Diagnostic accuracy of CT angiography and CT perfusion imaging for detecting distal medium vessel occlusions: Protocol for a systematic review and meta-analysis

Background: Distal medium vessel occlusions (DMVOs) represent 25-40% of all acute ischemic strokes (AIS). DMVO clinical syndromes are heterogenous, but as eloquent brain regions are frequently involved, they are often disabling. Since current intravenous fibrinolytic therapies may fail to recanalize up to two-thirds of DMVOs, endovascular treatment is progressively being considered in this setting. Nevertheless, the optimal imaging method for diagnosis remains to be defined. Stroke centers that use computed tomography as a routine stroke imaging approach rely on either isolated computed tomography angiography (CTA) or combined perfusion (CTP) studies. Despite a simplified non-CTP-dependent approach seeming reasonable for large vessel occlusion AIS diagnosis, CTP may still hold advantages for DMVOs workup. Therefore, this systematic review aims to compare the diagnostic performance of CTA and CTP in detecting DMVOs. Methods: We will perform a systematic search in PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials. In addition, grey literature and ClinicalTrials.gov will be scanned. We will include any type of study that presents data on the diagnostic accuracy of CTA and/or CTP for detecting DMVOs. Two authors will independently review retrieved studies, and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias in the selected studies. Data will be combined in a quantitative meta-analysis following the guidelines provided by the Cochrane Handbook for Systematic Reviews of Interventions. We will assess cumulative evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Discussion: This will be the first systematic review and meta-analysis that compares two different imaging approaches for detecting DMVOs. This study may help to define optimal acute ischemic stroke imaging work-up. Trial registration: PROSPERO registration: CRD42022344006.info:eu-repo/semantics/publishedVersio

CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis

Background: The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined. Purpose: The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs. Data sources: We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006). Study selection: A total of 12 studies reporting accuracy values of CTA and/or CTP were included, comprising 2607 patients with 479 cases (18.3%) of DMVOs. Data analysis: Pooled sensitivity and specificity of both imaging methods were compared using a random-effects model. Subgroup analyses were performed based on the technique used in CTA (multi or single-phase) and the subtype of DMVOs (M2-only vs. M2 and other DMVOs). We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria. Data synthesis: CTA demonstrated significantly lower sensitivity compared to CTP in detecting DMVOs [0.74, 95%CI (0.63-0.82) vs. 0.89, 95% CI (0.82-0.93), P < 0.01]. When subgrouped into single-phase and multi-phase CTA, multi-phase CTA exhibited higher sensitivity for DMVO detection than single-phase CTA [0.91, 95%CI (0.85-0.94) vs. 0.64, 95%CI (0.56-0.71), P < .01], while reaching similar levels to CTP. The sensitivity of single-phase CTA substantially decreased when extending from M2 to other non-M2 DMVOs [0.74, 95%CI (0.63-0.83) vs. 0.61, 0.95%CI (0.53-0.68), P = .02]. Limitations: We identified an overall high risk of bias and low quality of evidence, attributable to the design and reference standards of most studies. Conclusions: Our findings highlight a significantly lower sensitivity of single-phase CTA compared to multi-phase CTA and CTP in diagnosing DMVOs.info:eu-repo/semantics/publishedVersio

Comparing the Ligand Behavior of N-Heterocyclic Phosphenium and Nitrosyl Units in Iron and Chromium Complexes

N-Heterocyclic phosphenium (NHP) and nitro-sonium (NO+) ligands are often viewed as isolobal analogues that share the capability to switch between different charge states and thus display redox "noninnocent" behavior. We report here on mixed complexes [(NHP)M(CO)(n)(NO)] (M = Fe, Cr; n = 2, 3), which permit evaluating the donor/acceptor properties of both types of ligands and their interplay in a single complex. The crystalline target compounds were obtained from reactions of N-heterocyclic phosphenium triflates with PPN[Fe(CO)(3)(NO)] or PPN[Cr(CO)(4)-(NO)], respectively, and fully characterized (PPN = nitride-bistriphenylphosphonium cation). The structural and spectroscopic (IR, UV-vis) data support the presence of carbene-analogue NHP ligands with an overall positive charge state and pi-acceptor character. Even if the structural features of the M-NO unit were in all but one product blurred by crystallographic CO/NO disorder, spectroscopic studies and the structural data of the remaining compound suggest that the NO units exhibit nitroxide (NO-) character. This assignment was validated by computational studies, which reveal also that the electronic structure of iron NHP/ NO complexes is closely akin to that of the Hieber anion, [Fe(CO)(3)(NO)](-). The electrophilic character of the NHP units is further reflected in the chemical behavior of the mixed complexes. Cyclic voltammetry and IR-SEC studies revealed that complex [(NHP)Fe(CO)(2) (NO)] (4) undergoes chemically reversible one-electron reduction. Computational studies indicate that the NHP unit in the resulting product carries significant radical character, and the reduction may thus be classified as predominantly ligand-centered. Reaction of 4 with sodium azide proceeded likewise under nucleophilic attack at phosphorus and decomplexation, while super hydride and methyl lithium reacted with all chromium and iron complexes via transfer of a hydride or methyl anion to the NHP unit to afford anionic phosphine complexes. Some of these species were isolated after cation exchange or trapped with electrophiles (H+, SnPh3(+)) to afford neutral complexes representing the products of a formal hydrogenation or hydrostannylation of the original M=P double bond.Peer reviewe

Stochastic wave function approach to the calculation of multitime correlation functions of open quantum systems

Within the framework of probability distributions on projective Hilbert space a scheme for the calculation of multitime correlation functions is developed. The starting point is the Markovian stochastic wave function description of an open quantum system coupled to an environment consisting of an ensemble of harmonic oscillators in arbitrary pure or mixed states. It is shown that matrix elements of reduced Heisenberg picture operators and general time-ordered correlation functions can be expressed by time-symmetric expectation values of extended operators in a doubled Hilbert space. This representation allows the construction of a stochastic process in the doubled Hilbert space which enables the determination of arbitrary matrix elements and correlation functions. The numerical efficiency of the resulting stochastic simulation algorithm is investigated and compared with an alternative Monte Carlo wave function method proposed first by Dalibard et al. [Phys. Rev. Lett. {\bf 68}, 580 (1992)]. By means of a standard example the suggested algorithm is shown to be more efficient numerically and to converge faster. Finally, some specific examples from quantum optics are presented in order to illustrate the proposed method, such as the coupling of a system to a vacuum, a squeezed vacuum within a finite solid angle, and a thermal mixture of coherent states.Comment: RevTex, 19 pages, 3 figures, uses multico

Novel cyclic di-GMP effectors of the YajQ protein family control bacterial virulence

Bis-(3 ',5 ') cyclic di-guanylate (cyclic di-GMP) is a key bacterial second messenger that is implicated in the regulation of many critical processes that include motility, biofilm formation and virulence. Cyclic di-GMP influences diverse functions through interaction with a range of effectors. Our knowledge of these effectors and their different regulatory actions is far from complete, however. Here we have used an affinity pull-down assay using cyclic di-GMP-coupled magnetic beads to identify cyclic di-GMP binding proteins in the plant pathogen Xanthomonas campestris pv. campestris (Xcc). This analysis identified XC_3703, a protein of the YajQ family, as a potential cyclic di-GMP receptor. Isothermal titration calorimetry showed that the purified XC_3703 protein bound cyclic di-GMP with a high affinity (K-d similar to 2 mu M). Mutation of XC_3703 led to reduced virulence of Xcc to plants and alteration in biofilm formation. Yeast two-hybrid and far-western analyses showed that XC_3703 was able to interact with XC_2801, a transcription factor of the LysR family. Mutation of XC_2801 and XC_3703 had partially overlapping effects on the transcriptome of Xcc, and both affected virulence. Electromobility shift assays showed that XC_3703 positively affected the binding of XC_2801 to the promoters of target virulence genes, an effect that was reversed by cyclic di-GMP. Genetic and functional analysis of YajQ family members from the human pathogens Pseudomonas aeruginosa and Stenotrophomonas maltophilia showed that they also specifically bound cyclic di-GMP and contributed to virulence in model systems. The findings thus identify a new class of cyclic di-GMP effector that regulates bacterial virulence

Deterministic polarization chaos from a laser diode

Fifty years after the invention of the laser diode and fourty years after the report of the butterfly effect - i.e. the unpredictability of deterministic chaos, it is said that a laser diode behaves like a damped nonlinear oscillator. Hence no chaos can be generated unless with additional forcing or parameter modulation. Here we report the first counter-example of a free-running laser diode generating chaos. The underlying physics is a nonlinear coupling between two elliptically polarized modes in a vertical-cavity surface-emitting laser. We identify chaos in experimental time-series and show theoretically the bifurcations leading to single- and double-scroll attractors with characteristics similar to Lorenz chaos. The reported polarization chaos resembles at first sight a noise-driven mode hopping but shows opposite statistical properties. Our findings open up new research areas that combine the high speed performances of microcavity lasers with controllable and integrated sources of optical chaos.Comment: 13 pages, 5 figure

Generation of a wave packet tailored to efficient free space excitation of a single atom

We demonstrate the generation of an optical dipole wave suitable for the process of efficiently coupling single quanta of light and matter in free space. We employ a parabolic mirror for the conversion of a transverse beam mode to a focused dipole wave and show the required spatial and temporal shaping of the mode incident onto the mirror. The results include a proof of principle correction of the parabolic mirror's aberrations. For the application of exciting an atom with a single photon pulse we demonstrate the creation of a suitable temporal pulse envelope. We infer coupling strengths of 89% and success probabilities of up to 87% for the application of exciting a single atom for the current experimental parameters.Comment: to be published in Europ. Phys. J.

Heralded single photon absorption by a single atom

The emission and absorption of single photons by single atomic particles is a fundamental limit of matter-light interaction, manifesting its quantum mechanical nature. At the same time, as a controlled process it is a key enabling tool for quantum technologies, such as quantum optical information technology [1, 2] and quantum metrology [3, 4, 5, 6]. Controlling both emission and absorption will allow implementing quantum networking scenarios [1, 7, 8, 9], where photonic communication of quantum information is interfaced with its local processing in atoms. In studies of single-photon emission, recent progress includes control of the shape, bandwidth, frequency, and polarization of single-photon sources [10, 11, 12, 13, 14, 15, 16, 17], and the demonstration of atom-photon entanglement [18, 19, 20]. Controlled absorption of a single photon by a single atom is much less investigated; proposals exist but only very preliminary steps have been taken experimentally such as detecting the attenuation and phase shift of a weak laser beam by a single atom [21, 22], and designing an optical system that covers a large fraction of the full solid angle [23, 24, 25]. Here we report the interaction of single heralded photons with a single trapped atom. We find strong correlations of the detection of a heralding photon with a change in the quantum state of the atom marking absorption of the quantum-correlated heralded photon. In coupling a single absorber with a quantum light source, our experiment demonstrates previously unexplored matter-light interaction, while opening up new avenues towards photon-atom entanglement conversion in quantum technology.Comment: 10 pages, 4 figure

Mathematical utility theory and the representability of demand by continuous homogeneous functions

The resort to utility-theoretical issues will permit us to propose a constructive procedure for deriving a homogeneous of degree one continuous function that gives raise to a primitive demand function under suitably mild conditions. This constitutes the first self-contained and elementary proof of a necessary and sufficient condition for an integrability problem to have a solution by continuous (subjective utility) functions.info:eu-repo/semantics/publishedVersio