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To investigate whether hyperdense areas (HDAs) observed after endovascular treatment on multisection computed tomography (CT) are related to outcome.Data on 82 patients with acute anterior circulation ischaemic stroke resulting from intracranial large artery occlusion were analysed retrospectively All patients underwent mechanical thrombectomy and/or emergency angioplasty, and partial or complete recanalisation was successfully achieved. C-arm CT was performed immediately after endovascular treatment for all patients. Clinical and radiological data were compared between patients with and those without HDA and between patients with good and those with poor outcomes.Compared with non-HDA patients, HDA patients were more likely to present with severe neurological deficits (admission National Institutes of Health Stroke Scale [NIHSS] score: 18 versus 16, p=0.037) and had a higher number of stent retriever passes performed (2.9±1.3 versus 1.4±1, p0.001), longer onset-to-presentation times (229±78 versus 171±90 minutes; p=0.002), longer onset-to-recanalisation times (418±94 versus 331±105 minutes; p0.001), and longer puncture-to-recanalisation times (103±47 versus 69±42 minutes; p=0.001). Fewer HDA patients had a good prognosis (35.7% versus 70%, p0.001). Multivariate analysis showed the presence of HDAs was an independent negative prognostic factor (OR=0.208; p=0.002).HDAs on C-arm CT appear to be common in patients with acute ischaemic stroke who underwent successful endovascular treatment. HDA presence suggests a poor prognosis despite successful reperfusion.

Background and Objective The prognosis of progressive ischemic stroke (PIS) caused by large proximal artery occlusion with hemodynamic was poor. Our study aimed to investigate the safety of endovascular therapy (ET) for patients with PIS who were selected based on ischemic penumbra detected on brain imaging. Methods A cohort of consecutive patients with PIS, who were treated with ET, were identified. Patients were selected for ET based on the presence of ischemic penumbra using magnetic resonance imaging. Clinical outcome includes 90-day modified Rankin scale, mortality, and symptomatic intracerebral hemorrhage (sICH) rate. Multivariate analysis was performed to compare treatment time of ≤6 hours (early) with >6 hours (late) after stroke. Results One hundred forty-eight patients were treated (100 early and 48 late). Compared with the early group, more successful recanalization rate in the late group (100% vs. 89%, P = 0.017), lower mortality (2.1% vs. 12%, P = 0.046), better clinical outcome (modified Rankin scale score ≤2, 81.3% vs. 65%, P = 0.046), and sICH rate was similar between the 2 groups (7.0% vs. 9.5%, P = 1.00). Only pretreatment National Institutes of Health Stroke Scale score (odds ratio [OR] = 0.836, P = 0.025), successful recanalization (OR = 7.077, P = 0.038), collateral status (OR = 3.121, P = 0.016), and sICH (OR = 0.053, P = 0.013) were predictors of a good prognosis. Conclusions In appropriately selected patients with PIS, ET can be performed safely. Furthermore, randomized clinical trials are needed to assess its effectiveness.

Background. Balloon guide catheters (BGCs) have good performance in terms of radiological outcomes in acute ischemic thrombectomy. It is not uncommon for BGCs to be blocked by thrombi, especially in cases with acute intracranial internal carotid artery (ICA) occlusion. Our initial experience using repeat thrombectomy with a retrieval stent (RTRS) with continuous proximal flow arrest by BGC for acute intracranial ICA occlusion is presented. Methods. In patients with acute intracranial ICA occlusion treated with RTRS, clinical data, including the National Institutes of Health Stroke Scale (NIHSS) score at admission and modified Rankin Scale (mRS) score at 90 days, and procedural data, including the Extended treatment in Cerebral Infarction (eTICI) score, procedural time, and complications, were analyzed. Results. Thirty-two consecutive patients (12 men (37.5%); mean age: 73 years) were treated with RTRS using a BGC. The median NIHSS score was 19. The median puncture-to-reperfusion time was 46 minutes (range: 22-142 minutes). All patients were successfully revascularized; eTICI 2c or better recanalization was achieved in 30 (93.8%) patients. No procedure-related complications or symptomatic intracranial hemorrhage occurred. Two cases (6.3%) had distal emboli, but none had emboli to the anterior cerebral artery. Fourteen patients (43.8%) achieved a good outcome with an mRS score of 0–2 at 90 days, and 8 patients (25.0%) died. Conclusions. In patients with intracranial ICA occlusion, RTRS with proximal flow arrest by BGC is effective and safe, achieving good clinical and angiographic outcomes. This method may reduce the incidence of distal emboli in thrombectomy with stent retrievers.

The differentiation of intracranial atherosclerosis (ICAS) and embolism is important.In cases of ICAS, we observe a phenomenon that we call the "post-stent-deployment effect"; that is, all major branches are clearly visible beyond the occlusion segment when the stent is deployed at the site of occlusion. Our objective is to evaluates whether this post-stent-deployment effect can be used to differentiate ICAS from embolism in the distal M1 segment occlusion.We conduct a retrospective study which reviewed consecutive patients with acute distal M1 segment and in whom recanalization was achieved by endovascular treatment. The post-stent-deployment effect was assessed in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the post-stent-deployment effect for prediction of ICAS were assessed.From January 2015 to July 2018, a total of 80 patients were evaluated. The post-stent-deployment effect was more frequently observed in patients with ICAS than in those with embolism (100% vs 15.0%, P .001). For identifying ICAS in distal M1 segment, the sensitivity, specificity, PPV, and accuracy of the post-stent-deployment effect were 100%, 85.0%, 69.0%, and 88.7%, respectively.Our study finds that the sensitivity and accuracy of the post-stent-deployment effect in predicting distal M1 segment ICAS occlusion in patients with acute symptoms was high, and it may be useful in identifying ICAS lesion.

Objective Initial stenotic occlusion of the internal carotid artery with intracranial artery occlusion in acute ischemic stroke is associated with high morbidity and can benefit from endovascular therapy. However, the optimal endovascular strategy is unclear. This study aimed to evaluate the feasibility of the “half” anterograde approach and clinical outcome of treated patients. Revascularization validity of the 2 “half” anterograde approach with (Protect-Expand-Aspiration-Revascularization-Stent [PEARS] technique) or without (plain technique) using an embolic prevention device and aspiration was also compared. Methods Data on initial stenotic occlusion of the internal carotid artery with intracranial artery occlusion in our prospective stroke registry database between January 2015 and February 2017 were collected. Clinical and angiographic data were retrospectively analyzed. Clinical outcome was evaluated at 3 months, defined as a modified Rankin scale ≤2 as a good clinical outcome. Results Overall, 26 patients with tandem occlusion were included; 96.3% of patients had successful recanalization. The rate of a good clinical outcome was 61.8%, symptomatic parenchymal hemorrhage was 7.7%, and mortality was 15.4%. The PEARS technique took less time (56 ± 14 vs. 97 ± 31 minutes; P = 0.002) and had less embolic events (0 vs. 30.8%; P = 0.012) compared with the plain technique. Use of the PEARS technique was an independent predictor for shortening revascularization time (β = −0.651, P = 0.001). Conclusions The half anterograde approach technique is feasible and safe for treating tandem occlusion. Furthermore, the PEARS technique is associated with a shorter reperfusion time and less embolic events than the plain technique, and should be recommended in tandem occlusion.

Both intra-arterial recombinant tissue plasminogen activator (rt-PA) and stent retrieval are effective for treating acute ischemic stroke. The goal of this study was to evaluate the effectiveness of stent retrieval combined with intra-arterial rt-PA administration via micro-catheter (called the complex technique) in acute ischemic stroke.A retrospective analysis was performed of 93 consecutive patients treated between 2015 and 2017 for occlusions of the intracranial large artery using the complex technique (n=37) or stent retrieval alone (n=56) in our stroke center. Data on procedure duration, number of passes, and angiographic findings were collected. Successful recanalization was defined as the accomplishment of grade 3 or 2b modified Treatment in Cerebral Ischemia recanalization in 1 or 2 passes.Compared to the stent retrieval group, complex technique group had a higher successful revascularization rate with 1 or 2 passes with the stent retriever (81.1% versus 51.8%, P=0.004), a shorter procedure time (59±34min versus 94±56min, P0.001), fewer passes of the stent retriever (1.8±1.1 versus 2.5±1.4, P=0.012), a better prognosis (70.3% versus 48.2%, P=0.035), a lower embolic complication rate (18.9% versus 39.3%, P=0.038), similar mortality (13.5% versus 21.4%, P=0.334) and similar intracranial hemorrhage symptoms (2.7% versus 12.5%, P=0.204). Intra-arterial rt-PA administration was an independent negative predictor of procedure time (OR=-0.292, P=0.003).Mechanical thrombectomy utilizing stent retrieval combined with intra-arterial rt-PA administration in the anterior circulation of acute ischemic stroke patients improved the angiographic results and shortened the procedure duration without increasing adverse events.

A common-stem origin of lenticulostriate arteries (CS-LSAs) is an anatomical variation that supplies a moderate to large section of the basal ganglia. We hypothesized that CS-LSAs with a patent orifice are located at distal positions of the acute-occluded middle cerebral artery (MCA) and that the blood flow of CS-LSAs is supplied by pail arterial anastomoses and results in hypoperfusion of CS-LSAs, similar to a deep watershed (DWS) infarction. Our study evaluated the possibility of CS-LSAs in patients with DWS infarction and MCA occlusion and also assessed the safety of endovascular therapy (ET) in these patients. A cohort of consecutive patients with DWS infarction and MCA occlusion and in whom full recanalization via ET was achieved were identified. Patients were divided into two groups based on the presence of CS-LSAs observed during ET. In addition, radiological and clinical data were retrospectively analyzed. Thirty-three patients were included, and CS-LSAs were observed in 48.5% (16/33) of patients. The possibility (72.2%, 13/18) of CS-LSAs was high in patients with DWS infarction companied with basal ganglia infarction. A good clinical outcome was similar in patients with CS-LSAs and basal ganglia infarction and in patients without CS-LSAs and basal ganglia infarction (69.2% vs. 81.8%, P = 0.649). The possibility of CS-LSAs was 48.5% in patients with DWS infarction and MCA occlusion, and the revascularization procedure was safe and feasible in these patients despite the moderate-to-large basal ganglia infarction.

Background: Osteosarcoma is a malignant bone tumor prevalent in adolescents with poor prognosis. Toona sinensis showed potent antiproliferation effect on lung, melatonin, ovary, colon, and liver cancers. However, the effects of the species on osteosarcoma cells are rarely investigated. Results: In this study, we found fraction 1 of Toona sinensis leaf (TSL-1) resulted in inhibition of cell viability in MG-63, Saos-2, and U2OS osteosarcoma cell lines, while it only caused a moderate suppressive effect on normal osteoblasts. In addition, TSL-1 significantly elevated lactate dehydrogenase leakage and induced apoptosis and necrosis in Saos-2 cells. TSL-1 increased mRNA expression of pro-apoptotic factor Bad. Most important, TSL-1 significantly suppressed Saos-2 xenograft tumor growth in nude mice by increasing caspase-3. The IC-50 of TSL-1 for the 3 tested osteosarcoma cells is around 1/9 of that for lung cancer cells. Conclusion: We demonstrated that TSL-1, a fractionated extract from TSL, caused significant cytotoxicity to osteosarcoma cells due to apoptosis. In vivo xenograft study showed that TSL-1 suppressed the growth of osteosarcoma cells at least in part by inducing apoptosis. Our results indicate that TSL-1 has potential to be a promising anti-osteosarcoma adjuvant functional plant extract.

Objective Embolic occlusions of the common carotid artery (CCA)/internal carotid artery (ICA) and intracranial artery occlusions in acute ischemic stroke are associated with high morbidity and can benefit from endovascular therapy. However, the optimal endovascular strategy for these conditions is unclear. This study aimed to evaluate the feasibility of the pass-thrombectomy-protective thrombectomy (double PT) technique and the clinical outcome of treated patients. Methods We collected data on embolic occlusion of the CCA/ICA and intracranial artery occlusion in our prospective stroke registry database between January 2015 and February 2017. Clinical and angiographic data were retrospectively analyzed. Clinical outcome was evaluated at 3 months (modified Rankin scale [mRS] score), and an mRS score of 2 or lower was defined as a good clinical outcome. Results A total of 7 patients with tandem occlusion were included, with a mean age of 66 years. The median admission National Institutes of Health Stroke Scale score was 20, and 6 of 7 patients (85.7%) underwent successful recanalization. The median reperfusion time of the affected intracranial artery was 61 minutes. The rate of good clinical outcome was 42.9% (3/7), the mortality rate was 14.3% (1/7), and the embolic event rate was 14.3% (1/7) when the proximal clot was retrieved. Conclusions The double PT technique is feasible and safe in treating initial embolic tandem occlusion of the CCA/ICA.

To compare the differences of therapeutic effect of cervical spondylosis of neck type treated with acupuncture at starting and ending points of trapezius and the Jiaji (EX-B 2) points.Sixty cases of cervical spondylosis of neck type were randomly divided into an observation group and a control group, 30 cases in each group. In observation group, the acupoints related with starting and ending points of trapezius, such as Tianzhu (BL 10), Fengchi (GB 20), Quyuan (SI 13), Jugu (LI 16) and Ashi were punctured; in control group, Jiaji (EX-B 2) points of neck were punctured. The treatments were applied 5 times a week and 2 weeks made one course. The international simplified McGill scale was adoped to assess the scores of Pain Rating Index (PRI), Visual Analogue Scale (VAS) and Present Pain Intensity (PPI) before treatment and after one course treatment, and the therapeutic effects were measured.After treatment, all the scores were obviously reduced in both groups: (all P0.01), and the PRI-sensory subscore, PRI-affective subscore and total score in observation group reduced more obviously than those in control group, and there were statistically significant differences between groups (all P0.01). There were no statistically significant differences between groups in VAS and PPI score (both P0.05). The total effective rate of 96.7% (29/30) in observation group was superior to that of 70.0% (21/30) in control group (P0.01).The therapeutic effect of cervical spondylosis of neck type treated with acupuncture at the starting and ending points of trapezius is positive, which is better than that of acupuncture at the Jiaji (EX-B 2) points.

To investigate the effects of the transplantation of adipose-derived stem cells (ADSC) on the expression of Notch1-Dll4 signaling pathway in brains of rats with focal cerebral ischemia.Sixty-five male adult Sprague-Dawley rats were randomly divided into 4 groups: sham-operated group, MCAO (occlusion of middle cerebral artery) group, ADSC-treated group and ADSCDAPT-treated group. A permanent model of focal cerebral ischemia was established by modified Zea-Longa's method. At 24 hours post-MCAO, 1×10(6) DAPT-labeled ADSC were injected into the lateral ventricle of rats in the ADSC-treated group and the same dose of ADSC with DAPT (γ secretase inhibitor, N-[N-(3,5-difluorophenacetyl)-L-alanyl]-S-phenylglycine t-butyl ester) to the rats in the ADSCDAPT-treated group. Rats are sacrificed at 4, 7, 14 and 28 d post-MCAO. The amount of microvessels was quantified. And the levels of Notch1, Dll4 and Hes1 were detected by Western blot and immunohistochemistry.The density of microvessels significantly increased in the ADSC group (13.93 ± 0.50, 17.90 ± 0.62, 20.78 ± 0.80, 17.28 ± 1.65) versus the MCAO group (7.03 ± 0.22, 10.83 ± 0.63, 16.35 ± 0.54, 13.80 ± 2.38) (P0.05) and the ADSC + DAPT group (5.73 ± 0.30, 7.58 ± 0.52, 7.65 ± 0.45, 6.48 ± 1.47) (P0.05). And compared with the MCAO group (1.29 ± 0.07, 2.13 ± 0.21, 1.92 ± 0.03) and the ADSC + DAPT group (1.162 ± 0.099, 1.684 ± 0.180, 1.041 ± 0.040), the expressions of Notch1, Dll4 and Hes1 proteins were significantly up-regulated at 14d in the ADSC group (2.52 ± 0.22, 4.52 ± 0.36, 2.62 ± 0.05) (P0.05).The transplantation of ADSC can improve angiogenesis by up-regulating the post-MCAO expression of Notch1-Dll4 signaling pathway in rats.

We describe a Chinese family with a probable X-linked dominant inherited disorder characterized by early adult onset of distal muscle weakness and amyotrophy of four limbs, followed by severe disability of feet. The life expectancy of some patients is decreased due to severe respiratory failure associated with bilateral vocal cord involvement. The electrophysiological data showed predominantly the evidence of demyelization. Genetic analysis revealed that all tested patients from the family carried a novel c.186C>G mutation in the GJB1 gene, resulting in substitution of Serine for Arginine in the first extracellular loop domain of Cx32 protein. To our knowledge, this is the first time to describe this GJB1 mutation, which is associated with the rather severe phenotype of the X-linked Charcot–Marie–Tooth disease. The present report also provides further evidence for heterogeneity among the X-linked Charcot–Marie–Tooth disease.

To report an X-linked dominant Charcot-Marie-Tooth disease (CMTX) Chinese family with vocal cord paresis and to identify the mutation of gap junction protein beta 1 gene (GJB1).Part of the family members with dysphagia, dysphonia and lethal respiratory failure were studied through flexible laryngoscope, clinical, brain MRI and electrophysiological examinations. After excluding large fragment tandem duplication containing peripheral myelin protein 22 gene (PMP22), direct sequencing was performed to analyze the mutation of the GJB1 gene in 5 patients including the proband, 5 unaffected family members and 50 unrelated healthy individuals.Eight members spanning 3 generations in this family were affected with CMTX characterized by progressive atrophy and weakness of the anterior tibial and peroneal muscles, especially in the proband. Vocal cord paresis was observed through flexible laryngoscope in total of 4 affected members with dysarthria and dysphagia, 2 of them died of severe respiratory failure due to complete bilateral vocal cord involvement. Normal brain MRI was observed in the proband. The electrophysiological data showed predominant demyelization involving the motor and sensory nerves in the proband. DNA sequencing revealed a de novo c.186 CG missense mutation in exon 2 of the GJB1 gene, the mutation cosegregated with phenotype.Respiratory failure associated with vocal cord involvement may be a rare and severe symptom in CMTX. The present report provides further evidence for clinical and genetic heterogeneity in the X-linked Charcot-Marie-Tooth disease.