Importance In several randomized clinical trials, endovascular thrombectomy led to better functional outcomes than conventional treatment at 90 days poststroke in patients with acute basilar artery occlusion. However, the long-term clinical outcomes of these patients have not been well delineated. Objective To evaluate 1-year clinical outcomes in patients with acute basilar artery occlusion following endovascular thrombectomy vs control. Design, Setting, and Participants This study is an extension of the ATTENTION trial, a multicenter, randomized clinical trial. Patients were included between February 2021 and January 2022, with 1-year follow-up through April 2023. This multicenter, population-based study was conducted at 36 comprehensive stroke sites. Patients with acute basilar artery occlusion within 12 hours of estimated symptom onset were included. Of the 342 patients randomized in the ATTENTION trial, 330 (96.5%) had 1-year follow-up information available. Exposures Endovascular thrombectomy (thrombectomy group) vs best medical treatment (control group). Main Outcomes and Measures The primary outcome was defined as a score of 0 to 3 on the modified Rankin Scale (mRS) at 1 year. Secondary outcomes were functional independence (mRS score 0-2), excellent outcome (mRS score 0-1), level of disability (distribution of all 7 mRS scores), mortality, and health-related quality of life at 1 year. Results Among 330 patients who had 1-year follow-up data, 227 (68.8%) were male, and the mean (SD) age was 67.0 (10.7) years. An mRS score 0 to 3 at 1 year was achieved by 99 of 222 patients (44.6%) in the thrombectomy group and 21 of 108 (19.4%) in the control group (adjusted rate ratio, 2.23; 95% CI, 1.51-3.29). Mortality at 1 year compared with 90 days was more frequent in both the thrombectomy group (101 of 222 [45.5%] vs 83 of 226 [36.7%]) and the control group (69 of 108 [63.9%] vs 63 of 114 [55.3%]). Excellent outcome (mRS score 0-1) at 1 year compared with 90 days increased in the thrombectomy group (62 of 222 [27.9%] vs 45 of 226 [19.9%]) but not in the control group (9 of 108 [8.3%] vs 9 of 114 [7.9%]) resulting in a magnified treatment benefit. Conclusions and Relevance Among patients with basilar artery occlusion within 12 hours of onset, the benefits of endovascular thrombectomy at 1 year compared with 90 days were sustained for favorable (mRS score 0-3) outcome and enhanced for excellent (mRS score 0-1) outcome.

Objective  Our aim was to assess the efficacy of ventriculoperitoneal shunt (VPS) for treating postoperative central nervous system infection (PCNSI) complicated with hydrocephalus and to identify factors associated with treatment failure. Materials and Methods  We conducted a retrospective analysis of PCNSI patients with hydrocephalus treated by VPS at the Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, between December 2012 and January 2020. Functional recovery was evaluated during follow-up using the Glasgow Outcome Scale. Results  A total of 29 patients (21 males, 8 females) were enrolled in the study (mean age: 56.4 ± 12.0 years, range: 18.0-77.0 years). Seventeen patients were treated successfully by VPS (58.6%). Among the 11 patients with shunt complications (37.9%), 8 (27.6%) presented with fever, 3 (10.3%) with shunt infection, and 3 (10.3%) with shunt obstruction. Univariate analysis identified low Glasgow Coma Scale (GCS) score (3-8) at the time of VPS and post-treatment fever as predictive of shunt failure. Conclusion  VPS was effective for treating PCNSI complicated with hydrocephalus. However, patients with low GCS score at the time of VPS or fever post-treatment were at greater risk of shunt failure and poor outcome.

Background and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. Methods This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. Results Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.

Background To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Background Severe ventriculitis (SV) caused by multidrug-resistant bacteria is associated with high morbidity and mortality in neurosurgical patients. This study assessed the outcomes of patients with SV caused by Acinetobacter baumannii who were treated by intraventricular (IVT) lavage and colistin administration. Methods This retrospective study included consecutive patients with SV caused by A. baumannii who were admitted at the Neurosurgical Department of Shanghai Tenth People’s Hospital from January 2014 to September 2017. Patients’ medical records, radiographic images, and surgical notes were reviewed. The patients were followed up for at least 6 months after discharge. Results A total of 25 patients, including 20 male and five female, were enrolled in this study; the average age was 45.6 years. All patients underwent neurosurgery before infection, and all A. baumannii cultures from cerebrospinal fluid (CSF) showed extensive resistance to the tested antibiotics except for tigecycline and colistin. All the patients underwent IVT lavage followed by daily administration of colistin after surgery; 24 patients received a daily colistin dose of 100,000 IU, while one received 50,000 IU. The patients also received tigecycline-based systemic antibiotic treatment. The mean duration of IVT colistin was 13.4±2.8 days. The time required to obtain a negative CSF culture was 8.9±4.0 days. Of the 20 patients who were cured, eight underwent shunt surgery due to hydrocephalus before they were discharged to a rehabilitation center. Five patients died, including one who was re-admitted due to recurrence 1 month after discharge. Conclusions IVT lavage and colistin treatment may be an effective treatment for SV caused by extensively drug-resistant A. baumannii. Future studies with a larger sample size may be needed to verify the findings in this study.

Incorrect microRNA was used due to author negligence. Correct details are shown below. i) Details corrected: GAPDH in Fig. 2F (U87) and Fig. 3B (U251); ii) Cleaved caspase 3 in Fig. 2F (U251); iii) Bax in Fig. 2F (U251 and U87). All the authors agree to this statement. [the original article was published in the Oncology Reports 28: 1771-1777, 2012 DOI: 10.3892/or.2012.1970]

Bone marrow mesenchymal cells (BMSCs) are regarded as donor cells in cell transplantation therapies for spinal cord injury (SCI) for they have the ability of favourable proliferation and multi-directional differentiation, and are easily isolated and culturd and have less immunological reaction. It has been confirmed that subarachnoid space injection is the most ideal delivery technique of BMSCs. Bone marrow mesenchymal stem cells transplantation is safe and its reconditioning role is certain for SCI in early clinical application. The mechanism of BMSCs promoting functional recovery after SCI is probably concerned with vicarious function, nerve trophism, immunosuppression and promoting axonal regeneration by BMSCs.

SUMMARY Aims: We conducted systematic review as well as meta‐analyses on the association between particulate matter and daily stroke attack from a number of epidemiologic studies. Methods: Twelve quantitative studies about the associations between particulate matter and stroke attack met the inclusive criteria. We evaluated the odds ratio (OR) of stroke attack associated with per 10 μg/m3 increase of the concentration of PM10 (particulate matter with aerodynamic diameter ≤ 10 μm) or PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5 μm) as effect scale, and a sensitivity analysis for the results was conducted. Results: In the time‐series design, PM10 exposure wasn't related to an increased risk of daily stroke attack [OR per 10 μg/m3 = 1.002, 95% confidence interval (CI): 0.999∼1.005], PM2.5 exposure were related to an increased risk of daily stroke attack (OR per 10 μg/m3 = 1.006, 95%CI: 1.002∼1.010]; but in the case‐crossover studies, PM10 exposure was related to increase in risk of daily stroke attack (OR per 10 μg/m3= 1.028, 95%CI: 1.001∼1.057). PM2.5 exposure was not significant association with daily stroke attack (OR per 10 μg/m3= 1.016, 95%CI: 0.937∼1.097). Sensitivity analysis showed that the results for PM10, PM2.5 and daily stroke attack were robust in the time‐series design. Conclusions: We found some evidence for an effect of air pollutants on stroke attack risk.

Spontaneous intracranial hypotension (SIH) is an increasingly recognized disease characterized by postural headache. Subdural hematoma (SDH) is a severe complication of SIH. We describe 2 patients with SIH who developed bilateral SDHs and outline the typical clinical and neuroimaging findings. After failure of conservative treatment, one patient received epidural blood patch (EBP) and neurosurgical drainage of hematomas and the other was successfully managed by EBP alone without hematoma evacuation. SIH patients with SDH that suffered focal neurological deficits, decreased level of consciousness, or SDH with maximum thickness more than 1 cm were recommended to be treated with surgical drainage, followed by EBP to prevent SDH recurrence.

The last three decades have witnessed great social, political and economic change in China since the market reforms in the late 1970s. A market economy was adopted as a replacement to the planned economy in order to allocate resources more efficiently. Consequently, higher education in China has undergone dramatic reforms to adapt to this socio-economic transition. This paper adopts a mixed-methods approach, combining fieldwork data with documentary analysis, to investigate the rationales of privatization in Chinese universities. It starts by examining the conceptualization of privatization. This is followed by an introduction of the public/private mix in the higher education sector in China. It then turns to explore drivers of the higher education reforms. A key contribution of this paper therefore is a systematic examination of the causes and the aims of privatization identified in Western literature set in the context of radical change as seen in the Chinese context. Drawing to fieldwork data, this paper presents findings that stand in conflict with prior studies. This investigation of the implementation of the Chinese privatization reveals both common features shared with Western practice but also a special uniqueness. It concludes by arguing that the neo-liberal reforms in higher education in China is likely to be used as a contingency strategy to encourage private spending, rather than suggesting a paradigm shift in university governance.

OBJECTIVE:To report the authors' own experience in the treatment of spontaneous intracranial hypotension (SIH) with targeted epidural blood patch after locating the CSF leaks with CT myelography (CTM) and to discuss the mechanism and value of this method.METHODS:Six patients with SIH (3 males and 3 females aged 33-66 years) were included. All patients met the diagnostic criteria of 2nd edition of International Classification of Headache Disorders (2004). CT myelography revealed the CSF leak sites in all 6 patients. Autologous blood mixed with Omnipaque (300 mg/ml) was injected after selective puncture at the leak site indicated by CTM.RESULTS:All patients responded well to the treatment and achieved a complete resolution of symptoms. Nerve root irritation occurred in 2 patients. Three patients suffered from a temporary back pain.CONCLUSION:With the location of leak sites by CTM, targeted epidural blood patch is an effective way to treat spontaneous intracranial hypotension.

Six patients(3 male,3 female)aged 33-66 yr, Course of disease 6-35 days, diagnosed with spontaneous intracranial hypotemion in Sir Run Run Shaw Hospital from November 2007 to May 2008,Were treated with on epidural autologus blood patch trader X-ray guidance. According to the results of CT myelography. the puncture site Was chosen in the 1-2 vertebral interspaees below the site of a single eerebrospinal fluid leak. For patients with multiple cerebrospinal fluid leaks.the procedure was performed at the spinal cord segment of the most severe leak. The mixture of augous blood and Omnipaque(300g/100 ml)at a ratio of 2:1 was injected into the epidural space to cover the spinal cord segment of the leaks under C-arm fluoroscopic guidance.Side effects were recorded during and after the injection of autologus blood.The treatment was repeated one week later if the former one failed.One patient was treated with epidural blood patch 3 times.and the rest 5 patients were treated with epidural blood patch 1 time.During the injeetion of autologus blood,5 patients complained of pain in the purtclure site,2 experienced pain radiating to the upper limb,2 felt,numbness in the right leg and all of these syndromes could be self-relieved.No side effects were observed after the injection of autologus blood.All the patients were Cured and no recurrence was observed during a 2-6 month follow-up.

Objective: To determine the relationship between the overlying tissues and recurrence of Dupuytren's contracture.Methods: Forty‐three patients (68 hands) who accepted surgical treatment were divided into two groups according to treatment methods: partial fasciectomy or dermofasciectomy and full‐thickness skin graft. Diseased palmar fascia, subcutaneous tissues and skin obtained during surgery were then assessed by electron microscopy.Results: All patients were followed up. None of the hands which accepted dermofasciectomy and full‐thickness skin grafting recurred, while 46.4% of the hands which accepted partial fasciectomy recurred. Under electron microscopic observation, myofibroblasts were found in the skin and subcutaneous tissues.Conclusion: The overlying tissues play an important role in Dupuytren's contracture, which may be a reason for recurrence of this condition after surgical treatment.