Search

ObjectiveTo conduct a meta-analysis to evaluate the effect of endovascular therapy (EVT) in mild acute ischemic stroke (AIS) due to proximal versus distal occlusions.MethodsWe searched PubMed, Embase, the Cochrane Library, and clinicaltrials.gov from January 2000 to September 2021 to identify studies comparing EVT versus best medical management (BMM) in AIS with National Institutes of Health Stroke Scale (NIHSS) scores ≤5 due to proximal internal carotid artery (ICA) or M1 versus distal M2 occlusions. We included studies that reported the number of patients with proximal or distal occlusions separately and reported the number of patients with freedom of disability (modified Rankin Scale (mRS) score 0-1) or functional independence (mRS score 0-2) at 90 days in proximal or M2 occlusions, respectively. OR with 95% CI was used.ResultsWe identified six studies with 653 proximal ICA and M1 occlusion patients and 666 distal M2 occlusion patients. Pooled results showed EVT versus BMM was associated with a higher rate of being disability-free in patients with proximal occlusions (OR 1.58, 95% CI 1.09 to 2.30), but was associated with a lower rate of being disability-free in patients with M2 occlusions (OR 0.70, 95% CI 0.49 to 0.99). Effect of EVT in proximal versus distal occlusions was substantially different (P for interaction=0.002). A similar pattern was seen for functional independence (P for interaction=0.05).ConclusionsFor patients with mild AIS, observational data suggest that EVT may be beneficial for proximal ICA or M1 but not for distal M2 occlusions. Randomized trials are needed to confirm these findings.Prospero registration numberCRD42021281034.

ObjectiveTo conduct a meta-analysis of randomized trials to comprehensively compare the effect of endovascular thrombectomy (EVT) versus intravenous thrombolysis (IVT) plus EVT on functional independence (modified Rankin Scale (mRS) 0-2) after acute ischemic stroke due to large vessel occlusions (AIS-LVO).MethodsWe searched Pubmed, EMBASE, CENTRAL, and clinicaltrials.gov from January 2000 to February 2021 and abstracts presented at the International Stroke Conference in March 2021 to identify trials comparing EVT alone versus IVT plus EVT in AIS-LVO. Five non-inferiority margins established in the literature were assessed: -15%, -10%, -6.5%, -5%, and -1.3% for the risk difference for functional independence at 90 days.ResultsFour trials met the selection criteria, enrolling 1633 individuals, with 817 participants randomly assigned to EVT alone and 816 to IVT plus EVT. Crude cumulative rates of 90-day functional independence were 46.0% with EVT alone versus 45.5% with IVT plus EVT. Pooled results showed the risk difference of functional independence was 1% (95% CI -4% to 5%) between EVT alone versus IVT plus EVT. The lower 95% CI bound of -4% fell within the non-inferiority margins of -15%, -10%, -6.5%, and -5%, but not -1.3%. Pooled results also showed the risk difference between EVT alone versus IVT plus EVT was 1% (95% CI -3% to 5%) for mRS 0-1, and 1% (95% CI -1% to 3%) for symptomatic intracranial hemorrhage.ConclusionsThis meta-analysis suggests that EVT alone is non-inferior to IVT plus EVT for several, but not the most stringent, non-inferiority margins.

In this study, a synergetic structural design is developed to improve the photocatalytic performance of the sub‐micro core–shell hollow sphere (TiO2@H‐CeO2). TiO2@H‐CeO2 with maximum surface/interface effect is chosen as the substrate and then reacts with different concentrations of Ce(NO3)3·6H2O solutions. Optical properties analysis shows that after the reaction, the band gap of the composite structure and the electron–hole recombination efficiency both decrease while the photodegradation ability is effectively improved. Spectroscopic and microscopic observations reveal two changes in the structure after the reaction. The first is the deposition of CeO2 nanoparticles that can be observed inside and on the surface of the shell; the second is the doping of Ce3+ in the TiO2 nanoparticles of this shell. The deposition of CeO2 particles increases the interfacial area between the CeO2 and TiO2 and facilitates the corresponding charge transfer. The Ce3+ doping in the TiO2 shell changes the optical properties of TiO2. Therefore, the improved performance of the composite structure can be attributed to the synergy of different surfaces and interfacial effects caused by the reactions. [ABSTRACT FROM AUTHOR]

A portable data recorder was developed to parallel measure the electrocardiogram and body accelerations. A multilayer fuzzy clustering algorithm was proposed to classify the physical activity based on body accelerations. Discrete wavelet transform was incorporated to retrieve time-varying characteristics of heart rate variability under different physical activities. Nine healthy subjects were included to investigate activity-related heart rate variability during 24 h. The results showed that the heartbeat fluctuations in high frequencies were the greatest during lying and the smallest during standing. Moreover, very-low-frequency heartbeat fluctuations during low activity level (lying) were greater than during high activity level (nonlying). Index Terms--Discrete wavelet transform, fuzzy clustering, heart rate variability, physical activity.

Type 1 diabetes patients are well known to have a higher cardiovascular disease (CVD) morbidity and mortality. The risk estimate is only slightly attenuated after adjusting for proteinuria and chronic kidney disease, indicating that A1C is an independent risk factor for CVD in type 1 diabetes patients. Commentary on risk factors for first and subsequent cardiovascular disease events in type 1 diabetes: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study In the Diabetes Epidemiology Research International Mortality Study, Morimoto I et al i .3 followed 1,324 patients who developed type 1 diabetes before the age of 18 years for 35 years, and found that with increasing age, cardiovascular events became the leading cause of death in type 1 diabetes patients. [Extracted from the article]