The safety limitation of large new-built seagoing ves- sel design and operation is investigated to ensure safety of the new vessels towed through bridge area. We analyze the maneuverabil- ity characteristics of a towi...The safety limitation of large new-built seagoing ves- sel design and operation is investigated to ensure safety of the new vessels towed through bridge area. We analyze the maneuverabil- ity characteristics of a towing fleet, and develop a mathematical drift model of ship motion for the fleet. Based on this drift model and the hydro-meteorological conditions in bridge area, we pro- pose a method to systematically ascertain the safety limitations of water stages, current, wind, speed and visibility. This method is conducive to the safety of both navigation and bridges when large towing fleets transit through bridges.展开更多
BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug...BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.展开更多
Large size vessels sailing in continuous level ice and broken ice of high concentration are mostly assisted by icebreakers.This is done in order to provide for fast transportation through the North Sea Route and safe ...Large size vessels sailing in continuous level ice and broken ice of high concentration are mostly assisted by icebreakers.This is done in order to provide for fast transportation through the North Sea Route and safe operation in extreme ice conditions.Currently,new large size gas and oil carriers and container ships are being designed and built with beams much greater than the beams of existing icebreakers.At the same time,no mathematical description exists for the breaking mechanism of ice channel edges,when such vessels move under icebreaker escort.This paper suggests a simple method for assessment of the ice resistance in the case of a large ship running in an icebreaker channel;the method is based on modification of well-known semi-empirical methods for calculation of the ice resistance to ships in level and broken ice.The main feature of the proposed calculation scheme consists in that different methods are applied to estimate the ice resistance in broken ice and due to breaking of level ice edges.The combination of these methods gives a deliverable ice resistance of a large size vessel moving under icebreaker assistance in a newly made ice channel.In general,proposed method allows to define the speed of a carrier moving in an ice channel behind a modern linear icebreaker and could be applied at the ship design stage and during development of the marine transportation system.The paper also discusses the ways for further refinement of the assessment procedure suggested.展开更多
BACKGROUND Musculoskeletal involvement in primary large vessel vasculitis(LVV),including giant cell arteritis and Takayasu's arteritis(TAK),tends to be subacute.With the progression of arterial disease,patients ma...BACKGROUND Musculoskeletal involvement in primary large vessel vasculitis(LVV),including giant cell arteritis and Takayasu's arteritis(TAK),tends to be subacute.With the progression of arterial disease,patients may develop polyarthralgia and myalgias,mainly involving muscle stiffness,limb/jaw claudication,cold/swelling extremities,etc.Acute development of rhabdomyolysis in addition to aortic aneurysm is uncommon in LVV.Herein,we report a rare case of LVV with the first presentation of acute rhabdomyolysis.CASE SUMMARY A 70-year-old Asian woman suffering from long-term low back pain was hospitalized due to limb claudication,dark urine and an elevated creatine kinase(CK)level.After treatment with fluid resuscitation and antibiotics,the patient remained febrile.Her workup showed persistent elevated levels of inflammatory markers,and imaging studies revealed an aortic aneurysm.A decreasing CK was evidently combined with elevated inflammatory markers and negativity for antineutrophilic cytoplasmic antibodies.LVV was suspected and confirmed by magnetic resonance angiography and positron emission tomography with 18Ffluorodeoxyglucose/computed tomography.With a favourable response to immunosuppressive treatment,her symptoms resolved,and clinical remission was achieved one month later.However,after failing to follow the tapering schedule,the patient was readministered 25 mg/d prednisolone due to disease relapse.Follow-up examinations showed decreased inflammatory markers and substantial improvement in artery lesions after 6 mo of treatment.At the twelvemonth follow-up,she was clinically stable and maintained on corticosteroid therapy.CONCLUSION An exceptional presentation of LVV with acute rhabdomyolysis is described in this case,which exhibited a good response to immunosuppressive therapy,suggesting consideration for a differential diagnosis when evaluating febrile patients with myalgia and elevated CK.Timely use of high-dose steroids until a diagnosis is established may yield a favourable outcome.展开更多
Patients who received endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) and large-scaled core infarct volume in the time window were analyzed. Literature data were reviewed. Re...Patients who received endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) and large-scaled core infarct volume in the time window were analyzed. Literature data were reviewed. Results showed that although EVT is the first choice to AIS-LVO, patients often have poor prognosis. Alberta stroke program early CT score (ASPECTS) based on computerized tomography angiography source image (CTA-SI) can reflect the real cerebral perfusion more truly, and it can assess the size of core infarct more quickly and accurately, thus enabling to judge prognosis.展开更多
Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospita...Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospital paramedics distinguishing LVO-AIS patients with high efficiency and help to avoid unnecessary and costly delays.The current study aims to develop a screening tool to predict AIS-LVO patients based on prehospital available data.Method:A total of 251 suspected stroke patients who were transported to the emergency department of our hospital via emergency medical services were consecutively enrolled from August,2020 to January,2022.Data including demographic information,medical history,clinical manifestations,and vital signs were collected.A multivariate logistic regression model was developed based on statistically significant variables selected from univariate analysis.Result:Forty-two patients(16.7%)were diagnosed as LVO-AIS based on imaging validation at admission.A comprehensive model was developed with past medical history factors such as atrial fibrillation and coronary heart disease,vital signs such as systolic blood pressure,and prominent symptoms and signs such as gaze palsy,facial paralysis,and dysarthria.The model showed better diagnostic performance in terms of area under the receiver operating characteristic curves(0.884,95%CI,0.830-0.939),which was higher than other common prehospital prediction scales such as the Face,Arm,Speech,Time test(FAST),the Field Assessment Stroke Triage for Emergency Destination(FAST-ED)scale,and the Gaze-Face-Arm-Speech-Time test(G-FAST).Calibration curve analysis,decision curve analysis,and clinical impact curve analysis further validated the reliability,net benefit,and potential clinical impact of the prediction model,respectively.Conclusion:We conducted a prediction model based on prehospital accessible factors including past history of atrial fibrillation and coronary heart disease,systolic blood pressure,and signs such as gaze palsy,facial palsy,and dysarthria.The prediction model showed good diagnostic power and accuracy for identification of the high-risk patients with LVO and may become an effective tool for the LVO recognition in prehospital settings.Future studies are warranted to refine and validate the model further in order to enhance the accuracy and objectivity of clinical judgments.展开更多
Objective:To investigate the clinical effects of applying the magnetic resonance double mismatch technique to endovascular treatment of acute anterior circulation,large vessel occlusion with cerebral infarction in an ...Objective:To investigate the clinical effects of applying the magnetic resonance double mismatch technique to endovascular treatment of acute anterior circulation,large vessel occlusion with cerebral infarction in an unknown time window.Methods:The research work was carried out in our hospital,the work was carried out from November 2018 to November 2019,the patients with acute anterior circulation large vessel occlusion with cerebral infarction who were treated in our hospital during this period,100 patients,50 patients with an unknown time window and 50 patients with definite time window were selected,and they were named as the experimental and control groups,given different examination methods,were given to investigate the clinical treatment effect.Results:Patients’data on HIHSS score before treatment,the incidence of intracranial hemorrhage and rate of Mrs≤2 rating after 90 days of treatment were not significantly different(P>0.05),which was not meaningful.The differences in data between the two groups concerning HIHSS scores were relatively significant before,and after treatment(P<0.05).Conclusion:The magnetic resonance double mismatch technique will be applied in the endovascular treatment of acute anterior circulation large vessel occlusion with cerebral infarction of unknown time window.展开更多
BACKGROUND The combination of acute ST-segment elevation myocardial infarction(STEMI)and gastric ulcers poses a challenge to primary percutaneous coronary intervention(PPCI),particularly for young patients.The role of...BACKGROUND The combination of acute ST-segment elevation myocardial infarction(STEMI)and gastric ulcers poses a challenge to primary percutaneous coronary intervention(PPCI),particularly for young patients.The role of drug-coated balloons(DCBs)in the treatment of de novo coronary artery lesions in large vessels remains unclear,especially for patients with STEMI.Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion.CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24,2019.Within the first 3 minutes of the initial assessment in the emergency room,the electrocardiogram(ECG)showed significant changes.There was atrial fibrillation with ST-segment elevation.Subsequently,atrial fibrillation terminated spontaneously and reverted to sinus rhythm.Soon after,the patient experienced syncope.The ECG revealed torsades de pointes ventricular tachycardia.A few seconds later,it returned to sinus rhythm.High-sensitivity tropon in I was normal.The diagnosis was acute STEMI.Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery.Considering the patient's age and history of peptic ulcer disease,after the intracoronary injection of prourokinase,percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning,and paclitaxel drug-eluting balloon angioplasty was performed without any stents,achieving favorable outcomes.CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI,and further research is warranted.展开更多
A system designed for a rigid and flexible pipe laying purposes is presented in the paper.Mathematical and numerical models are developed by using the rigid finite element method（RFEM）.The RFEM is an efficient solut...A system designed for a rigid and flexible pipe laying purposes is presented in the paper.Mathematical and numerical models are developed by using the rigid finite element method（RFEM）.The RFEM is an efficient solution in the time domain.Static and dynamic problems related to pipe installation are solved by taking the advantage of simple interpretation and implementation of the method.Large deformations of the pipe during spooling and when it is reeled out at sea are considered.A material model implemented is used to take into consideration nonlinear material properties.In particular,the full elasto-plastic material characteristics with hardening and Bauschinger effect are included.Dynamic analyses are performed and the results attached in this work demonstrates how the sea conditions influence the machinery and pipeline,assuming a passive reel drive system. The influence of several other operational parameters on dynamic loads is verified.An active system,implemented as a part of the mathematical model,improves the system performance.Some results are presented as well.展开更多
BACKGROUND Pulmonary sequestrations often lead to serious complications such as infections,tuberculosis,fatal hemoptysis,cardiovascular problems,and even malignant degeneration,but it is rarely documented with medium ...BACKGROUND Pulmonary sequestrations often lead to serious complications such as infections,tuberculosis,fatal hemoptysis,cardiovascular problems,and even malignant degeneration,but it is rarely documented with medium and large vessel vasculitis,which is likely to result in acute aortic syndromes.CASE SUMMARY A 44-year-old man with a history of acute Stanford type A aortic dissection status post-reconstructive surgery five years ago.The contrast-enhanced computed tomography of the chest at that time had also revealed an intralobar pulmonary sequestration in the left lower lung region,and the angiography also presented perivascular changes with mild mural thickening and wall enhancement,which indicated mild vasculitis.The intralobar pulmonary sequestration in the left lower lung region was long-term unprocessed,which was probably associated with his intermittent chest tightness since no specific medical findings were detected but only positive sputum culture with mycobacterium avium-intracellular complex and Aspergillus.We performed uniportal video-assisted thoracoscopic surgery with wedge resection of the left lower lung.Hypervascularity over the parietal pleura,engorgement of the bronchus due to a moderate amount of mucus,and firm adhesion of the lesion to the thoracic aorta were histopathologically noticed.CONCLUSION We hypothesized that a long-term pulmonary sequestration-related bacterial or fungal infection can result in focal infectious aortitis gradually,which may threateningly aggravate the formation of aortic dissection.展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;">Stroke is the second highest cause of death globally and a leading cause of not only physical disability but also co...<div style="text-align:justify;"> <span style="font-family:Verdana;">Stroke is the second highest cause of death globally and a leading cause of not only physical disability but also cognitive. Approximately two-thirds of Ischemic Stroke patients, who represent the most common type of stroke are found to have mild deficits. Minor stroke, sometimes also referred to as “mild stroke”, is often defined in research studies as a National Institute of Health Stroke Scale (NIHSS) score of 5 or less, although, the cut point for NIHSS score or standardized criterion to define minor stroke has not been established. In the past, many studies have been focusing on the definition of the minor stroke to better stabilize the acute treatment guidelines, to predict the functional outcome, and also for early risk factors stratification. Different studies use different criteria or different cut-points of NIHSS scores to define minor stroke. Aside from indecision of acute management of minor stroke, many other questions have been raised regarding minor strokes, for example, the interaction of large vessel occlusion with minor stroke, the prevalence rate of depression, anxiety, cognitive dysfunction, chronic head after minor stroke, and so on. Finding a universal definition for minor stroke is the key to establish the guideline for management for this group of patients. However, the guidance of treatment of minor stroke is not the focus of this review. The review will focus on the deep comprehension of minor stroke characteristics, summarizing the new findings related to minor stroke, and highlight the essential points to consider for characterizing mild stroke symptoms for a new direction guide for future studies.</span> </div>展开更多
Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospecti...Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.展开更多
Background The impact of lowering systolic blood pressure(SBP)following endovascular treatment(EVT)in acute large vessel occlusion stroke(LVOS)patients remains unclear.We aimed to explore the effect of the magnitude o...Background The impact of lowering systolic blood pressure(SBP)following endovascular treatment(EVT)in acute large vessel occlusion stroke(LVOS)patients remains unclear.We aimed to explore the effect of the magnitude of SBP reduction(SBPr)after EVT on outcomes in LVOS patients.Methods We consecutively registered patients at three comprehensive stroke centres who had experienced EVT as a result of acute anterior circulation LVOS.SBPr was calculated as follows:(baseline SBP−mean SBP/baseline SBP)×100%.The 90-day modified Rankin Scale score ranging from 0 to 2 was defined as a favourable functional outcome.Based on CT scans obtained within 24 hours after procedure,symptomatic intracranial haemorrhage(sICH)was assessed according to the criteria of the European Cooperative Acute Stroke Study III.Results We enrolled 1080 patients,of which 908(84.1%)had successful recanalisation.In the overall cohort,SBPr was correlated with lower odds of sICH(SBPr±10%as a reference,20%-30%:OR 0.460;95%CI:0.245 to 0.864;p=0.016;>30%:OR 0.304;95%CI 0.123 to 0.749;p=0.010).In patients who achieved successful reperfusion,SBPr>30%was correlated with higher odds of a poor outcome(SBPr±10%as a reference,OR 2.150;95%CI 1.268 to 3.645;p=0.004)and SBPr has a similar tendency towards reducing the incidence of sICH.In the subgroup analyses,baseline Alberta Stroke Programme Early CT(ASPECT)score(p_(interact)=0.024)modified the effect of SBPr on the 90-day outcome.Conclusion Among patients with EVT,a significant drop in SBP may be related to a poor functional outcome and a reduced incidence of sICH.Baseline ASPECT score may be an important interacting factor in the association of SBPr with the 90-day outcome.This study provides new insights for individualised BP management in patients with EVT.展开更多
Rationale The management of residual stenosis after mechanical thrombectomy in patients with intracranial atherosclerotic stenosis-related emerge large vessel occlusive(ICAS-LVO)stroke is still unclear question in cli...Rationale The management of residual stenosis after mechanical thrombectomy in patients with intracranial atherosclerotic stenosis-related emerge large vessel occlusive(ICAS-LVO)stroke is still unclear question in clinical practice.Aim To demonstrate the design of a clinical trial on emergency balloon angioplasty and/or stenting(BAS)combined with standard medical treatment(SMT)for residual stenosis of ICAS-LVO stroke patients with successful recanalisation.Design ASSET is a multicentre,prospective,randomised,open-label,blinded end-point,controlled clinical trial designed(PROBE)by investigators.This trial evaluates the effectiveness and the safety of emergency BAS in combination with SMT compared with SMT alone in ICAS-LVO stroke patients with successful recanalisation(defined as expanded treatment in cerebral ischaemia grade of 2b50-3 and maintained for more than 20 min)and residual stenosis(defined as≥50%)up to 24 hours after the onset of symptoms or the last known well.Outcome The primary outcome assessed at 90(±7)days after randomisation is the incidence of ischaemic stroke in the responsible vessel.Symptomatic intracranial haemorrhage within 24(±3)hours is the primary safety outcome.展开更多
Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed ...Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed to assess the efficacy and safety of IVT administered before EVT in this patient population.Methods We analysed the data from a multicentre registry of patients who underwent EVT for AT-LVO.Patients were categorised based on presumed mechanism of occlusion:in situ occlusion(intracranial group)or embolism from cervical artery occlusion/stenosis(tandem group).We compared the efficacy and safety of IVT before EVT in patients who received IVT(IVT stratum)and those who did not(non-IVT stratum).The primary outcome was a modified Rankin Scale score of 0-2 at 90 days.Results Among the 336 patients in the intracranial group,99 patients underwent IVT.The rate of favourable functional outcomes did not differ between IVT and non-IVT strata(51.1%vs 47.6%;adjusted ORs(aORs)(95%CI),1.18(0.66 to 2.09));whereas any intracranial haemorrhage(ICH)(10.1%vs 3.8%;aOR,2.98(1.01 to 9.26))and mortality at 90 days(6.4%vs 1.3%;aOR,4.66(1.02 to 26.73))were significantly higher in the IVT stratum.Among the 233 patients in the tandem group,88 patients underwent IVT,with no significant differences in efficacy or safety outcomes between the strata.Conclusion In patients with AT-LVO,IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion.IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions.展开更多
Purpose This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score(ASPECTS)regions is associated with clinical outcome in patients with symptomatic non-acute internal ...Purpose This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score(ASPECTS)regions is associated with clinical outcome in patients with symptomatic non-acute internal carotid or middle cerebral artery occlusion who underwent endovascular recanalisation(ER).Methods Preoperative ASPECTS and region of infarction were recorded before recanalisation.Clinical outcome was evaluated 90 days after the procedure using the modified Rankin Scale;a score>2 was defined as poor outcome.Secondary outcomes included postprocedural cerebral oedema,intracranial haemorrhage(ICH)and symptomatic ICH.Results Among the 86 patients included,90-day outcome was poor in 30(34.9%)and 40 experienced cerebral oedema(46.5%).Multivariate logistic regression models showed that lenticular nucleus infarction(OR 19.61-26.00,p<0.05),admission diastolic blood pressure(OR 1.07-1.08,p<0.05),preprocedural National Institutes of Health Stroke Scale(OR 1.96-2.05,p<0.001)and haemorrhagic transformation(OR 14.99-18.81,p<0.05)were independent predictors of poor 90-day outcome.The area under the receiver operating characteristic curve for lenticular nucleus infarction as a predictor of poor outcome was 0.73.M2 region infarction(OR 26.07,p<0.001)and low American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation grade(OR 0.16,p=0.001)were independent predictors of postprocedural cerebral oedema.The area under the receiver operating characteristic curve for M2 region infarction as a predictor of cerebral oedema was 0.64.Region of infarction did not significantly differ between patients with and without postprocedural ICH or symptomatic ICH.Conclusions Lenticular nucleus and M2 region infarction were independent predictors of poor 90-day outcome and postprocedural cerebral oedema,respectively,in patients with non-acute anterior circulation large artery occlusion who underwent ER.展开更多
Background Despite successful reperfusion after thrombectomy for large vessel occlusion(LVO)stroke,up to half of patients are dependent or dead at 3-month follow-up.The aim of the current study is to demonstrate safet...Background Despite successful reperfusion after thrombectomy for large vessel occlusion(LVO)stroke,up to half of patients are dependent or dead at 3-month follow-up.The aim of the current study is to demonstrate safety and efficacy of administering adjunct intra-arterial(IA)tenecteplase in anterior circulation LVO patients who have achieved successful reperfusion defined as eTICI 2b50 to 3.Methods ANGEL-TNK is a multicentre,open-label,assessor-blinded endpoint,prospective randomised,controlled trial that will enrol up to 256 patients.Patients who meet inclusion criteria with anterior circulation LVO stroke and successful reperfusion will be randomised to receive IA tenecteplase or best medical management at 1:1 ratio.Results The primary endpoint is a 90-day excellent outcome defined as modified Rankin Scale(mRS)0–1.The primary safety endpoint is symptomatic intracranial haemorrhage within 48 hours from randomisation.Secondary endpoints include 90-day ordinal mRS,mRS 0–2,mRS 0–3,all-cause mortality and any intracranial haemorrhage.Conclusion In patients with anterior circulation LVO stroke,the ANGEL-TNK trial will inform whether adjunct IA tenecteplase administered after successful thrombectomy reperfusion improves patient outcomes.Trial registration number NCT05624190.展开更多
Background Acute ischaemic stroke,due to its high mortality and disability rates,imposes a significant economic and social burden worldwide.Typically,endovascular treatment within the therapeutic window is provided to...Background Acute ischaemic stroke,due to its high mortality and disability rates,imposes a significant economic and social burden worldwide.Typically,endovascular treatment within the therapeutic window is provided to salvage the ischaemic penumbra;however,even when recanalisation is successful during endovascular treatment,the clinical outcomes may still be disappointing.This highlights the necessity of further research,so as to discover better solutions to futile recanalisation and improve patient outcomes.Objective To investigate the efficacy and safety of Y-6 sublingual tablets(cilostazol and dexborneol)compared with a placebo in the treatment of patients with acute ischaemic stroke caused by large vessel occlusion.Method The efficacy and safety of Y-6 sublingual tablets in patients with acute ischaemic stroke are evaluated in a phase Ⅱ,randomised,double-blind,double-dummy,placebo-controlled,parallel clinical trial.Eligible patients having provided informed consent are randomised into five groups for a 28-day treatment period.The primary outcome is the percentage of patients achieving the modified Rankin Scale score of 0-1 at 90 days.Discussion The EFfects of Y-6 SUblingual Tablets for PaTients with AcUte Ischemic StRokE trial assesses whether Y-6 sublingual tablets are effective and safe in improving the clinical outcomes of patients with acute ischaemic stroke caused by large vessel occlusion.展开更多
Background and purpose Approximately 25%of acute large vessel occlusive(LVO)ischaemic strokes are of unknown thrombotic origin,and there is a need to establish the aetiology to guide subsequent preventative measures.T...Background and purpose Approximately 25%of acute large vessel occlusive(LVO)ischaemic strokes are of unknown thrombotic origin,and there is a need to establish the aetiology to guide subsequent preventative measures.The aim of this study was to quantify thrombus composition in patients with LVO and explore associations between thrombus composition and stroke aetiology.Methods Thrombi were extracted from 132 patients with acute ischaemic stroke.Erythrocytes,leucocytes and F+P(fibrin+platelet)proportions were assessed in tissue sections stained with H&E,while CD3+T cells and neutrophil extracellular traps(NETs)were quantified in immunohistochemistry-stained sections.Thrombus components,clinical parameters and interventional variables were compared between different stroke subtypes defined by Trial of ORG 10172 in Acute Stroke Treatment criteria.Results F+P composition was significantly higher(p<0.001)and erythrocyte proportions were significantly lower(p<0.001)in cardioembolic thrombi than in large artery atherosclerosis thrombi.The composition of thrombi from undetermined aetiology strokes resembled that from cardioembolic strokes.CD3+T cell and NET proportions were not significantly different between stroke subtypes.CD3+density per unit area was associated with the occlusive site,being significantly higher in the anterior circulation than the posterior circulation(p=0.004).Cardioembolic strokes were more common in the anterior circulation than large artery atherosclerosis strokes(p=0.002).Recanalisation time was significantly longer for large artery atherosclerosis emboli than for cardioembolic emboli(p=0.032).Conclusion There is significant heterogeneity in thrombus composition among different stroke subtypes.The quantitative assessment of thrombus composition may be a useful biomarker of stroke aetiology,and strokes of undetermined aetiology may be more likely to have a cardioembolic origin.展开更多
基金Supported by the Key Projects of Golden Waterway Transit Capacity Improving Technologies(201132822430)
文摘The safety limitation of large new-built seagoing ves- sel design and operation is investigated to ensure safety of the new vessels towed through bridge area. We analyze the maneuverabil- ity characteristics of a towing fleet, and develop a mathematical drift model of ship motion for the fleet. Based on this drift model and the hydro-meteorological conditions in bridge area, we pro- pose a method to systematically ascertain the safety limitations of water stages, current, wind, speed and visibility. This method is conducive to the safety of both navigation and bridges when large towing fleets transit through bridges.
基金Supported by Shandong Provincial TCM Science and Technology Development Program Project,No.2019-0481Jining City Science and Technology Key Research and Development Program,No.2021YXNS069.
文摘BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.
基金This work was funded by the Russian Science Foundation(Grant No.17-79-20162-П).
文摘Large size vessels sailing in continuous level ice and broken ice of high concentration are mostly assisted by icebreakers.This is done in order to provide for fast transportation through the North Sea Route and safe operation in extreme ice conditions.Currently,new large size gas and oil carriers and container ships are being designed and built with beams much greater than the beams of existing icebreakers.At the same time,no mathematical description exists for the breaking mechanism of ice channel edges,when such vessels move under icebreaker escort.This paper suggests a simple method for assessment of the ice resistance in the case of a large ship running in an icebreaker channel;the method is based on modification of well-known semi-empirical methods for calculation of the ice resistance to ships in level and broken ice.The main feature of the proposed calculation scheme consists in that different methods are applied to estimate the ice resistance in broken ice and due to breaking of level ice edges.The combination of these methods gives a deliverable ice resistance of a large size vessel moving under icebreaker assistance in a newly made ice channel.In general,proposed method allows to define the speed of a carrier moving in an ice channel behind a modern linear icebreaker and could be applied at the ship design stage and during development of the marine transportation system.The paper also discusses the ways for further refinement of the assessment procedure suggested.
基金Supported by Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2021KY833Traditional Chinese Medical Science and Technology Project of Zhejiang Province,No.2021ZB110.
文摘BACKGROUND Musculoskeletal involvement in primary large vessel vasculitis(LVV),including giant cell arteritis and Takayasu's arteritis(TAK),tends to be subacute.With the progression of arterial disease,patients may develop polyarthralgia and myalgias,mainly involving muscle stiffness,limb/jaw claudication,cold/swelling extremities,etc.Acute development of rhabdomyolysis in addition to aortic aneurysm is uncommon in LVV.Herein,we report a rare case of LVV with the first presentation of acute rhabdomyolysis.CASE SUMMARY A 70-year-old Asian woman suffering from long-term low back pain was hospitalized due to limb claudication,dark urine and an elevated creatine kinase(CK)level.After treatment with fluid resuscitation and antibiotics,the patient remained febrile.Her workup showed persistent elevated levels of inflammatory markers,and imaging studies revealed an aortic aneurysm.A decreasing CK was evidently combined with elevated inflammatory markers and negativity for antineutrophilic cytoplasmic antibodies.LVV was suspected and confirmed by magnetic resonance angiography and positron emission tomography with 18Ffluorodeoxyglucose/computed tomography.With a favourable response to immunosuppressive treatment,her symptoms resolved,and clinical remission was achieved one month later.However,after failing to follow the tapering schedule,the patient was readministered 25 mg/d prednisolone due to disease relapse.Follow-up examinations showed decreased inflammatory markers and substantial improvement in artery lesions after 6 mo of treatment.At the twelvemonth follow-up,she was clinically stable and maintained on corticosteroid therapy.CONCLUSION An exceptional presentation of LVV with acute rhabdomyolysis is described in this case,which exhibited a good response to immunosuppressive therapy,suggesting consideration for a differential diagnosis when evaluating febrile patients with myalgia and elevated CK.Timely use of high-dose steroids until a diagnosis is established may yield a favourable outcome.
文摘Patients who received endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) and large-scaled core infarct volume in the time window were analyzed. Literature data were reviewed. Results showed that although EVT is the first choice to AIS-LVO, patients often have poor prognosis. Alberta stroke program early CT score (ASPECTS) based on computerized tomography angiography source image (CTA-SI) can reflect the real cerebral perfusion more truly, and it can assess the size of core infarct more quickly and accurately, thus enabling to judge prognosis.
基金sponsored by National Natural Science Foundation of China(No.82101389 and 81971114)Beijing Nova Program(No.20230484286)General Project of Science and Technology of Beijing Municipal Education Commission(No.KM202110025018).
文摘Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospital paramedics distinguishing LVO-AIS patients with high efficiency and help to avoid unnecessary and costly delays.The current study aims to develop a screening tool to predict AIS-LVO patients based on prehospital available data.Method:A total of 251 suspected stroke patients who were transported to the emergency department of our hospital via emergency medical services were consecutively enrolled from August,2020 to January,2022.Data including demographic information,medical history,clinical manifestations,and vital signs were collected.A multivariate logistic regression model was developed based on statistically significant variables selected from univariate analysis.Result:Forty-two patients(16.7%)were diagnosed as LVO-AIS based on imaging validation at admission.A comprehensive model was developed with past medical history factors such as atrial fibrillation and coronary heart disease,vital signs such as systolic blood pressure,and prominent symptoms and signs such as gaze palsy,facial paralysis,and dysarthria.The model showed better diagnostic performance in terms of area under the receiver operating characteristic curves(0.884,95%CI,0.830-0.939),which was higher than other common prehospital prediction scales such as the Face,Arm,Speech,Time test(FAST),the Field Assessment Stroke Triage for Emergency Destination(FAST-ED)scale,and the Gaze-Face-Arm-Speech-Time test(G-FAST).Calibration curve analysis,decision curve analysis,and clinical impact curve analysis further validated the reliability,net benefit,and potential clinical impact of the prediction model,respectively.Conclusion:We conducted a prediction model based on prehospital accessible factors including past history of atrial fibrillation and coronary heart disease,systolic blood pressure,and signs such as gaze palsy,facial palsy,and dysarthria.The prediction model showed good diagnostic power and accuracy for identification of the high-risk patients with LVO and may become an effective tool for the LVO recognition in prehospital settings.Future studies are warranted to refine and validate the model further in order to enhance the accuracy and objectivity of clinical judgments.
文摘Objective:To investigate the clinical effects of applying the magnetic resonance double mismatch technique to endovascular treatment of acute anterior circulation,large vessel occlusion with cerebral infarction in an unknown time window.Methods:The research work was carried out in our hospital,the work was carried out from November 2018 to November 2019,the patients with acute anterior circulation large vessel occlusion with cerebral infarction who were treated in our hospital during this period,100 patients,50 patients with an unknown time window and 50 patients with definite time window were selected,and they were named as the experimental and control groups,given different examination methods,were given to investigate the clinical treatment effect.Results:Patients’data on HIHSS score before treatment,the incidence of intracranial hemorrhage and rate of Mrs≤2 rating after 90 days of treatment were not significantly different(P>0.05),which was not meaningful.The differences in data between the two groups concerning HIHSS scores were relatively significant before,and after treatment(P<0.05).Conclusion:The magnetic resonance double mismatch technique will be applied in the endovascular treatment of acute anterior circulation large vessel occlusion with cerebral infarction of unknown time window.
基金Supported by Mianyang Health Commission 2019 Scientific Research Encouragement Project,No.201948.
文摘BACKGROUND The combination of acute ST-segment elevation myocardial infarction(STEMI)and gastric ulcers poses a challenge to primary percutaneous coronary intervention(PPCI),particularly for young patients.The role of drug-coated balloons(DCBs)in the treatment of de novo coronary artery lesions in large vessels remains unclear,especially for patients with STEMI.Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion.CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24,2019.Within the first 3 minutes of the initial assessment in the emergency room,the electrocardiogram(ECG)showed significant changes.There was atrial fibrillation with ST-segment elevation.Subsequently,atrial fibrillation terminated spontaneously and reverted to sinus rhythm.Soon after,the patient experienced syncope.The ECG revealed torsades de pointes ventricular tachycardia.A few seconds later,it returned to sinus rhythm.High-sensitivity tropon in I was normal.The diagnosis was acute STEMI.Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery.Considering the patient's age and history of peptic ulcer disease,after the intracoronary injection of prourokinase,percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning,and paclitaxel drug-eluting balloon angioplasty was performed without any stents,achieving favorable outcomes.CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI,and further research is warranted.
基金supported by the Polish Ministry of Science and Higher Education(N N502 464934)
文摘A system designed for a rigid and flexible pipe laying purposes is presented in the paper.Mathematical and numerical models are developed by using the rigid finite element method（RFEM）.The RFEM is an efficient solution in the time domain.Static and dynamic problems related to pipe installation are solved by taking the advantage of simple interpretation and implementation of the method.Large deformations of the pipe during spooling and when it is reeled out at sea are considered.A material model implemented is used to take into consideration nonlinear material properties.In particular,the full elasto-plastic material characteristics with hardening and Bauschinger effect are included.Dynamic analyses are performed and the results attached in this work demonstrates how the sea conditions influence the machinery and pipeline,assuming a passive reel drive system. The influence of several other operational parameters on dynamic loads is verified.An active system,implemented as a part of the mathematical model,improves the system performance.Some results are presented as well.
文摘BACKGROUND Pulmonary sequestrations often lead to serious complications such as infections,tuberculosis,fatal hemoptysis,cardiovascular problems,and even malignant degeneration,but it is rarely documented with medium and large vessel vasculitis,which is likely to result in acute aortic syndromes.CASE SUMMARY A 44-year-old man with a history of acute Stanford type A aortic dissection status post-reconstructive surgery five years ago.The contrast-enhanced computed tomography of the chest at that time had also revealed an intralobar pulmonary sequestration in the left lower lung region,and the angiography also presented perivascular changes with mild mural thickening and wall enhancement,which indicated mild vasculitis.The intralobar pulmonary sequestration in the left lower lung region was long-term unprocessed,which was probably associated with his intermittent chest tightness since no specific medical findings were detected but only positive sputum culture with mycobacterium avium-intracellular complex and Aspergillus.We performed uniportal video-assisted thoracoscopic surgery with wedge resection of the left lower lung.Hypervascularity over the parietal pleura,engorgement of the bronchus due to a moderate amount of mucus,and firm adhesion of the lesion to the thoracic aorta were histopathologically noticed.CONCLUSION We hypothesized that a long-term pulmonary sequestration-related bacterial or fungal infection can result in focal infectious aortitis gradually,which may threateningly aggravate the formation of aortic dissection.
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;">Stroke is the second highest cause of death globally and a leading cause of not only physical disability but also cognitive. Approximately two-thirds of Ischemic Stroke patients, who represent the most common type of stroke are found to have mild deficits. Minor stroke, sometimes also referred to as “mild stroke”, is often defined in research studies as a National Institute of Health Stroke Scale (NIHSS) score of 5 or less, although, the cut point for NIHSS score or standardized criterion to define minor stroke has not been established. In the past, many studies have been focusing on the definition of the minor stroke to better stabilize the acute treatment guidelines, to predict the functional outcome, and also for early risk factors stratification. Different studies use different criteria or different cut-points of NIHSS scores to define minor stroke. Aside from indecision of acute management of minor stroke, many other questions have been raised regarding minor strokes, for example, the interaction of large vessel occlusion with minor stroke, the prevalence rate of depression, anxiety, cognitive dysfunction, chronic head after minor stroke, and so on. Finding a universal definition for minor stroke is the key to establish the guideline for management for this group of patients. However, the guidance of treatment of minor stroke is not the focus of this review. The review will focus on the deep comprehension of minor stroke characteristics, summarizing the new findings related to minor stroke, and highlight the essential points to consider for characterizing mild stroke symptoms for a new direction guide for future studies.</span> </div>
基金supported by Health Science and Technology Project of Inner Mongolia Autonomous Region 2022(202201571).
文摘Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.
基金supported by the Natural Science Research Projects in Anhui Universities(2022AH051244)the Scientific Research Fund Project for Talent Introduction of Yijishan Hospital,Wannan Medical College in China(No.YR202111,YR202210)+2 种基金the Health Research Program of Anhui in China(No.AHWJ2022b090)Key Research Project of Wannan Medical College(No.WK2023ZZD21)Wuhu Science and Technology Project(No.2023JC28).
文摘Background The impact of lowering systolic blood pressure(SBP)following endovascular treatment(EVT)in acute large vessel occlusion stroke(LVOS)patients remains unclear.We aimed to explore the effect of the magnitude of SBP reduction(SBPr)after EVT on outcomes in LVOS patients.Methods We consecutively registered patients at three comprehensive stroke centres who had experienced EVT as a result of acute anterior circulation LVOS.SBPr was calculated as follows:(baseline SBP−mean SBP/baseline SBP)×100%.The 90-day modified Rankin Scale score ranging from 0 to 2 was defined as a favourable functional outcome.Based on CT scans obtained within 24 hours after procedure,symptomatic intracranial haemorrhage(sICH)was assessed according to the criteria of the European Cooperative Acute Stroke Study III.Results We enrolled 1080 patients,of which 908(84.1%)had successful recanalisation.In the overall cohort,SBPr was correlated with lower odds of sICH(SBPr±10%as a reference,20%-30%:OR 0.460;95%CI:0.245 to 0.864;p=0.016;>30%:OR 0.304;95%CI 0.123 to 0.749;p=0.010).In patients who achieved successful reperfusion,SBPr>30%was correlated with higher odds of a poor outcome(SBPr±10%as a reference,OR 2.150;95%CI 1.268 to 3.645;p=0.004)and SBPr has a similar tendency towards reducing the incidence of sICH.In the subgroup analyses,baseline Alberta Stroke Programme Early CT(ASPECT)score(p_(interact)=0.024)modified the effect of SBPr on the 90-day outcome.Conclusion Among patients with EVT,a significant drop in SBP may be related to a poor functional outcome and a reduced incidence of sICH.Baseline ASPECT score may be an important interacting factor in the association of SBPr with the 90-day outcome.This study provides new insights for individualised BP management in patients with EVT.
基金funded by National Health Commission of the People's Republic of China(No.804079).
文摘Rationale The management of residual stenosis after mechanical thrombectomy in patients with intracranial atherosclerotic stenosis-related emerge large vessel occlusive(ICAS-LVO)stroke is still unclear question in clinical practice.Aim To demonstrate the design of a clinical trial on emergency balloon angioplasty and/or stenting(BAS)combined with standard medical treatment(SMT)for residual stenosis of ICAS-LVO stroke patients with successful recanalisation.Design ASSET is a multicentre,prospective,randomised,open-label,blinded end-point,controlled clinical trial designed(PROBE)by investigators.This trial evaluates the effectiveness and the safety of emergency BAS in combination with SMT compared with SMT alone in ICAS-LVO stroke patients with successful recanalisation(defined as expanded treatment in cerebral ischaemia grade of 2b50-3 and maintained for more than 20 min)and residual stenosis(defined as≥50%)up to 24 hours after the onset of symptoms or the last known well.Outcome The primary outcome assessed at 90(±7)days after randomisation is the incidence of ischaemic stroke in the responsible vessel.Symptomatic intracranial haemorrhage within 24(±3)hours is the primary safety outcome.
文摘Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed to assess the efficacy and safety of IVT administered before EVT in this patient population.Methods We analysed the data from a multicentre registry of patients who underwent EVT for AT-LVO.Patients were categorised based on presumed mechanism of occlusion:in situ occlusion(intracranial group)or embolism from cervical artery occlusion/stenosis(tandem group).We compared the efficacy and safety of IVT before EVT in patients who received IVT(IVT stratum)and those who did not(non-IVT stratum).The primary outcome was a modified Rankin Scale score of 0-2 at 90 days.Results Among the 336 patients in the intracranial group,99 patients underwent IVT.The rate of favourable functional outcomes did not differ between IVT and non-IVT strata(51.1%vs 47.6%;adjusted ORs(aORs)(95%CI),1.18(0.66 to 2.09));whereas any intracranial haemorrhage(ICH)(10.1%vs 3.8%;aOR,2.98(1.01 to 9.26))and mortality at 90 days(6.4%vs 1.3%;aOR,4.66(1.02 to 26.73))were significantly higher in the IVT stratum.Among the 233 patients in the tandem group,88 patients underwent IVT,with no significant differences in efficacy or safety outcomes between the strata.Conclusion In patients with AT-LVO,IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion.IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions.
文摘Purpose This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score(ASPECTS)regions is associated with clinical outcome in patients with symptomatic non-acute internal carotid or middle cerebral artery occlusion who underwent endovascular recanalisation(ER).Methods Preoperative ASPECTS and region of infarction were recorded before recanalisation.Clinical outcome was evaluated 90 days after the procedure using the modified Rankin Scale;a score>2 was defined as poor outcome.Secondary outcomes included postprocedural cerebral oedema,intracranial haemorrhage(ICH)and symptomatic ICH.Results Among the 86 patients included,90-day outcome was poor in 30(34.9%)and 40 experienced cerebral oedema(46.5%).Multivariate logistic regression models showed that lenticular nucleus infarction(OR 19.61-26.00,p<0.05),admission diastolic blood pressure(OR 1.07-1.08,p<0.05),preprocedural National Institutes of Health Stroke Scale(OR 1.96-2.05,p<0.001)and haemorrhagic transformation(OR 14.99-18.81,p<0.05)were independent predictors of poor 90-day outcome.The area under the receiver operating characteristic curve for lenticular nucleus infarction as a predictor of poor outcome was 0.73.M2 region infarction(OR 26.07,p<0.001)and low American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation grade(OR 0.16,p=0.001)were independent predictors of postprocedural cerebral oedema.The area under the receiver operating characteristic curve for M2 region infarction as a predictor of cerebral oedema was 0.64.Region of infarction did not significantly differ between patients with and without postprocedural ICH or symptomatic ICH.Conclusions Lenticular nucleus and M2 region infarction were independent predictors of poor 90-day outcome and postprocedural cerebral oedema,respectively,in patients with non-acute anterior circulation large artery occlusion who underwent ER.
文摘Background Despite successful reperfusion after thrombectomy for large vessel occlusion(LVO)stroke,up to half of patients are dependent or dead at 3-month follow-up.The aim of the current study is to demonstrate safety and efficacy of administering adjunct intra-arterial(IA)tenecteplase in anterior circulation LVO patients who have achieved successful reperfusion defined as eTICI 2b50 to 3.Methods ANGEL-TNK is a multicentre,open-label,assessor-blinded endpoint,prospective randomised,controlled trial that will enrol up to 256 patients.Patients who meet inclusion criteria with anterior circulation LVO stroke and successful reperfusion will be randomised to receive IA tenecteplase or best medical management at 1:1 ratio.Results The primary endpoint is a 90-day excellent outcome defined as modified Rankin Scale(mRS)0–1.The primary safety endpoint is symptomatic intracranial haemorrhage within 48 hours from randomisation.Secondary endpoints include 90-day ordinal mRS,mRS 0–2,mRS 0–3,all-cause mortality and any intracranial haemorrhage.Conclusion In patients with anterior circulation LVO stroke,the ANGEL-TNK trial will inform whether adjunct IA tenecteplase administered after successful thrombectomy reperfusion improves patient outcomes.Trial registration number NCT05624190.
基金supported by grants from the National Natural Science Foundation of China(No.82425101)Beijing Municipal Science&Technology Commission(No.Z231100004823036)+8 种基金Capital's Funds for Health Improvement and Research(2022-2-2045)National Key R&D Program of China(2024YFC3044800,2022YFF1501500,2022YFF1501501,2022YFF1501502,2022YFF1501503,2022YFF1501504,2022YFF1501505)Youth Beijing Scholar Program(No.010)Beijing Laboratory of Oral Health(PXM2021_014226_000041)Beijing Talent Project-Class A:Innovation and Development(No.2018A12)National Ten-Thousand Talent Plan"-Leadership of Scientific and Technological InnovationNational Key R&D Program of China(No.2017YFC1307900,2017YFC1307905)Beijing Outstanding Young Scientist Program(No.BJJWZYJH01201910025030)Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0504800,2023ZD0504801,2023ZD0504802,2023ZD0504803,2023ZD0504804)。
文摘Background Acute ischaemic stroke,due to its high mortality and disability rates,imposes a significant economic and social burden worldwide.Typically,endovascular treatment within the therapeutic window is provided to salvage the ischaemic penumbra;however,even when recanalisation is successful during endovascular treatment,the clinical outcomes may still be disappointing.This highlights the necessity of further research,so as to discover better solutions to futile recanalisation and improve patient outcomes.Objective To investigate the efficacy and safety of Y-6 sublingual tablets(cilostazol and dexborneol)compared with a placebo in the treatment of patients with acute ischaemic stroke caused by large vessel occlusion.Method The efficacy and safety of Y-6 sublingual tablets in patients with acute ischaemic stroke are evaluated in a phase Ⅱ,randomised,double-blind,double-dummy,placebo-controlled,parallel clinical trial.Eligible patients having provided informed consent are randomised into five groups for a 28-day treatment period.The primary outcome is the percentage of patients achieving the modified Rankin Scale score of 0-1 at 90 days.Discussion The EFfects of Y-6 SUblingual Tablets for PaTients with AcUte Ischemic StRokE trial assesses whether Y-6 sublingual tablets are effective and safe in improving the clinical outcomes of patients with acute ischaemic stroke caused by large vessel occlusion.
基金funding from the National Natural Science Foundation of China(82101529)the Natural Science Foundation of Hunan Province(2023JJ40891)the Wisdom Accumulation and Talent Cultivation Project of the Third Xiangya Hospital of Central South University(YX202213).
文摘Background and purpose Approximately 25%of acute large vessel occlusive(LVO)ischaemic strokes are of unknown thrombotic origin,and there is a need to establish the aetiology to guide subsequent preventative measures.The aim of this study was to quantify thrombus composition in patients with LVO and explore associations between thrombus composition and stroke aetiology.Methods Thrombi were extracted from 132 patients with acute ischaemic stroke.Erythrocytes,leucocytes and F+P(fibrin+platelet)proportions were assessed in tissue sections stained with H&E,while CD3+T cells and neutrophil extracellular traps(NETs)were quantified in immunohistochemistry-stained sections.Thrombus components,clinical parameters and interventional variables were compared between different stroke subtypes defined by Trial of ORG 10172 in Acute Stroke Treatment criteria.Results F+P composition was significantly higher(p<0.001)and erythrocyte proportions were significantly lower(p<0.001)in cardioembolic thrombi than in large artery atherosclerosis thrombi.The composition of thrombi from undetermined aetiology strokes resembled that from cardioembolic strokes.CD3+T cell and NET proportions were not significantly different between stroke subtypes.CD3+density per unit area was associated with the occlusive site,being significantly higher in the anterior circulation than the posterior circulation(p=0.004).Cardioembolic strokes were more common in the anterior circulation than large artery atherosclerosis strokes(p=0.002).Recanalisation time was significantly longer for large artery atherosclerosis emboli than for cardioembolic emboli(p=0.032).Conclusion There is significant heterogeneity in thrombus composition among different stroke subtypes.The quantitative assessment of thrombus composition may be a useful biomarker of stroke aetiology,and strokes of undetermined aetiology may be more likely to have a cardioembolic origin.
