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Elevated blood glucose is frequently detected early after aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate whether hyperglycemia at admission is associated with mortality in patients with aSAH.In a multicenter observational study of patients with aSAH, we defined normal glycemia, mild hyperglycemia, moderate hyperglycemia, and severe hyperglycemia as blood glucose of 4.00-6.09 mmol/L, 6.10-7.80 mmol/L, 7.81-10.00 mmol/L, and 10.00 mmol/L, respectively. We performed propensity score matching to obtain the adjusted odds ratios (OR) with 95 % confidence intervals (CI).Of 6771 patients with aSAH, 511(7.5 %) had died in hospital, and hyperglycemia at admission was observed in 4804 (70.9 %). Propensity scores matching analyses indicated that compared with normal glycemia, the odds of in-hospital mortality were slightly lower in patients with mild hyperglycemia (OR 0.89, 95 % CI 0.56-1.40), significantly higher in patients with moderate hyperglycemia (OR 1.90, 95 % CI 1.20-3.01), and in patients with severe hyperglycemia (OR 3.45, 95 % CI 2.15-5.53; P trend 0.001). Long-term survival was worse among patients with hyperglycemia and was proportional to its severity. Similar dose-response associations were evident for poor functional outcomes and major disability. Hyperglycemia was associated with an increased risk of hospital-acquired infections (OR 1.46, 95 % CI 1.29-1.66) and rebleeding (OR 1.58, 95 % CI 1.06-2.35).Among aSAH patients, hyperglycemia at admission was independently associated with increased mortality. Both moderate hyperglycemia and severe hyperglycemia were associated with an increased risk of mortality, but these associations were not seen in mild hyperglycemia (blood glucose 6.10-7.80 mmol/L).

Expanding urbanization and agricultural intensification across neighboring South Asia and East Asia have substantially threatened atmospheric condition over the Third Pole (TP) during the past few decades. Whether the atmospheric condition over the TP is still as clean as a representative of the regional background draws great concern. In this work, great differences in levoglucosan concentration within/above the atmospheric boundary layer height are revealed. Levoglucosan results support the hypothesis that atmospheric pollutants in the mid-troposphere over the TP are mainly affected by long-range transport, although there are some local biomass burning emissions in residential areas. In addition, levoglucosan concentration in the mid-troposphere over the TP is at the same magnitude as marine and polar regions, but about 2–3 magnitudes lower than neighboring densely-populated Asian regions. With insights of levoglucosan records, this work therefore proves that the high-altitude TP still has largely pristine atmospheric conditions, and is one of the cleanest remote regions on the Earth.

Surgical suture is commonly used in clinic due to its action in accelerating the process of wound healing. However, difficultly handling in minimally invasive surgery and bacteria-induced infection usually limit its use in a wide range of applications. Here, we report a facile scalable strategy to fabricate surgical sutures with shape memory function and antibacterial activity for wound healing. Specifically, a shape memory polyurethane (SMPU) with a transition temperature (Ttrans) at 41.3 °C was synthesized by adjusting the mole ratio of the hard/soft segment, and then the shape memory surgical sutures containing polyhexamethylene biguanide hydrochloride (PHMB) as a model drug for antibacterial activity were fabricated by a facile scalable one-step wet-spinning approach, in which PHMB was directly dissolved in the coagulation bath that enable its loading into the sutures through the dual diffusion during the phase separation. The prepared sutures were characterized by their morphology, mechanical properties, shape memory, antibacterial activity, as well as biocompatibility before the wound healing capability was tested in a mouse skin suture-wound model. It was demonstrated that the optimized suture is capable of both shape memory function and antibacterial activity, and promote wound healing, suggesting that the facile scalable one-step wet-spinning strategy provides a promising tool to fabricate surgical sutures for wound healing.

Background Intracranial aneurysm (IA) is a debilitating cerebrovascular degeneration. Current clinical diagnosis relies mainly on conventional angiogram except for some peculiar aneurysms. Nonetheless, there is no documentation of aneurysm showing robust intracranial artifact on computed tomography or magnetic resonance imaging. Case Description Herein, we report a 45-year-old female with an IA showing a robust intracranial metal artifact. During surgery, the culprit lesion for the artifact was discovered to be hard plaque on the ventral part of the aneurysm. Craniotomy clipping and vessel reconstruction were successful, but minor vasospasm was observed postoperatively. Postoperative pathology and optical emission spectrometer analyses showed elevated iron and copper level in the plaque on the IA. After comparing with other aneurysm samples, we believe the overenriched local iron deposition contributed to the metal artifact on imaging. Conclusions Taken together, accidental findings of intracranial metal artifacts on computed tomography and magnetic resonance imaging can be indicative to iron deposition on intracranial aneurysm. Neuroimaging using magnetic field should be performed with caution. Local accumulation of lysed products from erythrocyte might contribute to the occurrence of this enriched iron deposition, but further evidence regarding the pathogenesis of copper deposition should be provided. Surgically, measures should be taken to avoid perioperative complications like vasospasm and delayed cerebral ischemia. Future report of similar cases would be helpful in optimizing the treatment modality for the aneurysm with metallic plaque.

To evaluate whether the postoperative neutrophil-to-lymphocyte ratio (NLR) is a prognostic marker for patients with intracerebral hemorrhage (ICH) undergoing surgical hematoma evacuation.This retrospective cohort study was conducted to identify patients with ICH who underwent hematoma evacuation between January 2013 and December 2018. Data on demographics, clinical features, laboratory tests (admission and postoperative), and imaging information were collected. The associations between variables and 30-day mortality were assessed by multivariable logistic regression analysis. The predictive power of independent predictors was evaluated by receiver operating characteristic (ROC) curve analysis.A total of 380 patients were included. Multivariable analysis identified admission Glasgow Coma Scale score (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.53-0.70; P0.001) and initial hematoma volume (OR, 1.01; 95% CI, 1.01-1.02; P = 0.022) were independently associated with 30-day mortality. With regard to laboratory biomarkers, postoperative NLR (OR, 1.04; 95% CI, 1.01-1.08; P = 0.014) was independently correlated with 30-day death, but admission NLR (OR, 1.00; 95% CI, 0.97-1.03; P = 0.944) was not. The best predictive cutoff point of 12.97 for postoperative NLR (area under the ROC curve, 0.606; P = 0.006) for predicting 30-day mortality was determined by ROC analysis.In patients with ICH undergoing hematoma evacuation, admission Glasgow Coma Scale score, initial hematoma volume, and postoperative NLR were independently associated with 30-day mortality. Postoperative NLR may be a prognostic marker in surgical ICH patients, and future studies are needed to confirm this finding.

The adverse health effects of household air pollution have been widely explored, but few studies have evaluated the effects of household air pollution on the risk of cardiometabolic multimorbidity (CMM), a pressing public health concern worldwide. Thus, we aimed to investigate whether exposure to household use of polluting fuels is associated with morbid CMM and, if so, whether a healthy lifestyle could mitigate this association.In this prospective, nationwide representative cohort of the China Health and Retirement Longitudinal Study (CHARLS), participants free of CMM (defined as the coexistence of 2 or more of the following: heart disease, stroke, and diabetes or high blood sugar) were included in 2011-2012 and followed for CMM incidence until 2018. Household air pollution was measured as the use of solid fuels for cooking and heating. The healthy lifestyle score was determined by six factors, physical activity, smoking, body mass index, total cholesterol, blood glucose, and blood pressure, and categorized into three groups (unhealthy, 0-1 factors; intermediate, 2-4; and healthy, 5-6). Cox proportional hazards models investigated associations between household air pollution and incident CMM. The potential modifier effect of a healthy lifestyle score was tested through stratified analyses.Among 7125 eligible participants, 239 incident cases of CMM were identified over a median follow-up of 7.0 years. After adjustment for potential confounders, the use of solid household fuels for heating was associated with more significant hazards of CMM (adjusted hazard ratio [HR] 1.71, 95 % confidence interval [CI] 1.28 to 2.28), while use for cooking (HR, 1.14; 95 % CI, 0.85 to 1.52) was not. Compared with participants in the unhealthy group, those in the healthy and intermediate groups had considerably lower CMM risk, with adjusted HRs (95 % CI) of 0.17 (0.09 to 0.31) and 0.39 (0.29 to 0.53), respectively, regardless of the household air pollution category. Importantly, when participants adhered to a healthy lifestyle, exposure to household air pollution was no longer significantly associated with a higher risk of CMM (adjusted HR 1.77, 95 % CI 0.51 to 6.12; P = 0.369).Household usage of polluting fuels was significantly associated with a higher risk of CMM, and adherence to a healthy lifestyle may mitigate this adverse effect. From a broader perspective, our findings underscore the importance of public health policies and interventions targeting multiple exposures (air pollution, physical activity, smoking, etc.) in enhancing the prevention of detrimental cardiometabolic health effect.

Optical microscope (OM), scanning electron microscope (SEM), transmission electron microscope (TEM) and tensile machine were used to characterize the microstructures and mechanical properties of as-forged and aged Mg-9.5Gd-3.8Y-0.6Zr alloys. The results show that a novel kind of dislocation arrays, comprising parallel arranged dislocations, were obtained in the forged alloy. The arrays tend to extend parallel and are heterogeneously distributed with adjacent distances varying from 0.3 µm to 1.4 µm. After aging the alloy at 265 °C, a large number of preferential-oriented β' phases were precipitated on the dislocation arrays, forming a structure of “precipitation chains” (PCs), which results in simultaneous increments of strength and ductility. Keywords: Magnesium alloys, Dislocations, Precipitate, Mechanical property

Intracerebral hemorrhage (ICH) is a devastating subtype of stroke that is associated with high morbidity and mortality. However, up to now, there are no effective prevention methods or specific therapies to improve its clinical outcomes. Herein, we explore preliminarily the efficacy of crocin, a carotenoid extracted from the stigma of saffron known for its anti-oxidation and free radical scavenging activities, in a mouse ICH model induced with collagenase infusion. Crocin or saline was administrated 6 h after ICH and then every 12 h for up to 7 days. Neurological scores were examined on days 1, 3, and 7 after ICH. Mice were sacrificed after1, 3, and 7 days of crocin treatment for examination of histology and immunohistochemistry. The results showed that oral administration of crocin attenuated the neurological deficits and reduced the myelin loss, neuron degeneration, iron deposition, reactive oxygen species (ROS) production and heme oxygenase-1 (HO-1) expression in the early stage of ICH, making it potential to be an ideal candidate for medical therapy of ICH in clinic.

Background Brainstem hemorrhage (BSH) is the most dangerous and devastating subtype of intracerebral hemorrhage and is associated with high morbidity and mortality. However, to date, no effective prevention methods or specific therapies have been available to improve its clinical outcomes. We preliminarily explored the efficacy of deferoxamine (DFO), a clinical chelator known for its iron-scavenging activities, in a rat model of BSH induced with collagenase infusion. Methods DFO or saline was administrated 6 hours after BSH induction and then every 12 hours for ≤7 days. The survival curve of the rats was created, and the neurological scores were examined on days 1, 3, and 7 after BSH. The rats were sacrificed after 1, 3, and 7 days of DFO treatment for histological examination and immunohistochemistry. Results The results showed that administration of DFO delayed erythrocytes lysis, reduced iron deposition, reduced reactive oxygen species generation, reduced heme oxygenase-1 expression, and alleviated brain injury such as neuron degeneration and myelin sheath injury. However, DFO did not improve the survival rate and neurobehavioral outcomes in this model. Conclusions Administration of DFO had limited therapeutic effects on collagenase-induced brainstem hemorrhage in rats. Some potential explanations were proposed, and more preclinical work is required to clarify the controversial curative effect of DFO in ICH.

We investigated the outcomes of patients with an unruptured intracranial aneurysm (UIA) and2 risk factors concerning complications, obliteration rate, and other factors after surgical or endovascular treatment.Coiling and clipping were compared in patients with UIAs treated in West China Hospital from January 2015 to May 2017. Patient survival, dependency, retreatment, complications, and other clinical outcome indexes were compared between the 2 groups.A total of 82 patients (92 aneurysms) had undergone treatment for UIAs with multiple risk factors. Of these 82 patients, 45 (54.9%) had undergone clipping and 37 (45.1%) had undergone coiling. No deaths were related to either treatment. Morbidity (modified Rankin scale score2) at 1 year had developed in 1 of 45 and 1 of 37 patients in the clipping and coiling groups, without a statistically significant difference. Hospitalization5 days (30 of 45 vs. 12 of 37; P0.05) was less frequent after coiling. The number of aneurysms with complete occlusion (48 of 51 vs. 33 of 41; P0.05) was greater in the surgical group. No differences in peritreatment complications were found in the surgical and endovascular groups (8 of 45 vs. 6 of 37; P0.05).In our study, clipping and coiling showed advantages for the treatment of UIAs with multiple risk factors. Surgical clipping of UIAs is achievable with a low rate of unfavorable outcomes and a high rate of complete obliteration for patients with multiple risk factors. However, endovascular treatment was also successful, with a shorter length of stay and low procedure-related morbidity. Additional randomized evidence are required to support the superior efficacy of clipping.

Objective Delayed cerebral ischemia (DCI) is significantly related to death and unfavorable functional outcome in patients with aneurysmal subarachnoid hemorrhage (SAH). The association between alpha-delta ratio (ADR) on quantitative electroencephalography (EEG) and DCI has been reported in several previous studies, but their results are conflicting. This meta-analysis was conducted to assess the accuracy of ADR for DCI prediction in patients with aneurysmal SAH. Methods PubMed and Embase were systematically searched for related records. Study selection and data collection were completed by 2 investigators. Sensitivity, specificity, and their 95% confidence intervals (CIs) were pooled. A summary receiver operating characteristic curve was plotted to show the pooled accuracy. Deeks funnel plot was used to evaluate publication bias. Results Five studies were included in this meta-analysis. The pooled sensitivity and specificity of worsening ADR for DCI prediction in patients with aneurysmal SAH were 0.83 (95% CI 0.44–0.97) and 0.74 (95% CI 0.50–0.89), respectively. In addition, the area under the summary receiver operating characteristic curve was 0.84 (95% CI 0.81–0.87). No obvious publication bias was found using Deeks funnel plot (P = 0.29). Conclusions Worsening ADR on quantitative EEG is a reliable predictor of DCI in patients with aneurysmal SAH. Further studies are still needed to confirm the role of quantitative EEG in DCI prediction.

Primary intraventricular hemorrhage (PIVH) is a rare condition in adult patients. PIVH occurs frequently in adult hemorrhagic Moyamoya disease (MMD). Idiopathic PIVH is defined as PIVH without cerebrovascular abnormalities. This study is aimed to compare the baseline characteristics and outcomes of acute MMD-related and idiopathic PIVH.Adult patients with acute MMD-related or idiopathic PIVH were retrospectively included. Baseline characteristics and outcomes at discharge were obtained and compared. Chi-square test, Student's t-test, or rank-sum test were used in statistical analyses.This study finally included 32 patients with acute MMD-related PIVH and 112 with acute idiopathic PIVH. Patients with acute MMD-related PIVH were significantly younger (53.3 ± 15.8 vs. 42.8 ± 12.2 years, P0.001). The admission systolic blood pressure in patients with acute idiopathic PIVH was significantly higher (161.7 ± 30.9 vs. 134.6 ± 24.6 mm Hg, P0.001). Patients with acute idiopathic PIVH had significantly higher admission serum urea (5.68 ± 2.66 vs. 4.34 ± 1.62 mmol/L, P = 0.008), cystatin C (0.97 ± 0.72 vs. 0.68 ± 0.16 mg/L, P = 0.023), and uric acid (309.01 ± 105.97 vs. 242.24 ± 77.65 μmol/L, P = 0.001). In patients with acute MMD-related PIVH, only one (3.1%) patient was dead at discharge. In contrast, a total of 22 (19.6%) patients with acute idiopathic patients died at discharge (P = 0.027).Compared with patients with acute idiopathic PIVH, patients with acute MMD-related PIVH have younger age, lower blood pressure, and better renal function. Moreover, patients with acute MMD-related PIVH have lower short-term mortality.

With over 2 million new cases annually, stroke is associated with the highest disability-adjusted life-years lost of any disease in China. The burden is expected to increase further as a result of population ageing, an ongoing high prevalence of risk factors (eg, hypertension), and inadequate management. Despite improved access to overall health services, the availability of specialist stroke care is variable across the country, and especially uneven in rural areas. In-hospital outcomes have improved because of a greater availability of reperfusion therapies and supportive care, but adherence to secondary prevention strategies and long-term care are inadequate. Thrombolysis and stroke units are accepted as standards of care across the world, including in China, but bleeding-risk concerns and organisational challenges hamper widespread adoption of this care in China. Despite little supporting evidence, Chinese herbal products and neuroprotective drugs are widely used, and the increased availability of neuroimaging techniques also results in overdiagnosis and overtreatment of so-called silent stroke. Future efforts should focus on providing more balanced availability of specialised stroke services across the country, enhancing evidence-based practice, and encouraging greater translational research to improve outcome of patients with stroke.

Background Hematoma enlargement happens in about 30% patients with intracerebral hemorrhage, which is reported to be closely correlated with poor prognosis. Swirl sign has been reported to have correlation with hematoma enlargement. This meta-analysis analyzed the accuracy of swirl sign for predicting hematoma enlargement in intracerebral hemorrhage. Methods Five databases were searched for potentially eligible literature. Studies were included if they were about the predictive properties of swirl sign for hematoma enlargement in intracerebral hemorrhage. Sensitivity and specificity of swirl sign for hematoma enlargement prediction were pooled. Pooled positive and negative likelihood ratios were also calculated. Results Six studies with 2647 patients were finally included in meta-analysis. The pooled sensitivity and specificity of swirl sign were 0.45 (95%CI 0.32–0.59) and 0.79 (95%CI 0.73–0.84), respectively. The pooled positive likelihood ratio of swirl sign was 2.2 (95%CI 1.8–2.5). In contrast, the pooled negative likelihood ratio of swirl sign was 0.69 (95%CI 0.57–0.84). Conclusions This meta-analysis suggests that swirl sign has the relatively high specificity for hematoma enlargement prediction in patients with intracerebral hemorrhage.

Oligochitosan (OCHI) is known to have some specific biological activities. However, its interactions with blood components and related correlation with molecular structures remains to be clarified due to its growing use in biomedical areas. Herein, a series of OCHI were prepared by hydrogen peroxide induced degradation combined fractionation in ethanol solutions and their molecular structures were characterized by GPC, FTIR, 1H and 13C NMR, and then the interactions of the prepared OCHI with blood components, including red blood cells (hemolysis, deformability, and aggregation), coagulation system, complement (C3a, and C5a activation), and platelet (activation, and aggregation), were investigated. For red blood cells, OCHI has a quite low risk of hemolysis in a dose- and MW-dependent manner and the deformability and aggregation were observed in its high MW fraction. The coagulation tests revealed that OCHI is capable of a mild anticoagulation through blocking the intrinsic pathway and the anticoagulation corresponding MW was identified. In terms of complement, OCHI could inhibit C3a in a dose-dependent manner and activate C5a with its high MW fraction. In addition, there is no significant effect of OCHI on platelet activation and aggregation. Based on above results, the interactions related mechanism was discussed and proposed.

Tannic acid, a hydrolysable tannin, exists commonly in food plants. Tannic acid has already been shown various anticancer mechanisms such as inhibiting the proliferation, inducing a higher apoptotic rate and slowing down the metastasis of different cancers. Moreover, tannic acid was reported to reduce the side effects caused by chemotherapeutics on patients. But whether the tannic acid can improve the treatment of oxaliplatin on colorectal carcinomatosis has yet been studied. In this study, we developed an injectable drug delivery system by physical incorporation of oxaliplatin (OXA) and tannic acid (TA) polymeric nanoparticles (OXA/TA NPs) into a thermo-sensitive hydrogel, OXA/TA NPs-hydrogel (OXA/TA NPs-H). The OXA/TA NPs-H was injected into the peritoneal cavity for the treatment of colorectal peritoneal carcinoma. Firstly, a water-in-oil-in-water double-emulsion (w/o/w) method and solvent-evaporation procedure were used in the preparation of the biodegradable OXA/TA NPs. Then, we prepared the biodegradable thermo-sensitive poly(3-caprolactone) (PCL)-10R5-PCL (PCLR) hydrogel with a low critical solution temperature (LCST) which undergoes gelation process at body temperature. Transmission electron microscopy (TEM) showed the spherical profile of OXA/TA NPs. Fourier-transform infrared (FTIR) spectra demonstrated that OXA and TA were both encapsulated into the OXA/TA NPs. In this study, intraperitoneal application of OXA/TA NPs-H restricted the growth of CT26 peritoneal colon cancer in vivo, improved the quality of life and prolonged the survival time of the model mice. Our study suggested that OXA/TA NPs-H might have potential application in the treatment of colorectal cancer.

Objective Among several novel predictors on noncontrast computed tomography (CT) for hematoma expansion in spontaneous intracerebral hemorrhage (sICH), shape irregularity grade, satellite sign, and island sign are all related to irregular shape of hematoma. This study is aimed to compare the accuracy of these imaging markers for predicting hematoma expansion in the same cohort of sICH patients. Methods This retrospective study enrolled sICH patients who underwent diagnostic computed tomography (CT) scans within 6 hours after onset and another follow-up CT scan within 24 hours after initial CT scan. Shape irregularity grade, satellite sign, and island sign were assessed according to the definitions in previous studies. The accuracy of these imaging indicators for predicting hematoma expansion was analyzed using receiver operator analysis. Results Finally, a total of 196 patients were included. Shape irregularity grade ≥3 was found in 87 (44.39%) patients, satellite sign was identified in 76 (38.78%) patients, and island sign was shown in only 41 (20.92%) patients. Only island sign remained an independent predictor for hematoma expansion in multivariate logistic regression. The sensitivity values of shape irregularity grade ≥3, satellite sign, and island sign were 0.52, 0.63, and 0.48, respectively. By contrast, the specificity values of these 3 predictors were 0.58, 0.69, and 0.85, respectively. Shape irregularity grade ≥3 had the smallest area under the curve (0.597), and island sign had the largest (0.676). Conclusions Island sign seems to be the optimal shape-related predictor for hematoma expansion in sICH patients and could be included in the future predictive model for hematoma expansion.

The environmental significance of levoglucosan (LEV) records in Tibetan glacier ice layers on sub-annual to annual scales, in particular their suitability as a specific biomarker for indicating past fire changes, is poorly understood at present. In this work, a continuous LEV record was reconstructed in a central Tibetan ice core for the period 1990–2012. The LEV record was classified into two categories based on its LEV concentrations: background levels and extreme events. Annually-resolved LEV records and background levels in the ice core were strongly correlated with satellite observations of fire occurrence frequency over the northern Indian peninsula between 2003 and 2012, especially for strong fire events during the pre-monsoon season (March–May). In addition, peaks in LEV concentrations may represent extreme fire events in regions around the Tibetan Plateau. LEV records in the ice core reflect a long-term increasing trend in fire background and also an increase in fire extreme events, across the Tibetan Plateau and its surroundings. We therefore conclude that LEV records in Tibetan ice cores can be used as a powerful tool for calibrating and reconstructing past fire changes over subtropical Asia.

Background The island sign is a novel imaging predictor for early hematoma growth, implying multifocal active bleeding. The prognostic value of the island sign for long-term outcome in patients with intracranial hemorrhage (ICH) remains unrevealed. The aim of this study is to investigate associations between the island land and long-term prognosis in patients with ICH. Methods Both clinical characteristics and radiologic parameters were retrospectively obtained from electronic medical records. According to the initial and follow-up computed tomography scans of patients, hematoma expansion and the island sign were determined independently with 2 experienced physicians. Multivariate logistic regression analyses were used to explore the associations of hematoma expansion, 1-year poor outcome, and 1-year death on other clinical variables. Results A total of 322 patients were included, and 126 of them presented with early hematoma expansion, with 81 exhibiting the island sign. There were 116 patients who died, and 157 patients with ICH had poor outcome at the first year after onset. The multivariate logistic regression analyses revealed that initial Glasgow Coma Scale score, hematoma size, and presence of intraventricular hemorrhage and island sign were strongly associated with long-term poor outcomes. Conclusions The island sign is an easy-to-use and novel imaging marker which predicts both early hematoma expansion and long-term poor prognosis.

Summary: BackgroundHigh-sensitive cardiac troponin T (hs-cTnT), as a preferred biomarker, has been used for auxiliary diagnosis and risk stratification of acute myocardial infarction. The prognostic value of hs-cTnT in intracerebral haemorrhage (ICH) remains unclear. Methods: To gauge if the hs-cTnT, either alone or combined with other risk factors, has the potential to predict in-hospital mortality among the ICH population in a diverse clinical scenario setting. We performed a multi-center, population-based, retrospective cohort study between November 2016 and December 2018. Admission hs-cTnT in serum was accessed, and additional information, including the demographics, baseline laboratory parameters. Clinical and imaging characteristic was collected as well. The primary outcome was in-hospital all-cause mortality. The associations between hs-cTnT and in-hospital death were assessed by multinomial logistic regression. We also use the Net Reclassification Index analysis strategy to address the incremental prognostic impact of hs-cTnT. Findings: Elevated high-sensitivity cardiac troponin (hs-cTnT) was observed in the entire population of 485 non-survival ICH patients, but show diversity by age, gender, and disease severity. After adjusting for confounding factors, a normalization of hs-cTnT concentrations was significantly associated with higher in-hospital death (odd's ratio 1.84, 95% CI: 1.31, 2.59, P=0.0005). Notably, patients with the highest quartile of hs-cTnT levels face a 6.98-fold higher risk of in-hospital death compared with those in the lowest quartile (OR 6.98, 95%CI 2.11-23.10; P=0.0015). More importantly, incorporating hs-cTnT into the conventional risk factor model significantly increased the C statistic in predicting in-hospital mortality (0.859 vs. 0.874; P= 0.0188). Further subgroup analyses suggested the additional prediction value of hs-cTnT was more sensitive to younger adults (P=0.0208), males (P=0.0189), and tend to those with severity ICH stage (P=0.0975). Interpretation: Elevated hs-cTnT is independently associated with an increased risk of in-hospital death. A combination of hs-cTnT and conventional risk factors promoted the prognostic value of ICH, in particular, sensitive to young adults, males, and severity stage of ICH, highlighting the value of heterogeneity and personalized care in the management of ICH. Funding Statement: This paper presents independent research funded by the significant application demonstration project of the Chengdu Science and Technology Bureau (2019-YF09-00211-SN). CY is supported by 1.3.5 project for disciplines of excellence, West China Hospital,Sichuan University (18HXFH010). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The Biomedical Research Ethics Committee of West China Hospital approved this study. The requirement for informed consent was waived for this retrospective analysis of anonymous data.

The effects of laser shock peening (LSP) on the fatigue life of AA7075-T651 were investigated. The combined influence of surface imperfections (i.e. pits and intermetallics), compressive residual stresses (CRS) and the applied stress on crack initiation sites (surface or subsurface) and the associated fatigue life were investigated. Critical surface imperfections were found to significantly reduce the benefits of LSP in life improvement, by promoting surface crack initiation despite the resisting effects of CRS. To facilitate quantifying the effects of LSP on fatigue life, a finite element (FE) model was developed to simulate residual stress distribution induced by LSP, as well as its redistribution caused by the formation of surface pits. Based on the FE results, a method identifying whether the specified surfaces pits and intermetallics are critical to lead to surface cracking at given stress conditions was proposed, based on the Smith-Watson-Topper method and the Murakami’s model respectively. The interaction between surface imperfections, CRS and the applied loads were taken into account in this method. In addition, a fatigue life assessment framework was proposed based on the prediction of crack initiation sites, which was validated to be reliable in efficiently evaluating the efficacy of the applied LSP in improving fatigue life.

The inflammatory response plays a vital role in the pathologic mechanism of intracerebral hemorrhage. It recently has been reported that neutrophil to lymphocyte ratio (NLR) could represent a novel composite inflammatory marker for predicting the prognosis of intracranial hemorrhage (ICH). However, in considering the effects of surgical evacuation on the initiation of inflammatory responses, the relationship between NLR and functional outcome of patients with ICH after surgical treatment is still controversial. Here, we aimed to assess the predictive value of admission NLR and other available laboratory parameters for 90-day outcome of patients with ICH undergoing neurosurgical treatment.In total, 104 patients with acute ICH admitted to West China Hospital from October 2016 to January 2018 were retrospectively enrolled. Admission absolute neutrophil count, lymphocyte count, and white blood count were extracted from electronic medical records of patents with ICH. The associations between outcome and laboratory biomarkers were assessed by multivariable logistic regression analysis. The comparison of predictive power of independent predictors was evaluated by receiver operating characteristic curves.In total, 59 patients with ICH who underwent surgical treatment exhibited unfavorable outcomes, which was associated with greater admission NLR (odds ratio [OR] 0.692, 95% confidence interval [CI] 0.518-0.925, P = 0.01; OR 1.148, 95% CI 1.078-1.222, P0.01; OR 1.215, 95% CI 1.015-1.454, P = 0.03), lower Glasgow Coma Scale score, and larger hematoma. NLR showed the best predictive power by comparing with other laboratorial variables (area under the curve 0.668, 95% CI 0.569-0.757, P 0.01) and also was found to linearly correlate with Glasgow Coma Scale score at admission, hematoma volume, absolute neutrophil count, absolute lymphocyte count, and hydrocephalus. Meanwhile, the best predictive cutoff point of 6.46 for NLR also was identified.Other than the association of prognosis of patients with ICH, NLR exhibited potential independent predictive ability for 90-day functional outcomes of patients with ICH after surgery.

Magnesium phosphate cements (MPCs) have found a wide range of applications due to their superior properties. However, as a chemically bonded ceramic material, MPCs show highly brittle behavior. Fiber inclusion is a simple and effective way to improve their ductility and toughness. In this study, short discrete basalt fibers with different fiber contents by mixture volume (i.e. 0–1.5%) and lengths (i.e. 6 mm–30 mm) were added into MPC matrix. Properties of basalt fiber reinforced MPC composites (BFRMPCs) including workability, compressive, splitting tensile, flexural and post-peak residual strengths, and toughness were assessed. The fracture surfaces of BFRMPC samples were also investigated by using scanning electron microscopy (SEM). The results revealed that the addition of basalt fibers into MPC mixture led to a significant decrease in workability and a slight decrease in bulk density. The beneficial effect of basalt fibers on compressive strength began to weaken after 1% of fiber volume, while splitting tensile strength, flexural strength, and fracture toughness significantly increased with the increase of fiber volume. Moreover, the load-deflection behavior was highly related to the fiber content and testing age. In addition, the effect of basalt fiber lengths on the properties of MPC mixtures was insignificant. The results also suggested that basalt fiber reinforced MPCs showed better mechanical properties than glass fiber reinforced MPCs.

Objectives The prognostic value of admission serum glucose for early hematoma growth in patients with intracranial hemorrhage remains controversial. Island sign is a novel imaging predictor for early hematoma growth, implying multifocal active bleeding. The aim of this study is to investigate the potential associations between hyperglycemia and early hematoma expansion in patients with intracranial hemorrhage with or without island sign. Patients and Methods Clinical characteristics and radiologic parameters were retrospectively obtained from the electronic medical record. Admission blood glucose was measured within 24 hours from disease onset. Hematoma expansion and island sign were estimated by 2 experienced reviewers from initial and follow-up computed tomography scans. Multivariate logistic regression analyses were used to explore the associations of hematoma expansion and island sign on other clinical variables. Results In total, 187 patients were enrolled in current study; 61 patients were presented to have early hematoma expansion, whereas 32 exhibited island sign. The average blood glucose level was 7.64 mmol/L among all patients. The multivariate logistic regression analyses revealed that the time from ictus to initial computed tomography scan, Glasgow Coma Scale score on admission, hematoma volume, island sign, and hyperglycemia were associated with hematoma expansion, whereas only admission serum glucose and hematoma size were associated with island sign. Conclusions Admission serum glucose is associated with hematoma growth and prevalence of island sign, respectively. These results indicated that elevated blood glucose level plays a pathological role in active bleeding. Further studies concerning exact molecular signal pathway are urgently required.

Background Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating disease. Emerging evidence has indicated that the apolipoprotein E (ApoE) genotype might be associated with the risk of aSAH as well as complications and outcomes after aSAH, although the results remain controversial. Methods We searched published literature on PubMed, Embase, China National Knowledge Infrastructure, and Wanfang database to identify studies involving the ApoE genotype and aSAH. A meta-analysis was performed to summarize the relationship between ApoE genotype and aSAH, including susceptibility, complications, and prognosis. Results Eighteen studies were considered eligible for inclusion. Generally, e4 carriers had increased risk of aSAH (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.01–1.49). White patients with the e2/e2 genotype had a greater risk of aSAH (OR 3.38, 95% CI 1.13–10.11). The patients with aSAH carrying the e4 allele had an increased risk of poor outcome (OR 2.21, 95% CI 1.21–4.05) compared with non-e4 carriers, especially in Asian patients (OR 4.99, 95% CI 1.73–14.40). ApoE e4 carriers have increased risk of delayed ischemic neurologic deficit compared with non-e4 carriers in the overall population. No significant difference was detected regarding the effect of certain ApoE genotypes on aSAH admission severity, rebleeding, or cerebral vasospasm after aSAH. Conclusions We found that the ApoE genotype was significantly associated with aSAH risk, whereas its effect on certain ethnic populations differs. Patient carrying the e4 allele might have a worse outcome, whereas current evidence was insufficient to prove the association between ApoE genotypes and post-SAH complications.

Objective Hematoma expansion (HE) is closely related to poor outcome in spontaneous intracerebral hemorrhage (sICH). Island sign (IS) is a novel HE predictor based on noncontrast computed tomography (NCCT). This study is aimed to confirm the accuracy of IS for predicting HE and compare it to the spot sign (SS) on computed tomography angiography (CTA). Methods Patients with sICH and initial CTA within 6 hours after onset and follow-up NCCT within 24 hours after initial CTA were included. IS and SS were screened by 2 independent readers. The sensitivity and specificity were evaluated for both signs. Receiver-operator analysis was conducted to assess the accuracy of both signs for predicting HE. Results This study included 165 patients. IS was found in 33 (20.0%) patients, and SS was identified in 42 (25.5%) patients. In the 41 patients with HE, 19 (46.3%) had IS and 26 (63.4%) had SS. The sensitivity and specificity of IS were 46.3% and 88.7%, respectively. In contrast, the sensitivity and specificity of SS were 63.4% and 87.1%, respectively. The areas under the curve of IS and SS were 0.675 and 0.753, respectively (P = 0.275). Conclusions IS is independently associated with HE. Although the accuracy of IS for predicting HE is lower than SS, it can be an alternative predictor if CTA cannot be performed.

Objective To summarize the characteristics of intracranial pseudoaneurysms (IPAs) in pediatric patients. Methods Pediatric IPAs treated at our center between January 2012 and April 2017 were analyzed retrospectively. Related literature was reviewed, and the results of those studies were compared with our present findings. Results A total of 15 pediatric IPAs from 64 pediatric intracranial aneurysms (23.4%) were included in our study. Eleven of the 15 patients (73.3%) were male, and 9 (60%) had a history of head trauma. Seven patients (46.6%) presented with seizures, 9 of 11 patients (81.8%) with ruptured aneurysms with presented intracerebral hematoma, and 9 IPAs (60%) were large or giant in size. The internal carotid artery (ICA) and middle cerebral artery (MCA) were the most common aneurysm sites (n = 6; 40.0%). Eight IPAs (53.3%) were distal arterial aneurysms. Seven patients (46.7%) underwent craniotomy surgery, and 8 (53.3%) underwent endovascular treatment. During a mean follow-up of 2.0 ± 1.3 years, 12 patients (80.0%) had favorable outcomes, with a modified Rankin Scale (mRS) score of 0–2. One patient in the endovascular group died due to postoperative rebleeding. Conclusions IPAs are prevalent among all pediatric intracranial aneurysms, and head trauma is the most important risk factor. IPAs present with more intracerebral hematomas, tend to be larger, and are commonly observed in the ICA, MCA, and distal arterial location; they also carry a high risk of seizures. Both surgical and endovascular treatment could achieve favorable clinical outcomes, but more studies are needed to reveal which treatment approaches are best suited for pediatric IPAs.

To reveal the characteristics of spontaneous intracerebral hemorrhage (sICH) in a plateau area based on the Tibetan population.Data of Tibetan and Han patients (control group) with sICH treated at our center from January 2013 to April 2017 were retrospectively reviewed.A total of 122 Tibetan and 927 Han patients were included. Compared with Han patients, Tibetan patients were older (54.7 ± 11.2 vs. 50.9 ± 18.3 years, P = 0.027), exhibited higher male-to-female ratios (73.8% vs. 55.0%, P0.001), were more overweight (22.1% vs. 13.1%, P = 0.007) had more smokers (36.9% vs. 20.5%, P 0.001), had a higher concentration of hemoglobin (163.7 ± 17.6 vs. 134.8 ± 20.2 g/L, P 0.001), and included a higher number of patients with hypertension (83.6% vs. 60.5%, P 0.001), diabetes mellitus (19.2% vs. 9.3%, P = 0.002), and prior hemorrhagic stroke (9.0% vs. 2.0%, P0.001). Tibetan patients also experienced more brainstem hemorrhage (11.5% vs. 5.1%, P = 0.039) in the infratentorial region and had a higher risk of in-hospital complications resulting from hematoma enlargement (20.5% vs. 10.4%, P = 0.002) and cerebral infarction (59.0% vs. 9.7%, P 0.001). During a 6-month follow-up period, they had higher rates of unfavorable outcomes and case mortality (P0.05). A multivariable analysis adjusted for confounding factors revealed that the Tibetan race was positively associated with unfavorable clinical outcomes in sICH patients (P0.05).Tibetan sICH patients from the plateau area presented unique characteristics in their baseline measurements, incidence of comorbidities, hematoma location, risk of in-hospital complications, and clinical outcomes compared with Han patients. The Tibetan race was positively associated with unfavorable 6-month outcomes in ICH patients.

Background It remains unknown if ultra-early (within 24 hours after onset) treatment can improve the prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). We aimed to evaluate the effect of ultra-early treatment on functional outcomes and mortality in patients with poor-grade aSAH via a systematic review and meta-analysis. Methods We performed a literature search in the PubMed, MEDLINE, and Web of Science databases. Primary outcomes were death and functional outcome assessed at any time period. Secondary outcomes were the rebleeding rate before an aneurysm occlusion procedure and the incidence of intraoperative technique difficulty (ITD). The results are reported as odds ratio (OR) with 95% confidence interval (CI). Results A total of 14 articles containing 1111 patients met our inclusion criteria and were included in our analysis. The pooled incidence was 47% (95% CI, 40%–54%) for favorable outcome across 13 studies, 26% (95% CI, 19%–32%) for mortality in 11 studies, 10% (95% CI, 3%–16%) for rebleeding in 5 studies, and 20% (95% CI, 10%–31%) for ITD in 5 studies after ultra-early treatment of poor-grade aSAH. Compared with delayed treatment (>24 hours), the ultra-early treatment failed to improve outcomes (OR, 1.23; 95% CI, 0.75–2.01; P = 0.40) or reduce mortality (OR, 0.84; 95% CI, 0.58–1.22; P = 0.45), but tended to prevent preoperative rebleeding (OR, 0.59; 95% CI, 0.32 to 1.07; P = 0.08) in 6, 4, and 4 case-control studies, respectively. Conclusions Our findings show no significant change both in functional outcome and mortality between ultra-early and delayed treatment although ultra-early treatment may be associated with lower rebleeding rate.

A novel, rapid and ultrasensitive ratiometric and colorimetric fluorescence method was developed using bovine serum albumin protected gold/silver bimetallic nanoclusters (BSA-Au/Ag NCs) as fluorescent sensor for mercury (Hg) detection. The fluorescence sensor which was synthesized by one-pot approach shows dual-emissions at 470 nm (Ag NCs) and 630 nm (Au NCs) under a single excitation at 390 nm. In the presence of Hg2+, the red fluorescence of Au NCs was quenched while the fluorescence of Ag NCs almost unchanged, which exhibited a ratiometric fluorescence response and an obvious fluorescence color change toward Hg2+. The selective quenching mechanism may be due to the formation of gold amalgam bonds between Hg2+ (4f145d10) and Au+ (4f145d10). A limit of detection (LOD) of 2.2 μg L−1 and a relative standard deviation (RSD, n = 7) of 0.7% at a concentration of 50 μg L−1 of Hg2+ were obtained when using a commercial fluorescence spectrophotometer as the detector. In visual detection, as low as 10 μg L−1 of Hg2+ can be easily discriminated from the blank with the naked eye. The proposed method retains several unique advantages, including simplicity, rapidity, ease of usage and high-sensitively.

Objective To investigate the relationship between single nucleotide polymorphisms or haplotypes of COL4A1 gene and the outcome of intracerebral hemorrhage (ICH). Methods In our study, 181 patients with hypertensive ICH were enrolled and followed up at 3 and 6 months. Outcome data included any cause of death and disability. Genomic DNA was extracted by DNA extraction kit, and the 6 single nucleotide polymorphism genotyping of the COL4A1 gene was detected through MassARRAY Analyzer. Unphased 3.1.4 and SPSS 19.0 were used to analyze the association between alleles, genotypes, and haplotypes of the COL4A1 gene and the outcomes of ICH. Results Of the 181 patients with hypertensive ICH, 12 were lost in follow-up, which accounted for 6.6%. Our association analysis showed that the rs532625 AA genotype of the COL4A1 gene may increase risk of disability at 3 months; the rs532625 A allele and AA genotype were association factors of the risk of disability at 6 months; the rs532625 AA genotype was an association factor of the risk of death/disability at 6 months. After adjusting for gender, age, coma, and severe neurologic deficits, only the rs532625 AA genotype was independently associated with the risk of disability at 3 and 6 months and the risk of death/disability at 6 months. Conclusions Our study found that the rs532625 AA genotype in the COL4A1 gene was independently associated with the risk of disability at 3 and 6 months and death/disability at 6 months in a Chinese Han population. These conclusions need to be verified in future studies with larger samples.

Objective To investigate the association between single nucleotide polymorphisms or haplotypes of the COL4A1 gene and the risk of intracerebral hemorrhage (ICH). Methods We conducted a case-control study that included 181 patients from the Chinese Han population with hypertensive ICH and 197 hypertension patients without ICH. Genomic DNA was extracted by DNA extraction kit, and the 6 single nucleotide polymorphism genotypes of the COL4A1 gene were detected with a MassARRAY Analyzer. Unphased 3.1.4 and SPSS 19.0 were used to analyze the association between alleles, genotypes, and haplotypes of the COL4A1 gene and the risk of ICH. Results Compared with the control group, patients in the ICH group were significantly younger. There were no differences in gender, diabetes, hyperlipidemia, current smoking, and alcohol consumption between the 2 groups. Our association analysis showed that the rs3742207 A, rs11069830 A, and rs679505 A alleles were association factors of the risks of ICH; rs11069830 AA, rs544012 AC, and rs679505 AA genotypes were association factors of the risk of ICH; AA haplotype (rs3742207–rs11069830) was an association factor of the risk of ICH. After adjusting age and gender by multivariate logistic regression, the rs544012 AC and rs679505 AA genotypes were independently associated with the risk of ICH. Conclusions Our study showed that the rs544012 AC and rs679505 AA genotypes were independently associated with the risk of ICH in the Chinese Han population and that the AA haplotype (rs3742207–rs11069830) in the COL4A1 gene may be related to the risk of ICH in the Chinese Han population; these conclusions need further confirmation in future studies with larger samples.

In several applications of magnesium phosphate cement (MPC), one encounters a need for bonding old Portland cement (OPC) concrete with MPC. The bonding characteristics between MPC and OPC concrete substrate, were evaluated using flexural and tensile bond strength, failure modes, scanning electron microscopy (SEM) and X-ray diffraction (XRD). The experimental results show that samples having a lower magnesia to phosphate molar ratio (M/P) and water to cement mass ratio (w/c) exhibit higher bond strength and stronger affinity for OPC concrete, as well as better developed interfacial microstructure. Multiple interfacial interactions between MPC and OPC concrete are evidenced by microstructural analysis and XRD: MPC paste can infiltrate into the irregularities of the OPC substrate; etching of the surface of hardened OPC paste occurs under the pH condition of MPC paste; penetration of soluble phosphate creates the potential for the chemical reaction and filling effect at the interface.

Levoglucosan (LEV) in glacier snow and ice layers provides a fingerprint of fire activity, ranging from modern air pollution to ancient fire emissions. In this study, we review recent progress in our understanding and application of LEV in glaciers, including analytical methods, transport and post-depositional processes, and historical records. We firstly summarize progress in analytical methods for determination of LEV in glacier snow and ice. Then, we discuss the processes influencing the records of LEV in snow and ice layers. Finally, we make some recommendations for future work, such as assessing the stability of LEV and obtaining continuous records, to increase reliability of the reconstructed ancient fire activity. This review provides an update for researchers working with LEV and will facilitate the further use of LEV as a biomarker in paleo-fire studies based on ice core records.

Background Spontaneous intracerebral hemorrhage (sICH) is a devastating disease with high mortality and morbidity, and the application of decompressive craniectomy (DC) in sICH is controversial. We conducted a systematic review to verify the effects of DC on improving outcome in sICH. Methods Through searching several electronic databases, we screened eligible publications. Respective risk ratio (RR) and its 95% confidence interval (CI) were calculated, data were synthesized with a fixed-effect model, and sensitivity analyses and subgroup analyses were performed. Publication bias was measured with Begg and Egger tests. Results Overall effect showed that DC significantly reduced the poor outcome compared with the control group (RR, 0.91; 95% CI, 0.84–0.99; P = 0.03). But in the subgroup analyses, only studies published after 2010, studies using hematoma evacuation as control, and studies measuring outcome with Glasgow outcome score showed better outcomes in the DC group than in the control group. The other subgroup analyses and sensitivity analyses achieved inconsistent results. Compared with the control group, DC effectively decreased mortality (RR, 0.67; 95% CI, 0.53–0.85; P = 0.0008). The sensitivity analyses and subgroup analyses achieved consistent results. Conclusions The application of DC effectively reduced mortality in patients with sICH. DC might improve functional outcomes in certain populations and needs further verification. DC is not associated with increased incidences of postoperative rebleeding and hydrocephalus.

It is highly desired to enhance the catalytic activity of MnO2 for the oxygen evolution reaction (OER) in alkaline media. Herein we report the development of MnO2-CoP3 nanowires array on Ti mesh (MnO2-CoP3/Ti) as an efficient 3D OER electrocatalyst with good stability under basic conditions. In 1.0M KOH, the MnO2-CoP3/Ti requires a current density of 10mAcm−2 at overpotential of only 288mV, which is 120mV less than that for MnO2/Ti. In addition, such MnO2-CoP3/Ti also exhibits high long-term electrochemical durability. Keywords: MnO2-CoP3, Nanowires array, Electrocatalyst, Water oxidation, Alkaline solution

Background Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality. Both surgical and endovascular approaches have been used to treat BBAs; however, little is known about their safety and efficacy. Objective To review our experience with the treatment of BBAs and explore the optimal treatment strategy. Methods A total of 83 patients with BBAs were reviewed retrospectively. The characteristics of the patients and the aneurysms, treatment results, and follow-up outcomes were analyzed. Results The cohort comprised 52 females and 31 males with a mean age of 46.6 years; 33 patients were assigned to the microsurgical therapy. Subsequently, 27/33 patients underwent surgical clipping, 4/33 underwent trapping without bypass, 2/33 underwent wrapping, and 50 patients underwent endovascular therapy, including stent-assisted coiling (49 patients) and coiling (1 patient). Intraoperative rupture occurred in 14 and 4 patients in the microsurgical and endovascular groups, respectively. Ischemic events occurred in 16 and 8 patients in the microsurgical and endovascular groups, respectively. At 1-year follow-up, a favorable clinical outcome was achieved in 18 (54.5%) and 38 (76.0%) patients in the microsurgical and endovascular groups, respectively. The multivariate regression model showed that the treatment strategies, Fisher grade, and vasospasm contributed significantly to the prediction of outcome for 1 year. Conclusions BBAs are challenging vascular lesions with poor prognosis. Endovascular treatment may be more effective and safer with better outcomes than surgical approaches.