validation sets in a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) and Random Forest were employed to select and model image features, followed by logistic regression analysis of LASSO and Random Forest results. Diagnostic performance was assessed by calculating the area under the curve (AUC). RESULTS: In the training set, LASSO achieved AUC of 0.978, Random Forest had an AUC of 0.933. In the validation set, LASSO had AUC of 0.859, Random Forest had AUC of 0.986. By conducting Logistic Regression analysis in combination with LASSO and Random Forest, we identified a total of five radiomics features, with four related to morphology and one to textural features, originating from the medial prefrontal cortex and middle temporal gyrus. In the training set, Logistic Regression achieved AUC of 0.911, while in the validation set, it attained AUC of 0.925. CONCLUSION: The medial prefrontal cortex and middle temporal gyrus are the two brain regions within the default mode network that hold the highest significance for Alzheimer's disease diagnosis. Radiomics analysis contributes to the clinical assessment of Alzheimer's disease by delving into image data to extract deeper layers of information.

Omni-OTPE: Omnidirectional Optimal Real-Time Ground Target Position Estimation System for Moving Lightweight Unmanned Aerial Vehicle.

Ground target detection and positioning systems based on lightweight unmanned aerial vehicles (UAVs) are increasing in value for aerial reconnaissance and surveillance. However, the current method for estimating the target's position is limited by the field of view angle, rendering it challenging to fulfill the demands of a real-time omnidirectional reconnaissance operation. To address this issue, we propose an Omnidirectional Optimal Real-Time Ground Target Position Estimation System (Omni-OTPE) that utilizes a fisheye camera and LiDAR sensors. The object of interest is first identified in the fisheye image, and then, the image-based target position is obtained by solving using the fisheye projection model and the target center extraction algorithm based on the detected edge information. Next, the LiDAR's real-time point cloud data are filtered based on position-direction constraints using the image-based target position information. This step allows for the determination of point cloud clusters that are relevant to the characterization of the target's position information. Finally, the target positions obtained from the two methods are fused using an optimal Kalman fuser to obtain the optimal target position information. In order to evaluate the positioning accuracy, we designed a hardware and software setup, mounted on a lightweight UAV, and tested it in a real scenario. The experimental results validate that our method exhibits significant advantages over traditional methods and achieves a real-time high-performance ground target position estimation function.

Broadband near-infrared luminescence in erbium ion single-doped tellurite glass for optical amplification.

This Letter proposes a simple approach for the realization of a broadband near-infrared (NIR) luminescence source in erbium ion single-doped tellurite glass, which is bent on tailoring the network structure. Under the collective action of multiple broadening mechanisms and fluorescence capture, broadband fluorescence with a full width at half maximum (FWHM) of 132 nm (1500-1632 nm) was achieved. To the best of our knowledge, this is the largest FWHM reported for erbium single-doping of tellurite glass materials. Meanwhile, this fiberglass exhibits excellent thermal stability and high visible to NIR transmittance. Furthermore, a novel equivalent five-level Stark splitting model is proposed that can effectively explain the spectrum broadening. This study is beneficial for the further development of broadband optical amplification.

Effects of Antecedent Intravenous Thrombolysis on Endovascular Treatment of Acute Stroke Using Tirofiban.

PURPOSE: To investigate whether preceding intravenous thrombolysis combined with tirofiban in patients with acute ischemic stroke undergoing endovascular treatment is safe and effective. MATERIALS AND METHODS: Consecutive data were identified for patients who experienced acute ischemic stroke and were admitted to 2 comprehensive stroke centers from January 2015 to August 2021. All patients were divided into 2 groups-a thrombolytic with tirofiban group and a tirofiban-alone group-on the basis of whether intravenous thrombolysis before emergency endovascular angioplasty was used. Multivariate regression and propensity adjustment analyses were performed to characterize differences in safety and clinical outcomes between the 2 groups. RESULTS: Of 373 eligible patients, 111 (29.7%) were treated with thrombolysis with tirofiban. There was a significant difference in the rate of any intracerebral hemorrhage (35.1% vs 24.8%; P = .04) but not in the rates of symptomatic intracerebral hemorrhage (16.2% vs 11.5%; P = .23) and reocclusion at 24 hours (5.4% vs 7.6%; P = .51) between the 2 groups. Multivariate regression analysis revealed that intravenous thrombolysis was not associated with any or symptomatic intracerebral hemorrhage, artery occlusion, functional outcome, or death at the 3-month follow-up (all adjusted P > .05). After propensity adjustment, the thrombolytic with tirofiban group showed nonsignificant rates of clinical and safety outcomes compared with those of the tirofiban-alone group (all P > .05). CONCLUSIONS: Tirofiban may be used without increasing the risk of adverse events in selected patients who experienced ischemic stroke and were treated with intravenous thrombolysis and endovascular therapy.

New stress-induced hyperglycaemia markers predict prognosis in patients after mechanical thrombectomy.

OBJECTIVE: Stress-induced hyperglycaemia (SIH) is a frequent phenomenon that occurs in patients with acute ischaemic stroke. The aim of this study was to investigate the relationship between SIH and the prognosis of mechanical thrombectomy (MT) patients according to the stress hyperglycemia ratio (SHR) and glycaemic gap (GG) indicators, as well as explore its relationship with haemorrhagic transformation (HT). METHODS: Patients were enrolled from January 2019 to September 2021 in our centre. SHR was calculated as fasting blood glucose divided by the A1c-derived average glucose (ADAG). GG was calculated as fasting blood glucose minus ADAG. Logistic regression was used to analyse SHR, GG with outcome and HT. RESULTS: A total of 423 patients were enrolled in the study. The incidence of SIH was as follows: 191/423 of patients with SHR > 0.89, 169/423 of patients with GG > -0.53. SHR > 0.89 (OR: 2.247, 95% CI: 1.344-3.756, P = 0.002) and GG>-0.53 (OR: 2.305, 95% CI: 1.370-3.879, P = 0.002) were both associated with poor outcomes (modified Rankin Scale > 2) at Day 90 and an increase risk of HT. Additionlly, receiver operating characteristic curves were used to assess the predictive performance of the SHR and GG on outcomes. The area under the curve for SHR to predict poor outcomes was 0.691, with an optimal cut-off value of 0.89. The area under the curve for GG was 0.682, with an optimal cut-off value of -0.53. CONCLUSION: High SHR and high GG are strongly associated with poor 90-day prognosis in MT patients and an increased risk of HT.

Endovascular treatment in patients with middle cerebral artery occlusion of different aetiologies.

PURPOSE: The purpose of this study was to evaluate differences in endovascular treatment (EVT) outcomes in M1 segment middle cerebral artery occlusion (MCAO) patients with different pathologic subtypes. METHODS: Patients with MCAO who received EVT from July 2014 to December 2020 were categorized into three groups: embolism without internal carotid artery steno-occlusion (MCAO-E), in situ atherosclerotic thrombosis (MCAO-AS) and embolism from tandem ICA steno-occlusion (MCAO-T). Baseline characteristics, EVT-related factors and clinical outcomes were compared between groups. Multivariable regression analyses were performed to evaluate the relationship between aetiologic classification and outcomes at 90 days after stroke. RESULTS: Among eligible patients (n = 220), MCAO-E (n = 129, 58.6%) was the most common aetiology, followed by MCAO-AS (n = 47, 21.4%) and MCAO-T (n = 44, 20.0%). Patients with MCAO-E were significantly older but had a lower rate of dyslipidaemia and smoking history than those with MCAO-AS. Although patients with MCAO-AS and MCAO-T more often required rescue balloon angioplasty and stenting (p < 0.001), no significant difference in the rate of final recanalization was found. Patients in the MCAO-AS group obtained better functional outcomes (90-day modified Rankin Scale score, 0-2) (p = 0.002) and lower mortality than in the MCAO-E group (p = 0.009). On multivariable logistic regression, we failed to find that stroke subtype was an independent predictor of functional outcomes and mortality. CONCLUSIONS: Patients with acute MCA M1 occlusion stroke due to different pathogeneses had comparable successful recanalization rates and functional independence at 90 days. The optimal management for MCAO patients with different aetiologies requires further research.

Flow diagram of the differential diagnosis and clinical decision making in a rare case of contrast-induced encephalopathy following cardiac catheterization: a case report.

BACKGROUND: Contrast-induced encephalopathy (CIE) is considered as an uncommon complication following cardiac catheterization. Due to the varied manifestations, CIE has no formal diagnostic criteria. In fact, the incidence of CIE may be greatly underestimated because of the difficulty in its differential diagnosis with other cerebrovascular complications. Thus, making a flow diagram according to patients' clinical symptoms and examinations after cardiac catheterization to help clinicians diagnose CIE is important and needed. CASE PRESENTATION: In this report, we describe a case of probable CIE in a 66-year-old Chinese man with hypertension who underwent cardiac catheterization with stents placement in the bifurcation lesion, during which 80 ml iopromide contrast was used. About 2 h following the procedure, the patient lost his consciousness suddenly and suffered from a status epilepticus. Malignant arrhythmias were not found through continuous electrocardiogram monitoring, but mild ST-segment elevation was displayed in leads I and aVL. The echocardiography, plasma glucose and electrolyte levels were normal. Emergency re-angiography with percutaneous transluminal coronary angioplasty was performed in the culprit lesion, which involved 60 ml iopromide contrast. However, the patient remained unconsciousness and epilepticus. Non-contrast computed tomography (CT) of the head showed cortical and subarachnoid enhancement as well as prolonged retention of contrast media in the middle cerebral artery. With supportive treatment of intravenous hydration, sedative and dehydrant, the patient recovered 3 h later and finally discharged without any neurological deficits. CONCLUSIONS: CIE is an acute reversible encephalopathy induced by contrast media. It is exceptionally challenging to make the diagnosis of CIE following cardiac catheterization since there is a lack of consensus on the definition of CIE. Via this case we reviewed the related literatures, through which a flow diagram of the differential diagnosis and clinical decision making was given, which could help to differentiate CIE from other neurological complications following cardiac catheterization.

The relationship between occlusion patterns and outcomes after thrombectomy in patients with acute internal carotid artery occlusion.

BACKGROUND AND PURPOSES: Ischemic stroke caused by acute internal carotid artery occlusions (AICO) is usually associated with high disability and mortality. We aimed to investigate whether occlusion patterns significantly influence clinical outcome in patients receiving endovascular thrombectomy (EVT). PATIENTS AND METHODS: We performed a retrospective analysis of databases from two comprehensive stroke centers and consecutively investigated patients who had underwent EVT. AICO was defined as acute internal carotid artery occlusions (cervical segment to terminal segment). The clinical characteristics, intervention parameters, and prognosis data were collected. Leptomeningeal collaterals (LMC) were assessed with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale (ASITN/SIRs), graded on a 5-point scale. The occlusion patterns based on Willisian collaterals were categorized into I-type, L-type, and T-type by contralateral carotid artery injections at digital subtraction angiography. Multivariate regression models were applied to evaluate the relationship between occlusion patterns and the prognosis of patients at 90 days after stroke. RESULTS: A total of 213 patients were included in the study. Of those,142 (66.7%) achieved successful reperfusion and 64 (30.0%) achieved favorable outcomes at 90 days. Overall, 26 (12.2%), 117 (54.9%), and 70 (32.9%) cases respectively suffered from I-type, L-type, and T-type occlusion. In addition, patients with I-type occlusions had a higher percentage of complete LMC compared with L-type or T-type occlusions (88.5% versus 30.8% versus 27.1%, P< 0.0167). In multivariable logistic regression, we found T-type occlusion was no longer an independent predictor of poor functional outcomes in AICO after adjusting LMC (T versus I, OR, 2.555, 95%CI: 0.717-9.103, P = 0.148; L versus I, OR, 0.815, 95%CI: 0.258-2.574, P = 0.727). CONCLUSIONS: For ACIO, occlusion patterns are still a topic that needs attention. Furthermore, compensatory LMC may affect the association between occlusion patterns and functional prognosis in AICO. Occlusion patterns and LMC status distinguish the nature and impact of AICO on expected EVT and subsequent clinical outcomes.

High Pseudocapacitance-Driven CoC2 O4 Electrodes Exhibiting Superior Electrochemical Kinetics and Reversible Capacities for Lithium-Ion and Lithium-Sulfur Batteries.

In this study, cuboid-like anhydrous CoC2 O4 particles (CoC2 O4 -HK) are synthesized through a potassium citrate-assisted hydrothermal method, which possess well-crystallized structure for fast Li+ transportation and efficient Li+ intercalation pseudocapacitive behaviors. When being used in lithium-ion batteries, the as-prepared CoC2 O4 -HK delivers a high reversible capacity (≈1360 mAh g-1 at 0.1 A g-1 ), good rate capability (≈650 mAh g-1 at 5 A g-1 ) and outstanding cycling stability (835 mAh g-1 after 1000 cycles at 1 A g-1 ). Characterizations illustrate that the Li+ -intercalation pseudocapacitance dominates the charge storage of CoC2 O4 -HK electrode, together with the reversible reaction of CoC2 O4 +2Li+ +2e- →Co+Li2 C2 O4 on discharging and charging. In addition, CoC2 O4 -HK particles are also used together with carbon-sulfur composite materials as the electrocatalysts for lithium-sulfur (Li-S) battery, which displays a gratifying sulfur electrochemistry with a high reversibility of 1021.5 mAh g-1 at 2 C and a low decay rate of 0.079% per cycle after 500 cycles. The density functional theory (DFT) calculations show that CoC2 O4 /C can regulate the adsorption-activation of reaction intermediates and therefore boost the catalytic conversion of polysulfides. Therefore, this work presents a new prospect of applying CoC2 O4 as the high-performance electrode materials for rechargeable Li-ion and Li-S batteries.

Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial.

Importance: Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy. Objective: To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion. Design, Setting, and Participants: This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022. Interventions: Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy. Main Outcomes and Measures: The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours. Results: Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]). Conclusions and Relevance: Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.

Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China: A Real-World Nationwide Registry.

BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population. METHODS: We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome. RESULTS: Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56-73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55-72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%; P=0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age <66 years (odds ratio [OR], 1.733 [95% CI, 1.213-2.476]), time from onset to puncture >6 hours (OR, 1.536 [95% CI, 1.065-2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325-3.633]), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085-3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098-2.413]), and National Institutes of Health Stroke Scale score 24 hours after the procedure <11 (OR, 9.126 [95% CI, 6.222-13.385]). CONCLUSIONS: Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.

NMR for Mixture Analysis: Concentration-Ordered Spectroscopy.

A novel approach, concentration-ordered NMR spectroscopy (CORDY), is being proposed based on the principle that the ratio of the NMR peak area to its associated number of spins is proportional to the concentration of the assigned compound. Besides, prior information of chemical shift distribution and line shape characteristics of different chemical groups is utilized to shrink the solution space. CORDY generates a pseudo-two-dimensional NMR spectrum with chemical shifts in one axis and concentrations in the other, resulting in both separation and quantitation of components in complex samples. The method was validated by application to three samples-a model mixture containing six amino acids, sugar-free Red Bull, and human urine. It was demonstrated that CORDY could successfully separate the components with up to 2 orders of magnitude in the concentration dimension for the samples used in the current study. In addition, a combination of CORDY and DOSY (CORDY-DOSY) has been found to be more efficient in resolving the molecules with similar concentrations or self-diffusion coefficients.

Improving SERS Sensitivity toward Trace Sulfonamides: The Key Role of Trade-Off Interfacial Interactions among the Target Molecules, Anions, and Cations on the SERS Active Surface.

In recent years, ensuring the rational use and effective control of antibiotics has been a major focus in the eco-environment, which requires an effective monitoring method. However, on-site rapid detection of antibiotics in water environments remains a challenging issue. In this study, surface-enhanced Raman spectroscopy (SERS) was used to systematically achieve selective, rapid, and highly sensitive detection of sulfonamides, based on their fingerprint characteristics. The results show that the trade-off between the competitive and coadsorption behaviors of target molecules and agglomerates (inorganic salts) on the surface of the SERS substrate determines whether the molecules can be detected with high sensitivity. Based on this, the qualitative differentiation and quantitative detection of three structurally similar antibiotics, sulfadiazine, sulfamerazine, and sulfamethazine, were achieved, with the lowest detectable concentration being 1 µg/L for sulfadiazine and 50 µg/L for sulfamerazine and sulfamethazine.

Enhancing Interfacial Contact in Solid-State Batteries with a Gradient Composite Solid Electrolyte.

Solid-state batteries promise to meet the challenges of high energy density and high safety for future energy storage. However, poor interfacial contact and complex manufacturing processes limit their practical applications. Herein, a simple strategy is proposed to enhance interfacial contact by introducing a gradient composite polymer solid electrolyte (GCPE), which is prepared by a facile UV-curing polymerization technique. The high-Li6.4 La3 Zr1.4 Ta0.6 O12 (LLZTO)-content side of the electrolyte exhibits high oxidation resistance (5.4 V versus Li+ /Li), making it compatible with a high-voltage cathode material, whereas the LLZTO-deficient side achieves excellent interfacial contact with the Li metal anode, facilitating uniform Li deposition. Benefiting from the elaborate composition and structure of GCPE films, the symmetric Li//Li cell exhibits a low-voltage hysteresis potential of 42 mV and a long cycle life of >1900 h without short-circuiting. The Li//LiFePO4 solid-state batteries deliver a capacity of 161.0 mA h g-1 at 60 °C and 0.1 C (82.4% capacity is retained after 200 cycles). Even at 80 °C, the cell still shows an outstanding capacity of 132.9 mAh g-1 at 0.2 C after 100 cycles. The design principle of gradient electrolytes provides a new path for achieving enhanced interfacial contact in high-performance solid-state batteries.

A clinical-radiomics nomogram may provide a personalized 90-day functional outcome assessment for spontaneous intracerebral hemorrhage.

OBJECTIVES: To develop and validate a noncontrast computed tomography (NCCT)-based clinical-radiomics nomogram to identify spontaneous intracerebral hemorrhage (sICH) patients with a poor 90-day prognosis on admission. METHODS: In this double-center retrospective study, data from 435 patients with sICH (training cohort: n = 244; internal validation cohort: n = 104; external validation cohort: n = 87) were reviewed. The radiomics score (Rad-score) was calculated based on the coefficients of the selected radiomics features. A clinical-radiomics nomogram was developed by using independent predictors of poor outcome at 90 days through multivariate logistic regression analysis in the training cohort and was validated in the internal and external cohorts. RESULTS: At 90 days, 200 of 435 (46.0%) patients had a poor prognosis. The clinical-radiomics nomogram was developed by six independent predictors namely midline shift, NCCT time from sICH onset, Glasgow Coma Scale score, serum glucose, uric acid, and Rad-score. In identifying patients with poor prognosis, the clinical-radiomics nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.81 in the training cohort, an AUC of 0.78 in the internal validation cohort, and an AUC of 0.73 in the external validation cohort. The calibration curve revealed that the clinical-radiomics nomogram showed satisfactory calibration in the training and internal validation cohorts (both p > 0.05), but slightly poor agreement in the external validation cohort (p < 0.05). CONCLUSIONS: The clinical-radiomics nomogram is a valid computer-aided tool that may provide personalized risk assessment of 90-day functional outcome for sICH patients. KEY POINTS: • The proposed Rad-score was significantly associated with 90-day poor functional outcome in patients with sICH. • The clinical-radiomics nomogram showed satisfactory calibration and the most net benefit for discriminating 90-day poor outcome. • The clinical-radiomics nomogram may provide personalized risk assessment of 90-day functional outcome for sICH patients.

Impact of the COVID-19 pandemic and post-epidemic periods on the process of endovascular treatment for acute anterior circulation ischaemic stroke.

BACKGROUND AND PURPOSE: The purpose of our study was to analyse endovascular treatment (EVT) in patients presenting acute anterior circulation ischemic stroke with large-vessel occlusion (AIS-LVO) during the pandemic and post-epidemic periods. METHODS: Patients with AIS-LVO of the anterior circulation who underwent EVT were enrolled. According to the times of Wuhan closure and reopening, patients were divided into a pre-pandemic group (from November 8, 2019, to January 22, 2020), pandemic group (from January 23, 2020, to April 8, 2020) and post-epidemic group (from April 9, 2020, to June 24, 2020). The primary endpoints were the time delay among symptom onset to arriving hospital door, to groining puncture and to vascular reperfusion. Secondary endpoints were the functional outcomes evaluated by 90-day modified Rankin scale (mRS) score. RESULTS: In total, the times from onset to reperfusion (OTR, median 356 min vs. 310 min, p = 0.041) and onset to door (OTD, median 238 min vs. 167 min, p = 0.017) were prolonged in the pandemic group compared to the pre-pandemic group, and the delay continue in the post-epidemic period. In the subgroup analysis, the time from door to imaging (DTI) was significantly prolonged during the pandemic period. Interestingly, the prolonged DTI was corrected in the directly admitted subgroup during post-epidemic period. In addition, the functional outcomes showed no significant differences across the three periods. CONCLUSIONS: Total time and prehospital time were prolonged during the pandemic and post-epidemic periods. Urgent public education and improved in-hospital screening processes are necessary to decrease time delays.