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Background: Recent randomized trials have consistently demonstrated a clinical benefit of endovascular therapy (ET) over best medical therapy (including intravenous (IV) thrombolysis in eligible patients) or IV thrombolysis only in selected patients with acute ischemic stroke (AIS) due to proximal occlusion in the carotid territory. Previous study demonstrates that lack of improvement (LOI) at 24 hours is an independent predictor of poor outcome and death at 3 months in patients with AIS treated with IV alteplase. However, LOI at 24 hours following ET has not been studied systematically. The purpose of this study is to identify predictors of LOI at 24 hours in patients with AIS after ET as well as the relationship between LOI and unfavorable outcome at 3 months.Methods: A total of 98 consecutive patients with AIS treated with ET in two separate stroke centers from 2010 to 2014 were retrospectively reviewed. Data on demographics, preexisting vascular risk factors, occlusion site, pre- and post-treatment modified Treatment in Cerebral Ischemia (mTICI) classification, collaterals and National Institutes of Health Stroke Scale (NIHSS) score on admission as well as 24 hours after the endovascular procedurals were collected. LOI was defined as a reduction of 3 points or less on the NIHSS at 24 hours compared with baseline. A 3-month functional outcome was assessed using the modified Rankin scale (mRS). Unfavorable outcome was prespecified as a score of more than 2 on the mRS. The onset-to-reperfusion time (ORT) was defined as time to mTICI 2b or 3 or end of procedure. Long ORT was defined as time to reperfusion beyond 6 hours. Poor reperfusion was defined as mTICI ≦2a. The pretreatment collateral circulation extent was graded as poor (grades 0–1) or good (grades 2–4).Results: Among the 98 patients with AIS who were treated with ET, LOI was present in 48 (49%) subjects. Multivariate analysis indicated that poor collaterals (odds ratio [OR] 3.25; 95% confidence interval [CI]: 1.29–8.19;p= 0.012) and long ORT (OR 3.97, 95% CI: 1.66–9.54;p= 0.002) were independent predictors of LOI. LOI (OR 7.18, 95% CI: 2.39–21.61;p< 0.001) was independently associated with unfavorable outcome at 3 months.Conclusion: Among patients with AIS treated with ET, as an independent predictor of unfavorable outcome, LOI at 24 hours is associated with poor collaterals and long ORT. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies have evaluated the association between the C7673T polymorphism in apolipoprotein B (apoB) gene and ischemic stroke (IS), but the results are still debatable even in the Chinese population. This meta-analysis was therefore designed to clarify these controversies.Methods: All of the relevant studies were identified from PubMed, Embase, Chinese National Knowledge Infrastructure database and Chinese Wanfang database up to 31 October 2014. Statistical analyses were conducted with Revman 5.2 and STATA 12.0 software. Odds ratio (OR) with 95% confidence interval (CI) values were applied to evaluate the strength of the association. A fixed or random effect model was selected for pooling data based on the heterogeneity test. Publication bias was assessed by Begg's test and Egger's test.Results: A significant association was found between the C7673T polymorphism in apoB gene and IS under the heterozygous genetic model (OR = 1.868, 95% CI = 1.160–3.007) and the allelic genetic model (OR = 1.742, 95% CI = 1.294–2.346), respectively. In the subgroup analysis by the geographic region, T allele could increase the risk of IS in northern Chinese (OR = 2.359, 95% CI: 1.425–3.907), but not in southern Chinese individuals (OR = 1.485, 95% CI: 0.778–2.832). Further stratification for source of controls showed that statistical significance was found among the population-based studies.Conclusion: Our meta-analysis revealed that C7673T polymorphism in apoB gene was significantly associated with increased IS risk in the Chinese population. [ABSTRACT FROM AUTHOR]

Polymorphisms ofCYP2C19have been associated with variant risk of subsequent cardiovascular events in survivors of myocardial infarction (MI) receiving clopidogrel. This study evaluated the impacts ofCYP2C19polymorphisms on stroke recurrence and other vascular events in a cohort of Chinese patients receiving clopidogrel. From Nanjing Stroke Registry Program, 625 consecutive patients with ischemic stroke were enrolled between May 2008 and April 2010.CYP2C19variants (*2, *3, and*17) were genotyped. Clinical outcomes were determined with three monthly follow-up. The primary endpoint was a composite of vascular death, non-fatal ischemic stroke, and non-fatal MI. The second endpoint was bleeding events. The median exposure to clopidogrel was 13.2 (interquartile range, 8.9–18.0) months. Primary endpoint was observed in 85 (13.6%) patients and secondary endpoint in 13 (2.1%) patients. Frequencies ofCYP2C19*1, *2, *3, and*17alleles were 61.2, 34.0, 3.8, and 1.0%, respectively, in this patient cohort.CYP2C19loss-of-function allele (*2and*3, LOF) carriers were observed with higher risk of subsequent vascular events compared with non-carriers (17.2 versus 8.1%, HR = 2.16, 95% CI: 1.31–3.56,p = 0.003). After adjusted for age, sex, major cardiovascular risk factors, and drug agent,CYP2C19LOF carrier was independently associated with primary endpoint (HR = 2.31, 95% CI: 1.39–3.84,p = 0.001). No significant association betweenCYP2C19gain-of-function (*17, GOF) and clinical events was detected. In Chinese stroke survivors treated with clopidogrel, carriers ofCYP2C19LOF allele may have increased risk of recurrence. [ABSTRACT FROM PUBLISHER]

Based on radiocarbon dating and our analysis of plant and animal remains from Buziping, a Majiayao (5300–4300 BP) and Qijia (4200–3800 BP) period site located in Dingxi, Gansu Province, China, and our review of archaeobotanical studies in the Western Loess Plateau and adjacent areas, we discuss subsistence strategies during the Majiayao and Qijia periods. We also discuss the development of agriculture in the Western Loess Plateau and its influence on cultural expansion during the late Neolithic period. Humans settled at Buziping for the first time during the Majiayao period (4890–4710 cal. yr BP by 14C dating). Charred seeds from the site indicate that people engaged in millet-based agricultural production. People continued this type of agriculture during a second phase of occupation (4130–3880 cal. yr BP by 14C dating) during the Qijia period, but the proportion of foxtail millet to broomcorn millet increased from the Majiayao to Qijia period. Raising domestic animals was another aspect of subsistence during the Qijia period. The main domestic animals were likely pigs and dogs, although hunting of wild animals also took place. Subsistence at Buziping site was affected by the rapid development of intensive agriculture that diffused across eastern Gansu Province during the late Neolithic. Our work suggests that millet-based agriculture spread from east to west across the Western Loess Plateau and likely promoted the expansions of those two cultures in the area during the Majiayao period and early–mid Qijia period. Climate change might have also promoted Majiayao and Qijia expansions and probably facilitated the adoption of rain-fed agriculture in this region. [ABSTRACT FROM AUTHOR]

Staple crops play a pivotal role in human societies. Considerable attention has been dedicated to the changes in staple crops, particularly the alternation between wheat and foxtail millet in ancient China. However, the long-term development of staple crops in historical China is still unclear. Archaeobotanical investigations at the Zhengding Kaiyuan Temple South (ZKS) excavation site, which deposited continuously from the Tang Dynasty to the Qing Dynasty (618–1911 CE), have provided crucial clues. The result indicates to a recurring change in staple crops. During the Northern Song Dynasty and Yuan Dynasty, wheat dominated, while during the Tang Dynasty, Five Dynasties, Ming Dynasty and Qing Dynasty, foxtail millet was the most important staple crop. From the combination of written and paleo-climatic records, it can be inferred that the development of watermill technology and hydraulic engineering promoted wheat cultivation during the Tang Dynasty to Yuan Dynasty. While the deterioration of climate led to a resurgence of foxtail millet during the Ming Dynasty and Qing Dynasty. This study examines the changes in staple crops and their influencing factors in the North China Plain from the 7th to the 19th centuries, emphasizing the importance of technological innovations and climate changes in shaping human societies. [ABSTRACT FROM AUTHOR]

Rivers are the main water source for the oases, and rivers are essential for the wellbeing of the human inhabitants in the desert areas. The Keriya River flows through the south–central Taklimakan desert, the second largest mobile desert on Earth, in northwest China. The earliest archaeological site in the interior of the Taklimakan Desert together with the remains of several ancient cities are located along the Keriya River. Accurately dating the dry watercourses and ancient sites in this region is critical for understanding the changes in fluvial hydrology and their relationship with human activities in desert areas. Specially, the interactions between the hydrological processes of the Keriya River, and human activities are poorly understood due to the lack of a reliable chronology for this river associated with these ancient sites. In this study, we collected 18 samples from 12 fluvial and lacustrine sedimentary sequences for optically stimulated luminescence (OSL) dating, and we also, reviewed 23 dating results from previous studies to reconstruct the hydrological processes of the Keriya River since the early Holocene. Additionally, we also tested 28 14C dates from three ancient sites, combined with 33 14C dates from previous studies to reconstruct a timeline of human migration within the desert. The results show that the Keriya River retreated continuously from the early Holocene onward, due to the decreased supply of glacial meltwater and precipitation in the surrounding mountains, and this process triggered human migrations from north to south in the Taklimakan Desert after ∼3.5 ka. Overall, our findings reveal that variations in fluvial hydrological processes can trigger human migration in desert areas under the background of the global climate change. • We established the hydrological processes and human migration history along the Keriya River since the early Holocene. • The retreat of the river was synchronized with the human migration to the southern Taklimakan Desert. • The decreased supply of glacial meltwater and precipitation in the Kunlun Mountains triggered the river retreat. • The hydrological status and human settlements in the desert/arid area were sensitive to climate changes. [ABSTRACT FROM AUTHOR]

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Objectives: To assess the complementary value of high-resolution multi-contrast MRI (hrMRI) in identifying symptomatic patients with intracranial atherosclerosis (ICAS) who are likely to experience recurrent ischemic cerebrovascular events. Methods: In this retrospective cohort study, eighty patients with acute ischemic events attributed to ICAS who underwent hrMRI examination between January 2015 and January 2019 were included. Median follow-up for all patients was 30 months (range: 1 to 52 months) and recurrent ischemic cerebrovascular events were recorded. Cox regression analysis and time-dependent ROC were performed to quantify the association between the plaque characteristics and recurrent events. Results: During the follow-up, 14 patients experienced recurrent ischemic cerebrovascular events. Young males and those with diabetes and poor medication persistence were more likely to experience recurrent events. ICAS in patients with recurrence had significantly higher enhancement ratio and steepness which is defined as the ratio between the plaque height and length than those without (p < 0.001 and p = 0.015, respectively). After adjustment of clinical factors, enhancement ratio (HR, 13.13 [95% CI, 3.58–48.20], p < 0.001) and plaque steepness (HR, 110.27 [95% CI, 4.75–2560.91], p = 0.003) were independent imaging biomarkers associated with recurrent events. Time-dependent ROC indicated that integrated high enhancement ratio and steepness into clinical risk factors improved discrimination power with the ROC increased from 0.79 to 0.94 (p = 0.008). Conclusions: The enhancement ratio and plaque steepness improved the accuracy over traditional clinical risk factors in predicting recurrent ischemic cerebrovascular events for patients with ICAS. Key Points: • High-resolution magnetic resonance imaging helps clinicians to evaluate high-risk Intracranial plaque. • The higher enhancement ratio and plaque steepness (= height/length) were the primary biomarkers associated with future ischemic cerebrovascular events. • High-resolution magnetic resonance imaging combined with clinical characteristics showed a higher accuracy for the prediction of recurrent events in patients with intracranial atherosclerosis. [ABSTRACT FROM AUTHOR]

The innovations of agricultural production and their extensive dispersal promoted the transformation of human livelihoods and profoundly influenced the evolution of human-land relationships in late prehistoric Eurasia. The Steppe and Silk Roads (SSRs) played important roles in the transcontinental exchange and dispersal of cereal crops and livestock related to agricultural innovation across Eurasia before the Han Dynasty (202 BC to AD 220), while the geographical-temporal variations in prehistoric subsistence in relation to the spread and exchange of cereal crops and livestock originating from different areas of Eurasia still remain unclear. In this paper, we explore these issues based on the review and analysis of published archaeobotanical, zooarchaeological, and carbon-stable isotope data from human bones from Neolithic-Early Iron Age sites in areas along the SSRs, with a comparison to updated results based on radiocarbon dating and ancient DNA analyses. Our results suggest that humans engaged in hunting game, while foxtail/broomcorn millet cultivation gradually became the primary subsistence strategy in Eastern SSRs from 10,500 to 6000 a BP. In contemporaneous Western SSRs, humans mainly cultivated wheat/barley and raised sheep/goats, cattle, and pigs. Trans-Eurasian exchange, which is reflected by the mixed utilization of wheat/barley and millet, emerged in the south-central Steppe during 6000–4000 a BP, while millet cultivation and pig husbandry became the dominant livelihoods in most areas of Eastern SSRs. During 4000–2200 a BP, Silk Roads became the major passageway for trans-Eurasian exchange, the interactive development of oasis agriculture and pastoralism facilitated intensive human settlement in the Central Silk Roads, and subsistence strategies substantially changed with significant geographical differences in Eastern SSRs, while subsistence in some areas of Western SSRs was evidently affected by the introduction and adoption of millet crops after 3000 a BP. The geographical-temporal variations in subsistence in the SSRs from the Neolithic to Early Iron Age were primarily affected by the prehistoric dispersal of farming groups across Eurasia, which was accompanied by the spread of cereal crops/livestock, while the impacts of climate change still need to be further evaluated. [ABSTRACT FROM AUTHOR]

Human settlement and agricultural development are closely linked to local geomorphological and climatic environments. However, the variation in agricultural systems in different environmental and prehistoric contexts remains unknown. We report new archaeobotanical and radiocarbon dates from 34 Neolithic and Bronze Age sites in the Hutuo River Valley (HTRV) in north-central China and compare them with updated archaeobotanical studies in the Sushui River Valley (SSRV) and Henan Province (HNP), to explore the similarities and differences of agricultural patterns under different geomorphologic and climatic environments in north-central China. Our results reveal that humans consistently cultivated foxtail and broomcorn millet in the HTRV from the Miaodigou (6000–5700 cal. a BP) to the Shang-Zhou (3600–2256 cal. a BP) period, despite the introduction of wheat and barley into the area around 4000 a BP. Climate conditions and hilly landforms in the HTRV, SSRV and some parts of the HNP led people to develop foxtail and broomcorn millet dry land farming practices between 7000 and 3000 a BP. Alternatively, in other areas of the HNP, the climate conditions and alluvial plains enabled people to develop a mixed agriculture of millets, soybeans, and rice from 7000 to 4000 a BP, with the addition of wheat between 4000 and 3000 a BP. Farmers' different agricultural technologies and interactions with foreign cultures may have also influenced the formation of different agricultural patterns in the three regions between 7000 and 3000 a BP. Population growth during 7000–3000 a BP can explain the overall propensity of the higher-yield foxtail millet rather than broomcorn millet as the main cultivated crop. In the HTRV, however, higher proportions of broomcorn millet (as compared to the SSRV and HNP), may reflect the greater drought and heat tolerance of broomcorn millet, representing an adaptive agricultural strategy in the river valley. [ABSTRACT FROM AUTHOR]

Background: Previous randomised trials have shown an overwhelming benefit of mechanical thrombectomy for treating patients with stroke caused by large vessel occlusion of the anterior circulation. Whether endovascular treatment is beneficial for vertebrobasilar artery occlusion remains unknown. In this study, we aimed to investigate the safety and efficacy of endovascular treatment of acute strokes due to vertebrobasilar artery occlusion.Methods: We did a multicentre, randomised, open-label trial, with blinded outcome assessment of thrombectomy in patients presenting within 8 h of vertebrobasilar occlusion at 28 centres in China. Patients were randomly assigned (1:1) to endovascular therapy plus standard medical therapy (intervention group) or standard medical therapy alone (control group). The randomisation sequence was computer-generated and stratified by participating centres. Allocation concealment was implemented by use of sealed envelopes. The primary outcome was a modified Rankin scale (mRS) score of 3 or lower (indicating ability to walk unassisted) at 90 days, assessed on an intention-to-treat basis. The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial haemorrhage, device-related complications, and other severe adverse events. The BEST trial is registered with ClinicalTrials.gov, NCT02441556.Findings: Between April 27, 2015, and Sept 27, 2017, we assessed 288 patients for eligibility. The trial was terminated early after 131 patients had been randomly assigned (66 patients to the intervention group and 65 to the control group) because of high crossover rate and poor recruitment. In the intention-to-treat analysis, there was no evidence of a difference in the proportion of participants with mRS 0-3 at 90 days according to treatment (28 [42%] of 66 patients in the intervention group vs 21 [32%] of 65 in the control group; adjusted odds ratio [OR] 1·74, 95% CI 0·81-3·74). Secondary prespecified analyses of the primary outcome, done to assess the effect of crossovers, showed higher rates of mRS 0-3 at 90 days in patients who actually received the intervention compared with those who received standard medical therapy alone in both per-protocol (28 [44%] of 63 patients with intervention vs 13 [25%] of 51 with standard therapy; adjusted OR 2·90, 95% CI 1·20-7·03) and as-treated (36 [47%] of 77 patients with intervention vs 13 [24%] of 54 with standard therapy; 3·02, 1·31-7·00) populations. The 90-day mortality was similar between groups (22 [33%] of 66 patients in the intervention vs 25 [38%] of 65 in the control group; p=0·54) despite a numerically higher prevalence of symptomatic intracranial haemorrhage in the intervention group.Interpretation: There was no evidence of a difference in favourable outcomes of patients receiving endovascular therapy compared with those receiving standard medical therapy alone. Results might have been confounded by loss of equipoise over the course of the trial, resulting in poor adherence to the assigned study treatment and a reduced sample size due to the early termination of the study.Funding: Jiangsu Provincial Special Program of Medical Science. [ABSTRACT FROM AUTHOR]

Southern China and Southeast Asia were favourable habitats for foragers during the Last Glacial Maximum (∼25–18 ka BP) and the Last Deglaciation (∼18–11.7 ka BP), despite various climate fluctuation. However, the underlying subsistence strategies in these areas remains unclear, due to the lack of systematic chronological and archaeological data. The current study reports new results of radiocarbon dating, U-series dating, and zooarchaeological analysis from the Naminan cave site, located at the boundary between Southern China and Southeast Asia. It reveals that deer was consumed as the primary source of meat (91.7 %), supplemented by turtles, wild oxen, monkeys, wild boars, and mustelids during ∼17.35–16.49 ka BP. The subsequent period of ∼15.55–15.35 ka BP saw a radical declining proportion of deer, with various new species being consumed, such as shrews, porcupines, fish, crab, canidae, and wild cat. Human occupation of the Naminan cave site might have lasted until the Early Holocene. Comparing archaeological and paleoclimate evidence from Southern China and Southeast Asia, it is reasonable to argue that a progressively drier and colder climate during ∼17.35–15.35 ka BP appeared to trigger a remarkable decline in human activity but greater range of diets in locations such as the Naminan cave and Yuchanyan sites, facilitating further expansion of hunting-gathering groups during the late phase of the Last Deglaciation with warm and humid climate. This study contributes fresh data and perspective to a greater understanding of the evolution of human-climate interactions in low-latitude regions during Late Paleolithic period. • The first robust evidence of the broad-spectrum diet in Southern China in the LDG. • An obvious shift in faunal utilization strategies from ∼16.5 ka BP to ∼15.5 ka BP. • The diversified strategies and generally better climate are key factors for human expansion. [ABSTRACT FROM AUTHOR]

Yunnan in southwest China is a geographically and ethnically complex region at the intersection of southern China and Southeast Asia, and a focal point for human migrations. To clarify its maternal genetic history, we generated 152 complete mitogenomes from 17 Yunnan archaeological sites. Our results reveal distinct genetic histories segregated by geographical regions. Maternal lineages of ancient populations from northwestern and northern Yunnan exhibit closer affinities with past and present-day populations from northern East Asia and Tibet, providing important genetic evidence for the migration and interaction of populations along the Tibetan-Yi corridor since the Neolithic. Between 5500 to 1800 years ago, central Yunnan populations maintained their internal genetic relationships, including a 7000-year-old basal lineage of the rare and widely dispersed haplogroup M61. At the Xingyi site, changes in mitochondrial DNA haplogroups occurred between the Late Neolithic and Bronze Age, with haplogroups shifting from those predominant in the Yellow River region to those predominant in coastal southern China. These results highlight the high diversity of Yunnan populations during the Neolithic to Bronze Age., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

The southward expansion of East Asian farmers profoundly influenced the social evolution of Southeast Asia by introducing cereal agriculture. However, the timing and routes of cereal expansion in key regions are unclear due to limited empirical evidence. Here we report macrofossil, microfossil, multiple isotopic (C/N/Sr/O) and paleoproteomic data directly from radiocarbon-dated human samples, which were unearthed from a site in Xingyi in central Yunnan and which date between 7000 and 3300 a BP. Dietary isotopes reveal the earliest arrival of millet ca. 4900 a BP, and greater reliance on plant and animal agriculture was indicated between 3800 and 3300 a BP. The dietary differences between hunter-gatherer and agricultural groups are also evident in the metabolic and immune system proteins analysed from their skeletal remains. The results of paleoproteomic analysis indicate that humans had divergent biological adaptations, with and without farming. The combined application of isotopes, archaeobotanical data and proteomics provides a new approach to documenting dietary and health changes across major subsistence transitions., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2023 Science China Press. Published by Elsevier B.V. All rights reserved.)

Background and Aim: Stroke incidence rates are rising among young adults. Liver fibrosis has recently been recognized as a risk factor for cardiovascular events and stroke in the general population. It remains unclear whether liver fibrosis influences the prognosis of stroke. We aimed to evaluate the association between liver fibrosis and stroke recurrence in young stroke patients., Methods and Results: Young adults with first-ever ischemic stroke were enrolled from a prospective stroke registry and were followed up for stroke recurrence. Liver fibrosis was evaluated by Fibrosis-4 (FIB-4) score and was stratified into three categories. Cox regression analysis was performed to assess the relationship between liver fibrosis and stroke recurrence. Over a median follow-up of 3.1 (1.7-4.6) years, 72 (11.6%) recurrent strokes occurred among 621 patients. According to the FIB-4 score, 73 (11.7%) patients had indeterminate fibrosis, while 11 (1.8%) had advanced fibrosis. Univariate Cox analysis revealed that patients with a high FIB-4 score were more likely to experience stroke recurrence than those with a low FIB-4 score (hazard ratio 3.748, 95% confidence interval 1.359-10.332, P = 0.011). After adjusting for potential confounders in the multivariate analysis, FIB-4 score remained an independent risk factor., Conclusions: Young stroke patients with advanced liver fibrosis were at a greater risk of stroke recurrence. Evaluating liver fibrosis may provide valuable information for stroke risk stratification, and the FIB-4 score could serve as a useful tool., Competing Interests: Declaration of competing interest The authors declared that they had no conflict of interest., (Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objective: To determine the influence of renal impairment (RI) on clinical outcomes at 3 months and the risk of recurrent stroke in patients presenting with emergent large vessel occlusion (ELVO) treated with emergent endovascular treatment (EVT)., Methods: Consecutive patients with anterior circulation stroke due to ELVO treated with EVT in 21 endovascular centers were included. Multivariate regressions were used to evaluate the association of RI with mortality, functional independence (modified Rankin Scale [mRS] score 0-2), and functional improvement (shift in mRS score) at 3 months. The association between RI and the risk of recurrent stroke was evaluated with multivariate competing-risk regression analyses., Results: A total of 628 patients with ELVO (mean age 64.7 ± 12.5 years, median NIH Stroke Scale score 17 points, 99 [15.8%] with RI) who underwent EVT were enrolled. After adjustment for other relevant variables, multivariate regression analysis indicated that RI was independently associated with functional independence (adjusted odds ratio 0.53, 95% confidence interval [CI] 0.29-0.96, p = 0.035) at 3 months but not with mortality or functional improvement. Multivariate competing-risk regression analysis showed that patients with RI who received EVT had a significantly higher risk of recurrent stroke (adjusted hazard ratio 2.56, 95% CI 1.27-5.18, p = 0.009) compared to those with normal renal function., Conclusion: Our results suggest that RI is an independent predictor of functional independence at 3 months and long-term risk of recurrent stroke in patients with ELVO treated with EVT., (© 2019 American Academy of Neurology.)

The inflammatory response plays a vital role in the development of in-stent restenosis (ISR) after carotid angioplasty and stenting (CAS). The neutrophil to lymphocyte ratio (NLR) has been suggested as a sensitive inflammatory marker. We explored the association between NLR and ISR in CAS patients. A total of 427 patients who underwent CAS were enrolled. Neutrophil to lymphocyte ratio was measured before the procedure. Clinical examination and radiographic evaluation were performed at 6 months and annually after the procedure. In-stent restenosis was defined as ≥50% stenosis in the treated lesion. Cox regression was used to identify predictors of ISR after CAS. Of the 459 arteries (in 427 patients) with CAS, 72 (15.7%) were identified with ISR during a mean follow-up of 14.6 (19.1) months (range, 0.7-120.7 months). Increased NLR (≥2.13) was significantly related to ISR in patients with asymptomatic stenosis ( P = .001). However, significance was not observed in symptomatic stenosis. On multivariate analysis, baseline NLR ≥ 2.13 (hazard ratio [HR], 2.74; 95% confidence interval [CI], 1.46-5.14), smoking (HR, 1.99; 95% CI, 1.11-3.58), residual stenosis (HR, 1.12; 95% CI, 1.09-1.15), and baseline glucose level (HR, 1.01; 95% CI, 1.01-1.02) were associated with ISR. Elevated NLR may be a predictor of ISR after CAS for asymptomatic stenosis.

Astrocytes, the most numerous cells in the human brain, play a central role in the metabolic homeostasis following hypoxic injury. Caveolin-1 (Cav-1), a transmembrane scaffolding protein, has been shown to converge prosurvival signaling in the central nerve system. The present study aimed to investigate the role of Cav-1 in the hypoxia-induced astrocyte injury. We also examined how Cav-1 alleviates apoptotic astrocyte death. To this end, primary astrocytes were exposed to oxygen-glucose deprivation (OGD) for 6 h and a subsequent 24-h reoxygenation to mimic hypoxic injury. OGD significantly reduced Cav-1 expression. Downregulation of Cav-1 using Cav-1 small interfering RNA dramatically worsened astrocyte cell damage and impaired cellular glutamate uptake after OGD, whereas overexpression of Cav-1 with Cav-1 scaffolding domain peptide attenuated OGD-induced cell apoptosis. Mechanistically, the expressions of Ras-GTP, phospho-Raf, and phospho-ERK were sequestered in Cav-1 small interfering RNA-treated astrocytes, yet were stimulated after supplementation with caveolin peptide. MEK/ERK inhibitor U0126 remarkably blocked the Cav-1-induced counteraction against apoptosis following hypoxia, indicating Ras/Raf/ERK pathway is required for the Cav-1's prosurvival role. Together, these findings support Cav-1 as a checkpoint for the in hypoxia-induced astrocyte apoptosis and warrant further studies targeting Cav-1 to treat hypoxic-ischemic brain injury., (Copyright © 2016 the American Physiological Society.)

Background: Early neurological deterioration (END) is an important factor associated with worse clinical outcome in minor strokes. Early magnetic resonance imaging (MRI) findings can provide better sensitivity to delineate stroke pathophysiology and have diagnostic value associated with causative mechanisms. The aim of this study was to investigate the relationship between early MRI finding and the presence of END in minor stroke patients with lesions in the middle cerebral artery (MCA) territory., Methods: Consecutive MCA minor stroke patients who were admitted to our center within 24 hours of symptom onset were included in this study. All patients underwent MRI within 24 hours of admission. We analyzed baseline characteristics, infarction patterns, and treatment algorithms. The correlation between early MRI findings and END, defined as National Institutes of Health Stroke Scale score increasing more than 2 points during 72 hours after admission, was also determined., Results: Across 211 patients meeting entry criteria between January 2010 and December 2013, internal border-zone (IBZ) infarcts on early MRI scan were observed in 23 of 65 patients with END (35.4%) and in 18 of 146 patients without END (12.3%, P < .001). Patients with IBZ infarcts were found to have more hyperlipidemia, less perforating artery infarcts, more pial artery infarcts, more cortical border-zone infarcts and more ipsilateral large arterial stenosis. Logistic regression analysis revealed that IBZ infarct was independently associated with END after adjustment for other factors (odds ratio, 2.50; 95% confidence interval, 1.09-5.74; P = .031)., Conclusions: Early MRI patterns of IBZ infarction are associated with END in minor stroke patients with acute infarcts of the MCA territory., (Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.)