Enhancing the Room-Temperature Phosphorescence Performance by Salinization of Guests.

Although the host-guest doped strategy effectively improves the phosphorescence performance of materials and greatly enriches the variety of materials, most of the guests are organic molecules with weak luminescence ability, which leads to the need for further improvement in the phosphorescence performance of doped materials. Herein, by salinization of organic molecules, the luminescence performance of the guests was effectively improved, thereby significantly enhancing the phosphorescence performance of the doped system. A compound 4-(naphthalen-2-yl)quinoline (QL) containing nitrogen atom was synthesized as initial guest, then QL was salted to obtain six organic salt guests containing anions BF4-, PF6-, CF3SO3-, N(CF3SO2)2-, ClO4-, and C4F9SO3-, respectively. Two doped systems were constructed using benzophenone and poly(methyl methacrylate) as the hosts. The phosphorescence quantum yield and phosphorescence lifetime of doped materials with QL as guest were only 4.1%/5.2% and 131 ms/141 ms, while those of doped materials with salinized molecules as guests were improved to 32-39% and 534-625 ms, respectively. The single-crystal structures and theoretical calculations indicated that anions can not only enhance the intermolecular interaction of guests but also increase the spin-orbit coupling constant. This work provides an effective strategy for improving the phosphorescence performance of doped materials.

Impact of qualifying artery on the efficacy of stenting plus medical therapy versus medical therapy alone in patients with symptomatic intracranial stenosis: a post-hoc analysis of the CASSISS trial.

BACKGROUND: A recent trial failed to show any benefit of stenting plus medical therapy over medical therapy alone in patients with symptomatic intracranial stenosis. We aimed to examine whether the symptomatic qualifying artery modifies the effect of stenting plus medical therapy. METHODS: This is a post-hoc analysis of the CASSISS trial that included patients with symptomatic intracranial stenosis, randomly assigned to undergo stenting plus medical therapy or medical therapy alone; 358/380 patients were included. Multivariable logistic regression analysis was used with an interaction term to estimate the altered treatment effect by the qualifying artery. The primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The five secondary outcomes included stroke or death related to the qualifying artery territory at 2 and 3 years. RESULTS: No significant treatment allocation-by-stenosis site interaction was observed (Pinteraction=0.435). Compared with medical therapy alone, the adjusted ORs for stenting plus medical therapy were 2.73 (95% CI 0.42 to 17.65) for internal carotid artery stenosis, 1.20 (95% CI 0.29 to 4.99) for M1 stenosis, 0.23 (95% CI 0.02 to 2.31) for vertebral artery stenosis, and 1.33 (95% CI 0.34 to 5.28) for basilar artery stenosis. Of the five secondary outcomes, none showed a significant treatment allocation-by-stenosis site interaction including stroke in the qualifying artery territory at 2 years (Pinteraction=0.659) and 3 years (Pinteraction=0.493). CONCLUSIONS: Among patients with transient ischemic attacks or ischemic stroke due to severe intracranial atherosclerotic stenosis, there was no evidence that the symptomatic qualifying artery could determine the addition of stenting to medical therapy.

Randomized, prospective, multicenter trial assessing the numen coil embolization system in the endovascular treatment of small intracranial aneurysms: outcomes from the CATCH Trial.

BACKGROUND AND PURPOSE: The CATCH (Coil Application Trial in China) trial was designed to assess the safety and efficacy of the Numen Coil Embolization System in the treatment of intracranial aneurysms in comparison with the Axium coil (ev3/Medtronic). Although the endovascular treatment of small (< 5 mm) intracranial aneurysms has been reported with favorable long-term clinical and angiographic outcomes, randomized trials are still lacking. Data for aneurysms smaller than 5 mm were extracted from the CATCH trial. MATERIALS AND METHODS: A randomized, prospective, multicenter trial was conducted at ten centers throughout China. Enrolled subjects with small intracranial aneurysms were randomly assigned to receive treatment with the Numen Coil or the Axium coil. The primary outcome was successful aneurysm occlusion at the 6-month follow-up. In contrast, the secondary outcomes included complete aneurysm occlusion, recurrence rate, clinical deterioration, and safety data at the 6-month and 12-month follow-ups. RESULTS: A total of 124 patients were enrolled in the study. Overall, 58 patients were assigned to the Numen group, and 66 were assigned to the Axium group. At the 6-month follow-up, the successful aneurysm occlusion rate was 93.1% (54/58) in the MicroPort NeuroTech group and 97.0% (64/66) in the Axium group, with a common odds ratio of 0.208 (95% confidence interval, 0.023-1.914; P = 0.184). Complications were comparable between the groups. CONCLUSIONS: Compared with the Aixum coil, the Numen coil is safe and effective in treating small intracranial aneurysms. TRIAL REGISTRATION: (13/12/2016, NCT02990156).

Application of the pressure cooker technique for transarterial embolization of brain arteriovenous malformations: Factors affecting obliteration and outcomes.

Objective: The typical pressure cooker technique (PCT) and several modifications with similar mechanisms have been introduced to enhance the embolization of brain arteriovenous malformations (bAVMs). This study aimed to assess the effectiveness of transarterial embolization of bAVMs with the PCT. Method: From January 2019 to December 2021, 125 consecutive patients with bAVM managed by transarterial embolization in the prospective database on cerebral vascular diseases of a single center were retrospectively reviewed. Patient data and lesion characteristics were collected. According to the treatment strategy, the patients were assigned to the PCT group (46 patients) and conventional embolization technique (CET) group (79 patients). Results: Baseline patient features were comparable between the two groups. After the first procedure, complete obliteration immediately was observed in 61 and 42% of patients in the PCT and CET groups, respectively. The rate was markedly elevated in the PCT group (p = 0.04). In subgroup analysis, the rate of immediate complete obliteration was starkly increased in PCT group patients with Spetzler-Martin grade I/II bAVM (86 and 53% in the PCT and CET groups, respectively; p = 0.0036). The overall complication rates were similar in the two groups (13 and 10% in the PCT and CET groups, respectively; p = 0.77). In multivariable analysis, nidus size >3 cm (OR = 8.826, 95% CI: 1.250-62.312; p = 0.03) and deep location (OR = 8.576, 95% CI: 1.480-49.690; p = 0.02) were significant factors affecting complete obliteration in the PCT group. Conclusion: The PCT may yield a higher rate of immediate complete obliteration with transarterial embolization of bAVMs, without increasing the rate of procedure-related complications.

Endovascular treatment of distal internal carotid artery aneurysms and vertebral artery dissecting aneurysms with the Willis covered stent: A single-center, retrospective study.

BACKGROUND: More data is needed on the short- and medium-term efficacy and safety of the Willis covered stent in treating distal internal carotid artery (DICA) aneurysms and vertebral artery dissecting aneurysms (VADAs). METHODS: Records of all 42 patients with DICA aneurysms or VADAs treated with the Willis covered stents at our institute between July 2014 and January 2019 were retrospectively examined. The patients' demographic information, symptoms, diagnosis, treatment procedure, immediate and follow-up clinical and angiographic outcomes were extracted. RESULTS: 46 Willis covered stents were successfully implanted in all of the 42 patients (total 43 aneurysms). Immediate complete aneurysm occlusion was achieved in 37 patients (38 aneurysms) (88.4%), and endoleak occurred to 5 patients (5 aneurysms) (11.6%). 2 patients died post-operatively from procedure-related complications, another one died from reasons unrelated to the procedure. Among the remaining 39 patients, non-lethal complications occurred in 4 patients including ptosis and diplopia of the right eye, intra-operative hemorrhage and carotid cavernous fistulas (CCF). Angiographic and clinical follow-ups (means ± standard deviation: 8.8 ± 5.3 months) were done for 32 patients (33 aneurysms). Complete occlusion was maintained in all of the 33 aneurysms. 2 of the 32 patients had significant though asymptomatic parent artery (PA) occlusion. No ischemic or hemorrhagic event occurred during the follow-up period. The modified Rankin Scale (mRS) score was 0 in 31 patients and 1 in the remaining 1 patient. CONCLUSIONS: The Willis covered stent could be a safe and effective treatment for complex DICA aneurysms with excellent durability. In addition, the Willis covered stent treated all of the 3 cases of VADAs in the study with complete success without any complications, however, as the number of the VADA cases was small, more cases are needed to further confirm the efficacy and safety of the Willis covered stent in treating VADAs.

Peri-procedure efficacy and safety of one-stop hybrid surgery for the treatment of brain arteriovenous malformations: A single-center preliminary experience.

Background: Some deficiencies and shortcomings in treatment strategies of brain arteriovenous malformation (bAVM) remain. It is worth exploring whether the one-stop hybrid surgical platform can play a positive role in the treatment of bAVM. Objective: This study investigated short clinical and angiographic results of one-stop hybrid surgery for the treatment of bAVM. Methods: All patients with bAVM treated with one-stop hybrid surgery were reviewed from February 2017 to December 2021. Data including demographic information, clinical conditions, characteristics of AVM, procedure details, and clinical and angiographic results were collected. Result: In total, 150 cerebral bAVM patients received one-stop hybrid surgery; among them, 122 received surgical resection assisted by intraoperative DSA, and 28 were treated with combination surgical resection and endovascular embolization. Complete angiographic obliteration of the AVM was achieved in 136 patients (90.7%), and procedure-related death and neurological deficit rates were 7.3%. Of all relevant variables, logistic regression analysis showed that the Spetzler & Martin (S&M) score was the only factor related to the cure rate (P < 0.001) and endpoint complication rate (P = 0.007). Conclusions: In our preliminary experience, one-stop hybrid surgery for the treatment of brain AVMs achieves a high angiographic total occlusion rate, with acceptable peri-procedure morbidity and mortality. For S&M 4 and 5 lesions, more cases and further study are needed to investigate the effects and safety of hybrid surgery.

Use of covered stents to treat complex cerebrovascular diseases: Expert consensus.

The treatment of complex cerebrovascular diseases (CCVDs) at the skull base, such as complex intracranial aneurysms, carotid-cavernous sinus fistulas, and intracranial artery traumatic injuries, is a difficult clinical problem despite advances in endovascular and surgical therapies. Covered stents or stent graft insertion is a new concept for endovascular treatment that focuses on arterial wall defect reconstruction, differing from endovascular lesion embolization or flow diverter therapies. In recent years, covered stents specifically designed for cerebrovascular treatment have been applied in the clinical setting, allowing thousands of patients with CCVDs to undergo intraluminal reconstruction treatment and achieving positive results, even in the era of flow diverters. Since there is no unified reference standard for the application of covered stents for treating CCVDs, it is necessary to further standardize and guide the clinical application of this technique. Thus, we organized authoritative experts in the field of neurointervention in China to write an expert consensus, which aims to summarize the results of covered stent insertion in the treatment of CCVDs and propose suitable standards for its application in the clinical setting. Based on the contents of this consensus, clinicians can use individualized intraluminal reconstruction treatment techniques for patients with CCVDs.

Case report: Spontaneous carotid-cavernous fistula associated with persistent primitive trigeminal artery aneurysm rupture.

Background: The incidence of carotid cavernous fistula (CCF) associated with persistent primitive trigeminal artery (PPTA) aneurysm rupture is extremely rare. We presented a case about a spontaneous CCF secondary to a ruptured PPTA aneurysm, which was successfully embolized with coils and onyx-18 by a trans-arterial approach. Case presentation: A 55-year-old female suffered a sudden onset of headache, left orbital pain, and pulsatile exophthalmos for a month without any history of trauma. Angiography revealed a left-sided CCF associated with a ruptured PPTA aneurysm, with major drainage to the ipsilateral superior ophthalmic vein. Through a trans-arterial approach, the fistula and ruptured PPTA aneurysm were embolized with coils and onyx-18, while the cavernous sinus and PPTA were well-preserved. However, the preserved PPTA vanished at 4 month follow-up. The patient had no neurological deficit from hospitalization to 1 year follow-up period. Conclusion: Trans-arterial approach was a reasonable choice for spontaneous CCF associated with ruptured PPTA aneurysm. The requirement for PPTA preservation depended on individual evaluation.

Effect of Stenting Plus Medical Therapy vs Medical Therapy Alone on Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis: The CASSISS Randomized Clinical Trial.

Importance: Prior randomized trials have generally shown harm or no benefit of stenting added to medical therapy for patients with symptomatic severe intracranial atherosclerotic stenosis, but it remains uncertain as to whether refined patient selection and more experienced surgeons might result in improved outcomes. Objective: To compare stenting plus medical therapy vs medical therapy alone in patients with symptomatic severe intracranial atherosclerotic stenosis. Design, Setting, and Participants: Multicenter, open-label, randomized, outcome assessor-blinded trial conducted at 8 centers in China. A total of 380 patients with transient ischemic attack or nondisabling, nonperforator (defined as nonbrainstem or non-basal ganglia end artery) territory ischemic stroke attributed to severe intracranial stenosis (70%-99%) and beyond a duration of 3 weeks from the latest ischemic symptom onset were recruited between March 5, 2014, and November 10, 2016, and followed up for 3 years (final follow-up: November 10, 2019). Interventions: Medical therapy plus stenting (n = 176) or medical therapy alone (n = 182). Medical therapy included dual-antiplatelet therapy for 90 days (single antiplatelet therapy thereafter) and stroke risk factor control. Main Outcomes and Measures: The primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. There were 5 secondary outcomes, including stroke in the qualifying artery territory at 2 years and 3 years as well as mortality at 3 years. Results: Among 380 patients who were randomized, 358 were confirmed eligible (mean age, 56.3 years; 263 male [73.5%]) and 343 (95.8%) completed the trial. For the stenting plus medical therapy group vs medical therapy alone, no significant difference was found for the primary outcome of risk of stroke or death (8.0% [14/176] vs 7.2% [13/181]; difference, 0.4% [95% CI, -5.0% to 5.9%]; hazard ratio, 1.10 [95% CI, 0.52-2.35]; P = .82). Of the 5 prespecified secondary end points, none showed a significant difference including stroke in the qualifying artery territory at 2 years (9.9% [17/171] vs 9.0% [16/178]; difference, 0.7% [95% CI, -5.4% to 6.7%]; hazard ratio, 1.10 [95% CI, 0.56-2.16]; P = .80) and 3 years (11.3% [19/168] vs 11.2% [19/170]; difference, -0.2% [95% CI, -7.0% to 6.5%]; hazard ratio, 1.00 [95% CI, 0.53-1.90]; P > .99). Mortality at 3 years was 4.4% (7/160) in the stenting plus medical therapy group vs 1.3% (2/159) in the medical therapy alone group (difference, 3.2% [95% CI, -0.5% to 6.9%]; hazard ratio, 3.75 [95% CI, 0.77-18.13]; P = .08). Conclusions and Relevance: Among patients with transient ischemic attack or ischemic stroke due to symptomatic severe intracranial atherosclerotic stenosis, the addition of percutaneous transluminal angioplasty and stenting to medical therapy, compared with medical therapy alone, resulted in no significant difference in the risk of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The findings do not support the addition of percutaneous transluminal angioplasty and stenting to medical therapy for the treatment of patients with symptomatic severe intracranial atherosclerotic stenosis. Trial Registration: ClinicalTrials.gov Identifier: NCT01763320.

Application of the Willis Covered Stent in the Treatment of Blood Blister-Like Aneurysms: A Single-Center Experience.

Objective: To evaluate the effectiveness of the Willis covered stent (WCS) in the treatment of ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). Method: The clinical data of 16 patients consecutively treated with WCSs from December 2015 to January 2019 were retrospectively analyzed. Clinical data and angiographic findings were analyzed by two experienced neuroradiologists and neurosurgeons, including age, sex, Hunt and Hess (H&H) grade at admission, modified Rankin scale (mRS) score, aneurysm size, and location, the diameter of the patent artery in proximal and distal ends, stent size, rate of aneurysm occlusion, procedure-related complications, and follow-up. Results: All the 16 patients (five males, 11 females) with ICA BBAs underwent WCS deployment successfully. The median age was 49 years (range, 29-72). All patients had complete aneurysm occlusion on immediate postoperative angiography. Anterior choroidal artery (AChA) was occluded in one patient accidentally while no obvious neurological dysfunction was observed. However, this patient underwent subarachnoid hemorrhage 1 day after the treatment; endoleak and aneurysm recurred, and the patient died 10 days later. Therefore, the effective rate of WCS treatment was 93.8% (15/16), and procedure-related complications rate was 6.3% (1/16). Moreover, one patient was urgently treated because of accidental aneurysm rupture after anesthesia, and external ventricular drainage was then performed postoperatively. Another patient developed coma and hemiplegia 3 days after treatment, with emergency angiography showing in-stent thrombosis and ICA occlusion which was recanalized with arterial rt-PA thrombolysis; the patient recovered completely. The clinical follow-up period was 3-30 months in 14 patients. The mRS scores were 0 in 12 patients (85.7%) and 4 in 1 case (7.1%), while 1 patient (7.1%) died 6 months postoperatively for unknown reasons. Angiographic follow-up was performed in 13 patients, and no recurrence was observed. However, ICA occlusion without neurological deficit was observed in one patient. Conclusion: Based on careful preoperative evaluation, appropriate WCS size selection, and precise surgical operation, WCSs may provide an alternative and effective solution for blood BBAs via aneurysm isolation and ICA reconstruction immediately; However, further follow-up studies with larger samples are required.

A Real-Time Monitoring Method for Civil Aircraft Take-Off and Landing Based on Synthetic Aperture Microwave Radiation Technology.

It is important to monitor the take-off and landing of civil aircraft using passive detection methods. Due to the strict aircraft safety requirements and the electromagnetic environment around an airport, using too many active detection methods should be avoided. Using an aircraft's microwave radiation signal detection is very advantageous because it does not actively emit signals and has a strong cloud penetration, suitable for all-weather observation. This paper introduces a synthetic aperture microwave radiation system for monitoring the take-off and landing of civil aircraft, which is characterized by real-time two-dimensional imaging, and the image refresh rate can reach 10 ms, which meets the high refresh rate requirements for aircraft imaging. Applicable system parameters and antenna array distribution scheme and imaging algorithm are given. Then the paper focuses on the error analysis and correction method of the system. The correction method is simple and fast, which avoids the disadvantage that the error needs to be corrected regularly in the laboratory environment, and is suitable for airport application. Finally, the simulation and experimental results show that this technology can be used for real-time monitoring of civil aircraft during take-off and landing, and it is a practical means to assisting landing.

Endovascular Aneurysm Treatment with the Numen Coil Embolization System: A Prospective Randomized Controlled Open-Label Multicenter Noninferiority Trial in China.

OBJECTIVE: We investigated the safety and efficacy of the Numen coil compared with the Axium coil in the treatment of intracranial aneurysms. METHODS: Because CATCH (Coil Application Trial in China) is a prospective randomized controlled open-label noninferiority trial conducted in 10 centers across China, patients who fulfilled the inclusion and exclusion criteria were randomized 1:1 to either a test group (Numen) or a control group (Axium). The primary outcome was based on successful aneurysm occlusion at 6 months follow-up, whereas secondary outcomes included technical success, the recanalization and retreatment rates, and the rate of serious adverse events (SAEs) at 6 months and 12 months follow-up. RESULTS: Between August 2017 and December 2019, 350 patients presenting with 350 aneurysms were enrolled and randomized. Per-protocol analysis showed that the successful aneurysm occlusion rate at 6 months was 91.18% for the test group compared with 91.85% in the control group, with a difference of -0.68% (P = 0.8419), and the overall mortality during the 30-day follow-up period was 1.19% and 1.81% in the test and control group, respectively, showing no significant difference between the 2 groups (P = 0.6837), whereas the SAE incidence during the 12-month follow-up period was 12.50% and 17.47% in the test and control groups, respectively, which was not statistically significant (P = 0.2222). CONCLUSIONS: This trial showed that the Numen coil was noninferior to the Axium coil in terms of intracranial aneurysm embolization and can be considered as a safe and effective coil for treating patients with intracranial aneurysm in clinical practice.

Safety of endovascular therapy for symptomatic intracranial artery stenosis: a national prospective registry.

INTRODUCTION: The safety outcomes of endovascular therapy for intracranial artery stenosis in a real-world stetting are largely unknown. The Clinical Registration Trial of Intracranial Stenting for Patients with Symptomatic Intracranial Artery Stenosis (CRTICAS) was a prospective, multicentre, real-world registry designed to assess these outcomes and the impact of centre experience. METHODS: 1140 severe, symptomatic intracranial arterial stenosis (ICAS) patients treated with endovascular therapy were included from 26 centres, further divided into three groups according to the annual centre volume of intracranial angioplasty and stent placement procedures over 2 years: (1) high volume for ≥25 cases/year; (2) moderate volume for 10-25 cases/year and (3) low volume for <10 cases/year. RESULTS: The rate of 30-day stroke, transient ischaemic attack or death was 9.7% (111), with 5.4%, 21.1% and 9.7% in high-volume, moderate-volume and low-volume centres, respectively (p<0.05). Multivariable logistic regression confirmed high-volume centres had a significantly lower primary endpoint compared with moderate-volume centres (OR=0.187, 95% CI: 0.056 to 0.627; p≤0.0001), while moderate-volume and low-volume centres showed no significant difference (p=0.8456). CONCLUSION: Compared with the preceding randomised controlled trials, this real-world, prospective, multicentre registry shows a lower complication rate of endovascular treatment for symptomatic ICAS. Non-uniform utilisation in endovascular technology, institutional experience and patient selection in different volumes of centres may have an impact on overall safety of this treatment.

Safety and Efficacy of Rapamycin-Eluting Vertebral Stents in Patients With Symptomatic Extracranial Vertebral Artery Stenosis.

Background and Purpose: Drug-eluting stents generally have superior performance to bare metal stents in the treatment of vertebral artery stenosis (VAS). This prospective, multicenter, and single-arm clinical trial was initiated to assess in-stent restenosis (ISR) and midterm outcome after rapamycin-eluting stent placement in patients with symptomatic extracranial VAS. Methods: The subjects underwent angiographic follow-up at 6 months and final clinical follow-up at 12 months. The primary efficacy endpoint was ISR at 6 months. Secondary endpoints included technical success, target lesion-related transient ischemic attack (TIA), stroke, or death, and all-cause TIA, stroke, or death during the 12-month follow-up period. Results: A total of 104 stents were implanted in the 101 patients and 83 patients (82.2%) completed angiographic follow-up at 6 months. The technical success rate was 86.1% (87/101); mean in-stent stenosis rate was 25.1 ± 17.1% and ISR rate was 5.9% (95% CI: 0.8-10.9%). All the patients with ISR were completely asymptomatic and no stent fractures were observed during angiographic follow-up. At the 12-month clinical follow-up, target lesion-related TIA, stroke, or death had occurred in two (2.0%) patients and all-cause TIA, stroke, or death had occurred in six (6.1%) patients. Conclusion: The placement of rapamycin-eluting stents in patients with symptomatic extracranial VAS yields favorable ISR results and showed a trend of favorable safety outcomes including low rates of perioperative complications and late stroke. However, further study is needed to establish the long-term clinical benefits of this stent in the treatment of VA disease.

Health Evaluation and Fault Diagnosis of Medical Imaging Equipment Based on Neural Network Algorithm.

In recent years, high-precision medical equipment, especially large-scale medical imaging equipment, is usually composed of circuit, water, light, and other structures. Its structure is cumbersome and complex, so it is difficult to detect and diagnose the health status of medical imaging equipment. Based on the vibration signal of mechanical equipment, a PLSR-DNN hybrid network model for health prediction of medical equipment is proposed by using partial least squares regression (PLSR) algorithm and deep neural networks (DNNs). At the same time, in the diagnosis of medical imaging equipment fault, the paper proposes to use rough set to screen the fault factors and then use BP neural network to classify and identify the fault and analyzes the practical application effect of the two technologies. The results show that the PLSR-DNN hybrid network model for health prediction of medical imaging equipment is basically consistent with the actual health value of medical equipment; medical imaging equipment fault diagnosis technology is based on rough set and BP neural network. In the test set, the sensitivity, specificity, and accuracy of medical imaging equipment fault identification are 75.0%, 83.3%, and 85.0%. The above results show that the proposed health prediction method and fault diagnosis method of medical imaging equipment have good performance in health prediction and fault diagnosis of medical equipment.

Efficacy and Safety of a Novel Thrombectomy Device in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial.

Purpose: The Tonbridge stent is a novel retriever with several design improvements which aim to achieve promising flow reperfusion in the treatment of acute ischemic stroke (AIS). We conducted a randomized controlled, multicenter, non-inferiority trial to compare the safety and efficacy of the Tonbridge stent with the Solitaire FR. Methods: AIS patients aged 18-85 years with large vessel occlusion in anterior circulation who could undergo puncture within 6 h of symptom onset were included. Randomization was performed on a 1:1 ratio to thrombectomy with either the Tonbridge stent or the Solitaire FR. The primary efficacy endpoint was successful reperfusion using a modified thrombolysis in cerebral infarction score (mTICI) of 2b/3. Safety outcomes were symptomatic intracranial hemorrhage (sICH) within 24 ± 6 h and all-cause mortality within 90 days. A clinically relevant non-inferiority margin of 12% was chosen as the acceptable difference between groups. Secondary endpoints included time from groin puncture to reperfusion, National Institutes of Health Stroke Scale (NIHSS) score at 24 h and at 7 days, and a modified Rankin Scale (mRS) score of 0-2 at 90 days. Results: A total of 220 patients were enrolled; 104 patients underwent thrombectomy with the Tonbridge stent and 104 were treated with the Solitaire FR. In all test group patients, the Tonbridge was used as a single retriever without rescuing by other thrombectomy devices. Angioplasty with balloon and/or stent was performed in 26 patients in the Tonbridge group and 16 patients in the Solitaire group (p = 0.084). Before angioplasty, 86.5% of those in the Tonbridge group and 81.7% of those in the Solitaire group reached successful reperfusion (p = 0.343). Finally, more patients in the Tonbridge group achieved successful reperfusion (92.3 vs. 84.6%, 95% CI of difference value 0.9-16.7%, p < 0.0001). There were no significant differences on sICH within 24 ± 6 h between the two groups. All-cause mortality within 90 days was 13.5% in the Tonbridge group and 16.3% in the Solitaire group (p = 0.559). We noted no significant differences between groups on the NIHSS at either 24 h or 7 days and the mRS of 0-2 at 90 days. Conclusion: The trial indicated that the Tonbridge stent was non-inferior to the Solitaire FR within 6 h of symptom onset in cases of large vessel occlusion stroke. Clinical Trial Registration:ClinicalTrials.gov, number: NCT03210623.

Significance of TRPV5 and OPN biomarker levels in clinical diagnosis of patients with early urinary calculi.

OBJECTIVE: To investigate the clinical significance of the expression levels of transient receptor potential vanilloid 5 (TRPV5) and Osteopontin (OPN) biomarkers for the diagnosis of early-stage urinary stones. METHODS: A total of 48 calcium-containing kidney stone patients admitted to our hospital between February 2018 and February 2019 were selected as the experimental group in this study, and another 48 age-matched stone-free healthy individuals were selected as the control group, and the expression levels of TRPV5 and OPN biomarkers in the two groups were examined and compared with respect to related indicators. RESULTS: The urine oxalic acid content of the experimental group was found to be notably higher than the control group, while the citric acid content was lower; we observed higher levels of the 24-hour urine calcium content in the experimental group, while the citric acid/calcium ratio was remarkably lower; 24-hour urine magnesium and phosphorus levels of the two groups showed no marked difference; the mRNA expression levels of TRPV5 and OPN in the kidney tissues of the two groups were statistically different. CONCLUSION: The level of TRPV5 in urinary calculi patients was found to be significantly lower, whereas the level of OPN was significantly higher than the normal control, thus TRPV5 and OPN biomarker levels can be used as diagnostic markers for early urinary calculi.

Single-Cell RNA Sequencing With Combined Use of Bulk RNA Sequencing to Reveal Cell Heterogeneity and Molecular Changes at Acute Stage of Ischemic Stroke in Mouse Cortex Penumbra Area.

Stroke has been the leading cause of adult morbidity and mortality over the past several years. After an ischemic stroke attack, many dormant or reversibly injured brain cells exist in the penumbra area. However, the pathological processes and unique cell information in the penumbra area of an acute ischemic stroke remain elusive. We applied unbiased single cell sequencing in combination with bulk RNA-seq analysis to investigate the heterogeneity of each cell type in the early stages of ischemic stroke and to detect early possible therapeutic targets to help cell survival. We used these analyses to study the mouse brain penumbra during this phase. Our results reveal the impact of ischemic stroke on specific genes and pathways of different cell types and the alterations of cell differentiation trajectories, suggesting potential pathological mechanisms and therapeutic targets. In addition to classical gene markers, single-cell genomics demonstrates unique information on subclusters of several cell types and metabolism changes in an ischemic stroke. These findings suggest that Gadd45b in microglia, Cyr61 in astrocytes, and Sgk3 in oligodendrocytes may play a subcluster-specific role in cell death or survival in the early stages of ischemic stroke. Moreover, RNA-scope multiplex in situ hybridization and immunofluorescence staining were applied to selected target gene markers to validate and confirm the existence of these cell subtypes and molecular changes during acute stage of ischemic stroke.

Carotid Endarterectomy and Stenting in a Chinese Population: Safety Outcome of the Revascularization of Extracranial Carotid Artery Stenosis Trial.

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) have been well-established as two effective treatment modalities for carotid artery stenosis, while their clinical outcomes in real-world China are still unknown due to lack of nationwide trials. We aimed to evaluate the safety outcome profile of CEA and CAS in Chinese patients with carotid artery stenosis. The Revascularization of Extracranial Carotid Artery Stenosis trial was a multicentre, prospective cohort study of CEA or CAS in treating patients with carotid artery stenosis. We included symptomatic or asymptomatic patients with carotid artery stenosis (≥ 50%). The primary endpoint was any stroke, myocardial infarction and/or death within 1 month post-procedure. Overall, 2719 cases (1543 CAS-treated patients and 1176 CEA-treated patients) were enrolled from 36 centres. The primary outcome was 4.3% (95% CI 3.2-5.6%) and 4.7% (95%CI 3.5-6.3%) in the symptomatic and asymptomatic patients, respectively. No significant difference in the primary outcome was found between CAS and CEA in both symptomatic (p = 0.338) and asymptomatic (p = 0.890) patients. High- versus low-volume centre significantly related to lower rate of primary outcome in CEA-treated patients (OR 2.54; 95%CI 1.19-5.44; p = 0.017) and asymptomatic patients (OR 2.54; 95%CI 1.42-4.54; p = 0.002). CEA and CAS decided by surgeons' discretion have comparable risks among patients with carotid artery stenosis in China. Both CEA and CAS should be avoided in asymptomatic patients until a consistently low complication rate is showed with centre-level audits. Medical treatment for patients with carotid stenosis in China needs to be improved. Trial registration: NCT01994187 ( ClinicalTrials.gov ).

[Recombinant adiponectin inhibits the expression of inflammation-associated proteins from mouse astrocytes via AMPK-independent PKC pathway].

Objective To investigate whether recombinant adiponectin peptide (APN) plays an anti-inflammatory role in the oxy-glucose deprivation/reoxygenation (OGD/R) model of astrocytes via the protein kinase C (PKC) and AMP dependent protein kinase (AMPK) pathway. Methods The phosphorylation levels of PKC and AMPK in astrocytic cell line MA1800 was assessed by Western blotting under the condition of OGD/R with the time gradient (2, 4, 6, 8, 12, 24 hours) or the condition of cobalt chloride (CoCl2) treatment with the concentration gradient (20, 50, 100, 200, 400, 600, 800, 1000, 1200, 1600, 2000 µmol/L) to determine the optimal condition of OGD/R in the following study. The cells were grouped into a normal control group, OGD/R treatment group, APN only group, OGD/R combined with APN treatment group, and AMPK inhibition combined with OGD/R and APN treatment group. Western blotting was used to detect the levels of PKCα, phospho-PKC(pan), AMPKα, phospho-AMPKα, NLRP3 inflammasome in the cells, and tumor necrosis factor α (TNF-α) in the conditioned medium of cell culture. Results After OGD/R or 400 µmol/L CoCl2 treatment for 6 hours, the phosphorylation level of p-PKC reached a peak. Compared with the control group, the levels of PKCα, p-AMPKα, AMPK, NLRP3 and TNF-α in the supernatant increased significantly in the experimental groups. Compared with the ODG/R group, the phosphorylation level of PKC, the expression of TNF-α and NLRP3 significantly decreased in the APN treated groups, while the phosphorylation of AMPK remained unchanged. Conclusion APN treatment can inhibit the expression of inflammatory factors in astrocyte model of OGD/R via AMPK-independent PKC signaling pathway.