[Research progress on the role of astrocytes in cerebral ischemia/reperfusion injury].

The pathophysiological mechanism of cerebral ischemia/reperfusion injury (CIRI) is complex, and the current treatment methods are limited and the efficacy is not good. Previous therapeutic strategies of CIRI mostly target neurons, but no significant progress has been made. At present, astrocytes are expected to be promising effector cells for the treatment of CIRI. Astrocytes are a "double-edged sword" in the pathological process of CIRI, with both neurotoxic and neuroprotective effects on the central nervous system. How to effectively use astrocytes to treat CIRI has become a research hotspot. In this review, the dual roles of astrocytes in CIRI mechanism were reviewed, and the related mechanisms of astrocytes in relieving oxidative stress induced by CIRI were emphasized, in order to provide new ideas for the treatment of CIRI.

Sophoricoside ameliorates cerebral ischemia-reperfusion injury dependent on activating AMPK.

AIMS: Ischemic stroke accounts for 87% of all strokes, and its death and disability bring a huge burden to society. Brain injury caused by ischemia-reperfusion (I/R) is also a major difficulty in clinical treatment and prognosis. Sophoricoside (SOP) is an isoflavone glycoside isolated from the seed of medical herb Sophora japonica L. Previously, SOP was found to be effective in anti-inflammation and glucose-lipid metabolism-related diseases. In order to investigate whether SOP has a regulatory effect on cerebral I/R injury, we conducted this study. METHODS: Here, by application of SOP into MCAO (transient middle cerebral artery occlusion)-induced mice and OGD/R (oxygen glucose deprivation/reperfusion)-induced primary neurons, the regulation effects of SOP was analyzed by detecting neurological score of post-stroke mice, phenotypes of brains and brain sections, cell viabilities, and apoptosis- and inflammation-regulation. RNA sequencing and molecular biology experiments were performed to explore the mechanism of SOP regulating cerebral I/R injury. RESULTS: SOP administration decreased the infarct size, neurological deficit score, neuronal cell injury, inflammation and apoptosis. Mechanistically, SOP exerted its protective effect by activating the AMP-activated protein kinase (AMPK) signaling pathway. CONCLUSION: SOP inhibits cerebral I/R injury by promoting the phosphorylation of AMPK.

Fully immersive virtual reality for skull-base surgery: surgical training and beyond.

PURPOSE: A virtual reality (VR) system, where surgeons can practice procedures on virtual anatomies, is a scalable and cost-effective alternative to cadaveric training. The fully digitized virtual surgeries can also be used to assess the surgeon's skills using measurements that are otherwise hard to collect in reality. Thus, we present the Fully Immersive Virtual Reality System (FIVRS) for skull-base surgery, which combines surgical simulation software with a high-fidelity hardware setup. METHODS: FIVRS allows surgeons to follow normal clinical workflows inside the VR environment. FIVRS uses advanced rendering designs and drilling algorithms for realistic bone ablation. A head-mounted display with ergonomics similar to that of surgical microscopes is used to improve immersiveness. Extensive multi-modal data are recorded for post-analysis, including eye gaze, motion, force, and video of the surgery. A user-friendly interface is also designed to ease the learning curve of using FIVRS. RESULTS: We present results from a user study involving surgeons with various levels of expertise. The preliminary data recorded by FIVRS differentiate between participants with different levels of expertise, promising future research on automatic skill assessment. Furthermore, informal feedback from the study participants about the system's intuitiveness and immersiveness was positive. CONCLUSION: We present FIVRS, a fully immersive VR system for skull-base surgery. FIVRS features a realistic software simulation coupled with modern hardware for improved realism. The system is completely open source and provides feature-rich data in an industry-standard format.

TAToo: vision-based joint tracking of anatomy and tool for skull-base surgery.

PURPOSE: Tracking the 3D motion of the surgical tool and the patient anatomy is a fundamental requirement for computer-assisted skull-base surgery. The estimated motion can be used both for intra-operative guidance and for downstream skill analysis. Recovering such motion solely from surgical videos is desirable, as it is compliant with current clinical workflows and instrumentation. METHODS: We present Tracker of Anatomy and Tool (TAToo). TAToo jointly tracks the rigid 3D motion of the patient skull and surgical drill from stereo microscopic videos. TAToo estimates motion via an iterative optimization process in an end-to-end differentiable form. For robust tracking performance, TAToo adopts a probabilistic formulation and enforces geometric constraints on the object level. RESULTS: We validate TAToo on both simulation data, where ground truth motion is available, as well as on anthropomorphic phantom data, where optical tracking provides a strong baseline. We report sub-millimeter and millimeter inter-frame tracking accuracy for skull and drill, respectively, with rotation errors below [Formula: see text]. We further illustrate how TAToo may be used in a surgical navigation setting. CONCLUSIONS: We present TAToo, which simultaneously tracks the surgical tool and the patient anatomy in skull-base surgery. TAToo directly predicts the motion from surgical videos, without the need of any markers. Our results show that the performance of TAToo compares favorably to competing approaches. Future work will include fine-tuning of our depth network to reach a 1 mm clinical accuracy goal desired for surgical applications in the skull base.

Twin-S: a digital twin for skull base surgery.

PURPOSE: Digital twins are virtual replicas of real-world objects and processes, and they have potential applications in the field of surgical procedures, such as enhancing situational awareness. We introduce Twin-S, a digital twin framework designed specifically for skull base surgeries. METHODS: Twin-S is a novel framework that combines high-precision optical tracking and real-time simulation, making it possible to integrate it into image-guided interventions. To guarantee accurate representation, Twin-S employs calibration routines to ensure that the virtual model precisely reflects all real-world processes. Twin-S models and tracks key elements of skull base surgery, including surgical tools, patient anatomy, and surgical cameras. Importantly, Twin-S mirrors real-world drilling and updates the virtual model at frame rate of 28. RESULTS: Our evaluation of Twin-S demonstrates its accuracy, with an average error of 1.39 mm during the drilling process. Our study also highlights the benefits of Twin-S, such as its ability to provide augmented surgical views derived from the continuously updated virtual model, thus offering additional situational awareness to the surgeon. CONCLUSION: We present Twin-S, a digital twin environment for skull base surgery. Twin-S captures the real-world surgical progresses and updates the virtual model in real time through the use of modern tracking technologies. Future research that integrates vision-based techniques could further increase the accuracy of Twin-S.

Rethinking causality-driven robot tool segmentation with temporal constraints.

PURPOSE: Vision-based robot tool segmentation plays a fundamental role in surgical robots perception and downstream tasks. CaRTS, based on a complementary causal model, has shown promising performance in unseen counterfactual surgical environments in the presence of smoke, blood, etc. However, CaRTS requires over 30 iterations of optimization to converge for a single image due to limited observability. METHOD: To address the above limitations, we take temporal relation into consideration and propose a temporal causal model for robot tool segmentation on video sequences. We design an architecture named Temporally Constrained CaRTS (TC-CaRTS). TC-CaRTS has three novel modules to complement CaRTS-temporal optimization pipeline, kinematics correction network, and spatial-temporal regularization. RESULTS: Experiment results show that TC-CaRTS requires fewer iterations to achieve the same or better performance as CaRTS on different domains. All three modules are proven to be effective. CONCLUSION: We propose TC-CaRTS, which takes advantage of temporal constraints as additional observability. We show that TC-CaRTS outperforms prior work in the robot tool segmentation task with improved convergence speed on test datasets from different domains.

A Self-Configuring Deep Learning Network for Segmentation of Temporal Bone Anatomy in Cone-Beam CT Imaging.

OBJECTIVE: Preoperative planning for otologic or neurotologic procedures often requires manual segmentation of relevant structures, which can be tedious and time-consuming. Automated methods for segmenting multiple geometrically complex structures can not only streamline preoperative planning but also augment minimally invasive and/or robot-assisted procedures in this space. This study evaluates a state-of-the-art deep learning pipeline for semantic segmentation of temporal bone anatomy. STUDY DESIGN: A descriptive study of a segmentation network. SETTING: Academic institution. METHODS: A total of 15 high-resolution cone-beam temporal bone computed tomography (CT) data sets were included in this study. All images were co-registered, with relevant anatomical structures (eg, ossicles, inner ear, facial nerve, chorda tympani, bony labyrinth) manually segmented. Predicted segmentations from no new U-Net (nnU-Net), an open-source 3-dimensional semantic segmentation neural network, were compared against ground-truth segmentations using modified Hausdorff distances (mHD) and Dice scores. RESULTS: Fivefold cross-validation with nnU-Net between predicted and ground-truth labels were as follows: malleus (mHD: 0.044 ± 0.024 mm, dice: 0.914 ± 0.035), incus (mHD: 0.051 ± 0.027 mm, dice: 0.916 ± 0.034), stapes (mHD: 0.147 ± 0.113 mm, dice: 0.560 ± 0.106), bony labyrinth (mHD: 0.038 ± 0.031 mm, dice: 0.952 ± 0.017), and facial nerve (mHD: 0.139 ± 0.072 mm, dice: 0.862 ± 0.039). Comparison against atlas-based segmentation propagation showed significantly higher Dice scores for all structures (p < .05). CONCLUSION: Using an open-source deep learning pipeline, we demonstrate consistently submillimeter accuracy for semantic CT segmentation of temporal bone anatomy compared to hand-segmented labels. This pipeline has the potential to greatly improve preoperative planning workflows for a variety of otologic and neurotologic procedures and augment existing image guidance and robot-assisted systems for the temporal bone.

New device multisegment Mechanical Thrombectomy System for endovascular treatment in acute ischaemic stroke: study protocol for a prospective, multicentre, randomised controlled trial.

INTRODUCTION: Endovascular treatment is the standard of care for acute large vessel occlusion (LVO) in the anterior circulation. However, successful complete recanalisation is considerably difficult when the vessels are severely tortuous. At the bend, the stent retriever can distort, collapse and lose its ability to capture the clot due to structural change. The aim of the present study is to evaluate the safety and efficacy of the new thrombectomy device multisegment Mechanical Thrombectomy (MT) System for endovascular treatment of acute ischaemic stroke (AIS). METHODS AND ANALYSIS: The present study is a prospective, multicentre, randomised controlled trial conducted in 11 stroke centres in China. The safety and efficacy of vascular recanalisation in patients with AIS who will be treated with a new thrombectomy device-multi-segment MT System or with Solitare FR within 8 hours of symptom onset will be compared. A total of 238 subjects who met the inclusion and exclusion criteria will be randomised into either a treatment group or a control group by an internet-based Central Random System in a 1:1 manner, and 30 subjects will be recruited into the small sample study. SAS V.9.4 statistical software will be used for statistical analysis of the primary endpoint indicators and other indicators. ETHICS AND DISSEMINATION: The study involving human participants was reviewed and approved by the Ethics Committee of Drugs (devices) Clinical Experiment in Henan Provincial People's Hospital (reference number: AF/SC-07/04.0) and other research centres participating in the clinical trial. The results yielded from this study will be presented at international conferences and sent to a peer-review journal to be considered for publication. The Standard Protocol Items: Recommendations for Interventional Trials checklist was utilised when drafting the study protocol. TRIAL REGISTRATION NUMBER: Registry on 10 September 2021 with Chinese clinical trial registry: ChiCTR2100051048.

Safety and efficacy of adjunct tirofiban treatment following mechanical thrombectomy for acute ischemic stroke patients with large vessel occlusion (LVO) resulting in successful reperfusion.

BACKGROUND AND PURPOSE: Tirofiban administration after mechanical thrombectomy (MT) remains controversial. This study aimed to investigate the efficacy and safety of adjunct tirofiban treatment following MT for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) that resulted in successful reperfusion on digital subtraction angiography (DSA). METHODS: This retrospective study was conducted in Zhengzhou University University People's Hospital, an advanced stroke center in China. Consecutive patients with AIS who underwent endovascular therapy (EVT) were enrolled from June 2018 to January 2022. The safety endpoints were symptomatic intracerebral hemorrhage (sICH), total intracranial hemorrhage (ICH), and 3-month mortality. The efficacy endpoints were 3-month modified Rankin scale (mRS) score and 24-h neurological improvement. RESULTS: A total of 145 consecutive patients with AIS who underwent MT were analyzed, of whom 51 (35.2%) patients were in the tirofiban group. There were 30 (20.7%) patients with sICH, 50 (34.5%) patients suffered from ICH within 24-h post-MT, and 47 (32.4%) dead at 3-month. Besides, 31 (21.4%) patients achieved excellent clinical outcomes (mRS, 0-1), and 24-h neurological improvement was found in 29 (20.0%) patients. No statistically significant differences were found in safety outcomes on sICH, total ICH, and 3-month mortality, as well as efficacy outcomes on 3-month mRS scores (0-1) and 24-h neurological improvement between the two groups (P > 0.05 for all). Additionally, tirofiban was associated with 3-month mRS scores of 0-2 (adjusted odds ratio (OR), 3.75; 95% confidence interval (CI), 1.41-10.02, P = 0.008). CONCLUSION: Adjunct tirofiban treatment following MT for AIS patients with LVO that resulted in successful reperfusion on DSA was not correlated with the increased risk of safety endpoints on sICH, ICH, and 3-month mortality, and it may be associated with a lower 3-month mRS score.

Efficacy of Balloon Guide Catheter-Assisted Thrombus Repair in Stroke Treatment: A Retrospective Survey in China.

Background: The first-pass (FP) effect, defined by successful cerebral reperfusion from a single pass of an endovascular stentriever, was associated with shorter procedural times and possible improved outcomes in patients with ischemic stroke secondary to large vessel occlusion. The adjunctive use of balloon guide catheter (BGC) may increase the rates of the first-pass effect. In this retrospective study we examined the impact of BGC on the first-pass effect in acute stroke patients. Methods: We included patients with acute ischemic stroke with large vessel occlusion treated by endovascular thrombectomy from 2018 to 2019. We categorized the cases into BGC and non-BGC groups. Differences in time metrics and outcomes were compared. Result: One hundred and thirty-two patients were included, and sixty-two were in BGC group (47.0%). The median procedural time was shorter (83.0 minutes vs 120.0 minutes, P = 0.000), and FP rate was higher in BGC group (58.1% vs 32.9%, P = 0.004) compared with non-BGC group. Proportion of modified Thrombolysis in Cerebral Infarction (mMTICI) 3 was higher (66.1% vs 37.1%, P = 0.001), and modified Rankin Scale (mRS) 0 to 2 was higher (59.7% vs 41.4%, P = 0.036) in BGC group compared with non-BGC group. In addition, BGC was associated with successful reperfusion odds ratio, 0.383; 95% confidence interval: 0.174-0.847; P = 0.018). The FP rate of BGC in the distal ICA was higher than that in the proximal ICA (87.5% vs 39.5%, P = 0.000), and the good clinical outcome rate at 90 days in the distal ICA was also higher than that in the proximal ICA (91.7% vs 39.5%, P = 0.000). Conclusion: We showed that BGC shortened the procedural time and increased the rate of the successful FP. We recommend that BGC could be considered the preferred technique for endovascular intervention in stroke.

Unequal Efficacy of Different Infarct Location in Predicting Futile Recanalization of Patients With Acute Ischemic Stroke.

Objectives: Endovascular thrombectomy (EVT) is a standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion, while futile recanalization is the main factor influencing the prognosis. The present study aimed to investigate the efficacy of different infarct sites in predicting futile recanalization of patients with AIS. Methods: Data were obtained from two multicenter, prospective, randomized, and controlled trials, which were concurrently conducted in China. Cases achieving a successful recanalization and with complete data of preoperative Alberta Stroke Program Early CT score (ASPECTS) and 90-day follow-up were included. The ASPECTS subregions were used to mark different infarct locations in the two cerebral hemispheres. First, the distribution of each ASPECTS subregion in the left and right hemispheres and the whole brain was analyzed, respectively. Then, the regions associated with futile recanalization were initially assessed by a univariate model. Afterward, a multivariate logistic regression model was used to identify the efficacy of different infarct sites in predicting futile recanalization. Results: A total of 336 patients were included in this study with a median age of 65 years (IQR: 51-74), of whom 210 (62.50%) patients were male, and 189 (56.25%) met the definition of futile recanalization. The correlation between each ASPECTS subregion and poor outcome was different when it was restricted to a specific cerebral hemisphere. Moreover, in the left hemisphere, the internal capsule region (OR: 1.42, 95%CI: 1.13-1.95, P = 0.03) and the M3 region (OR: 2.26, 95%CI: 1.36-3.52, P = 0.001), and in the right hemisphere, M6 region (OR: 2.24, 95%CI: 1.32-3.36, P = 0.001) showed significantly higher efficacy in predicting futile recanalization. Conclusion: The efficacy of different infarct locations in predicting futile recanalization is different. Different preoperative patterns of the high-efficiency regions in the infarction core or penumbra can guide the thrombectomy decision-making.

Statistical Shape Model of the Temporal Bone Using Segmentation Propagation.

HYPOTHESIS: Automated image registration techniques can successfully determine anatomical variation in human temporal bones with statistical shape modeling. BACKGROUND: There is a lack of knowledge about inter-patient anatomical variation in the temporal bone. Statistical shape models (SSMs) provide a powerful method for quantifying variation of anatomical structures in medical images but are time-intensive to manually develop. This study presents SSMs of temporal bone anatomy using automated image-registration techniques. METHODS: Fifty-three cone-beam temporal bone CTs were included for SSM generation. The malleus, incus, stapes, bony labyrinth, and facial nerve were automatically segmented using 3D Slicer and a template-based segmentation propagation technique. Segmentations were then used to construct SSMs using MATLAB. The first three principal components of each SSM were analyzed to describe shape variation. RESULTS: Principal component analysis of middle and inner ear structures revealed novel modes of anatomical variation. The first three principal components for the malleus represented variability in manubrium length (mean: 4.47 mm; ±2-SDs: 4.03-5.03 mm) and rotation about its long axis (±2-SDs: -1.6° to 1.8° posteriorly). The facial nerve exhibits variability in first and second genu angles. The bony labyrinth varies in the angle between the posterior and superior canals (mean: 88.9°; ±2-SDs: 83.7°-95.7°) and cochlear orientation (±2-SDs: -4.0° to 3.0° anterolaterally). CONCLUSIONS: SSMs of temporal bone anatomy can inform surgeons on clinically relevant inter-patient variability. Anatomical variation elucidated by these models can provide novel insight into function and pathophysiology. These models also allow further investigation of anatomical variation based on age, BMI, sex, and geographical location.

[Research progress of nuclear factor E 2-related factor 2 signaling pathway in neuroprotective mechanism of cerebral ischemia/reperfusion injury].

Cerebral ischemia/reperfusion (I/R) injury refers to an aggravated brain tissue damage caused by the restoration of blood supply after acute ischemia for a period of time. Its pathogenesis is complex, including oxidative stress, inflammatory response, and excitatory amino acid toxicity. The effective clinical treatments of cerebral I/R injury after ischemic stroke (IS) are limited. Nuclear factor E 2-related factor 2 (Nrf2), the most critical antioxidant transcription factor in cells, can coordinate multiple cytoprotective factors to inhibit oxidative stress. Since Nrf2 signaling pathway is considered to be one of the most important cellular defense mechanisms against oxidative stress, targeting Nrf2 intervention has become an attractive therapeutic strategy in the prevention and treatment of cerebral I/R injury. This review focuses on the structure, regulation and function of Nrf2 signaling pathway, as well as its activation and potential therapeutic targets in cerebral I/R injury. The important role and future potential of Nrf2 pathway in the pathogenesis of cerebral I/R injury were discussed.

Transcriptional factor 3 binds to sirtuin 1 to activate the Wnt/ß-catenin signaling in cervical cancer.

Transcriptional factor 3 (TCF3, also termed E2A), first reported to exert crucial functions during lymphocyte development, has been revealed to participate in the pathogenesis of human cancers. The aim of this work was to investigate the function of TCF3 in cervical cancer (CC) and the molecular interactions. The bioinformatics prediction suggested that TCF3 was highly expressed in CC and linked to poor prognosis. Increased TCF3 expression was identified in CC cell lines, and its downregulation reduced proliferation and migration of CC cells in vitro as well as growth of xenograft tumors in vivo. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses showed that the TCF-3-related genes and genes showed differential expression between CC and normal tissues were mainly enriched in the Wnt/ß-catenin pathway. TCF3 bound to sirtuin 1 (SIRT1) promoter for transcriptional activation, and SIRT1 promoted deacetylation and nuclear translocation of ß-catenin in CC. SIRT1 overexpression blocked the role of TCF3 silencing and restored cell proliferation in vitro and tumor growth in vivo. Treatment with XAV-939, a ß-catenin inhibitor, significantly suppressed the cell proliferation and tumor growth induced by SIRT1 overexpression. In conclusion, this study demonstrates that TCF3 augments progression of CC by activating SIRT1-mediated ß-catenin signaling.

Automated Extraction of Anatomical Measurements From Temporal Bone CT Imaging.

OBJECTIVE: Proposed methods of minimally invasive and robot-assisted procedures within the temporal bone require measurements of surgically relevant distances and angles, which often require time-consuming manual segmentation of preoperative imaging. This study aims to describe an automatic segmentation and measurement extraction pipeline of temporal bone cone-beam computed tomography (CT) scans. STUDY DESIGN: Descriptive study of temporal bone measurements. SETTING: Academic institution. METHODS: A propagation template composed of 16 temporal bone CT scans was formed with relevant anatomical structures and landmarks manually segmented. Next, 52 temporal bone CT scans were autonomously segmented using deformable registration techniques from the Advanced Normalization Tools Python package. Anatomical measurements were extracted via in-house Python algorithms. Extracted measurements were compared to ground truth values from manual segmentations. RESULTS: Paired t test analyses showed no statistical difference between measurements using this pipeline and ground truth measurements from manually segmented images. Mean (SD) malleus manubrium length was 4.39 (0.34) mm. Mean (SD) incus short and long processes were 2.91 (0.18) mm and 3.53 (0.38) mm, respectively. The mean (SD) maximal diameter of the incus long process was 0.74 (0.17) mm. The first and second facial nerve genus had mean (SD) angles of 68.6 (6.7) degrees and 111.1 (5.3) degrees, respectively. The facial recess had a mean (SD) span of 3.21 (0.46) mm. Mean (SD) minimum distance between the external auditory canal and tegmen was 3.79 (1.05) mm. CONCLUSIONS: This is the first study to automatically extract relevant temporal bone anatomical measurements from CT scans using segmentation propagation. Measurements from these models can streamline preoperative planning, improve future segmentation techniques, and help develop future image-guided or robot-assisted systems for temporal bone procedures.

SAGE: SLAM with Appearance and Geometry Prior for Endoscopy.

In endoscopy, many applications (e.g., surgical navigation) would benefit from a real-time method that can simultaneously track the endoscope and reconstruct the dense 3D geometry of the observed anatomy from a monocular endoscopic video. To this end, we develop a Simultaneous Localization and Mapping system by combining the learning-based appearance and optimizable geometry priors and factor graph optimization. The appearance and geometry priors are explicitly learned in an end-to-end differentiable training pipeline to master the task of pair-wise image alignment, one of the core components of the SLAM system. In our experiments, the proposed SLAM system is shown to robustly handle the challenges of texture scarceness and illumination variation that are commonly seen in endoscopy. The system generalizes well to unseen endoscopes and subjects and performs favorably compared with a state-of-the-art feature-based SLAM system. The code repository is available at https://github.com/lppllppl920/SAGE-SLAM.git.

Automated Registration-Based Temporal Bone Computed Tomography Segmentation for Applications in Neurotologic Surgery.

OBJECTIVE: This study investigates the accuracy of an automated method to rapidly segment relevant temporal bone anatomy from cone beam computed tomography (CT) images. Implementation of this segmentation pipeline has potential to improve surgical safety and decrease operative time by augmenting preoperative planning and interfacing with image-guided robotic surgical systems. STUDY DESIGN: Descriptive study of predicted segmentations. SETTING: Academic institution. METHODS: We have developed a computational pipeline based on the symmetric normalization registration method that predicts segmentations of anatomic structures in temporal bone CT scans using a labeled atlas. To evaluate accuracy, we created a data set by manually labeling relevant anatomic structures (eg, ossicles, labyrinth, facial nerve, external auditory canal, dura) for 16 deidentified high-resolution cone beam temporal bone CT images. Automated segmentations from this pipeline were compared against ground-truth manual segmentations by using modified Hausdorff distances and Dice scores. Runtimes were documented to determine the computational requirements of this method. RESULTS: Modified Hausdorff distances and Dice scores between predicted and ground-truth labels were as follows: malleus (0.100 ± 0.054 mm; Dice, 0.827 ± 0.068), incus (0.100 ± 0.033 mm; Dice, 0.837 ± 0.068), stapes (0.157 ± 0.048 mm; Dice, 0.358 ± 0.100), labyrinth (0.169 ± 0.100 mm; Dice, 0.838 ± 0.060), and facial nerve (0.522 ± 0.278 mm; Dice, 0.567 ± 0.130). A quad-core 16GB RAM workstation completed this segmentation pipeline in 10 minutes. CONCLUSIONS: We demonstrated submillimeter accuracy for automated segmentation of temporal bone anatomy when compared against hand-segmented ground truth using our template registration pipeline. This method is not dependent on the training data volume that plagues many complex deep learning models. Favorable runtime and low computational requirements underscore this method's translational potential.

Predictors of futile recanalization in patients undergoing endovascular treatment in the DIRECT-MT trial.

BACKGROUND: Futile recanalization-when patients have a successful recanalization but fail to achieve a satisfactory functional outcome- is a common phenomenon of endovascular treatment of acute ischemic stroke (AIS). The present study aimed to identify the predictors of futile recanalization in AIS patients who received endovascular treatment. METHODS: This is a post-hoc analysis of the DIRECT-MT trial. Demographics, clinical characteristics, acute stroke workflow interval times, biochemical parameters, and imaging characteristics were compared between futile and meaningful recanalization groups. Multivariate analysis was performed to identify the predictors of futile recanalization. RESULTS: Futile recanalization was observed in 277 patients. In multivariable logistic regression analysis, older age (p<0.001), higher baseline systolic blood pressure (SBP) (p=0.032), incomplete reperfusion defined by extended Thrombolysis In Cerebral Infarction (eTICI) grades (p=0.020), and larger final infarct volume (FIV) (p<0.001) were independent predictors of futile recanalization. CONCLUSIONS: Old age, high baseline SBP, incomplete reperfusion defined by eTICI, and large FIV were independent predictors of futile recanalization after endovascular therapy for AIS.

Comparing the efficacy and safety of the Skyflow device with those of the Solitaire FR stent in patients with acute ischemic stroke: a prospective, multicenter, randomized, non-inferiority clinical trial.

BACKGROUND: Mechanical thrombectomy is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation. This trial aimed to indicate whether Skyflow, a new thrombectomy device, could achieve the same safety and efficacy as Solitaire FR in the treatment of AIS. METHODS: This study was a prospective, multicenter, randomized, single blind, parallel, positive controlled, non-inferiority clinical trial. Patients with intracranial anterior circulation LVO within 8 hours from onset were included to receive thrombectomy treatment with either the Skyflow or Solitaire FR stent retriever. The primary endpoint was the rate of successful reperfusion (modified Treatment In Cerebral Infarction (mTICI) ≥2b) after the operation. The safety endpoints were the rate of symptomatic intracranial hemorrhage (sICH) and subarachnoid hemorrhage (SAH) at 24 hours after operation. RESULTS: A total of 95 and 97 patients were involved in the Skyflow group and Solitaire FR group, respectively. A successful reperfusion (mTICI ≥2b) was finally achieved in 84 (88.4%) patients in the Skyflow group and 80 (82.5%) patients in the Solitaire FR group. Skyflow was non-inferior to Solitaire FR in regard to the primary outcome, with the criterion of a non-inferiority margin of 12.5% (p=0.0002) after being adjusted for the combined center effect and the National Institutes of Health Stroke Scale (NIHSS) score. The rate of periprocedural sICH and SAH did not differ significantly between the two groups. CONCLUSION: Endovascular thrombectomy with the Skyflow stent retriever was non-inferior to Solitaire FR with regard to successful reperfusion in AIS due to LVO (with a pre-specified non-inferiority margin of 12.5%).

One-stop stroke management platform reduces workflow times in patients receiving mechanical thrombectomy.

Background and purpose: Clinical outcome in patients who received thrombectomy treatment is time-dependent. The purpose of this study was to evaluate the efficacy of the one-stop stroke management (OSSM) platform in reducing in-hospital workflow times in patients receiving thrombectomy compared with the traditional model. Methods: The data of patients who received thrombectomy treatment through the OSSM platform and traditional protocol transshipment pathway were retrospectively analyzed and compared. The treatment-related time interval and the clinical outcome of the two groups were also assessed and compared. The primary efficacy endpoint was the time from door to groin puncture (DPT). Results: There were 196 patients in the OSSM group and 210 patients in the control group, in which they were treated by the traditional approach. The mean DPT was significantly shorter in the OSSM group than in the control group (76 vs. 122 min; P < 0.001). The percentages of good clinical outcomes at the 90-day time point of the two groups were comparable (P = 0.110). A total of 121 patients in the OSSM group and 124 patients in the control group arrived at the hospital within 360 min from symptom onset. The mean DPT and time from symptom onset to recanalization (ORT) were significantly shorter in the OSSM group than in the control group. Finally, a higher rate of good functional outcomes was achieved in the OSSM group than in the control group (53.71 vs. 40.32%; P = 0.036). Conclusion: Compared to the traditional transfer model, the OSSM transfer model significantly reduced the in-hospital delay in patients with acute stroke receiving thrombectomy treatment. This novel model significantly improved the clinical outcomes of patients presenting within the first 6 h after symptom onset.