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Background Middle cerebral artery (MCA) fenestration is a rare vascular variant of the MCA. When this occlusion occurs, it presents challenges to identification and recanalization. We describe a patient with a partially occluded MCA fenestration in whom recanalization was successfully achieved via mechanical thrombectomy using a stent retriever with an intermediate catheter. Case Description A 65-year-old man with a history of ischemic stroke and homocysteinemia presented with dysarthria and expressive aphasia 14 hours after symptom onset. National Institutes of Health Stroke Scale score was 12/42. Noncontrast computed tomography scan revealed encephalomalacia in the left cerebral hemisphere. Catheter angiography displayed a left internal carotid artery orifice and M1 segment subocclusion. The primary diagnosis was acute ischemic stroke. Mechanical thrombectomy was performed by passing a stent retriever through the subtotal occlusive segment of the left MCA. After angiography was completed, reperfusion was considered successful, with a modified Thrombolysis in Cerebral Infarction grade 3. The fenestration was discovered in the middle to distal part of the left MCA M1 segment where the thrombus was located. After 3 days, magnetic resonance imaging showed much ischemic damage to the left hemicerebrum area. The day after endovascular treatment, the patient's neurologic deficit recovered to its pre-onset state. At 6-months follow-up, stroke had not recurred, and the patient is living independently with a modified Rankin scale score of 1. Conclusions Mechanical thrombectomy may be feasible and safe in MCA fenestration occlusion.

Background and Aims: Aspiration thrombectomy is an effective method of recanalizing large vessel occlusion (LVO). However, the efficacy of a direct aspiration first-pass technique (ADAPT) for recanalization of LVO of different etiologies is not properly understood.Methods: The prospectively collected database on ADAPT was reviewed retrospectively. We defined two groups of enrolled patients: the embolism-related occlusions (EMB-O) group and the intracranial atherosclerotic stenosis (ICAS)-related occlusion (ICAS-O) group. Baseline characteristics, procedural variables, and post-procedural variables were collected. Multivariate logistic regression analysis was used to identify first-pass recanalization predictors.Results: Of 114 registered patients, 94 were eligible for this study (51 patients in the EMB-O group and 43 patients in the ICAS-O group). Achieving successful reperfusion immediately after direct aspiration was more frequent in the EMB-O group than in the ICAS-O group (64.71 vs. 27.91%, respectively, p = 0.006), with fewer additional rescue treatments needed (35.29 vs. 70.09%, respectively, p = 0.001). The EMB-O group also showed a higher final successful reperfusion rate (96.8 vs. 74.41%, p = 0.006). However, the 90-day good functional outcomes were not affected by the groups. Independent predictors of first-pass success of aspiration included the isolated middle cerebral artery site of occlusion, embolic etiology, and use of larger bore catheters.Conclusions: The efficacy of ADAPT recanalization approach was better in EMB-O than in ICAS-O. In case of embolic etiology and the isolated MCA site of occlusion, using a larger aspiration catheter for direct aspiration thrombectomy may be reasonable.

Introduction Thallium poisoning is a rare occurrence. Therefore, thallium poisoning is easily misdiagnosed and is often accompanied by a series of serious sequelae and can even result in death in severe cases. Here, we report long‐term follow‐up of a case of a patient who was poisoned with thallium on two separate occasions. Methods A 43‐year‐old man was initially misdiagnosed as gastroenteritis, diabetic peripheral neuropathy, and Guillain–Barré Syndrome (GBS) within 21 months. The correct diagnosis was confirmed by blood and urine thallium assays. After Prussian blue treatment, thallium was undetectable in the blood by day 60. Following this investigation, a criminal suspect confessed to two instances of adulterating thallium sulfate in the patient's beverage. A 6‐year follow‐up was performed after discharge, and a comprehensive literature was review. Results We found that the original gastrointestinal symptoms, skin lesions, and hair loss were reversed and had recovered, except for residual neurologic damage, even with long‐term rehabilitation. Discussion Thallium intoxication may have been initially identified if neurologic symptoms had occurred concurrently with gastrointestinal and cutaneous symptoms. Neurologic damage represented the main sequelae of thallium poisoning in our present case report., Thallium poisoning; neurologic outcome; neuroelectrophysiology

Background: Data regarding the comparative efficacy and safety of endovascular treatment (EVT) versus best medical management (BMM) in strokes due to acute basilar artery occlusion (BAO) remains controversial. Methods: The present analysis was based on the ongoing prospective multicentre endovascular treatment for acute basilar artery occlusion (ATTENTION) registry in China. We performed a propensity score analysis matching patients treated with BMM with those treated with EVT on a 1:3 ratio. Qualifying patients had to present within 24 hours of estimated BAO. The primary clinical outcome was favourable functional outcome (modified Rankin Score 0-3) at 90 days. We also performed a sensitivity analysis within the inversed propensity of treatment weighting (IPTW) cohort. Findings: Our analytic sample comprised 2,134 patients recruited across 48 sites between 2017 and 2021, including 462 patients received BMM and 1,672 patients who received EVT. Age (median, 65), sex (male, 68%), baseline NIHSS score (median, 21), the proportions of favourable imaging profile (PC-ASPECTS ≥8: ~89%), intravenous alteplase use (~23%) and time from onset to admission (median ~ 333 minutes) were comparable across the PSM groups (n=443 in BMM group; n=1,329 in EVT group). Compared with BMM treated patients, there was a significantly higher rate of favourable outcome at 90 days among EVT patients (adjusted relative risk (1.37 [95% CI: 1.18 to 1.60], absolute risk difference 0.11 [95% CI: 0.06 to 0.15]). The mortality was significantly lower (adjusted relative risk (0.81 [95% CI: 0.72 to 0.91], absolute risk difference -0.09 [95% CI: -0.14 to -0.04]) in patients undergoing EVT. Results were generally consistent across the secondary endpoints. Similar associations were seen in the IPTW cohort. Interpretation: In this large, real-world study, EVT was associated with significantly better functional outcomes and survival at 90 days. Well-designed randomized studies comparing EVT with BMM in the acute BAO are needed. Clinical Trial Registration Details: ATTENTION is registered on the Chinese Clinical Trial Registry (http://www.chictr.org.cn; ChiCTR2000041117). Funding Information: ATTENTION was an independent, investigator-initiated registry, and no external support was received. Declaration of Interests: RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze. RGN is one of the Principal Investigators of the “Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW)” trial. Funding for this project is provided by Cerenovus. RGN is an investor in Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, and Viseon. Other authors have no conflict of interest. Ethics Approval Statement: The study was approved by the ethical committee of the first affiliated hospital of university of science and technology of China. All patients or their legally authorized representatives provided signed informed consent.

Background: Identification of occlusion mechanism before endovascular treatment (EVT) is of great significance for intracranial large vessel occlusion stroke (ILVOs). Cardioembolism occlusion and large-artery atherosclerosis are the two common etiologies of ILVOs. However, there is few of valid methods to predict the two etiologies of ILVOs before EVT. Methods: We evaluated retrospectively two etiologies of ILVOs: intracranial atherosclerosis stenosis-related occlusion (ICAS-O) and embolism-related occlusion( EMB-O) in a cohort of patients at a national comprehensive stroke centre database of China over a 77-month period. Patients were divided at a ratio of 2:1 randomly into the training and the validation cohorts. We derived a score for ILVOs in the derivation cohort of patients , and assessed the score in the validation cohort. Results: We identified 608 from 662 patients with ILVOs who received EVT in the study period. Subsequent to adjustment for confounding factors, atrial fibrillation. (AF) (no vs. yes, OR=27·29, 95%CI: 13·27-56·09), hypertension (yes vs. no, OR=2·90, 95%CI: 1·34-6·26), diabetes mellitus (DM) (yes vs. no, OR=2·80, 95%CI: 1·45-5·42), National Institutes of Health Stroke Scale(NIHSS) (

Summary Background Previous randomised trials have shown an overwhelming benefit of mechanical thrombectomy for treating patients with stroke caused by large vessel occlusion of the anterior circulation. Whether endovascular treatment is beneficial for vertebrobasilar artery occlusion remains unknown. In this study, we aimed to investigate the safety and efficacy of endovascular treatment of acute strokes due to vertebrobasilar artery occlusion. Methods We did a multicentre, randomised, open-label trial, with blinded outcome assessment of thrombectomy in patients presenting within 8 h of vertebrobasilar occlusion at 28 centres in China. Patients were randomly assigned (1:1) to endovascular therapy plus standard medical therapy (intervention group) or standard medical therapy alone (control group). The randomisation sequence was computer-generated and stratified by participating centres. Allocation concealment was implemented by use of sealed envelopes. The primary outcome was a modified Rankin scale (mRS) score of 3 or lower (indicating ability to walk unassisted) at 90 days, assessed on an intention-to-treat basis. The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial haemorrhage, device-related complications, and other severe adverse events. The BEST trial is registered with ClinicalTrials.gov , NCT02441556 . Findings Between April 27, 2015, and Sept 27, 2017, we assessed 288 patients for eligibility. The trial was terminated early after 131 patients had been randomly assigned (66 patients to the intervention group and 65 to the control group) because of high crossover rate and poor recruitment. In the intention-to-treat analysis, there was no evidence of a difference in the proportion of participants with mRS 0–3 at 90 days according to treatment (28 [42%] of 66 patients in the intervention group vs 21 [32%] of 65 in the control group; adjusted odds ratio [OR] 1·74, 95% CI 0·81–3·74). Secondary prespecified analyses of the primary outcome, done to assess the effect of crossovers, showed higher rates of mRS 0–3 at 90 days in patients who actually received the intervention compared with those who received standard medical therapy alone in both per-protocol (28 [44%] of 63 patients with intervention vs 13 [25%] of 51 with standard therapy; adjusted OR 2·90, 95% CI 1·20–7·03) and as-treated (36 [47%] of 77 patients with intervention vs 13 [24%] of 54 with standard therapy; 3·02, 1·31–7·00) populations. The 90-day mortality was similar between groups (22 [33%] of 66 patients in the intervention vs 25 [38%] of 65 in the control group; p=0·54) despite a numerically higher prevalence of symptomatic intracranial haemorrhage in the intervention group. Interpretation There was no evidence of a difference in favourable outcomes of patients receiving endovascular therapy compared with those receiving standard medical therapy alone. Results might have been confounded by loss of equipoise over the course of the trial, resulting in poor adherence to the assigned study treatment and a reduced sample size due to the early termination of the study. Funding Jiangsu Provincial Special Program of Medical Science.

We systematically study the influence of amplitude modulation on the steady-state bosonic squeezing and entanglement in a dissipative three-mode optomechanical system, where a vibrational mode of the membrane is coupled to the left and right cavity modes via the radiation pressure. Numerical simulation results show that the steady-state bosonic squeezing and entanglement can be significantly enhanced by periodically modulated external laser driving either or both ends of the cavity. Remarkably, the fact that as long as one periodically modulated external laser driving either end of the cavities is sufficient to enhance the squeezing and entanglement is convenient for actual experiment, whose cost is that required modulation period number for achieving system stability is more. In addition, we numerically confirm the analytical prediction for optimal modulation frequency and discuss the corresponding physical mechanism., Comment: 25 pages, 8 figures, accepted for publication in Optics Express

We discuss the one-excitation dynamics of two atomic qubits, trapped in separate cavities coupled through a short optical fiber. Our investigation shows that a wide variety of time-evolution behaviors can be realized by modulating the atom–cavity detuning δ , the atom–cavity coupling strength g and the cavity–fiber hopping strength v .