Management of intervenable factors to reduce vascular complications in patients with internal carotid artery occlusion treated by non-emergency endovascular treatment.

Objective: This study aims to identify risk factors for vascular complications during non-emergency endovascular treatment in patients with internal carotid artery occlusion (ICAO) and to propose potential interventions. Method: A retrospective analysis of 92 patients with ICAO who received non-emergency endovascular treatment in our center from 1 January 2018 to 31 June 2023, was conducted. The correlation between intraoperative vascular complications and potential risk factors was studied, and interaction analysis was performed. Results: Our findings revealed that the use of non-neurology guide wires to open vessels (adjusted OR: 4.1, 95%CI: 1.3-12.8; p = 0.014) and glycosylated hemoglobin (HbA1c) ≥ 6.5 mmol/L (adjusted OR: 3.2, 95%CI: 1.2-8.9; p = 0.023) was significantly associated with vascular complications in non-emergency endovascular treatment of ICAO patients. The restricted cubic spline (RCS) showed that the higher the HbA1c level, the higher the risk of vascular complications. Conclusion: The use of non-neurology guide wires for vessel opening during non-emergency endovascular treatment in patients with ICAO increases the risk of vascular complications. Preoperative assessment and management of HbA1c levels can reduce the incidence of intraoperative vascular complications.

Efficacy and Safety of Butylphthalide in Patients With Acute Ischemic Stroke: A Randomized Clinical Trial.

Importance: DL-3-n-butylphthalide (NBP) is a drug for treating acute ischemic stroke and may play a neuroprotective role by acting on multiple active targets. The efficacy of NBP in patients with acute ischemic stroke receiving reperfusion therapy remains unknown. Objective: To assess the efficacy and safety of NBP in patients with acute ischemic stroke receiving reperfusion therapy of intravenous thrombolysis and/or endovascular treatment. Design, Setting, and Participants: This multicenter, double-blind, placebo-controlled, parallel randomized clinical trial was conducted in 59 centers in China with 90-day follow-up. Of 1236 patients with acute ischemic stroke, 1216 patients 18 years and older diagnosed with acute ischemic stroke with a National Institutes of Health Stroke Scale score ranging from 4 to 25 who could start the trial drug within 6 hours from symptom onset and received either intravenous recombinant tissue plasminogen activator (rt-PA) or endovascular treatment or intravenous rt-PA bridging to endovascular treatment were enrolled, after excluding 20 patients who declined to participate or did not meet eligibility criteria. Data were collected from July 1, 2018, to May 22, 2022. Interventions: Within 6 hours after symptom onset, patients were randomized to receive NBP or placebo in a 1:1 ratio. Main Outcomes and Measures: The primary efficacy outcome was the proportion of patients with a favorable outcome based on 90-day modified Rankin Scale score (a global stroke disability scale ranging from 0 [no symptoms or completely recovered] to 6 [death]) thresholds of 0 to 2 points, depending on baseline stroke severity. Results: Of 1216 enrolled patients, 827 (68.0%) were men, and the median (IQR) age was 66 (56-72) years. A total of 607 were randomly assigned to the butylphthalide group and 609 to the placebo group. A favorable functional outcome at 90 days occurred in 344 patients (56.7%) in the butylphthalide group and 268 patients (44.0%) in the placebo group (odds ratio, 1.70; 95% CI, 1.35-2.14; P < .001). Serious adverse events within 90 days occurred in 61 patients (10.1%) in the butylphthalide group and 73 patients (12.0%) in the placebo group. Conclusions and Relevance: Among patients with acute ischemic stroke receiving intravenous thrombolysis and/or endovascular treatment, NBP was associated with a higher proportion of patients achieving a favorable functional outcome at 90 days compared with placebo. Trial Registration: ClinicalTrials.gov Identifier: NCT03539445.

Endovascular recanalization for symptomatic subacute and chronically occluded internal carotid artery: feasibility, safety, a modified radiographic classification system, and clinical outcomes.

PURPOSE: To evaluate the feasibility and safety of endovascular recanalization for symptomatic subacute and chronic internal carotid artery occlusion (ICAO); to propose a newly modified radiographic classification of ICAO that can rigorously identify suitable candidates for endovascular ICAO treatment. METHODS: We included 42 consecutive patients who had ICAO with ischaemic symptoms refractory to medical therapy. We examined the symptomatology, complications, follow-up results and radiographic images of ICAO receiving attempted endovascular treatment. We attempted to stratify all radiographic images into categories based on morphological occlusion patterns, occlusion segments and distal ICA reconstitution on digital subtraction angiography (DSA). RESULTS: Four types (A-D) of radiographic ICAO were identified. We redefined type B as having a tapered stump but no distal lumen. The rate of successful recanalization was 83.33% (35/42 ICAOs; type A, 18/20; type B, 7/10; type C, 10/11; type D, 0/1). The perioperative complication rate was 11.90% (5/42), including 3 asymptomatic distal embolisms, 1 symptomatic cerebral infarction and 1 asymptomatic carotid artery dissection. None of these technique-related complications led to severe neurological damage or death. Modified Rankin Scale (mRS) scores after 1-20 months of follow-up were significantly decreased in successfully revascularized patients (P < 0.001). There was no significant change in mRS scores in the 7 patients in whom recanalization failed (P > 0.05). CONCLUSIONS: Endovascular recanalization seems to achieve technical success and clinical improvement for symptomatic subacute and chronic ICAO. Additionally, our newly modified radiographic classification of ICAO may be valuable in assessing the technical feasibility and safety of procedures in symptomatic ICAO patients.

Self-absorption reduction in laser-induced breakdown spectroscopy using laser-stimulated absorption: publisher's note.

This publisher's note contains corrections to Opt. Lett.40, 5224 (2015).OPLEDP0146-959210.1364/OL.40.005224.

In Situ Surface-Enhanced Raman Spectroscopy Detection of Uranyl Ions with Silver Nanorod-Decorated Tape.

Surface-enhanced Raman spectroscopy (SERS) has been utilized for rapid analysis of uranyl ions (UO2 2+) on account of its fast response and high sensitivity. However, the difficulty of fabricating a suitable SERS substrate for in situ analysis of uranyl ions severely restricts its practical application. Hence, we proposed flexible and adhesive SERS tape decorated with silver nanorod (AgNR) arrays for in situ detection of UO2 2+. The SERS tape was fabricated through a simple "paste & peel off" procedure by transferring the slanted AgNR arrays from silicon to the transparent tape surface. UO2 2+ can be easily in situ detected by placing the AgNR SERS tape into an aqueous solution or pasting it onto the solid matrix surface due to the excellent transparent feature of the tape. The proposed SERS tape with well-distributed AgNRs effectively improved the reproducibility and sensitivity for UO2 2+ analysis. UO2 2+ with concentration as low as 100 nM was easily detected. Besides, UO2 2+ adsorbed on an iron disc and rock surface also can be rapidly in situ detected. With its simplicity and convenience, the AgNR SERS tape-based SERS technique offers a promising approach for environmental monitoring and nuclear accident emergency detection.

The spectral background problem of portable fiber Raman instruments and a solution for the on-site detection of extremely weak signals.

High sensitivity and low spectral background of the Raman instruments are essential for the analysis of weak Raman-active samples. The design of the present portable fiber Raman probes leads to an interferential background that limits the application of the portable Raman technique in many situations. In this work, the spectral backgrounds of commercial probes with different optical configurations were analyzed, and the results indicated the backgrounds arose from the objective lenses and the dichroic filters. A universal solution was proposed, and a flat and clean background was achieved by utilizing the longpass optical configuration and an off-axis parabolic mirror. Combined with a high-throughput spectrometer with a research-grade CCD, this portable Raman equipment was successfully applied to identify the corrosion products on the surface of uranium (with extremely weak Raman signals). The developed portable Raman instrument with high sensitivity and low background is anticipated to be very useful for the on-site Raman detection of weak signals.

A Follow-up Study of Cerebral Microbleeds in Patients Who Received Stents for Symptomatic Cerebral Artery Stenosis.

BACKGROUND: The aims of this study were to explore (i) the dynamic changes in cerebral microbleeds (CMBs) in patients with symptomatic cerebral artery stenosis who received endovascular stent-assisted angioplasty and (ii) the risk factors associated with the new incidence of CMBs as well as whether CMBs increased the risk of vascular events in these patients. METHODS: Clinical information and magnetic resonance images were collected on admission and 3 months after endovascular stent-assisted angioplasty. Based on susceptibility-weighted imaging, the patients were divided into groups with or without newly developed CMBs, and between-group differences in risk factors were compared. We also compared whether CMBs increased the risk of vascular events among those patients. RESULTS: Seventy-three patients completed the relevant follow-up examinations. After an average follow-up period of 109 days, 7 (9.6%) patients showed new CMBs. A univariate analysis showed that the number of lacunar infarcts and the increase in systolic blood pressure were higher in patients with new CMBs than in those without new CMBs, and these differences were significant (P = 0.034, P = 0.001). Increased systolic blood pressure was an independent risk factor for developing new CMBs (P = 0.017). CONCLUSIONS: CMBs may be a continuously progressing cerebral small-vessel disease. The newly developed CMBs in patients with intracranial and/or extracranial stents were associated with increased systolic blood pressure but not with the number of baseline CMBs.

A practical wide-field Raman imaging method with high spectral and spatial resolution.

Raman imaging has a great advantage in characterizing inhomogeneous systems. A practical wide-field Raman imaging platform is developed that shows major improvements on imaging speed, sensitivity, and resolution. Different from the traditional Raman imaging systems using the wavelength-fixed lasers and the chromatic dispersion devices, this system adopts an inverted architecture, integrated with a tunable laser and the wavelength-fixed filters. Owing to the high transmission of the fixed filters, the imaging sensitivity can be improved 5-10 times in comparison to the present wide-field Raman imaging setups using liquid-crystal tunable filters. Via combining with the high-power tunable laser, Raman images could be obtained in minutes and the Raman shift of the images could be tuned easily and accurately. The resolution of this system can reach 1.5 cm-1 in the spectrum and 490 nm in space, which could provide more fingerprint details of the analytes. This effective Raman imaging method allowing us to see chemical spatial variations on microscale is anticipated to be widely applied in scientific research fields.

New spectral reduction algorithm for echelle spectrometer in laser-induced breakdown spectroscopy.

In this work, a new spectral reduction algorithm for the echelle spectrometer was proposed. Unlike conventional approaches, the key concept in this algorithm is to model the spectrogram rather the spectrometer, which makes the algorithm more adaptive to different designs. This algorithm also introduces a dynamic adjusting procedure for generating optimized spectra from laser-induced plasmas. This additional step improved the spectrum stability and absolute line intensity of the spectrum and yielded better quantification performance. Experimental results demonstrated that the quantification results of analyzing aluminum alloy samples were improved using this new algorithm.

Determinations of trace boron in superalloys and steels using laser-induced breakdown spectroscopy assisted with laser-induced fluorescence.

Boron (B) is widely applied in microalloying of metals. As a typical light element, however, determination of boron in alloys with complex matrix spectra is still a challenge for laser-induced breakdown spectroscopy (LIBS) due to its weak line intensities in the UV-visible-NIR range and strong spectral interference from the matrix spectra. In this study, a wavelength-tunable laser was used to enhance the intensities of boron lines selectively. The intensities of B I 208.96 nm from boron plasmas were enhanced approximately 3 and 5.8 times while the wavelength-tunable laser was tuned to 249.68 and 249.77 nm, respectively. Utilizing the selective enhancement effect, accurate determinations of trace boron in nickel-based superalloys and steels were achieved by laser-induced breakdown spectroscopy assisted by laser-induced fluorescence (LIBS-LIF), with limits of detection (LoDs) of 0.9 and 0.5 ppm, respectively. The results demonstrated that LIBS-LIF can hopefully be used in boron determinations and has great potential for improving the ability of LIBS to determine light elements in alloys with a complex matrix.

Self-absorption reduction in laser-induced breakdown spectroscopy using laser-stimulated absorption.

The self-absorption effect is one of the main bottlenecks for the laser-induced breakdown spectroscopy (LIBS) technique. In this Letter, LIBS assisted by laser-stimulated absorption (LSA-LIBS) is proposed to solve this problem. The process of LSA in self-absorption reduction is discussed and confirmed. The serious self-absorption phenomena of spectral lines (K, Mn, and Al) were not observed in LSA-LIBS. The full width at half-maximum (FWHM) of K, Mn, and Al was reduced by about 58%, 25%, and 52%, respectively. The results demonstrate the capability of this approach to self-absorption reduction in the LIBS technique.

[Quantitative analysis of vanadium and titanium in steel samples using LIBS].

The concentrations of vanadium and titanium elements in the steel samples were quantitatively analyzed by Laser-induced breakdown spectroscopy technique in the present paper. The lines of V (VI: 440.85 nm) and Ti (Ti I: 334.19 nm) were chosen as the quantitative analysis spectral lines, while spectral line of Fe (Fe I: 438.35 nm) was chosen as the internal calibration line due to it being the matrix element. Then the calibration curves of V and Ti elements were established with basic calibration method and internal calibration method respectively to quantitatively analyze the concentrations of vanadium and titanium elements in steel. The experimental results showed that the fitting correlation coefficient (R2) of vanadium and titanium elements are 0.9875 and 0.9909 when using basic calibration method, and their maximum relative errors of measurement are 11.09% and 4% respectively; while the fitting correlation coefficient (R2) of vanadium and titanium elements reachs 0.9952 and 0.9921 respectively when using internal calibration method, at the same time, the relative errors of measurement for vanadium and titanium elements were decreased to be lower than 4%. The results of this study demonstrated that the concentration measurement of vanadium and titanium elements in the steel was more suitable with internal calibration method in laser-induced breakdown spectroscopy.

[Correlation of collateral circulation and prognosis in patients with acute cerebral infarction].

OBJECTIVE: To evaluate the correlation of collateral circulation with prognosis in patients with acute cerebral infarction. METHODS: A total of 260 patients with acute ischemic stroke within 1 week of symptom onset underwent digital subtraction angiogram (DSA). The National Institutes of Health Stroke Scale (NIHSS) scores were obtained at admission. And the Modified Rankin scores (mRS) were assessed at a 3-month follow-up. The follow-up data were acquired through clinic visits or telephone interviews. RESULTS: Among them, 86 were found to have intra- or extra-cranial culprit artery severe stenosis or occlusion. And 36 (75.00%) in 48 patients had collateral arterial circulation while 11 (28.64%) in 38 patients posterior circulation. There were statistical differences in the NIHSS scores at admission and favorite clinical outcome (mRS ≤ 2) at 3-month follow-up for patients with and without collateral circulation. CONCLUSION: DSA is the golden standard for the assessment of collateral circulation in patients with severe cerebral artery stenosis or occlusion. The prognosis is better in stroke patients with collateral circulation.

Clinical study of PTAS therapy for patients with ischemia cerebrovascular disease caused by artery stenosis.

The curative efficacy of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of patients with ischemia cerebrovascular disease caused by artery stenosis was explored. The clinical data of 111 patients with ischemia cerebrovascular disease receiving PTAS in Guangdong Province General Hospital from Aug. 2007 to Nov. 2009 were retrospectively analyzed. In total 132 stents were implanted in the 111 patients. The mortality and rate of neural and non-neural complications were assessed perioperatively. Outcomes [including the frequency of transient ischemic attack (TIA), stroke, or death from vascular diseases) were assessed after operation. NIHSS rating was performed in all cases before and at first week, 6th month and 12th month after the operation. The PTAS success rate was 100%. The degree of stenosis was reduced after PTAS. The total complication rate during perioperative period was 15.3% (the rate of neural complications was 3.6%). Sixty-seven patients were followed up. Three patients (4.48%) developed cerebrovascular events within 1 month, containing one case of TIA, one case of ipsilateral mild stroke and one case of contralateral mild stroke. No severe stroke or death was observed. During a follow-up period of 12 months 7 patients had cerebrovascular events (10.44%), including 2 cases of ipsilateral TIA (2.99%), 2 cases of ipsilateral mild stroke and 2 cases of contralateral mild stroke (2.99%), one case of severe stroke (1.49%). In 13 patients receiving DSA re-examination one year after PTAS, 2 patients (15.38%) had in-stent restenosis. NIHSS scores were obviously decreased during a follow-up period as compared with those pre-operation (P<0.05). It was concluded that PTAS could significantly alleviate the neural function deficit of the patients with ischemia cerebrovascular disease. The success rate of PTAS was high, and the rate of complications was lower and the clinical outcomes were satisfactory. PTAS is a safe and effective therapeutic method, though the long-term outcomes need further study.

Clinical Study of PTAS Therapy for Patients with Ischemia Cerebrovascular Disease Caused by Artery Stenosis / 华中科技大学学报（医学）（英德文版）

The curative efficacy of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of patients with ischemia cerebrovascular disease caused by artery stenosis was explored.The clinical data of 111 patients with ischemia cerebrovascular disease receiving PTAS in Guangdong Province General Hospital from Aug.2007 to Nov.2009 were retrospectively analyzed.In total 132 stents were implanted in the 111 patients.The mortality and rate of neural and non-neural complications were assessed perioperatively.Outcomes [including the frequency of transient ischemic attack (TIA),stroke,or death from vascular diseases) were assessed after operation.NIHSS rating was performed in all cases before and at first week,6th month and 12th month after the operation.The PTAS success rate was 100％.The degree of stenosis was reduced after PTAS.The total complication rate during perioperative period was 15.3％ (the rate of neural complications was 3.6％).Sixty-seven patients were followed up.Three patients (4.48％) developed cerebrovascular events within 1 month,containing one case of TIA,one case of ipsilateral mild stroke and one case of contralateral mild stroke.No severe stroke or death was observed.During a follow-up period of 12 months 7 patients had cerebrovascular events (10.44％),including 2 cases of ipsilateral TIA (2.99％),2 cases of ipsilateral mild stroke and 2 cases of contralateral mild stroke (2.99％),one case of severe stroke (1.49％).In 13 patients receiving DSA re-examination one year after PTAS,2 patients (15.38％) had in-stent restenosis.NIHSS scores were obviously decreased during a follow-up period as compared with those pre-operation (P＜0.05).It was concluded that PTAS could significantly alleviate the neural function deficit of the patients with ischemia cerebrovascular disease.The success rate of PTAS was high,and the rate of complications was lower and the clinical outcomes were satisfactory.PTAS is a safe and effective therapeutic method,though the long-term outcomes need further study.