Predictors of successful endovascular recanalization in patients with symptomatic nonacute intracranial large artery occlusion.

BACKGROUND: Endovascular recanalization in patients with symptomatic nonacute intracranial large artery occlusion (ILAO) has been reported to be feasible, but technically challenging. This study aimed to determine the predictors of successful endovascular recanalization in patients with symptomatic nonacute ILAO. METHODS: The outcomes of endovascular recanalization attempts performed in 70 consecutive patients showing symptomatic nonacute ILAO with hemodynamic cerebral ischemia between January 2016 to December 2022 were reviewed. Potential variables, including clinical and radiological characteristics related to technical success, were collected. Univariate analysis and multivariate logistic regression were performed to identify predictors of successful recanalization for nonacute ILAO. RESULTS: Technically successful recanalization was achieved in 57 patients (81.4%). The periprocedural complication rate was 21.4% (15 of 70), and the overall 30-day morbidity and mortality rates were 7.1% (5 of 70) and 2.9% (2 of 70), respectively. Univariate analysis showed that successful recanalization was associated with occlusion duration, stump morphology, occlusion length, slow distal antegrade flow sign, and the presence of bridging collateral vessels. Multivariate analysis showed that occlusion duration ≤ 3 months (odds ratio [OR]: 22.529; 95% confidence interval [CI]: 1.636-310.141), tapered stump (OR: 7.498; 95% CI: 1.533-36.671), and occlusion length < 10 mm (OR: 7.049; 95% CI: 1.402-35.441) were independent predictive factors for technical success of recanalization. CONCLUSIONS: Occlusion duration ≤ 3 months, tapered stump, and occlusion length < 10 mm were independent positive predictors of technical success of endovascular recanalization for symptomatic nonacute ILAO. These findings may help predict the likelihood of successful recanalization in patients with symptomatic nonacute ILAO and also provide a reference for the selection of appropriate patients. Further prospective and multicenter studies are required to validate our findings.

A chemiresistive-potentiometric multivariate sensor for discriminative gas detection.

Highly efficient gas sensors able to detect and identify hazardous gases are crucial for numerous applications. Array of conventional single-output sensors is currently limited by problems including drift, large size, and high cost. Here, we report a sensor with multiple chemiresistive and potentiometric outputs for discriminative gas detection. Such sensor is applicable to a wide range of semiconducting electrodes and solid electrolytes, which allows to tailor and optimize the sensing pattern by tuning the material combination and conditions. The sensor performance is boosted by equipping a mixed-conducting perovskite electrode with reverse potentiometric polarity. A conceptual sensor with dual sensitive electrodes achieves superior three-dimensional (sub)ppm sensing and discrimination of humidity and seven hazardous gases (2-Ethylhexanol, ethanol, acetone, toluene, ammonia, carbon monoxide, and nitrogen dioxide), and enables accurate and early warning of fire hazards. Our findings offer possibilities to design simple, compact, inexpensive, and highly efficient multivariate gas sensors.

An MMP-9 exclusive neutralizing antibody attenuates blood-brain barrier breakdown in mice with stroke and reduces stroke patient-derived MMP-9 activity.

Rapid upregulation of matrix metalloproteinase 9 (MMP-9) leads to blood-brain barrier (BBB) breakdown following stroke, but no MMP-9 inhibitors have been approved in clinic largely due to their low specificities and side effects. Here, we explored the therapeutic potential of a human IgG monoclonal antibody (mAb), L13, which was recently developed with exclusive neutralizing specificity to MMP-9, nanomolar potency, and biological function, using mouse stroke models and stroke patient samples. We found that L13 treatment at the onset of reperfusion following cerebral ischemia or after intracranial hemorrhage (ICH) significantly reduced brain tissue injury and improved the neurological outcomes of mice. Compared to control IgG, L13 substantially attenuated BBB breakdown in both types of stroke model by inhibiting MMP-9 activity-mediated degradations of basement membrane and endothelial tight junction proteins. Importantly, these BBB-protective and neuroprotective effects of L13 in wild-type mice were comparable to Mmp9 genetic deletion and fully abolished in Mmp9 knockout mice, highlighting the in vivo target specificity of L13. Meanwhile, ex vivo co-incubation with L13 significantly neutralized the enzymatic activities of human MMP-9 in the sera of ischemic and hemorrhagic stroke patients, or in the peri-hematoma brain tissues from hemorrhagic stroke patients. Overall, we demonstrated that MMP-9 exclusive neutralizing mAbs constitute a potential feasible therapeutic approach for both ischemic and hemorrhagic stroke.

Electrochemical Response of Mixed Conducting Perovskite Enables Low-Cost High-Efficiency Hydrogen Sensing.

High-performance noble metal-free gas sensors are crucial for widespread applications in various areas. Non-Nernstian electrochemical sensors have attracted tremendous attention, but are limited by the high cost and low efficiency of Pt electrode. Moreover, responses from different electrodes usually have the same polarity, degrading the sensor performance. Here we report a reverse response on a series of mixed ionic-electronic conductors (MIECs). Exemplary SrFe0.5Ti0.5O3-δ (SFT50) perovskite shows excellent H2 sensing properties, including high sensitivity and selectivity, humidity resistance, and long-term stability. Strikingly, the response is positive, as opposed to the usual one. Such an unusual response is ascribed to the change of the surface electrostatic potential due to the gas chemical reaction, which outcompetes traditional mechanisms, thereby reversing the response polarity. A conceptual noble-metal-free sensor with dual oxide electrodes of opposite polarity is designed by substituting SFT50 for the benchmark Pt, achieving a 1.5-2.0× increase in H2 response, sensitivity, and selectivity and a low limit of detection of 16 ppb. The ideal unity of excellent sensing and unusual polarity for MIECs can be used to optimize the performance of a variety of conventional sensors while reducing the cost. Our findings provide new insights into electrochemical gas sensing and offer a facile approach for developing low-cost high-performance gas sensors.

Postoperative Adjuvant Radiotherapy in Atypical Meningioma Patients: A Meta-Analysis Study.

BACKGROUND AND PURPOSE: Consensus regarding the need for adjuvant radiotherapy (RT) in patients with atypical meningiomas (AMs) is lacking. We compared the effects of adjuvant RT after surgery, gross total resection (GTR), and subtotal resection (STR) on progression-free survival (PFS) and overall survival (OS) in patients with AMs, respectively. METHODS: We performed a systematic review and meta-analysis of the literature published in PubMed, Embase, and the Cochrane Library from inception to February 1, 2021, to identify articles comparing the PFS and OS of patients receiving postoperative RT after surgery, GTR and STR. RESULTS: We identified 2307 unique studies; 24 articles including 3078 patients met the inclusion criteria. The sensitivity analysis results showed that for patients undergoing undifferentiated surgical resection, adjuvant RT reduced tumor recurrence (HR=0.70, p<0.0001) with no significant effect on survival (HR=0.89, p=0.49). Postoperative RT significantly increased PFS (HR=0.69, p=0.01) and OS (HR=0.55, p=0.007) in patients undergoing GTR. The same improvement was observed in patients undergoing STR plus RT (PFS: HR=0.41, p<0.00001; OS: HR=0.47, p=0.01). A subgroup analysis of RT in patients undergoing GTR showed no change in PFS in patients undergoing Simpson grade I and II resection (HR=1.82, p=0.22) but significant improvement in patients undergoing Simpson grade III resection (HR=0.64, p=0.02). CONCLUSION: Regardless of whether GTR or STR was performed, postoperative RT improved PFS and OS to varying degrees. Especially for patients undergoing Simpson grade III or IV resection, postoperative RT confers the benefits for recurrence and survival.

Roles of taurine in cognitive function of physiology, pathologies and toxication.

Taurine is a key functional amino acid with many functions in the nervous system. The effects of taurine on cognitive function have aroused increasing attention. First, the fluctuations of taurine and its transporters are associated with cognitive impairments in physiology and pathology. This may help diagnose and treat cognitive impairment though mechanisms are not fully uncovered in existing studies. Then, taurine supplements in cognitive impairment of different physiologies, pathologies and toxicologies have been demonstrated to significantly improve and restore cognition in most cases. However, elevated taurine level in cerebrospinal fluid (CSF) by exogenous administration causes cognition retardations only in physiologically sensitive period between the perinatal to early postnatal period. In this review, taurine levels are summarized in different types of cognitive impairments. Subsequently, the effects of taurine supplements on cognitions in physiology, different pathologies and toxication of cognitive impairments (e.g. aging, Alzheimer' disease, streptozotocin (STZ)-induced brain damage, ischemia model, mental disorder, genetic diseases and cognitive injuries of pharmaceuticals and toxins) are analyzed. These data suggest that taurine can improve cognition function through multiple potential mechanisms (e.g. restoring functions of taurine transporters and γ-aminobutyric acid (GABA) A receptors subunit; mitigating neuroinflammation; up-regulating Nrf2 expression and antioxidant capacities; activating Akt/CREB/PGC1α pathway, and further enhancing mitochondria biogenesis, synaptic function and reducing oxidative stress; increasing neurogenesis and synaptic function by pERK; activating PKA pathway). However, more mechanisms still need explorations.

Endovascular recanalization for symptomatic subacute and chronic intracranial large artery occlusion of the anterior circulation: initial experience and technical considerations.

PURPOSE: This study aimed to report the clinical findings and initial clinical experience of endovascular recanalization for symptomatic subacute/chronic intracranial large artery occlusion (ILAO) of the anterior circulation. METHODS: From October 2015 to December 2017, 13 patients with symptomatic subacute/chronic ILAO of the anterior circulation were enrolled in this study and underwent endovascular recanalization. We collected the initial procedural results, including the rate of successful recanalization and periprocedural complications, and data pertaining to angiographic and clinical follow-up. RESULTS: Recanalization was successful in 11 of 13 patients (84.6%). Intraoperative complications occurred in four cases, including symptomatic distal embolism in three cases; one of which was simultaneously complicated with artery dissection. Intracerebral hemorrhage occurred in one case. Eleven patients underwent angiographic follow-up, and 12 patients underwent clinical follow-up. The results of the angiography follow-up (mean 6 ± 3.29 months) showed that in-stent restenosis occurred in one of the 11 successfully recanalized patients. However, the artery was occluded again in the patient who achieved thrombolysis in cerebral infarction (TICI) grade of 2a after treatment. Clinical follow-up (mean 5.8 ± 2.25 months) showed no recurrence of transient ischemic attack (TIA) or stroke in ten successfully recanalized cases. However, the patient who developed in-stent stenosis suffered TIA. CONCLUSIONS: Endovascular recanalization for symptomatic subacute/chronic ILAO of anterior circulation is feasible, relatively safe, and efficacious in highly selected cases, improving patients' symptoms in the short-term. However, further larger scale pilot studies are needed to determine the efficacy and long-term outcome associated with this treatment.

Rescue Glue Embolization of Vessel Perforation During Mechanical Thrombectomy for Acute Ischemic Stroke: Technical Note.

BACKGROUND: Vessel perforation is a serious technical complication during mechanical thrombectomy (MT) for the treatment of acute ischemic stroke with large vessel occlusion. Routine rescue strategy includes balloon occlusion for tamponade, procedure suspension, and lowering or normalizing blood pressure. However, this complication is still associated with poor outcome and high mortality. METHODS: In this paper, the authors report their experience by using glue to embolize the ruptured vessel secondary to microcatheter/microwire perforation, preventing further deterioration in clinical outcome. Rescue glue embolization was attempted in 2 patients who developed intraprocedural vessel perforation while trying to gain access through the blocked artery with a microcatheter/microwire. RESULTS: The ruptured vessels were effectively occluded. Stent retriever thrombectomies were then continued, and TICI 2b and 3 recanalizations were achieved. Both patients' neurologic status improved. CONCLUSIONS: The key benefit of this method exists in embolizing the ruptured vessel without affecting the following MT. We propose the rescue glue embolization is simple yet effective in managing vessel perforation complication during MT.

The miR-143/145 cluster reverses the regulation effect of KLF5 in smooth muscle cells with proliferation and contractility in intracranial aneurysm.

Alterations in vascular smooth muscle cells (VSMCs) contribute to the pathogenesis of intracranial aneurysms (IAs), but the molecular mechanisms of these alterations are unclear. The aim of this study was therefore to identify the molecular mechanism of VSMC-mediated IAs at clinical and cellular levels. We used bioinformatic and biochemical analyses to show that the microRNA (miR)-143/145 cluster was involved in various biological processes related to aneurysm formation. Clinical studies showed that the miR-143/145 cluster was downregulated in IA patients when compared with healthy subjects. However, KLF5 expression was upregulated in IA patients. In vitro experiments showed that overexpression of the miR-143/145 cluster inhibited proliferation and migration of VSMCs, but increased contractile protein expression and decreased matrix metalloproteinase-2 and -3. KLF5 overexpression had the opposite effect, even reversing the protective effect of the miR-143/145 cluster on IAs. Bifluorescein report experiments further confirmed that both miR-143 and miR-145 interacted with the 3'-UTR of KLF5 and inhibited post-transcriptional expression of KLF5. Taken together, the results showed that VSMC phenotypic modulation with upregulation of KLF5 by downregulation of the miR-143/145 cluster played an important role in formation and growth of IAs. The process of IA formation was reversed by overexpression of the miR-143/145 cluster. Together, the results provided a theoretical basis for further investigation of the potential clinical prevention and treatment of IAs.

A single-center experience in the endovascular treatment of carotid siphon aneurysms using the Willis covered stent: a retrospective analysis.

OBJECTIVE: To report the clinical results and initial clinical experience of endovascular isolation with the Willis covered stent for carotid siphon aneurysms. METHODS: Between November 2013 and December 2016, a total of 57 patients who presented with carotid siphon aneurysms were treated with the Willis covered stent. Results of the procedures, technical events, and complications were recorded. Clinical and imaging follow-ups were performed at 3 months following the endovascular procedures. RESULTS: Placement of the Willis covered stent was successful in all patients. Immediate angiography revealed complete exclusion of aneurysms in 48 patients (84%), while endoleak occurred in nine patients (16%). Procedure-related complications occurred in three cases, including displacement of the covered stent in one patient, acute in-stent thrombosis in one patient, and microwire-related intracranial hemorrhage in one patient. Angiographic follow-ups were done in 49 patients, with complete exclusion of aneurysms in 47 patients. Endoleak was present in two patients. No aneurysm recurrence occurred. Forty-four patients showed good parent artery patency, while the other five patients showed mild to moderate asymptomatic in-stent stenosis. During the follow-up period, no ischemic or hemorrhagic event occurred. The modified Rankin Scale scores at follow-up were 0-2 in 56 patients and >2 in one patient. CONCLUSIONS: The treatment of siphon aneurysms with Willis covered stent implantation resulted in satisfactory clinical outcomes. The Willis covered stent seems safe and feasible for the treatment of siphon aneurysms, which still needs to be confirmed by longer follow-up periods and controlled studies with larger samples.

Endovascular isolation of intracranial blood blister-like aneurysms with Willis covered stent.

OBJECTIVE: Intracranial blood blister-like aneurysm (BBA) is a rare type of aneurysm that lacks all layers of the arterial wall. These fragile aneurysms have the propensity to rupture with minimal manipulation, which makes them hazardous and difficult to treat. The present study evaluated the safety and feasibility of endovascular treatment of BBAs with the Willis covered stent. MATERIALS: Thirteen patients (7 men and 6 women, age range 28-68 years) who presented with ruptured BBAs and were treated with the Willis covered stent were retrospectively reviewed. Results of the procedures and treatment-related complications were recorded. Angiographic and clinical follow-ups were performed 4-6 months after the procedure. RESULTS: Placement of the covered stent was successful in all patients. Immediate angiography showed complete aneurysm occlusion in 12 patients while one patient showed a mild endoleak. This high rate of aneurysm exclusion ensured the security of postoperative antiplatelet treatment. Occlusion of the ophthalmic artery occurred in two patients and occlusion of the anterior choroidal artery occurred in one patient; however, none of them showed acute or delayed clinical symptoms. Thrombosis, aneurysm rupture, and other complications did not develop in any case. Angiographic follow-up showed complete aneurysm exclusion without aneurysm recurrence in any patients. Only two patients showed asymptomatic mild to moderate in-stent stenosis. All patients had satisfactory clinical outcomes (modified Rankin Scale score ≤1). CONCLUSIONS: Willis covered stent implementation may be safe and feasible for BBAs. This strategy might be a promising option for this high-risk type of aneurysm.

Multifactor analysis for risk factors involved in the fear of falling in patients with chronic stroke from mainland China.

OBJECTIVE: To analyze the risk factors involved in FOF in patients with chronic stroke from mainland China. METHODS: A cohort of 245 patients with chronic stroke were included in this study. Fear of falling severity was assessed using the Activities-specific Balance Confidence (ABC) Scale. Physical function was assessed using the Berg Balance Scale (BBS), the Timed Up and Go Test (TUGT), and the lower extremity of Fugl-Meyer Assessment. Psychosocial function was assessed with the Center for Epidemiologic Studies Depression (CES-D) Scale, the State-Trait Anxiety Inventory, and the Social Support Rating Scale, respectively. All factors related to FOF severity were analyzed by regression analysis. RESULTS: Statistically significant factors affecting FOF severity included age, history of falling, balance, functional mobility, economic burden, and depression. Participants with a history of falls (N = 81) were divided into high (score ≥ 70, N = 19) and low ABC score (score < 70, N = 62) groups. Compared with the low ABC score group, the high ABC score group had higher BBS scores, and lower CES-D scores. CONCLUSIONS: Our findings suggest that - in addition to age, economic burden, and a history of falls - balance, functional mobility, and depression are risk factors associated with FOF in patients with chronic stroke in mainland China.

Transferrin receptor and ferritin-H are developmentally regulated in oligodendrocyte lineage cells.

Iron is an essential trophic element that is required for cell viability and differentiation, especially in oligodendrocytes, which consume relatively high rates of energy to produce myelin. Multiple iron metabolism proteins are expressed in the brain including transferrin receptor and ferritin-H. However, it is still unknown whether they are developmentally regulated in oligodendrocyte lineage cells for myelination. Here, using an in vitro cultured differentiation model of oligodendrocytes, we found that both transferrin receptor and ferritin-H are significantly upregulated during oligodendrocyte maturation, implying the essential role of iron in the development of oligodendrocytes. Additional different doses of Fe(3+) in the cultured medium did not affect oligodendrocyte precursor cell maturation or ferritin-H expression but decreased the expression of the transferrin receptor. These results indicate that upregulation of both transferrin receptor and ferritin-H contributes to maturation and myelination of oligodendrocyte precursor cells.

Disrupted iron metabolism and ensuing oxidative stress may mediate cognitive dysfunction induced by chronic cerebral hypoperfusion.

Iron is a highly reactive free radical catalyst that has been shown to exacerbate oxidative stress and cell death in many neurodegenerative diseases. In this study, we produced a rat model of chronic cerebral hypoperfusion (CCH) by permanent bilateral carotid artery occlusion to investigate markers of iron and oxidative stress associated with it. We found CCH led to significant spatial memory impairment in the Morris water maze at 4 months after bilateral ligation. Iron deposition was observed in both the hippocampal CA1 area and cerebral cortex, and was correlated with localized neuronal death and increased lipid peroxidation. Western blotting revealed that the expression levels of ferritin heavy chain and the transferrin receptor were significantly elevated in hippocampus and cortex after CCH, whereas expression of iron regulatory protein 1 was significantly lower than in sham-treated rats. We conclude that localized neurodegeneration and concomitant cognitive impairments following CCH may result, at least in part, from local disruption of neuronal iron metabolism.

Activities-specific Balance Confidence (ABC) Scale adapted for the mainland population of China.

OBJECTIVE: To evaluate the reliability and validity of a Chinese Mandarin version of the Activities-specific Balance Confidence (ABC) Scale. DESIGN: Cross-sectional. SETTING: A rehabilitation centre for adults. PARTICIPANTS: Sixty-one elderly people living in the community. MAIN OUTCOME MEASURE: Self-efficacy in balancing ability was assessed via a Mandarin Chinese version of the ABC Scale. RESULTS: The intraclass correlation coefficients for test-retest and inter-rater reliability of the Chinese Mandarin version of the ABC Scale were 0.98 (95% confidence interval (CI) 0.96-0.99) and 0.96 (95% CI 0.94-0.98), respectively. The Cronbach's α coefficient of internal consistency was 0.94. In the Bland-Altman analysis the mean difference in the ABC test-retest scores was -1.81, and the 95% limits of agreement varied from -10.67 to 7.03. The evaluation of inter-rater reliability showed that the mean difference was -1.13, and the 95% limits of agreement varied from -9.55 to 7.30. The factor analysis method was adopted to assess the validity of the scaled activities and two factors contributed to total variance at 52.5% and 13.6%, respectively. CONCLUSION: The Chinese Mandarin version of the ABC Scale is reliable and valid, and is suitable for assessments of balance confidence in aged people in mainland China.

[Treatment of dural arteriovenous fistula by transarterial embolization with low dose of N-butyl-2-cyanoacrylate].

OBJECTIVE: To evaluate the efficacy of treatment of dural arteriovenous fistula (DAVF) by transarterial embolization with low dose of N-butyl-2-cyanoacrylate (NBCA). METHODS: Eighteen patients, 6 males and 12 females, aged 47.5 (23-72), with DAVF, 12 with carotid cavernous fistula and 6 with fistula in parietal lobe, underwent transarterial embolization with low dose of NBCA (10%-20%). The key point of transarterial embolization with low dose of NBCA was that low dose NBCA was injected and embolized the veins and then was reversed into the other supplying arteries. RESULTS: Seventeen patients with DAVF in cavernous region and 6 patients with DAVF in parietal lobe were cured anatomically, with the clinical syndromes disappearing. In 1 patient with DAVF in cavernous region the clinical syndrome were moderately improved after transarterial embolization, however, worsened 2 days later. Cerebrovascular angiography demonstrated that the vein was not completely embolized and the draining vein was broadened, and the clinical syndromes were moderately improved again after carotid artery compression therapy for 10 days. CONCLUSION: Convenient and fast, and with low cost and satisfying efficacy, transarterial embolization with low dose of NBCA is a better choice for treatment of DAVF in some cases. The key point of this approach is that the tip of microcatheter is close as much as possible to the fistulae, and NBCA is injected into the fistulae and make the vein diffused well. Attention should be paid to avoid dangerous anastomosis.

Effectiveness of intra-arterial anesthesia for uterine fibroid embolization using dilute lidocaine.

A modified protocol of uterine fibroid embolization (UFE) is proposed for alleviating the postinterventional pain. This randomized and double-blinded clinical trial is to evaluate the effectiveness of intra-arterial infusion of dilute lidocaine for postinterventional pain relief in UFE. Forty-six patients who underwent UFE were randomly grouped equally. In the test group, after the poly(vinyl alcohol) embolization was complete, a dilute lidocaine solution with 40 mg in 6.0 ml, 3.0 ml for each side or 4.0 and 2.0 ml for two sides, was given through the catheter. In the control group, the patients received 6.0 ml of saline solution as a placebo. A simple pain degree classification method for patient self-evaluation was developed. A questionnaire was completed by each patient to record the degree of pain during five periods; these were during the procedure, the first 12 h, the second 12 h, between 24 and 48 h, and between 48 and 72 h. The numbers of patients with the same degree of pain in the five time segments from the two groups were statistically compared. Compared with the control group, the patients in the test group experienced less pain within 48 h after the procedure (p<0.01). The results suggest that this improved UFE protocol is a simple approach to prevent the acute postinterventional pain of UFE.