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BACKGROUND: Glycated albumin (GA) is an indicator of glycemic variability over the past 2-4 weeks and has suitable characteristics for predicting the prognosis of ischemic stroke during the acute phase. This study evaluated the association between early neurological deterioration (END) and GA values in patients with acute ischemic stroke (AIS). METHODS: We assessed consecutive patients with AIS between 2022 and 2023 at two large medical centers in Korea. END was defined as an increase of ≥ 2 in the total National Institutes of Health Stroke Scale (NIHSS) score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. We evaluated various glycemic parameters including fasting glucose (mg/dL), hemoglobin A1c (%), and GA (%). RESULTS: In total, 531 patients with AIS were evaluated (median age: 69 years, male sex: 66.3%). In the multivariable logistic regression analysis, GA value was positively associated with END (adjusted odds ratio [aOR] = 3.24, 95% confidence interval [CI]: 1.10-9.50). Initial NIHSS score (aOR = 1.04, 95% CI: 1.01-1.08) and thrombolytic therapy (aOR = 2.06, 95% CI: 1.14-3.73) were also associated with END. In a comparison of the predictive power of glycemic parameters for END, GA showed a higher area under the curve value on the receiver operating characteristic curve than fasting glucose and hemoglobin A1c. CONCLUSIONS: High GA values were associated with END in patients with AIS. Furthermore, GA was a better predictor of END than fasting glucose or hemoglobin A1c.
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Albúmina Sérica Glicada , Productos Finales de Glicación Avanzada , Accidente Cerebrovascular Isquémico , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Biomarcadores/sangre , Glucemia/metabolismo , Glucemia/análisis , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismo , Accidente Cerebrovascular Isquémico/sangre , Accidente Cerebrovascular Isquémico/diagnóstico , PronósticoRESUMEN
Introduction: We developed and externally validated a fully automated algorithm using deep learning to detect large vessel occlusion (LVO) in computed tomography angiography (CTA). Method: A total of 2,045 patients with acute ischemic stroke who underwent CTA were included in the development of our model. We validated the algorithm using two separate external datasets: one with 64 patients (external 1) and another with 313 patients (external 2), with ischemic stroke. In the context of current clinical practice, thrombectomy amenable vessel occlusion (TAVO) was defined as an occlusion in the intracranial internal carotid artery (ICA), or in the M1 or M2 segment of the middle cerebral artery (MCA). We employed the U-Net for vessel segmentation on the maximum intensity projection images, followed by the application of the EfficientNetV2 to predict TAVO. The algorithm's diagnostic performance was evaluated by calculating the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The mean age in the training and validation dataset was 68.7 ± 12.6; 56.3% of participants were men, and 18.0% had TAVO. The algorithm achieved AUC of 0.950 (95% CI, 0.915-0.971) in the internal test. For the external datasets 1 and 2, the AUCs were 0.970 (0.897-0.997) and 0.971 (0.924-0.990), respectively. With a fixed sensitivity of 0.900, the specificities and PPVs for the internal test, external test 1, and external test 2 were 0.891, 0.796, and 0.930, and 0.665, 0.583, and 0.667, respectively. The algorithm demonstrated a sensitivity and specificity of approximately 0.95 in both internal and external datasets, specifically for cases involving intracranial ICA or M1-MCA occlusion. However, the diagnostic performance was somewhat reduced for isolated M2-MCA occlusion; the AUC for the internal and combined external datasets were 0.903 (0.812-0.944) and 0.916 (0.816-0.963), respectively. Conclusion: We developed and externally validated a fully automated algorithm that identifies TAVO. Further research is needed to evaluate its effectiveness in real-world clinical settings. This validated algorithm has the potential to assist early-career physicians, thereby streamlining the treatment process for patients who can benefit from endovascular treatment.
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Herein, a heterojunction structure integrating p-type tellurium (Te) and n-type aluminum-doped indium-zinc-tin oxide (Al:IZTO) is shown to precisely modulate the threshold voltage (VT) of the oxide thin-film transistor (TFT). The proposed architecture integrates Te as an electron-blocking layer and Al:IZTO as a charge-carrier transporting layer, thereby enabling controlled electron injection. The effects of incorporating the Te layer onto Al:IZTO are investigated, with a focus on X-ray photoelectron spectroscopy (XPS) analysis, in order to explain the behavior of oxygen vacancies and to depict the energy band structure configurations. By modulating the thickness and employing both single and double deposition methods for the heterojunction Te layer, a remarkable VT shift of up to +20 V is achieved. Furthermore, this study also shows excellent stability to a positive bias stress of +2 MV/cm for 10,000 s without additional passivation layers, demonstrating the robustness of the designed TFT. By a thorough optimization of the Al:IZTO/Te interface, the results demonstrate not only the substantial impact of the introduced heterojunction structure on VT control but also the endurance, durability, and stability of the optimized TFTs under prolonged long-term operating stress, thus offering promising prospects for tailored semiconductor device applications.
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We study diffusion in systems of classical particles whose dynamics conserves the total center of mass. This conservation law leads to several interesting consequences. In finite systems, it allows for equilibrium distributions that are exponentially localized near system boundaries. It also yields an unusual approach to equilibrium, which in d dimensions exhibits scaling with dynamical exponent z=4+d. Similar phenomena occur for dynamics that conserves higher moments of the density, which we systematically classify using a family of nonlinear diffusion equations. In the quantum setting, analogous fermionic systems are shown to form real-space Fermi surfaces, while bosonic versions display a real-space analog of Bose-Einstein condensation.
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BACKGROUND AND PURPOSE: The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO). METHODS: This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0-5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality within 1 year. RESULTS: In total, 1,067 patients (age=67.2±13.1 years [mean±SD], 61.3% males) were analyzed. The proportions of patients according to the numbers of brain frailty burdens were as follows: no burden in 49.2%, one burden in 30.0%, two burdens in 17.3%, and three burdens in 3.5%. In the Cox proportional-hazards analysis, the presence of more brain frailty burdens was associated with a higher risk of 1-year primary outcomes, but after adjusting for clinically relevant variables there were no significant associations between burdens of brain frailty and 1-year vascular outcomes. For individual components of brain frailty, an advanced WMH was independently associated with an increased risk of 1-year primary outcomes (adjusted hazard ratio [aHR]=1.33, 95% confidence interval [CI]=1.03-1.71) and stroke (aHR=1.32, 95% CI=1.00-1.75). CONCLUSIONS: The baseline imaging markers of brain frailty were common in acute minor ischemic stroke patients with LVO. An advanced WMH was the only frailty marker associated with an increased risk of vascular events. Further research is needed into the association between brain frailty and prognosis in patients with acute minor LVO.
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BACKGROUND: The effect of amyloid-ß (Aß) on cognitive impairment in patients with small subcortical infarction remains controversial, although a growing body of evidence shows a substantial overlap between Alzheimer's disease (AD) and subcortical ischemic vascular dementia, another form of cerebral small vessel disease (cSVD). Therefore, we investigated the relationships between Aß positivity and the development of post-stroke cognitive impairment (PSCI) in patients with small subcortical infarction. METHODS: We prospectively recruited 37 patients aged ≥ 50 years, with first-ever small subcortical infarction, who underwent amyloid positron emission tomography, 3 months after stroke at Korea University Guro Hospital. We also enrolled CU participants matched for age and sex with stroke patients for comparison of Aß positivity. Patients were followed up at 3 and 12 months after the stroke to assess cognitive decline. Logistic and linear mixed-effect regression analyses were performed to identify the effect of Aß positivity on PSCI development and long-term cognitive trajectories. RESULTS: At 3 months after stroke, 12/37 (32.4%) patients developed PSCI, and 11/37 (29.7%) patients had Aß deposition. Aß positivity (odds ratio [OR] = 72.2, p = 0.024) was predictive of PSCI development regardless of cSVD burden. Aß positivity (ß = 0.846, p = 0.014) was also associated with poor cognitive trajectory, assessed by the Clinical Dementia Rating-Sum of Box, for 1 year after stroke. CONCLUSIONS: Our findings highlight that Aß positivity is an important predictor for PSCI development and cognitive decline over 1 year. Furthermore, our results provide evidence that anti-AD medications may be a strategy for preventing cognitive decline in patients with small subcortical infarctions.
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Enfermedad de Alzheimer , Enfermedades de los Pequeños Vasos Cerebrales , Disfunción Cognitiva , Demencia Vascular , Accidente Cerebrovascular , Humanos , Disfunción Cognitiva/etiología , Disfunción Cognitiva/complicaciones , Péptidos beta-Amiloides , Enfermedad de Alzheimer/complicaciones , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/psicología , Infarto Cerebral/complicaciones , Infarto Cerebral/diagnóstico por imagen , Demencia Vascular/complicaciones , Tomografía de Emisión de Positrones , Enfermedades de los Pequeños Vasos Cerebrales/complicacionesRESUMEN
Finding d-electron heavy fermion states has been an important topic as the diversity in d-electron materials can lead to many exotic Kondo effect-related phenomena or new states of matter such as correlation-driven topological Kondo insulator. Yet, obtaining direct spectroscopic evidence for a d-electron heavy fermion system has been elusive to date. Here, we report the observation of Kondo lattice behavior in an antiferromagnetic metal, FeTe, via angle-resolved photoemission spectroscopy, scanning tunneling spectroscopy and transport property measurements. The Kondo lattice behavior is represented by the emergence of a sharp quasiparticle and Fano-type tunneling spectra at low temperatures. The transport property measurements confirm the low-temperature Fermi liquid behavior and reveal successive coherent-incoherent crossover upon increasing temperature. We interpret the Kondo lattice behavior as a result of hybridization between localized Fe 3dxy and itinerant Te 5pz orbitals. Our observations strongly suggest unusual cooperation between Kondo lattice behavior and long-range magnetic order.
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Background and purpose: There is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits. Methods: From a prospective, nationwide stroke registry, all patients with LVO and baseline NIHSS <6 presenting within 24 h from the time last known well (LKW) were included. Early neurological deterioration (END) developed before EVT was prospectively collected as an increasing total NIHSS score ≥2 or any worsening of the NIHSS consciousness or motor subscores during hospitalization not related to EVT. Significant hemorrhage was defined as PH2 hemorrhagic transformation or hemorrhage at a remote site. The modified Rankin Scale (mRS) was prospectively collected at 3 months. Results: Among 1,083 patients, 149 (14%) patients received EVT after a median of 5.9 [3.6-12.3] h after LKW. In propensity score-matched analyses, EVT was not associated with mRS 0-1 (matched OR 0.99 [0.63-1.54]) but increased the risk of a significant hemorrhage (matched OR, 4.51 [1.59-12.80]). Extraneous END occurred in 207 (19%) patients after a median of 24.5 h [IQR, 13.5-41.9 h] after LKW (incidence rate, 1.41 [95% CI, 1.23-1.62] per 100 person-hours). END unrelated to EVT showed a tendency to modify the effectiveness of EVT (P-for-interaction, 0.08), which decreased the odds of having mRS 0-1 in mild LVO patients without END (adjusted OR, 0.63 [0.40-0.99]). Conclusions: The use of EVT in patients with acute LVO and low NIHSS scores may require the assessment of individual risks of early deterioration, hemorrhagic complications and expected benefit.
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Chiral symmetry breaking of phonons plays an essential role in emergent quantum phenomena owing to its strong coupling to spin degree of freedom. However, direct experimental evidence of the chiral phonon-spin coupling is lacking. In this study, we report a chiral phonon-mediated interlayer exchange interaction in atomically controlled ferromagnetic metal (SrRuO3)-nonmagnetic insulator (SrTiO3) heterostructures. Owing to the unconventional interlayer exchange interaction, we have observed rotation of spins as a function of nonmagnetic insulating spacer thickness, resulting in a spin spiral state. The chiral phonon-spin coupling is further confirmed by phonon Zeeman effect. The existence of the chiral phonons and their interplay with spins along with our atomic-scale heterostructure approach unveil the crucial roles of chiral phonons in magnetic materials.
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The fluctuation-dissipation theorem (FDT) is a simple yet powerful consequence of the first-order differential equation governing the dynamics of systems subject simultaneously to dissipative and stochastic forces. The linear learning dynamics, in which the input vector maps to the output vector by a linear matrix whose elements are the subject of learning, has a stochastic version closely mimicking the Langevin dynamics when a full-batch gradient descent scheme is replaced by that of a stochastic gradient descent. We derive a generalized FDT for the stochastic linear learning dynamics and verify its validity among the well-known machine learning data sets such as MNIST, CIFAR-10, and EMNIST.
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BACKGROUND: It remains unclear whether thrombolysis outcomes can be influenced by the affected vascular territory (i.e. anterior circulation stroke vs. posterior circulation stroke) in stroke patients owing to the lack of randomized controlled trials. AIMS: Using multiple comprehensive databases, we searched for observational studies of the safety and efficacy of intravenous thrombolytics and intra-arterial treatment with or without intravenous thrombolytics in accordance with the affected vascular territory. We performed a systematic review and meta-analysis. We evaluated symptomatic intracerebral hemorrhage, all-type intracerebral hemorrhage, mortality, and functional outcomes at three months. The recanalization rate was assessed in the intra-arterial treatment group. SUMMARY OF REVIEW: Twenty-one studies including a report from our own stroke registry were included through quantitative synthesis. Compared with the anterior circulation stroke group, the posterior circulation stroke group had a lower risk of ICH, including symptomatic intracerebral hemorrhage and all-type intracerebral hemorrhage, after intravenous thrombolytics and tended to have favorable functional outcomes at three months. Mortality was similar between the two groups. Regarding intra-arterial treatment, the symptomatic intracerebral hemorrhage and post-procedural recanalization rates were comparable between the two groups, although the posterior circulation stroke group had a higher mortality risk and lower tendency for a favorable functional outcome. CONCLUSIONS: Safety and efficacy of thrombolysis in posterior circulation stroke depends on involvement of large vessel occlusion and reperfusion modality such that intravenous thrombolytics is more effective and safer than in anterior circulation stroke; the safety and efficacy of intra-arterial treatment is comparable or lower than anterior circulation stroke. Considering the limitations of our meta-analysis, further studies are needed to provide high level evidence of a beneficial effect of intra-arterial treatment, and to identify patients' profiles associated with benefit of treatment.
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Isquemia Encefálica , Accidente Cerebrovascular , Isquemia Encefálica/tratamiento farmacológico , Hemorragia Cerebral/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Humanos , Reperfusión , Accidente Cerebrovascular/tratamiento farmacológico , Trombectomía , Terapia Trombolítica , Resultado del TratamientoRESUMEN
Artificial crystals synthesized by atomic-scale epitaxy provide the ability to control the dimensions of the quantum phases and associated phase transitions via precise thickness modulation. In particular, the reduction in dimensionality via quantized control of atomic layers is a powerful approach to revealing hidden electronic and magnetic phases. Here, we demonstrate a dimensionality-controlled and induced metal-insulator transition (MIT) in atomically designed superlattices by synthesizing a genuine two-dimensional (2D) SrRuO_{3} crystal with highly suppressed charge transfer. The tendency to ferromagnetically align the spins in an SrRuO_{3} layer diminishes in 2D as the interlayer exchange interaction vanishes, accompanying the 2D localization of electrons. Furthermore, electronic and magnetic instabilities in the two SrRuO_{3} unit cell layers induce a thermally driven MIT along with a metamagnetic transition.
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Searching for the ground state of a kagomé Heisenberg antiferromagnet (KHA) has been one of the central issues of condensed-matter physics, because the KHA is expected to host spin-liquid phases with exotic elementary excitations. Here, we show our longitudinal ([Formula: see text]) and transverse ([Formula: see text]) thermal conductivities measurements of the two kagomé materials, volborthite and Ca kapellasite. Although magnetic orders appear at temperatures much lower than the antiferromagnetic energy scale in both materials, the nature of spin liquids can be captured above the transition temperatures. The temperature and field dependence of [Formula: see text] is analyzed by spin and phonon contributions, and large sample variations of the spin contribution are found in volborthite. Clear changes in [Formula: see text] are observed at the multiple magnetic transitions in volborthite, showing different magnetic thermal conduction in different magnetic structures. These magnetic contributions are not clearly observed in low-[Formula: see text] crystals of volborthite, and are almost absent in Ca kapellasite, showing the high sensitivity of the magnetic excitation in [Formula: see text] to the defects in crystals. On the other hand, a clear thermal Hall signal has been observed in the lowest-[Formula: see text] crystal of volborthite and in Ca kapellasite. Remarkably, both the temperature dependence and the magnitude of [Formula: see text] of volborthite are found to be very similar to those of Ca kapellasite, despite of about an order of magnitude difference in [Formula: see text] We find that [Formula: see text] of both compounds is well reproduced, both qualitatively and quantitatively, by spin excitations described by the Schwinger-boson mean-field theory applied to KHA with the Dzyaloshinskii-Moriya interaction. This excellent agreement demonstrates not only that the thermal Hall effect in these kagomé antiferromagnets is caused by spins in the spin liquid phase, but also that the elementary excitations of this spin liquid phase are well described by the bosonic spin excitations.
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We investigate the hidden Berry curvature in bulk 2H-WSe_{2} by utilizing the surface sensitivity of angle resolved photoemission (ARPES). The symmetry in the electronic structure of transition metal dichalcogenides is used to uniquely determine the local orbital angular momentum (OAM) contribution to the circular dichroism (CD) in ARPES. The extracted CD signals for the K and K^{'} valleys are almost identical, but their signs, which should be determined by the valley index, are opposite. In addition, the sign is found to be the same for the two spin-split bands, indicating that it is independent of spin state. These observed CD behaviors are what are expected from Berry curvature of a monolayer of WSe_{2}. In order to see if CD-ARPES is indeed representative of hidden Berry curvature within a layer, we use tight binding analysis as well as density functional calculation to calculate the Berry curvature and local OAM of a monolayer WSe_{2}. We find that measured CD-ARPES is approximately proportional to the calculated Berry curvature as well as local OAM, further supporting our interpretation.
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Magnetic skyrmions are topologically protected whirling spin texture. Their nanoscale dimensions, topologically protected stability and solitonic nature, together are promising for future spintronics applications. To translate these compelling features into practical spintronic devices, a key challenge lies in achieving effective control of skyrmion properties, such as size, density and thermodynamic stability. Here, we report the discovery of ferroelectrically tunable skyrmions in ultrathin BaTiO3/SrRuO3 bilayer heterostructures. The ferroelectric proximity effect at the BaTiO3/SrRuO3 heterointerface triggers a sizeable Dzyaloshinskii-Moriya interaction, thus stabilizing robust skyrmions with diameters less than a hundred nanometres. Moreover, by manipulating the ferroelectric polarization of the BaTiO3 layer, we achieve local, switchable and nonvolatile control of both skyrmion density and thermodynamic stability. This ferroelectrically tunable skyrmion system can simultaneously enhance the integratability and addressability of skyrmion-based functional devices.
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A clear thermal Hall signal (κ_{xy}) was observed in the spin-liquid phase of the S=1/2 kagome antiferromagnet Ca kapellasite [CaCu_{3}(OH)_{6}Cl_{2}·0.6H_{2}O]. We found that κ_{xy} is well reproduced, both qualitatively and quantitatively, using the Schwinger-boson mean-field theory with the Dzyaloshinskii-Moriya interaction of D/Jâ¼0.1. In particular, κ_{xy} values of Ca kapellasite and those of another kagome antiferromagnet, volborthite, converge to one single curve in simulations modeled using Schwinger bosons, indicating a common temperature dependence of κ_{xy} for the spins of a kagome antiferromagnet.
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OBJECTIVE: The Korean Dementia Screening Questionnaire (KDSQ) is an informant-based instrument used to screen for cognitive dysfunction. However, its ability to only dichotomously discriminate between dementia and normal cognition has been previously investigated. This study investigated the ability of the KDSQ to classify not only dichotomous but also multiple stages of cognitive dysfunction. METHODS: We examined 582 participants. Receiver operating characteristic (ROC) curves were used to determine dichotomous classification parameters. Multi-category ROC surfaces were evaluated to classify the three stages of cognitive dysfunction. RESULTS: Dichotomous classification using the ROC curve analyses showed that the area under the curve was 0.92 for dementia for subjects without dementia and 0.96 for dementia in controls. Simultaneous multi-category classification analyses showed that the volume under the ROC surface (VUS) was 0.57 and that the derived optimal cut-off points were 2 and 8 for controls, MCI, and dementia. The estimated Youden index for the KDSQ was 0.48, and the derived optimal cut-off points were 5 and 10. The overall classification accuracy of the VUS and Youden index was 61.2% and 58.6%, respectively. CONCLUSION: The KDSQ is useful for classifying dichotomous and multi-category stages of cognitive dysfunction.