Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke

Importance It is uncertain whether intravenous methylprednisolone improves outcomes for patients with acute ischemic stroke due to large-vessel occlusion (LVO) undergoing endovascular thrombectomy. Objective To assess the efficacy and adverse events of adjunctive intravenous low-dose methylprednisolone to endovascular thrombectomy for acute ischemic stroke secondary to LVO. Design, Setting, and Participants This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 82 hospitals in China, enrolling 1680 patients with stroke and proximal intracranial LVO presenting within 24 hours of time last known to be well. Recruitment took place between February 9, 2022, and June 30, 2023, with a final follow-up on September 30, 2023.InterventionsEligible patients were randomly assigned to intravenous methylprednisolone (n = 839) at 2 mg/kg/d or placebo (n = 841) for 3 days adjunctive to endovascular thrombectomy. Main Outcomes and Measures The primary efficacy outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores (range, 0 [no symptoms] to 6 [death]). The primary safety outcomes included mortality at 90 days and the incidence of symptomatic intracranial hemorrhage within 48 hours. Results Among 1680 patients randomized (median age, 69 years; 727 female [43.3%]), 1673 (99.6%) completed the trial. The median 90-day modified Rankin Scale score was 3 (IQR, 1-5) in the methylprednisolone group vs 3 (IQR, 1-6) in the placebo group (adjusted generalized odds ratio for a lower level of disability, 1.10 [95% CI, 0.96-1.25]; P = .17). In the methylprednisolone group, there was a lower mortality rate (23.2% vs 28.5%; adjusted risk ratio, 0.84 [95% CI, 0.71-0.98]; P = .03) and a lower rate of symptomatic intracranial hemorrhage (8.6% vs 11.7%; adjusted risk ratio, 0.74 [95% CI, 0.55-0.99]; P = .04) compared with placebo. Conclusions and Relevance Among patients with acute ischemic stroke due to LVO undergoing endovascular thrombectomy, adjunctive methylprednisolone added to endovascular thrombectomy did not significantly improve the degree of overall disability.Trial RegistrationChiCTR.org.cn Identifier: ChiCTR210005172

ArtBank: Artistic Style Transfer with Pre-trained Diffusion Model and Implicit Style Prompt Bank

Artistic style transfer aims to repaint the content image with the learned artistic style. Existing artistic style transfer methods can be divided into two categories: small model-based approaches and pre-trained large-scale model-based approaches. Small model-based approaches can preserve the content strucuture, but fail to produce highly realistic stylized images and introduce artifacts and disharmonious patterns; Pre-trained large-scale model-based approaches can generate highly realistic stylized images but struggle with preserving the content structure. To address the above issues, we propose ArtBank, a novel artistic style transfer framework, to generate highly realistic stylized images while preserving the content structure of the content images. Specifically, to sufficiently dig out the knowledge embedded in pre-trained large-scale models, an Implicit Style Prompt Bank (ISPB), a set of trainable parameter matrices, is designed to learn and store knowledge from the collection of artworks and behave as a visual prompt to guide pre-trained large-scale models to generate highly realistic stylized images while preserving content structure. Besides, to accelerate training the above ISPB, we propose a novel Spatial-Statistical-based self-Attention Module (SSAM). The qualitative and quantitative experiments demonstrate the superiority of our proposed method over state-of-the-art artistic style transfer methods. Code is available at https://github.com/Jamie-Cheung/ArtBank