BackgroundCoronary artery calcium score (CACS) quantifies calcification to assess coronary artery disease (CAD), but it provides insufficient warning for low-attenuation non-calcified plaques. This study proposes and validates an automated pipeline that combines deep learning and radiomics for efficient detection of non-calcified plaques in the left anterior descending artery (LAD) and right coronary artery (RCA) using non-contrast CACS.MethodsPatients undergoing coronary CT angiography for suspected CAD from two medical sites were retrospectively enrolled and categorized into lesion and control groups. LAD and RCA vessels on CACS images from the development set were manually annotated to train deep learning-based segmentation models for automated coronary segmentation and subsequent pericoronary adipose tissue (PCAT) extraction. Radiomics models were built for LAD and RCA using three regions of interest—coronary artery, PCAT, and their combination—based on the training set. Model performance was evaluated across all datasets using receiver operating characteristic analyses, and DeLong tests were applied for pairwise comparisons.ResultsThe SegResNet models achieved optimal performance in coronary segmentation. Radiomics models for predicting non-calcified plaques demonstrated moderate to good vessel-level diagnostic performance, with areas under the curve (AUCs) ranging from 0.700 to 0.855 across datasets, encompassing separate LAD and RCA models and all ROI strategies. The coronary artery and combined-region models generally outperformed or matched the PCAT model, with comparable AUCs between them in most settings.ConclusionsThe automated pipeline enables efficient detection of non-calcified coronary plaques in CACS, with combined-region models showing promise for future use. The approach may facilitate further research and support the clinical translation of chest CT for large-scale CAD screening.

随着 16 层螺旋进入临床使用后,CT技师开始尝试冠状动脉CT血管造影检查,但时间分辨率较低,检查成功率也较低,图像清晰度不够,随着 64层螺旋CT应用于临床,时间和空间分辨率进一步提高,使得冠状动脉CT血管造影检查在临床上广泛开展.随着科技的发展,128 层、256 层、320 层的宽体探测器CT及双源螺旋CT的应用,气悬浮技术和磁悬浮技术的应用使门架系统旋转速度也进一步提高,目前冠状动脉CT血管造影检查的图像质量和成功率显著提升,图像质量也有明显改善,现将冠状动脉CT血管造影检查技术规范总结如下.

Background Alteplase before thrombectomy for patients with large vessel occlusion stroke raises concerns regarding an increased risk of intracranial hemorrhage (ICH), but the details of this relationship are not well understood. Methods This was a secondary analysis of the DIRECT-MT trial. ICH and its subtypes were independently reviewed and classified according to the Heidelberg Bleeding Classification. The effects of alteplase before thrombectomy on ICH and ICH subtypes occurrence were evaluated using logistic regression. Clinical and imaging characteristics that may modify these effects were exploratorily tested. Results Among 591 patients, any ICH occurred in 254 (43.0%), including hemorrhagic infarction type 1 in 12 (2.1%), hemorrhagic infarction type 2 in 127 (21.7%), parenchymal hematoma type 1 in 34 (5.8%), parenchymal hematoma type 2 in 50 (8.6%), and other hemorrhage types (3a-3c) in 24 (4.1%). Similar ICH frequencies were observed with combined alteplase and thrombectomy versus thrombectomy only (134/292 (45.9%) vs 120/299 (40.1%); OR 1.27, 95% CI 0.91 to 1.75, P=0.16), but patients treated with alteplase had a higher parenchymal hematoma rate (51/287 (17.8%) vs 33/297 (11.1%); OR 1.75, 95% CI 1.08 to 2.85, P=0.024). In the adjusted model, difference in parenchymal hematoma occurrence between groups remained significant (adjusted OR 1.71, 95% CI 1.00 to 2.92, P=0.049). Patients with history of diabetes (P interaction =0.048), hypertension (P interaction =0.02), antiplatelet therapy (P interaction =0.02), anticoagulation therapy (P interaction =0.04), and statin administration (P interaction =0.02) harbored a higher ICH rate when they received combination therapy. Conclusions Our data showed that in the DIRECT-MT trial, alteplase did not increase overall ICH for large vessel occlusion patients treated with thrombectomy, but it increased the parenchymal hematoma rate.

目的 观察CT门静脉成像(CTPV)用于TIPS治疗门静脉高压(PH)的价值.方法 纳入267例接受TIPS治疗的肝硬化失代偿期PH患者,分析其治疗前CTPV资料,观察肝内有无肿瘤、肝静脉与门静脉的相对空间位置、门静脉通畅度,曲张静脉分型、程度及有无异常分流道等.结果 在267例中,23例合并肝脏肿瘤,79例存在门静脉血栓,14例门静脉海绵样变性.门静脉分叉部、左支、右支裸露者占比分别为13.11％(35/267)、5.62％(15/267)及2.25％(6/267),肝静脉与门静脉之间的垂直距离为(22.83±9.56)mm,前后距离为(28.23±10.06)mm.术前增强CT及CTPV显示227例胃左静脉曲张、111例胃后/胃短静脉曲张及72例自发性门体静脉分流,其与术中DSA的一致率分别为98.24％(223/227)、85.59％(95/111)及100％(72/72).264例TIPS成功(264/267,98.88％),对其中58例采用辅助手段穿刺门静脉成功.结论 CT PV对于指导实施T IPS治疗P H具有重要价值.

Background and Purpose: This study was dedicated to investigating the agreement of the calculated results of two CT perfusion (CTP) postprocessing software packages, including parameter maps and ischemic volume, focusing on the infarct core volume (ICV) and penumbra volume (PV).Methods: A retrospective collection of 235 patients with acute ischemic stroke who underwent CTP examination were enrolled. All images had been analyzed with two software pipelines, RAPID CTP and AccuCTP, and the comparative analysis was based on ICV and PV results calculated by both software packages. The agreement of parameter maps was evaluated by root mean square error and Bland-Altman analysis. The ICV and PV agreement was evaluated by intraclass correlation coefficient (ICC) and Bland-Altman analysis. The accuracy of ICV and PV based on multiple thresholds was also analyzed.Results: The ICV and PV of AccuCTP and RAPID CTP show excellent agreement. The relative differences of the parameter maps were all within 10% and the Bland-Altman analysis also showed a strong agreement. From ordinary least squares fitting results, both ICV and PV had a remarkably high goodness of fit (ICV, R-2= 0.975 [p<.001]; PV, R-2= 0.964 [p<.001]). For the ICC analysis, both had high ICC scores (ICV ICC 0.984, 95% CI [confidence interval] 0.973-0.989; PV ICC 0.955, 95% CI 0.947-0.964). Furthermore, multi-threshold analysis on the basis of ICV and PV also achieved reliable analytical accuracy.Conclusions: The image analysis results of AccuCTP are in excellent agreement with RAPID CTP and can be used as an alternative analysis tool to RAPID CTP software in stroke clinical practice.

选择合适的监测方法,科学规范地开展鼠类监测,是鼠害评估、鼠害及鼠传疾病预防和控制的基础.鼠类监测方法种类较多、优缺点各异、适用范围差异大,在实际工作中如何选择应用仍困扰着监测工作者.因此,本文就当前常用鼠类监测方法的种类、优缺点、适用范围、监测要点及发展趋势进行综合分析论述,以期为今后的鼠类监测工作提供参考依据.

OBJECTIVE To explore the characteristics of ADC value changes in DWI of newly diagnosed symptomatic MM patients and its correlation with R-ISS stage. METHODS The data of 148 newly diagnosed symptomatic MM patients treated by whole-body DWI scan at The First Affiliated Hospital of Soochow University from June 2016 to June 2019 were selected and retrospectively analyzed and 30 cases of age-matched healthy people were selected as controls. The differences of ADC values between the patients in normal control group, DWI- group and DWI+ group were compared, and the relationship between ADC values and R-ISS stage in MM patients was compared. RESULTS The plasma cell percentage of the patients in DWI+ group was higher than those in DWI- group. ADC values of vertebra, sternum, rib, pectoral girdle, pelvic girdle of the patients in DWI+ group were significantly higher than those in DWI- group and normal control group. The ADC values of each part of the patients in DWI- group were higher than those in normal control group. ADC values of sternum, rib and pectoral girdle in the patients at R-ISS stage III were higher than those at R-ISS stage I and II, while, there was no statistical difference between R-ISS stage I and II groups. And there was no significant difference in ADC values of other bone parts such as vertebra and pelvic girdle in patients at R-ISS stage Ⅰ-Ⅲ. CONCLUSION DWI+ in MM patients is related to higher tumor invasion. The ADC values of the DWI+ group are higher than those of the DWI- group; the bone ADC values of the DWI- patients are still higher than the normal ones. And there is a certain relationship between ADC value and R-ISS stage.

Abstract Background The pathological grade of bladder cancer(BCa)is a critical determinant for the follow-up clinical decision and treatment of patients. The authors investigated a radiomic-clinical model in predicting the pathological grade of BCa. Objective This study explored the feasibility of the radiomics based on multi-phase thick-slice CT images combined with clinical risk factors in predicting of the pathological grade of BCa. Methods Patients with BCa who underwent CT scan and surgical treatment from January 2019 to December 2021 were analyzed retrospectively, with 104 cases of high-grade BCa and 100 cases of low-grade BCa included. Radiomics features were extracted from tumor volume in the images of the plain scan, corticomedullary phase, and parenchymal phase, respectively. Logistic Regression model, SVM model, and Random Forest model were established, and the model with higher diagnostic efficiency was chosen. Additionally, a radiomics-clinical model was conducted by selected independent predictors according to logistic regression analysis. Then the performance of the model was assessed. Results Among the 204 patients enrolled, the training cohort was consisted of 142 patients and the validation cohort was made up of 62 patients. The Logistic Regression model proved to be the most effective one among the three models. The radiomics-clinical model consisted of 2 independent predictors, patient age and Rad-Score, with an AUC of 0.904(95%CI 0.857–0.951) and 0.906༈95%CI 0.837–0.975༉in the training and validation cohorts, respectively. The diagnostic accuracy, sensitivity, and specificity of the validation cohort were 0.790, 0.813, and 0.767 respectively. Conclusion The radiomics-clinical model possesses great potential in predicting the pathological grade of BCa.

Objective: To investigate the value of pre-treatment spectral CT angiography (CTA) in predicting hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) treatment in acute ischemic stroke (AIS) patients. Materials and Methods: AIS patients who underwent IVT with recombinant tissue plasminogen activator and pre-treatment head and neck spectral CTA and head CT perfusion (CTP) from January 2018 to June 2020 were reviewed retrospectively. Finally, 20 patients were included in the HT group and 22 age-matched patients were included in the non-HT group. Spectral and CTP parameters of the region of interest on pre-treatment CTA axial raw images and CTP images, including the infarct core (IC) and ischemic penumbral (IP) regions, were recorded. The differences in clinical variables, CTP, collateral scores and spectral parameters between the two groups were analyzed. Three multivariate logistic regression models were then developed, where model 1 included clinical and spectral parameters, model 2 included clinical and CTP parameters and a combined model included clinical, CTP, and spectral parameters. Receiver operating characteristic analysis was used to evaluate the performance of the multivariate model. Results: Patients with HT had higher Safe Implementation of Treatments in Stroke (SITS) score (p = 0.023), the volume of perfusion lesions (p = 0.005), the volume of IP (p = 0.003), the mean transit time (MIT) in the IC area (p = 0.012), as well as the TTP in IP area (p = 0.015) compared with patients without HT. The HT group showed significantly lower CBF in the IC area (p = 0.019), iodine concentration (p = 0.017) and the effective atomic number (p = 0.024) in the IP area than non-HT group. And the slope of the spectral curve of the HT group in the IP region was larger than that of the non-HT group (p = 0.023). Gender, age, SITS score, the volume of entire perfusion lesion, CBF and MIT in the IC area, TTP in the IP area, as well as iodine concentration in the IP area were included in the final multivariate model for predicting HT. And CBF in the IC area (OR = 0.779, 95 % CI:0.609-0.996, p = 0.046) as well as the iodine concentration of IP area (OR = 0.343, 95 % CI: 0.131-0.901, p = 0.030) were proved to be independent predictors for HT. The combined model including clinical, spectral, and CTP parameters, showed improved accuracy compared to the other two models, while the Delong test did not suggest a statistically significant difference (both p values > 0.05). Conclusions: The iodine concentration of IP area derived from pre-treatment spectral CTA was an independent predictor of HT after IVT treatment for AIS patients. Moreover, multivariate models combined with clinical, spectral, and CTP parameters may be able to predict HT.

Few prospective studies have examined posttransplant chimeric antigen receptor (CAR) T cell infusion as candidates for front-line consolidation therapy for high-risk multiple myeloma (MM) patients. This single-arm exploratory clinical trial is the first to evaluate the safety and efficacy of sequential anti-CD19 and anti-BCMA CAR-T cell infusion, followed by lenalidomide maintenance after autologous stem cell transplantation (ASCT), in 10 high-risk newly diagnosed multiple myeloma (NDMM) patients. The treatment was generally well tolerated, with hematologic toxicities being the most common grade 3 or higher adverse events. All patients had cytokine release syndrome (CRS), which was grade 1 in 5 patients (50%) and grade 2 in 5 patients (50%). No neurotoxicity was observed after CAR-T cell infusion. The overall response rate was 100%, with the best response being 90% for a stringent complete response (sCR), and 10% for a complete response (CR). At a median follow-up of 42 (36-49) months, seven (70%) of 10 patients showed sustained minimal residual disease (MRD) negativity for more than 2 years. The median progression-free survival (PFS) and overall survival (OS) were not reached. Although the sample size was small and there was a lack of control in this single-arm study, the clinical benefits observed warrant ongoing randomized controlled trials.

OBJECTIVE:To explore the potential value of quantitative parameters derived from dual-energy spectral computed tomography (DESCT) as comparing to the parameters derived from magnetic resonance imaging (MRI) in detecting bone marrow (BM) infiltration and distinguishing different patterns of BM infiltration in patients diagnosed with Multiple myeloma (MM).METHODS:This study involved 35MM patients and 15 healthy control subjects who had undergone spinal DESCT and MRI. Pattern assignment was based on visual assessment of MR images, and the regions of interest were defined on both DESCT and apparent diffusion coefficient maps. Quantitative values of DESCT parameters were measured and compared between infiltrated and healthy bone marrow. Receiver operating characteristic (ROC) analysis was performed to determine potential utility of DESCT parameters in identifying BM infiltration and different patterns defined by MRI. Sensitivity and specificity under the optimal thresholds determined by the Youden Index were also calculated.RSULTS:Statistical differences were observed between the DESCT parameters including Ca(Water), Water(Ca), HAP(Fat), Fat(HAP) and Effective atomic number (Eff-Z) but not for the 70-keV CT value between the infiltrated and healthy BM (all P < 0.001). The 70keV CT value and Ca(Water), HAP(Fat) and Eff-Z values were also found to be statistically different in comparing different infiltration patterns (all P < 0.05). Performance of the model-based parameter Ca/Water was superior in differentiating between infiltrated and healthy BM in which the area under ROC curve, AUC = 0.856 [95% CI, 81.4-89.1%] with sensitivity = 0.841 and specificity = 0.768, as well as between MM patients and control subjects (AUC = 0.910 [95% CI, 79.5-97.3%], sensitivity = 0.829 and specificity = 1.000).CONCLUSIONS:Analysis of DESCT offers potential as a quantitative method to detect infiltrated BM and evaluate infiltration patterns of BM in patients diagnosed with MM.

OBJECTIVE:We aim to determine the risk of acute ischemic stroke in patients with severe and non-severe coronavirus disease 2019 (COVID-19). METHODS:A literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases until October 28, 2020. Studies covering COVID-19's severity classification data and COVID-19 patients with acute ischemic stroke were included. Two independent evaluators extracted data, and the random effects model was used to calculate the risk ratios (RR) and 95% confidence interval (95% CI) of acute ischemic stroke associated with COVID-19's severity. RESULTS:A total of 8 studies were included, involving 5266 patients. Among all COVID-19 patients, the total incidence of ischemic stroke was 1.76% (95% CI: 0.82-3.01). Severe patients have an increased risk of acute ischemic stroke compared with non-severe patients (RR = 3.53, 95% CI: 2.06-6.07, P < 0.0001; I2 = 12%). This association was also observed when COVID-19's severity was defined by clinical parameters (RR 2.91, 95% CI: 1.17-7.26, P = 0.02; I2 = 29%) and the need for intensive care (RR 4.47, 95% CI: 2.40-8.31, P < 0.0001; I2 = 0%). CONCLUSIONS:This meta-analysis shows that the severe course of COVID-19 is associated with an increased risk of acute ischemic stroke.

Background and purpose: We aimed to investigate the association between cerebral arteriosclerosis stenosis (CAS) and the short-term prognosis of non-valvular atrial fibrillation (NVAF) related cardioembolic stroke treated by reperfusion therapy. Methods: The data of 195 consecutive NVAF related cardioembolic stroke patients were retrospectively collected. We defined poor functional outcome as a modified Rankin scale (mRS) score of > 2 at 90 days. Results: Patients with CAS were more likely to be older (75.5 +/- 6.8 vs. 72.5 +/- 9.2 years, p = 0.001), more current smokers (35.6% vs. 24.1%, p = 0.018), with hypertension (88.1% vs. 65.6%, p < 0.001), diabetes mellitus (50.0% vs. 20.0%, p = 0.020), dyslipidemia (33.9% vs. 23.6%, p = 0.029), previous history of stroke (30.5% vs. 19.5%, p = 0.012), and congestive heart failure (32.2% vs. 22.6%, p = 0.041). Patients with CAS had higher National Institutes of Health Stroke Scale (NIHSS) (18 [13, 22] vs. 15 [9, 19], p < 0.001), and 90-day mRS scores (5 [3, 6] vs. 3[2, 5], p < 0.001). Multivariate logistic regression analysis showed that CAS (odds ratio [OR] 3.184, 95% confidence interval [CI] 1.314-7.713, p = 0.01), NIHSS score on admission (OR 1.228 [per 1 point], 95% CI 1.146-1.316, p < 0.001), congestive heart failure (OR 2.850, 95% CI 1.108-7.331, p = 0.030), and current smokers (OR 2.841, 95% CI 1.102-7.326, p = 0.031) were independent predictors of a poor functional outcome at 90 days. Conclusion: We should give the coexistence of CAS and NVAF related cardioembolic stroke proper attention. CAS was an independent factor for predicting the short-term prognosis of NVAF associated cardioembolic stroke patients treated by reperfusion therapy.

目的 探讨基于FastStroke软件的多期CT血管成像(CTA)侧支循环评分在评估急性缺血性脑卒中患者侧支循环中的临床可靠性.方法 回顾性分析51例前循环急性缺血性脑卒中患者,入组患者治疗前均进行了一站式CT检查及数字减影血管造影(DSA)检查.多期CTA均应用FastStroke软件进行后处理.结果 FastStroke和DSA侧支循环评分方法的一致性检验Wighted Kappa系数分别为0.783[95％置信区间(CI)0.659～0.907]、0.854(95 ％CI 0.753～0.956).基于FastStroke软件的多期CTA侧支循环评分与金标准DSA侧支循环评分具有很强的相关性(r=0.864,P＜0.001).结论 基于FastStroke软件的多期CTA侧支循环评分为一种可靠且快速的侧支循环评分方法,可为临床医生提供一种新的可视化侧支循环评分方法.

OBJECTIVE: To assess the cerebral hemodynamic data associated with transient cerebral hemodynamic disturbance (TCHD), including cerebral hyperperfusion syndrome (CHS) and watershed shift ischemia (WSI), by whole-brain (WB) computed tomography perfusion (CTP) before and after revascularization for ischemic moyamoya disease. METHODS: A total of 115 consecutive patients with ischemic moyamoya disease underwent revascularization. All patients underwent WB-CTP 24 hours before operation and on the day of onset of TCHD and 6 months after revascularization. The volumes of delay time (DT) >3 seconds and mismatch and relative cerebral blood flow <30% were calculated in 3 time points. RESULTS: Of the 115 patients, 18 115 had TCHD, comprising 10 with CHS and 8 with WSI. Compared with the brain volume of DT >3 seconds before revascularization, the volume decreased significantly (P < 0.05) on the day of CHS. The volume of mismatch in 3 time points indicated no significant differences (P > 0.05). The volume of relative cerebral blood flow <30% showed obvious differences of significance among 10 patients with CHS (P < 0.05) at 3 time points. In the WSI group, the volume of DT >3 seconds, mismatch, and DT >3 seconds showed significant differences, relatively (P < 0.05), at 3 time points. At the time of onset of TCHD, DT >3 seconds and mismatch in the CHS group were dramatically lower than those in the WSI group (P < 0.05). DT >3 seconds in the no-TCHD group showed significant differences ( P < 0.05) at 3 time points. CONCLUSIONS: WB-CTP could be used to assess the cerebral hemodynamic characteristics before and after revascularization. DT >3 seconds and mismatch played important roles in evaluating distinct features of TCHD.

Objective: This study compared the clinical features and hemodynamic characteristics of patients in different Suzuki stages of ischemic moyamoya disease (iMMD) before and after treatment with extracranial-intracranial (EC-IC) bypass surgery combined with encephalo-duro-myo-synangiosis and whole-brain computed tomography perfusion (WB-CTP). Methods: A total of 126 patients in different Suzuki stages (II, III, IV, and V) of iMMD who underwent bypass surgery from April 2013 to August 2020 were included in this retrospective study. MIStar automatic analysis of Whole brain CT perfusion imaging software (WB-CTP, Apollo Medical Imaging Technology, Melbourne, Australia) was used. The patients also underwent WB-CTP 1 day before and 1 week and 3 months after the surgery. The relationships between hemodynamic parameters in WB-CTP including delay time (DT) > 3 s, relative cerebral blood flow (rCBF) < 30%, mismatch and mismatch ratio, and clinical outcomes were evaluated for different Suzuki stages, with comparisons between early (II and III) and late (IV and V) stages. Results: Combined bypass surgery was performed in 161 hemispheres of 126 patients with iMMD. Brain volume with DT > 3 s was decreased 1 week (51.5 ± 11.8 ml, P < 0.05) and 3 months (41.5 ± 10.7 ml, P < 0.05) after bypass compared to 1 day before bypass (104.7 ± 15.1 ml) in early-stage patients. In late-stage patients, the volume was increased 1 week after bypass compared to the preoperative value (154.3 ± 14.7 vs. 118.3 ± 19.1 ml, P < 0.05). Preoperative brain volume with rCBF < 30% was lower (9.8 ± 3.9 vs. 33.5 ± 11.0 ml) whereas preoperative mismatch ratio was higher (11.2 ± 2.8 vs. 3.6 ± 1.6) in early-stage as compared to late-stage patients (both P < 0.05). A higher modified Rankin scale score (0–1) was achieved by early-stage patients than by those in the late stage (93.8 vs. 80.4%, P < 0.05) at the 3-month follow-up. Conclusions: WB-CTP is useful for assessing the effectiveness of combined bypass/revascularization in different Suzuki stages of iMMD. Patients in the early stage of disease with higher preoperative brain volume with DT > 3 s and mismatch ratio show greater improvements in hemodynamic parameters and fewer postoperative complications associated with hemodynamic disturbance following bypass than patients in the late stage. Preoperative mismatch ratio can serve as a marker for assessing the status of collateral circulation in different Suzuki stages of iMMD.

In recent years, the implantable cardiac monitors (ICM) have enhanced the recognition ability of atrial fibrillation (AF), which makes ICM have a new application in AF detection. We conducted a meta-analysis to determine the total incidence of newly found AF detected by ICM after cryptogenic stroke and to evaluate the factors related to the detection of AF. A literature search was conducted in the PubMed, EMBASE, Web of Science, and Cochrane library databases until March 1, 2020. Studies that reported the detection rate of AF using ICM in cryptogenic stroke patients with negative initial AF screening were analyzed. A total of 23 studies were included. The overall proportion of AF detected by ICM in cryptogenic stroke patients was 25% (95% confidence interval [CI], 22–29%). The rate of AF detected by ICM was independently related to both cardiac monitoring time (coefficient = 0.0003; 95% CI, 0.0001–0.0005; P = 0.0001) and CHA2DS2-VASc score (coefficient = 0.0834; 95% CI, 0.0339–0.1329; P = 0.001). In subgroup analysis, we found a significant difference in the detection rate of AF for monitoring duration (< 6 months: 9.6% [95% CI, 4.4–16.4%]; ≥ 6 and ≤ 12 months: 19.3% [95% CI, 15.9–23.0%]; > 12 and ≤ 24 months: 23.6% [95% CI, 19.9–27.5%]; > 24 months and ≤ 36 months: 36.5% [95% CI, 24.2–49.9%]; P < 0.001), and continent (Europe: 26.5% [95% CI, 22.2–31.0%]; North America: 16.0% [95% CI, 10.3–22.6%]; Asia: 17.4% [95% CI, 12.4–23.0%]; P = 0.005). The longer the time of ICM monitoring after cryptogenic stroke, the higher the detection rate of AF. Further research is still needed to determine the optimal duration of long-term cardiac monitoring.

BACKGROUND:The combination of inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) can improve motor function of stroke patients with undefined mechanism. It has been demonstrated that rTMS exhibits a neuro-modulatory effect by regulating the major inhibitory neurotransmitter γ-aminobutyric acid (GABA) in other diseases. OBJECTIVES:To evaluate the effect of combined inhibitory and facilitatory rTMS on GABA in the primary motor cortex (M1) for treating motor dysfunction after acute ischemic stroke. METHODS:44 ischemic stroke patients with motor dysfunction were randomly divided into two groups. The treatment group was stimulated with 10 Hz rTMS at the ipsilesional M1 and 1 Hz rTMS at the contralesional M1. The sham group received bilateral sham stimulation at the motor cortices. The GABA level in the bilateral M1 was measured by proton magnetic resonance spectroscopy (1H-MRS) at 24 hours before and after rTMS stimulation. Motor function was measured using the Fugl-Meyer Assessment (FMA). The clinical assessments were performed before and after rTMS and after 3 months. RESULTS:The treatment group exhibited a greater improvement in motor function 24 hours after rTMS compared to the sham group. The increased improvement in motor function lasted for at least 3 months after treatment. Following 4 weeks of rTMS, the GABA level in the ipsilesional M1 of the treatment group was significantly decreased compared to the sham group. Furthermore, the change of FMA score for motor function was negatively correlated to the change of the GABA:Cr ratio. Finally, the effect of rTMS on motor function outcome was partially mediated by GABA level change in response to the treatment (27.7%). CONCLUSIONS:Combining inhibitory and facilitatory rTMS can decrease the GABA level in M1, which is correlated to the improvement of motor function. Thus, the GABA level in M1 may be a potential biomarker for treatment strategy decisions regarding rTMS neuromodulatory interventions.

This study aimed to assess the collateral circulation in patients with acute ischemic stroke (AIS) using a single time-variant color map (ColorViz) and evaluate its reliability. The relationship between collateral status and computed tomography perfusion (CTP) parameters was also explored. The retrospective study included 74 patients with acute ischemic stroke patients treated with endovascular treatment. The Spearman correlation coefficient was calculated to determine the reliability of the novel evaluation method using ColorViz images compared with that using digital subtraction angiography (DSA) images, and to evaluate the correlation between the collateral status and CTP parameters. The Spearman correlation between collateral scores derived from ColorViz images and DSA images showed considerable reliability (ρ = 0.716, P < 0.001). The infarct core volume and mismatch ratio were significantly different (P < 0.05) in different collateral status based on ColorViz images. Evaluating the collateral status based on ColorViz images is reliable and provides a new and rapid visual method for clinicians. The infarct core volume and the mismatch ratio can indirectly reflect the degree of collateral circulation in AIS patients and provide help for clinicians to choose appropriate treatment options.

Objective:To evaluate the efficacy and safety of reperfusion therapy in patients with wake-up stroke (WUS) under the guidance of "tissue-window" by comparing with patients with non-WUS who received reperfusion therapy within "time-window".Methods:Two hundred and thirty-five acute ischemic stroke patients admitted to our hospital from January 2018 to December 2019 were enrolled in our study. Patients with non-WUS received reperfusion therapy within "time-window"; patients with WUS accepted multimodal CT examination at Emergency right after admission, Mistar software was used to reconstruct CT perfusion imaging (CTP) images, and reperfusion therapy was given to these patients after the judgement of "tissue-window". The differences of clinical data, prognoses, and safety indexes were compared between patients with WUS and non-WUS.Results:In these 235 patients, 45 patients were with WUS and 190 were with non-WUS. As compared with patients with non-WUS, those with WUS had significantly lower percentages of patients with hypertension history and patients accepted intravenous thrombolysis ( P<0.05). In 153 patients accepted intravenous thrombolysis, 23 patients were with WUS and 130 were with non-WUS; the time from admission to intravenous thrombolysis in WUS patients was significantly longer than that in non-WUS patients ( P<0.05); the clinical data, prognoses, and safety indexes showed no significant differences between these patients with WUS and non-WUS ( P>0.05). In 82 patients accepted bridging thrombectomy and direct thrombectomy, 22 patients were with WUS and 60 were with non-WUS; the clinical data, prognoses, and safety indexes showed no significant differences between these patients with WUS and non-WUS ( P>0.05). Conclusion:By comparing with patients with non-WUS who received reperfusion therapy within "time-window", reperfusion therapy is effective and safe for WUS patients under the guidance of multimodal CT "tissue-window".