Analysis of early efficacy and safety of endovascular therapy for acute mild ischemic stroke with large vessel occlusion

Objective·To investigate the early efficiency and safety of endovascular therapy (EVT) for patients with acute mild ischemic stroke with large vessel occlusion (LVO-MIS).Methods·A total of 31 patients with LVO-MIS who received emergency EVT-assisted standard medical treatment at the Green Channel of Stroke in Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine from June 2016 to October 2022 were retrospectively included as endovascular therapy group (EVT group), and 32 LVO-MIS patients who only received standard medical treatment in the same period were selected as the control group. General clinical data and parameters related to EVT of the two groups were collected. The primary outcome was early efficacy, that is, the NIHSS at seventh day after treatment (d7NIHSS) score decreased by ≥3 points or directly to 0 points from baseline NIHSS score. Secondary outcomes included successful revascularization of blood vessels and early neurological deterioration (END), and safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality. The primary and secondary outcomes of the two groups of patients were analyzed to evaluate the early efficiency of EVT, and the safety evaluation indicators of the two groups of patients were analyzed to evaluate the safety of EVT. Kruskal-Wallis H test was used to analyze the NIHSS scores of 24 patients in the EVT group who underwent EVT before and after treatment.Results·There was no statistically significant difference in the general clinical data between the two groups, as well as parameters related to EVT such as occlusion site, and onset-to-admission time. The baseline NIHSS score of the EVT group [5.0 (3.0, 5.0) points] was higher than that of the control group [3.5 (2.0, 5.0) points] (P=0.001), and their d7NIHSS score [1.0 (0, 3.0) points] was lower than that of the control group [2.0 (1.0, 5.8) points] (P=0.040). A total of 24 patients (38.1%) in the two groups achieved early efficacy, including 16 cases in the EVT group and 8 cases in the control group; and the early efficacy rate of the EVT group was higher than that of the control group (χ2=4.729, P=0.030). The END rate in the EVT group was lower than that in the control group (χ2=6.097, P=0.014), and there were 29 cases (93.5%) in the EVT group of patients whose blood vessels were successfully reopened. There was no statistically significant difference in sICH rate and mortality rate between the two groups. In the EVT group, there was a statistically significant difference (H=16.997, P=0.000) among the baseline NIHSS scores [5.0 (3.0, 5.0) points] of 24 patients, postoperative 24hNIHSS score [2.0 (0.3, 3.8) points] and d7NIHSS scores [1.0 (0, 2.8) points].Conclusion·EVT is safe and effective in treating LVO-MIS, and the early efficacy rate of EVT is superior to standard medicine treatment, with a lower rate of END and no increased risk of sICH

Clinical and genetic characteristics of adult cerebral adrenoleukodystrophy

Objective·To summarize and analyze the clinical and genetic characteristics of adult cerebral adrenoleukodystrophy(ACALD ).Methods·The data of eight patients with ACALD who attended the Shanghai Sixth People′s Hospital, Shanghai Jiao Tong University School of Medicine from June 2018 to September 2022 were collected and comprehensively analyzed. Clinical data included age at onset, duration of disease, family history, present history and physical examination. Imaging examinations included magnetic resonance imaging (MRI) of the cranial, cervical spine and thoracic spine. Laboratory tests included serum very-long-chain fatty acids (VLCFA), adrenal cortical function and genetic test. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (Moca) were used to assess patients′ cognitive function.Results·A total of 8 male patients with ACALD were included in this study. Ageat onset ranged from 23 to 40 years old with an average age of (32.75±5.80) years, and the disease duration ranged from 4 to 59 months. Patients′ first symptoms were highly variable. Three patients showed memory loss and cognitive dysfunction, two showed irritability and personality change, one showed mental and behavioral abnormalities, one showed dysarthria and ataxia, and one showed persistent dizziness, occipital numbness and insomnia. All the patients had multiple white matter demyelination lesions, and white matter demyelination in parietal occipital lobe and posterior corpus callosum was the most common. Enhancement MRI showed patchy Gd-enhancement of partial lesions in three cases. In two patients, magnetic resonance spectroscopy showed that choline (Cho) peak increased and N-acetyl-aspartate (NAA) peak decreased. Serum VLCFA levels of C26, C24/C22 and C26/C22 were elevated in six patients who underwent serum VLCFA examination. Seven patients underwent adrenal cortical function testing, of which six experienced adrenal cortical dysfunction. Six patients were cognitively impaired, four of whom had decreased MMSE and MoCA scores, and two of whom were unable to cooperate with the assessment due to severe cognitive impairment. Eight different ABCD1 gene mutations were identified, among which c.1750delC (p.H584Tfs*52) and c.160_170delACGCAGGAGGC (p.T54Lfs*137) were novel mutations.Conclusion·The initial symptoms of ACALD vary, among which memory loss and cognitive dysfunction are the most common. White matter demyelination lesions in the parietal and corpus callosum pressure are the most common, and imaging abnormalities precede neurological symptoms. The clinical features of the disease are hair thinning and skin pigmentation, and the biochemical features are elevated serum VLCFA and adrenal insufficiency. Missense mutations are more common in the ABCD1 gene, and exons 1 and 6 are the hot mutant exons in Chinese

Comparison of formulas for resonant interactions between energetic electrons and oblique whistler-mode waves

Test particle simulation is a useful method for studying both linear and nonlinear wave-particle interactions in the magnetosphere. The gyro-averaged equations of particle motion for first-order and other cyclotron harmonic resonances with oblique whistler-mode waves were first derived by Bell [J. Geophys. Res. 89, 905 (1984)] and the most recent relativistic form was given by Ginet and Albert [Phys. Fluids B 3, 2994 (1991)], and Bortnik [Ph.D. thesis (Stanford University, 2004), p. 40]. However, recently we found there was a (- 1) l - 1 term difference between their formulas of perpendicular motion for the lth-order resonance. This article presents the detailed derivation process of the generalized resonance formulas, and suggests a check of the signs for self-consistency, which is independent of the choice of conventions, that is, the energy variation equation resulting from the momentum equations should not contain any wave magnetic components, simply because the magnetic field does not contribute to changes of particle energy. In addition, we show that the wave centripetal force, which was considered small and was neglect in previous studies of nonlinear interactions, has a profound time derivative and can significantly enhance electron phase trapping especially in high frequency waves. This force can also bounce the low pitch angle particles out of the loss cone. We justify both the sign problem and the missing wave centripetal force by demonstrating wave-particle interaction examples, and comparing the gyro-averaged particle motion to the full particle motion under the Lorentz force. ? 2015 AIP Publishing LLC.SCI(E)[email protected]; [email protected]

A deep learning framework for joint image restoration and recognition

Image restoration and recognition are important computer vision tasks representing an inherent part of autonomous systems. These two tasks are often implemented in a sequential manner, in which the restoration process is followed by a recognition. In contrast, this paper proposes a joint framework that simultaneously performs both tasks within a shared deep neural network architecture. This joint framework integrates the restoration and recognition tasks by incorporating: i) common layers, ii) restoration layers and iii) classification layers. The total loss function combines the restoration and classification losses. The proposed joint framework, based on capsules, provides an efficient solution that can cope with challenges due to noise, image rotations and occlusions. The developed framework has been validated and evaluated on a public vehicle logo dataset under various degradation conditions, including Gaussian noise, rotation and occlusion. The results show that the joint framework improves the accuracy compared with the single task networks

Revealing the source of Jupiter’s x-ray auroral flares

Jupiter’s rapidly rotating, strong magnetic field provides a natural laboratory that is key to understanding the dynamics of high-energy plasmas. Spectacular auroral x-ray flares are diagnostic of the most energetic processes governing magnetospheres but seemingly unique to Jupiter. Since their discovery 40 years ago, the processes that produce Jupiter’s x-ray flares have remained unknown. Here, we report simultaneous in situ satellite and space-based telescope observations that reveal the processes that produce Jupiter’s x-ray flares, showing surprising similarities to terrestrial ion aurora. Planetary-scale electromagnetic waves are observed to modulate electromagnetic ion cyclotron waves, periodically causing heavy ions to precipitate and produce Jupiter’s x-ray pulses. Our findings show that ion aurorae share common mechanisms across planetary systems, despite temporal, spatial, and energetic scales varying by orders of magnitude

Photocatalytic Boryl Radicals Triggered Sequential B─N/C─N Bond Formation to Assemble Boron‐Handled Pyrazoles

Abstract Vinyldiazo compounds are one of the most important synthons in the construction of a cyclic ring. Most photochemical transformations of vinyldiazo compounds are mainly focusing on utilization of their C═C bond site, while reactions taking place at terminal nitrogen atom are largely unexplored. Herein, a photocatalytic cascade radical cyclization of LBRs with vinyldiazo reagents through sequential B─N/C─N bond formation is described. The reaction starts with the addition of LBRs (Lewis base–boryl radicals) at diazo site, followed by intramolecular radical cyclization to access a wide range of important boron‐handled pyrazoles in good to excellent yields. Control experiments, together with detailed mechanism studies well explain the observed reactivity. Further studies demonstrate the utility of this approach for applications in pharmaceutical and agrochemical research

Comparison of formulas for resonant interactions between energetic electrons and oblique whistler-mode waves

Test particle simulation is a useful method for studying both linear and nonlinear wave-particle interactions in the magnetosphere. The gyro-averaged equations of particle motion for first-order and other cyclotron harmonic resonances with oblique whistler-mode waves were first derived by Bell [J. Geophys. Res. 89, 905 (1984)] and the most recent relativistic form was given by Ginet and Albert [Phys. Fluids B 3, 2994 (1991)], and Bortnik [Ph.D. thesis (Stanford University, 2004), p. 40]. However, recently we found there was a (- 1) l - 1 term difference between their formulas of perpendicular motion for the lth-order resonance. This article presents the detailed derivation process of the generalized resonance formulas, and suggests a check of the signs for self-consistency, which is independent of the choice of conventions, that is, the energy variation equation resulting from the momentum equations should not contain any wave magnetic components, simply because the magnetic field does not contribute to changes of particle energy. In addition, we show that the wave centripetal force, which was considered small and was neglect in previous studies of nonlinear interactions, has a profound time derivative and can significantly enhance electron phase trapping especially in high frequency waves. This force can also bounce the low pitch angle particles out of the loss cone. We justify both the sign problem and the missing wave centripetal force by demonstrating wave-particle interaction examples, and comparing the gyro-averaged particle motion to the full particle motion under the Lorentz force. ? 2015 AIP Publishing LLC.SCI(E)[email protected]; [email protected]

Efficacy of Wearable low-intensity pulsed Ultrasound treatment in the Movement disorder in Parkinson’s disease (the SWUMP trial): protocol for a single-site, double-blind, randomized controlled trial

Abstract Background Parkinson’s disease (PD) is a progressive, neurodegenerative illness marked by the loss of dopaminergic neurons, causing motor symptoms. Oral levodopa replacement therapy remains the gold standard in the treatment of PD. It is, nevertheless, a symptomatic treatment. There is currently no effective treatment for PD. Therefore, new therapies for PD are highly desirable. Low-intensity pulsed ultrasound (LIPUS) has been shown to improve behavioral functions in PD animal models. It is a new type of neuromodulation approach that combines noninvasiveness with high spatial precision. The purpose of this study is to establish a new clinical protocol for LIPUS in the treatment of movement disorders in patients with PD. Methods This protocol is a single-site, prospective, double-blind, randomized controlled trial (RCT). Forty-eight participants with clinically confirmed PD will be randomly allocated to one of two groups: LIPUS group or sham group. All of the participants continue to use pharmacological therapy as a fundamental treatment. The primary outcome is the difference between groups from baseline to 4 months in the change in the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score (part III). The secondary outcomes include the rating scales such as the Mini-Mental State Examination (MMSE), and other three rating scales, and medical examinations including high-density electroencephalography (hdEEG) and functional magnetic resonance imaging (fMRI). The primary safety outcome will be assessed at 4 months, and adverse events will be recorded. Discussion This study represents the clinical investigation into the efficacy of therapeutic LIPUS in the treatment of PD for the first time. If LIPUS is determined to be effective, it could offer a practical and innovative means of expanding the accessibility of ultrasound therapy by using a wearable LIPUS device within a home setting. Trial registration Chinese Clinical Trial Registry ChiCTR2100052093. Registered on 17 October 2021