Objective:To investigate the risk factors for futile recanalization after endovascular mechanical thrombectomy (EMT) beyond 24 hours from last known well in patients with anterior circulation large vessel occlusion stroke, and develop a nomogram prediction model.Methods:Patients with anterior circulation large vessel occlusion stroke underwent EMT beyond 24 hours from last known well in the China Interventional Stroke Registry (CISR) database from May 2016 to September 2023 were included retrospectively. Futile recanalization was defined as successful vascular recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b), but the modified Rankin Scale score was >2 at 3 months after procedure. Independent predictive factors for futile recanalization were screened through stepwise multivariate logistic regression analysis and a nomogram prediction model was developed based on these factors, and the predictive value of the nomogram model was evaluated through receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Results:A total of 98 patients with anterior circulation large vessel occlusion stroke underwent EMT and achieved successful recanalization beyond 24 hours from last known well were included. There were 80 males (81.63%), with a median age of 63 (interquartile range, 52-69) years, and 44 patients (44.90%) had futile recanalization. Univariate analysis showed that the age, baseline National Institutes of Health Stroke Scale (NIHSS) score, and fasting blood glucose of the futile reperfusion group were significantly higher than those of the effective reperfusion group, while the Alberta Stroke Program Early CT Score (ASPECTS) and the proportion of patients with good collateral circulation were significantly lower than those of the effective reperfusion group (all P<0.05). Stepwise multivariate logistic regression analysis showed that higher age, blood glucose and baseline NIHSS score, lower collateral circulation score and ASPECTS were the independent predictive factors of futile recanalization. ROC curve analysis shows that the area under the curve of the nomogram model developed based on the above predictive factors was 0.84 (95% confidence interval 0.79-0.94). Further internal validation using bootstrap method with 1 000 repeated samples showed that the area under the curve was still as high as 0.83 (95% confidence interval 0.76-0.90). The calibration curve and clinical decision curve showed that this prediction model had good calibration accuracy and clinical net benefit. Conclusions:Patients with anterior circulation large vessel occlusion stroke beyond 24 hours from last known well have a higher risk of futile recanalization after undergoing EMT. Advanced age, higher blood sugar level, more serious baseline neurological deficits, larger infarct volume, and poorer collateral circulation are significantly associated with the futile recanalization. The nomogram developed based on the above factors provides a quantitative tool for predicting the risk of futile recanalization before procedures.

Secondary white matter injury after ischemic stroke refers to the secondary changes in the white matter structure outside the infarct site that are not directly damaged after stroke, often involving key connecting areas such as the corpus callosum and contralateral internal capsule. This injury is closely associated with post-stroke cognitive impairment, motor dysfunction, and language disorders, which affects the long-term outcome. Its pathophysiological mechanisms mainly include immune and inflammatory imbalance, excitotoxicity and mitochondrial dysfunction, blood-brain barrier damage, axonal injury, and remyelination disorder. Exploring these mechanisms in depth can help promote early diagnosis and intervention of secondary white matter damage after ischemic stroke, provide theoretical basis for the development of targeted treatment strategies, and promote functional recovery in patients with stroke.

Approximately 8%to 15%of patients with metastatic colorectal cancer(mCRC)harbor BRAF mutation,and the V600E mutation is the most common form of BRAF mutation.The prognosis of patients with metastatic colorectal cancer harboring BRAF V600E mutation is poor.Initial standard chemotherapy is often ineffective,necessitating an intensive follow-up treatment,which usually provides limited effic-acy.Consequently,the disease becomes notably difficult to treat and progresses rapidly,resulting in a decreased overall patient survival rate.This review details the research advancements in treatment of BRAF V600E-mutant metastatic colorectal cancer.

Objective:To investigate the clinical outcome of endovascular treatment vs. drug treatment in patients with symptomatic non-acute long-segment occlusion of the internal carotid artery. Methods:Based on prospective cohort registration research data, patients with symptomatic non-acute long-segment occlusion of internal carotid artery were retrospectively included. They were divided into a drug treatment group and an endovascular treatment group according to the actual treatment received. The latter was further divided into a successful recanalization group and an unsuccessful recanalization group. The endpoint events included ipsilateral ischemic stroke, any stroke, and all-cause death. Multivariate logistic regression analysis was used to compare the endpoint events between groups during the perioprocedural period (within 30 days), and multivariate Cox proportional hazards model was use to compare the endpoint events between the groups during the long-term follow-up. Results:A total of 684 patients were included, of which 570 (83.33%) were male, median aged 63 years (interquartile range, 56-70 years). Three hundred and fifty-three patients (51.6%) received drug treatment; 331 (48.4%) received endovascular treatment, of which 161 (48.6%) had successful recanalization. The median follow-up time was 1 223 days (interquartile range, 646.5-2 082 days), with 109 patients (15.9%) experiencing stroke recurrence events (including 87 ipsilateral ischemic stroke) and 78 (11.4%) experiencing all-cause mortality. The risk of any stroke during the perioprocedural period in the successful recanalization group was significantly higher than that in the drug treatment group (odds ratio 3.679, 95% confidence interval 1.038-13.036; P=0.044), but the risk of ipsilateral ischemic stroke recurrence (risk ratio 0.347, 95% confidence interval 0.152-0.791; P=0.012) and all-cause mortality (risk ratio 0.239, 95% confidence interval 0.093-0.618; P=0.003) during the long-term follow-up were significantly lower than those in the drug treatment group. Conclusions:In patients with symptomatic non-acute long-segment occlusion of the internal carotid artery, endovascular treatment can increase the risk of stroke recurrence within 30 days, but successful recanalization can reduce the risks of long-term ipsilateral ischemic stroke recurrence and all-cause mortality.

ObjectiveTo investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) combined with rehabilitation robot on upper limb and hand dysfunction in patients with subacute stroke. MethodsFrom December, 2019 to December, 2021, 50 inpatients with subacute stroke in Zhejiang Provincial People's Hospital were randomly divided into control group (n = 25) and experimental group (n = 25). Both groups received routine rehabilitation therapy, while the control group added sham HD-tDCS combined with rehabilitation robot, and the experimental group added HD-tDCS combined with rehabilitation robot, for four weeks. The upper limb and hand function was assessed with Action Research Arm Test (ARAT), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Motor Assessment Scale (MAS) before and after treatment. ResultsAfter treatment, the scores of ARAT, FMA-UE and MAS increased in the two groups (∣Z∣ > 3.320, t > 6.379, P < 0.01), while the scores of FMA-UE and MAS were higher in the experimental group than in the control group (Z = -2.379, t = 3.181, P < 0.05), as well as the scores of grasping and gross motor of ARAT (∣Z∣ > 2.033, P < 0.05). ConclusionThe combination of HD-tDCS and rehabilitation robot can be more effective on upper limb and hand function in patients with subacute stroke than rehabilitation robot alone.

Objective:To investigate predictive factors for successful endovascular recanalization in patients with non-acute symptomatic internal carotid artery occlusion (SICAO), to develop a decision tree model using the Classification and Regression Tree (CART) algorithm, and to evaluate the predictive performance of the model.Methods:Patients with non-acute SICAO received endovascular therapy at 8 comprehensive stroke centers in China were included retrospectively. They were randomly assigned to a training set and a validation set. In the training set, the least absolute shrinkage and selection operator (LASSO) algorithm was used to screen important variables, and a decision tree prediction model was constructed based on CART algorithm. The model was evaluated using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test and confusion matrix in the validation set.Results:A total of 511 patients with non-acute SICAO were included. They were randomly divided into a training set ( n=357) and a validation set ( n=154) in a 7:3 ratio. The successful recanalization rates after endovascular therapy were 58.8% and 58.4%, respectively. There was no statistically significant difference ( χ2=0.007, P=0.936). A CART decision tree model consisting of 5 variables, 5 layers and 9 classification rules was constructed using the six non-zero-coefficient variables selected by LASSO regression. The predictive factors for successful recanalization included fewer occluded segments, proximal tapered stump, ASITN/SIR collateral grading of 1-2, ischemic stroke, and a recent event to endovascular therapy time of 1-30 d. ROC analysis showed that the area under curve of the decision tree model in the training set was 0.810 (95% confidence interval 0.764-0.857), and the optimal cut-off value for predicting successful recanalization was 0.71. The area under curve in the validation set was 0.763 (95% confidence interval 0.687-0.839). The accuracy was 70.1%, precision was 81.4%, sensitivity was 63.3%, and specificity was 79.7%. The Hosmer-Lemeshow test in both groups showed P>0.05. Conclusion:Based on the type of ischemic event, the time from the latest event to endovascular therapy, proximal stump morphology, the number of occluded segments, and the ASITN/SIR collateral grading constructed the decision tree model can effectively predict successful recanalization after non-acute SICAO endovascular therapy.

Objective:To investigate the influencing factors, periprocedural complications, and long-term outcomes of successful recanalization after endovascular treatment in patients with non-acute symptomatic internal carotid artery occlusion.Methods:Patients with non-acute internal carotid artery occlusion received endovascular treatment in the Nanjing Stroke Registration System between January 2010 and December 2021 were retrospectively enrolled. Clinical endpoint events were defined as successful vascular recanalization, periprocedural complications (symptomatic embolism and symptomatic intracranial hemorrhage), neurological function improvement, and recurrence of ipsilateral ischemic events. Multivariate logistic regression analysis was used to investigate the independent influencing factors of successful vascular recanalization. Cox proportional hazards regression analysis was used to investigate the correlation between endovascular treatment outcomes and neurological function improvement, as well as ipsilateral ischemic cerebrovascular events. Results:A total of 296 patients were included, of which 190 (64.2%) were successfully recanalized. Multivariate logistic regression analysis showed that symptoms manifest as ischemic stroke (odds ratio [ OR] 3.353, 95% confidence interval [ CI] 1.399-8.038; P=0.007), the time from the most recent symptom onset to endovascular therapy within 1 to 30 d ( OR 2.327, 95% CI 1.271-4.261; P=0.006), proximal conical residual cavity ( OR 2.853, 95% CI 1.242-6.552; P=0.013) and focal occlusion (C1-C2: OR 3.255, 95% CI 1.296-8.027, P=0.012; C6/C7: OR 5.079, 95% CI 1.334-19.334; P=0.017) were the independent influencing factors for successful vascular recanalization. Successful recanalization did not increase the risk of symptomatic intracranial hemorrhage within 7 d after procedure (3.2% vs. 0.9%; P=0.428). The median follow-up time after procedure was 38 months. Cox proportional hazards regression analysis showed that after adjusting for confounding factors, successful recanalization was significantly associated with postprocedural neurological improvement (hazard ratio 1.608, 95% CI 1.091-2.371; P=0.017), and significantly reduced the risk of recurrence of long-term ischemic events (hazard ratio 0.351, 95% CI 0.162-0.773; P=0.010). Conclusion:In patients with non-acute internal carotid artery occlusion, successful endovascular recanalization can effectively reduce the risk of long-term ischemic events without increasing the risk of symptomatic intracranial hemorrhage.

Brain functional network changes over time along with the process of brain development, disease, and aging. However, most of the available measurements for evaluation of the difference (or similarity) between the individual brain functional networks are for charactering static networks, which do not work with the dynamic characteristics of the brain networks that typically involve a long-span and large-scale evolution over the time. The current study proposes an index for measuring the similarity of dynamic brain networks, named as dynamic network similarity (DNS). It measures the similarity by combining the "evolutional" and "structural" properties of the dynamic network. Four sets of simulated dynamic networks with different evolutional and structural properties (varying amplitude of changes, trend of changes, distribution of connectivity strength, range of connectivity strength) were generated to validate the performance of DNS. In addition, real world imaging datasets, acquired from 13 stroke patients who were treated by transcranial direct current stimulation (tDCS), were used to further validate the proposed method and compared with the traditional similarity measurements that were developed for static network similarity. The results showed that DNS was significantly correlated with the varying amplitude of changes, trend of changes, distribution of connectivity strength and range of connectivity strength of the dynamic networks. DNS was able to appropriately measure the significant similarity of the dynamics of network changes over the time for the patients before and after the tDCS treatments. However, the traditional methods failed, which showed significantly differences between the data before and after the tDCS treatments. The experiment results demonstrate that DNS may robustly measure the similarity of evolutional and structural properties of dynamic networks. The new method appears to be superior to the traditional methods in that the new one is capable of assessing the temporal similarity of dynamic functional imaging data.
Aging/physiology* ; Brain/physiology* ; Brain Mapping ; Humans ; Magnetic Resonance Imaging/methods* ; Nerve Net/physiology* ; Transcranial Direct Current Stimulation/methods*

Objective:To evaluate the characteristics of carotid plaque and the immediate outcomes after carotid artery stenting (CAS) in diabetic and non-diabetic patients by optical coherence tomography (OCT).Methods:Patients underwent CAS and OCT before and after operation in the Department of Neurology, Jinling Hospital from January 2014 to March 2019 were enrolled retrospectively. The clinical features, the characteristics of carotid plaque on OCT and the immediate outcomes after CAS were compared between diabetic group and non-diabetic group. The risk factors of stent malapposition were analyzed.Results:A total of 46 patients were enrolled. Their age was 64.02±8.32 years and 41 were males (89.1%). There were 20 patients (43.5%) in the diabetes group and 26 (56.5%) in the non-diabetes group. The proportions of atherosclerotic plaque with thin fibrous cap (40.0% vs. 7.7%; χ2=5.166, P=0.023), plaque rupture (55.0% vs. 23.1%; χ2=4.945, P=0.026) and macrophage infiltration (60.0% vs. 30.8%; χ2=3.930, P=0.047) in the diabetic group were significantly higher than those in the non-diabetic group. Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.208, 95% confidence interval [ CI] 1.033-1.413; P=0.018), coronary heart disease ( OR 15.953, 95% CI 1.142-222.952; P=0.040), alcohol consumption ( OR 6.192, 95% CI 1.098-34.923; P=0.039) and lower systolic blood pressure ( OR 0.944, 95% CI 0.894-0.997; P=0.037) were independently associated with stent malaposition. Conclusion:Compared with the non-diabetic patients, carotid plaque in diabetic patients may be more unstable. Older age, coronary heart disease, alcohol consumption and lower systolic blood pressure were associated with stent malaposition after carotid stenting. OCT can reveal the characteristics of carotid plaque and the immediate outcomes after CAS, which can provide strong evidence for treatment decision.

Objective:To validate the predictive function of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score on large vessel occlusion (LVO) in Chinese population.Methods:The information about the patients who had the disease onset within 24 hours, were treated in the Emergency Department of Jinling Hospital, and diagnosed as ‘acute ischemic stroke’ was collected. Via the emergent brain computed tomography angiography or digital subtraction angiography, the patients were divided into LVO group and non-LVO group. The scores of FAST-ED were calculated according to the National Institutes of Health Stroke Scale (NIHSS) scores and compared with Rapid Arterial oCclusion Evaluation (RACE), 3-item Stroke Scale (3I-SS), Cincinnati Stroke Triage Assessment Tool (C-STAT), and Prehospital Acute Stroke Scale (PASS) scores. Moreover, the patients were further divided into anterior and posterior circulation lesion groups to explore whether the FAST-ED scale can differ the anterior or posterior circulation effectively.Results:Three hundred and eighty-one patients were eventually included, among whom 284 were diagnosed as LVO, and 97 were diagnosed as non-LVO. Receiver operating characteristic curves showed that cut-off value of 4 optimized the scale (sensitivity: 0.76, specificity: 0.69, area under the curve: 0.78). The area under the curve of FAST-ED score(0.78) showed no statistically significant difference with NIHSS (0.79), RACE (0.77), 3I-SS (0.78) and C-STAT scores (0.75), and exhibited statistically significant difference with PASS score (0.74; 95% CI 0.69-0.78, P=0.01). FAST-ED score showed no statistically significant difference in predicting anterior and posterior circulation lesions. Conclusions:FAST-ED score can predict LVO in a rather accurate manner. It can predict anterior and posterior circulation lesions with similar effectiveness. So FAST-ED is able to be a prehospital screening tool and make assistance to the prehospital treatment.