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BackgroundWhether deep learning models using clinical data and brain imaging can predict the long-term risk of major adverse cerebro/cardiovascular events (MACE) after acute ischaemic stroke (AIS) at the individual level has not yet been studied.MethodsA total of 8590 patients with AIS admitted within 5 days of symptom onset were enrolled. The primary outcome was the occurrence of MACEs (a composite of stroke, acute myocardial infarction or death) over 12 months. The performance of deep learning models (DeepSurv and Deep-Survival-Machines (DeepSM)) and traditional survival models (Cox proportional hazards (CoxPH) and random survival forest (RSF)) were compared using the time-dependent concordance index (Ctdindex).ResultsGiven the top 1 to all 60 clinical factors according to feature importance, CoxPH and RSF yieldedCtdindex of 0.7236–0.8222 and 0.7279–0.8335, respectively. Adding image features improved the performance of deep learning models and traditional models assisted by deep learning models. DeepSurv and DeepSM yielded the bestCtdindex of 0.8496 and 0.8531 when images were added to all 39 relevant clinical factors, respectively. In feature importance, brain image was consistently ranked highly. Deep learning models automatically extracted the image features directly from personalised brain images and predicted the risk and date of future MACEs at the individual level.ConclusionsDeep learning models using clinical data and brain images could improve the prediction of MACEs and provide personalised outcome prediction for patients with AIS. Deep learning models will allow us to develop more accurate and tailored prognostic prediction systems that outperform traditional models.

Nanostructuring has become a powerful tool for tuning the electronic properties of materials and enhancing transport. As an example of relevance to next-generation battery technologies, nanocrystals have shown promise for realizing fast-ion conduction in solids; however, dissipationless ion transport over extended length scales is hindered by lossy interfaces formed between nanocrystals in a solid. Here we address this challenge by exploiting one-dimensional nanostructures for ion transport. Superionic conduction, with a record-high ionic conductivity of ∼4 S/cm at 150 °C, is demonstrated in solid electrolytes fabricated from nanowires of the earth-abundant solid copper selenide. This quasi-one-dimensional ionic conductivity is ∼5× higher than that in bulk cuprous selenide. Nanoscale dimensions in the radial direction lower ion-hopping barriers, while mesoscopically long, interface-free transport paths are available for ion transport in the axial direction. One-dimensional nanostructures can exceptionally boost solid-state devices that rely on ion transport.

Background The demand for aesthetic procedures continues to grow globally, particularly in East Asian countries. The popularity of specific aesthetic procedures varies, however, depending on the particular East Asian geographical region being studied. This study aimed to evaluate the experiences of and attitudes toward aesthetic procedures in five East Asian countries/regions, including China, Japan, South Korea, Hong Kong, and Taiwan. Methods To recruit participants, an online questionnaire was designed and distributed on social media networks between May 2015 and March 2016. The statistical analysis was conducted using SPSS software, version 22.0. Results A total of 3,088 people responded (approximately 600 in each country/region). Of these, 940 participants (47.8%) responded that they had experienced at least one aesthetic procedure in the past. Taiwan had the highest number of participants who had experienced at least one procedure (264/940, 41%), with primarily non-surgical experiences. Only in South Korea did surgical cosmetic experiences exceed non-surgical cosmetic experiences (55.9% vs. 44.1%). The popularity of particular procedures and the motivation for undergoing aesthetic procedures varied by country. Conclusions The popularity of aesthetic procedures continues to evolve. Similar trends were observed across the East Asian regions; however, each country had its unique demands and preferences. The information provided by this study can help aesthetic plastic surgeons further understand the patients in their corresponding region, customize their practice, and develop the requisite skills.

African swine fever (ASF) was first reported in South Korea in September 2019, and as of 31 December 2021, a total of 21 cases in domestic pig farms and 1875 ASFV-infected wild boars have been confirmed in the country. With the continued circulation of ASF in wild boars, and subsequent outbreaks in domestic pigs, concerns were raised about the possible changes in virulence occurring among African swine fever viruses (ASFV) circulating in South Korea. In this study, four Korean ASFV strains isolated from domestic pig farms at different time points between 2019 and 2021 were chosen, and used to experimentally infect domestic pigs by intramuscular inoculation to compare their virulence. All challenged pigs died at 4–9 days post-inoculation, with many showing clinical symptoms of fever, depression, loss of appetite, and recumbency. Gross lesions observed at necropsy included enlargement and hemorrhage of the lymph nodes and hydropericardium. The study showed that all four Korean ASFV isolates caused acute forms of illness, which supports the view that virulence among the circulating ASFV isolates in South Korea remained unchanged and highly virulent during this period.

This study aimed to elucidate whether low-density lipoprotein cholesterol (LDL-C) levels differentially affect functional outcomes after intravenous thrombolysis (IVT) depending on prestroke statin use. Patients with acute ischemic stroke treated with IVT were categorized into low, intermediate, and high LDL-C groups based on LDL-C levels at admission ( 130 mg/dl, respectively). Multivariable logistic regression analyses were performed to explore the relationships between LDL-C and clinical outcomes (good outcomes at 3 months, modified Rankin Scale scores 0–2). The interaction between LDL-C levels and prestroke statin use regarding functional outcomes was investigated. Among the 4711 patients (age, 67 ± 12 years; males, 62.1%) who met the eligibility criteria, compared with the high LDL-C group, the low and intermediate LDL-C groups were not associated with good outcomes at 3 months according to the multivariable analysis. A potential interaction between the LDL-C group and prestroke statin use on good outcomes at 3 months was observed (Pinteraction = 0.07). Among patients with prestroke statin use, low (aOR 1.84 [1.04–3.26]) and intermediate (aOR 2.31 [1.20–4.47]) LDL-C groups were independently associated with a greater likelihood of having a 3-month good outcome. Our study showed that LDL-C was not associated with a 3-month good outcome, but prestroke statin use could modify the influence of LDL-C levels on functional outcomes after IVT.

BackgroundNo study has thoroughly compared the effectiveness of combined antiplatelet treatments (other than clopidogrel–aspirin) versus clopidogrel–aspirin or aspirin alone for early secondary prevention in acute ischaemic stroke.MethodsWe identified patients with acute, minor, non-cardiogenic ischaemic stroke treated with aspirin alone, clopidogrel–aspirin or other combination treatment. Propensity scores considering the inverse probability of treatment weighting were used to adjust for baseline imbalances. The primary outcome was the composite of all strokes (ischaemic or haemorrhagic), myocardial infarction and all-cause mortality at 3 months.ResultsAmong 12 234 patients (male: 61.9%; age: 65.5±13 years) who met the eligibility criteria, aspirin, clopidogrel–aspirin and other combination treatments were administered in 52.2%, 42.9% and 4.9% of patients, respectively. In the crude analysis, the primary outcome event at 3 months occurred in 14.5% of the other combination group, 14.4% of the aspirin group and 13.0% of the clopidogrel–aspirin group. In the weighted Cox proportional hazards analysis, the 3-month primary outcome event occurred less frequently in the clopidogrel–aspirin group than in the other combination group (weighted HR: 0.82 (0.59–1.13)), while no association was found between the aspirin group (weighted HR: 1.04 (0.76–1.44)) or other combination group and the 3-month primary outcome.ConclusionOther combined antiplatelet treatment, compared with aspirin alone or clopidogrel–aspirin, was not associated with reduced risks of primary composite vascular events or recurrent stroke during the first 3 months after stroke. Therefore, the results suggest that other combination treatments, particularly the cilostazol-based combination, may not be effective alternatives for clopidogrel–aspirin to prevent early vascular events in patients with acute minor stroke. Further exploration in clinical trials will be needed.

Background and Purpose: This study aimed to investigate the value of d -dimer levels in predicting recurrent stroke in patients with embolic stroke of undetermined source. We also evaluated the underlying causes of recurrent stroke according to d -dimer levels. Methods: A total of 1431 patients with undetermined source were enrolled in this study and divided into quartiles according to their baseline plasma d -dimer levels. The primary outcome measure was the occurrence of recurrent stroke (ischemic or hemorrhagic) in the year following the stroke event. Results: The risk of recurrent stroke increased significantly with the increasing d -dimer quartile (log-rank P =0.001). Patients in the higher d -dimer quartiles had a higher probability of recurrent embolic stroke because of covert atrial fibrillation, hidden malignancy, or undetermined sources. Most recurrent strokes in Q3 and Q4 were embolic but not in Q1 or Q2. Multivariate analysis revealed that patients in Q3 and Q4 had a significantly increased risk of recurrent stroke compared with those in Q1 (hazard ratio, 3.12 [95% CI, 1.07−9.07], P =0.036; hazard ratio, 7.29 [95% CI, 2.59−20.52], P P trend d -dimer level above normal range and the risk of recurrent stroke (hazard ratio, 2.48 [95% CI, 1.31−4.70], P =0.005). In subgroup analyses, a high d -dimer level was associated with a significantly higher risk of recurrent stroke in men than in women ( P =0.039). Conclusions: Our findings suggest that d -dimer levels can be a useful risk assessment biomarker for predicting recurrent stroke, especially embolic ischemic stroke, in patients with undetermined source.

The expected growth of stroke burden in Korea in early 2000s led to the initiation of a government-funded clinical research project with the goal of development and implementation of national stroke guidelines. The CRCS-K (Clinical Research Collaboration for Stroke in Korea) began as a part of this project. For stroke epidemiology and quality of care research, the CRCS-K developed a multicenter, prospective, stroke registry and began collection of data in 2008. Now, about 100 000 cases have been registered at 17 university hospitals or regional stroke centers and about 200 articles have been published based on the registry experience. The analysis of the 10-year secular trends showed overall improvement of stroke care and outcomes and areas for improvement. This large-scale, high-quality dataset provides opportunities to explore and compare treatment disparities using the comparative effectiveness research methods, design and conduct a registry-based randomized clinical trial, connect the registry data with other data sources including the national claims data and neuroimaging or genetic data, and collaborate with other international researchers. An international stroke registry consortium may be a viable future direction.

Rationale: The optimal duration of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin for the large artery atherosclerotic (LAA) stroke subtype has been debated. Aims: To determine whether the 1-year risk of recurrent vascular events could be reduced by a longer duration of DAPT in patients with the LAA stroke subtype. Methods and study design: A total of 4806 participants will be recruited to detect a statistically significant relative risk reduction of 22% with 80% power and a two-sided alpha error of 0.05, including a 10% loss to follow-up. This is a registry-based, multicenter, prospective, randomized, open-label, blinded end point study designed to evaluate the efficacy and safety of a 12-month duration of DAPT compared with a 3-month duration of DAPT in the LAA stroke subtype. Patients will be randomized (1:1) to either DAPT for 12 months or DAPT for 3 months, followed by monotherapy (either aspirin or clopidogrel) for the remaining 9 months. Study outcomes: The primary efficacy outcome of the study is a composite of stroke (ischemic or hemorrhagic), myocardial infarction, and all-cause mortality for 1 year after the index stroke. The secondary efficacy outcomes are (1) stroke, (2) ischemic stroke or transient ischemic attack, (3) hemorrhagic stroke, and (4) all-cause mortality. The primary safety outcome is major bleeding. Discussion: This study will help stroke physicians determine the appropriate duration of dual therapy with clopidogrel-aspirin for patients with the LAA stroke subtype. Trial registration: URL: https://cris.nih.go.kr/cris . CRIS Registration Number: KCT0004407

African swine fever (ASF) is a highly infectious disease of pigs caused by African swine fever virus (ASFV). In order to identify potential genetic variations among ASFV strains circulating in Vietnam, 26 ASFV isolates from organs and blood samples collected from domestic pigs from 23 different provinces of northern, central and southern Vietnam during 2019-2020 ASF outbreaks were genetically characterized. Nucleotide sequences were determined for a portion of the B646L (p72) gene, the complete E183L (p54) gene, the variable region of EP402R (CD2v), the central variable region (CVR) of pB602L, and a tandem repeat sequence (TRS) between the I73R and I329L genes. Analysis of the partial B646L (p72) and EP402R (CD2v) gene sequences and the full-length E183L (p54) gene sequence showed that all 26 ASFV isolates belonged to genotype II and serotype VIII and that they were identical to the strain Georgia/2007/1 and all ASFV strains sequenced in China. The TRS between the I73R and I329L genes contained a 10-nucleotide insertion that was observed in the Chinese ASFV strain CN201801 isolated from domestic pigs in 2018, but not in the Georgia/2007/1 and China/Jilin/2018/boar strains isolated from wild boar in China. This is the first intra-epidemic genome analysis reported for the ASFV strains circulating in Vietnam.

Hydrogen energy is an attractive alternative to fossil fuels. Among the various methods for H2 production, solar-driven photoelectrochemical (PEC) water splitting is considered as the representative technique because of its ecofriendly process and the abundance of resources. To achieve higher PEC performance, one-dimensional (1D) nanostructures have been highlighted owing to their considerable potential as photocatalyst materials. Not only the enhanced surface area, but also the unique and novel properties ascribed to their anisotropic characteristics have allowed enhanced PEC performance compared to thin-film photoelectrodes. In this manuscript, we review the recent research on 1D nanostructured photoelectrodes for solar-driven PEC water splitting. The brief synthetic approaches to develop 1D nanostructured photoelectrodes and various strategies to improve their performance are summarized, which can provide a roadmap on the development of advanced photoelectrodes for H2 generation.

Superionic conductors are prime candidates for the electrolytes of all-solid-state batteries. Our understanding of the mechanism and performance of superionic conductors is largely based on their idealized lattice structures. But how do defects in the lattice affect ionic structure and transport in these materials? This is a question answered here by in situ transmission electron microscopy of copper selenide, a classic superionic conductor. Nanowires of copper selenide exhibit antiphase boundaries which are a form of a planar defect. We examine the lattice structure around an antiphase boundary and monitor with atomic resolution how this structure evolves in an ordered-to-superionic phase transition. Antiphase boundaries are found to act as barriers to the propagation of the superionic phase. Antiphase boundaries also undergo spatial diffusion and shape changes resulting from thermally activated fluctuations of the neighboring ionic structure. These spatiotemporal insights highlight the importance of collective ionic transport and the role of defects in superionic conduction.

Objective Neuromodulation for trigeminal pain syndromes such as trigeminal neuropathic pain (TNP) necessitates accurate localization of foramen ovale (FO). The Hartel-type approach is very well-established and safe, ideal for temporary cannulation of the FO for ablative procedures such as balloon microcompression. A key shortcoming of the Hartel approach for placement of neuromodulation leads is the limited opportunity for secure anchoring. The aim of this study is to introduce a novel surgical approach for the treatment of TNP by investigating key osseous landmarks and their spatial relationships to the FO. Materials and methods Sixteen sides of cadaver heads were dissected to investigate a surgical route of the FO via transoral gingival buccal approach. Alveolar arch of the maxilla and zygomaticomaxillary suture were selected to serve as an osseous landmark for the surgical guidance to the FO. Through the intraoral route, a needle simulating electrode was traversed to aim the FO from the inferior lateral to the superior medial direction to target specific fibers of the aimed division of the nerve. Results Visual identification and access to the trigeminal nerve at the external opening of FO was successful in all 16 hemifacial cadavers. A needle successfully targeted different regions of the trigeminal nerve by changing the angle of the trajectory allowing the needle to reach a specific division of the trigeminal nerve. Conclusions This study provides a novel means of approaching the FO via transoral gingival buccal access.

Background Masculinization of the face is a common finding in facelift patients. It is attributed to deflation and decent of the midface-jowls coupled with skin laxity. Fullness is evident lateral to the jowl in a small percentage due to prominent buccal fat pad (BFP). Objectives The authors sought to examine the anatomy of the BFP, triangulate the prominent BFP with surgical landmarks, and describe an external approach to excise the BFP during facelift surgery. Methods Eighteen cadaveric dissections were performed. Facelift flap was elevated and the prominent buccal extension of the BFP protruding through the superficial-musculo-aponeurotic-system was identified. Measurements were taken from the BFP to surgical landmarks: zygomatic arch, tragus, and gonial angle. The locations of the facial nerve, parotid duct, and vascular pedicle relative to the BFP were calculated. Results BFP was 4.1 cm inferior to the zygomatic arch, 7.5 cm anterior the tragus, and 4.5 cm medial the gonial angle. The middle facial artery supplied the BFP on the inferior-lateral quadrant in 61% and inferior-medial quadrant in 39% of specimens . In all specimens, the parotid duct traversed the BFP superiorly, and the buccal branches of the facial nerve traversed the capsule superficially. Conclusions The buccal extension of the BFP can pseudoherniate in the aging face. Excision may improve lower facial contour. Measurements from facial landmarks may help surgeons identify the buccal extension of the BFP intraoperatively. The surgeon must be careful of the vascular pedicle, parotid duct, and the facial nerve. The external approach safely excises buccal fat during facelift dissection while avoiding intraoral incisions and unnecessary contamination. Level of Evidence: 4

We, for the first time, report the development of infrared (IR)-driven photoelectrochemical (PEC) cells using up-conversion glass-ceramics as substrates, which is different from the previous strategies of decorating photocatalysts with up-conversion (UC) rare earth-doped fluoride nanoparticles to utilize IR light. Our approach is more efficient since the use of UC glass-ceramics as substrates of photocatalysts could overcome the chemical instability of fluoride nanoparticles, the blockage of incident light, and the limited exposure of photocatalysts to liquid electrolytes. Oxyfluoride glass-ceramics bearing (Yb,Er)-doped YF3 and (Yb,Tm)-doped YF3 nanocrystals turned out to generate UC green and ultraviolet/blue emissions, respectively, under 980 nm illumination. High-density ZnO nanorods were grown on the up-conversion glass-ceramic substrates by the hydrothermal method and they were subsequently overcoated with CdSe nanocrystals to obtain CdSe/ZnO heterostructures by the chemical bath deposition method. CdSe nanoparticles were excited by both the UC UV emission from Tm and the visible emission from Er and Tm, while ZnO nanorods were excited mostly by the UC UV emission from Tm. Because of the difference in the UC emissions from Er and Tm, two distinct carrier transportations, sensitization and type-II cascade, occurred in the identical CdSe/ZnO heterostructures. Eventually, CdSe/ZnO fabricated on the glass-ceramics bearing (Yb,Tm)-doped YF3 showed increased photocurrent density compared to that fabricated on the glass-ceramics bearing (Yb,Er)-doped YF3 due to the charge separation activated by the type-II cascade structure.

Objective Anxiety is one of the most common complications in patients with stroke, but studies on its relationship to functional outcomes are limited and controversial. We investigated the association between post-stroke anxiety (PSA) and a 1-year trajectory of functional outcome. Methods A total of 423 patients were recruited within 2 weeks after a stroke (acute phase) during hospitalization. Of them, 306 (72.3%) completed follow-up examinations 1 year thereafter (chronic phase). Anxiety was evaluated using the Hospital Anxiety and Depression Scale-Anxiety subscale, and functional outcomes were measured using the National Institutes of Health Stroke Scale for stroke severity, the Barthel Index for activities of daily living (ADL), and the Mini-Mental State Examination for cognitive function at 2 weeks and 1 year. A range of demographic and clinical covariates were considered. The cross-sectional and longitudinal associations between PSA and functional outcomes were investigated. Results PSA at the acute phase was not associated with functional outcomes at the cross-sectional point, but predicted worsening of outcome on stroke severity and ADL 1 year after stroke. PSA at the chronic phase was cross-sectionally associated with poor functional outcomes in all three measures. All associations were independent of potential covariates. Conclusion Screening for anxiety is recommended even during the acute phase of stroke, considering its independent detrimental effect on functional prognosis. Screening for anxiety during the chronic phase is also encouraged, as this may reflect the functional status of stroke.

Nanogels have been recently attracted attentions because they exhibit significantly different behaviors compared with nanoparticles. Among them, chitosan (CS) nanogels have gained considerable attentions from researchers for in vivo applications due to bioactivity, biodegradability, mucoadhesiveness, and biocompatibility of CS. In this review, we have summarized the applications of CS nanogels for efficient drug delivery. Specifically, CS nanogels can be modified by pH-sensitive groups or specific ligands to obtain the corresponding functions. These functional CS nanogels have been used to deliver therapeutic agents, such as anti-cancer drugs, genes, and vaccines. By reviewing the recent research progress on CS nanogels in pharmaceutical applications, it will provide biomaterial researchers potential help for the development of CS nanogel delivery system to meet clinical needs.

African swine fever (ASF) is a contagious and deadly viral disease affecting swine of all ages. ASF was first reported in Vietnam in February 2019, and it is now considered endemic in Vietnam. In this study, 122 ASF-positive samples collected from domestic pigs in 28 different provinces of northern, central, and southern Vietnam during outbreaks in 2019-2021 were genetically characterized. The findings confirmed that all ASF virus (ASFV) strains circulating in Vietnam belonged to p72 genotype II, p54 genotype II, CD2v serogroup 8, and CVR gene variant type I. However, further analysis based on the tandem repeat sequences located between I73R and I329L genes revealed that there were three different variants of ASFV, IGR I, II, and III, circulating in the domestic pig population in Vietnam. The IGR II variants were the most prevalent (117/122 strains) and were detected in pigs in all of the provinces tested, followed by IGR III (4/122 strains) and IGR I (1/122 strains). This study confirms for the first time the presence of IGR III variants in Vietnam.

Although isolated contralateral tongue deviation following unilateral cortical infarction was occasionally reported, the unilateral lesion usually produces no significant deficit of tongue motility considering bilateral supranuclear innervation of the hypoglossal nerve. We observed a patient with obvious tongue paralysis, including intrinsic muscles, caused by ischemic stroke involving the motor area of the tongue in the primary motor cortex.

In South Korea, a total of 21 African swine fever (ASF) infected farms were confirmed during 2019–2021. ASF viruses (ASFVs) were isolated from the blood and spleen samples of the 21 affected farms and their genetic characteristics were analyzed. Phylogenetic analysis indicated that the 21 Korean ASFV strains belonged to p72 genotype II and serogroup 8. All isolates were of the intergenic region (IGR) II variant with 10 tandem repeat sequences between I73R and I329L and the central variable region (CVR) 1 variant of the B602L gene. There were no IGR variations between the A179L and A137R and between the MGF 505 9R and10R nor mutations in the O174L, K145R, MGF 505-5R, CP204L, and Bt/Sj regions. The genes of the 21 ASFV strains were identical to those of Georgia 2007/1 and Chinese and Vietnamese strains (Pig/HLJ/2018, China/2018/AnhuiXCGQ, and ASFV_NgheAn_2019); however, X69R of the J268L region of the 18th isolate (Korea/Pig/Goseong/2021) had three nucleotide (CTA) insertions at the 209th position, which led to the addition of one tyrosine (Y) at the C-terminal. This suggests that there are variations among ASFVs circulating in South Korea and the 18th ASFV-infected farm was due to a variant different from those of the other 20 pig farms.

Objectives This study aimed to investigate whether acute and chronic poststroke depression (PSD) were associated with cardio-cerebrovascular events (CVEs). Methods A total of 423 patients with recent stroke were recruited from 2006 to 2009. They were diagnosed with major or minor depressive disorder during the acute phase (within 2 weeks) after stroke. Of these, 284 completed the same diagnostic evaluation during the chronic phase (1 year) after stroke. An average 12-year (range 8.7-14.1 years) follow-up was conducted to assess composite CVEs including recurrent stroke, myocardial infarction, and vascular death after the index stroke. During the follow-up, Kaplan-Meier event rates for outcomes were calculated, and hazard ratios were estimated using Cox regression models after adjusting for a range of covariates. Results The composite CVE incidence was higher in patients with acute or chronic PSD than in those without. Composite event incidence was highest in patients with PSD during both the acute and chronic phases. Conclusions The presence of depression at acute and chronic phase of stroke predicted worse long-term cardio-cerebrovascular outcomes. Evaluation of PSD during both the acute and chronic phases is recommended. This article is protected by copyright. All rights reserved.

African swine fever, a fatal haemorrhagic disease of swine, was confirmed in domestic pigs for the first time in South Korea in September 2019. The causative virus belonged to the p72 genotype II and had an additional tandem repeat sequence in the intergenic region (IGR) between the I73R and I329L.

Background and Purpose— This study aimed to compare the effectiveness of dual antiplatelet therapy with clopidogrel plus aspirin (DAPT) with that of aspirin monotherapy (AM) in patients with acute, nonminor, and noncardioembolic stroke. Methods— Using a prospective, nationwide, multicenter stroke registry database, acute (within 24 hours of onset), nonminor (baseline National Institutes of Health Stroke Scale score, 4–15), and noncardioembolic stroke patients were identified. Propensity scores using inverse probability of treatment weighting were used to adjust baseline imbalances between the DAPT and AM groups. A primary outcome measure was a composite of all types of stroke (ischemic and hemorrhagic), myocardial infarction, and all-cause mortality within 3 months of stroke onset. Results— Among the 4461 patients meeting the eligibility criteria (age, 69±13 years; men, 57.7%), 52.5% (n=2340) received AM, and 47.5% (n=2121) received DAPT. The primary outcome event was not significantly different between the DAPT group and the AM group (20.9% versus 22.6%, P =0.13). The event rates of all types of stroke were also not different between the 2 groups (19.3% versus 20.1%, P =0.35), while all-cause mortality was significantly lower in the DAPT group than in the AM group (3.4% versus 4.9%, P =0.02). In the propensity-weighted Cox proportional hazards models with robust estimation, DAPT did not reduce the risk of the primary outcome event (hazards ratio, 0.91; 95% CI, 0.79–1.04) but did reduce the risk of all-cause mortality (0.69; 0.49–0.97). There was no treatment heterogeneity among the predefined subgroups, although the potential benefits of DAPT were suggested in subpopulations of moderate-to-severe relevant arterial stenosis and relatively severe deficits (National Institutes of Health Stroke Scale score, 12–15). Conclusions— Compared to AM, clopidogrel plus aspirin did not reduce the risk of the primary outcome event during the first 3 months after a nonminor, noncardioembolic, ischemic stroke.

The role of endovascular recanalization in the treatment of cancer patients with acute stroke remains elusive. Our study aimed to investigate the clinical and imaging outcomes of endovascular recanalization treatment in patients with acute large vessel occlusion stroke who had active cancer. We retrospectively reviewed the data from our stroke registry from January 2011 to September 2016 which was collected prospectively. Acute stroke patients with large artery occlusion in the anterior circulation who had active cancer were identified. Baseline clinical characteristics and postprocedural and long-term clinicoradiological outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. Outcomes were also compared with those of non-malignancy patients who had received endovascular therapy during the same period. A total of 378 ischemic stroke patients received endovascular treatment, of whom 27 (7.14 %) had current malignancy. In patients with current malignancy, a low baseline NIHSS score and male sex were associated with functional independency at 90 days. When comparing with non-malignancy patients, no significant differences in the proportions of patients with symptomatic intracranial hemorrhage (11.1% vs 16.2%, p = 0.60) and good functional outcome (37.0% vs 39.6%, p = 0.84) were found in the malignancy patients. Endovascular treatment might be a feasible therapeutic option for acute ischemic stroke patients with current malignancy when candidates are selected carefully because the outcomes were not differed. Future large-scale prospective studies are necessary.

We investigated the relationship between the mean blood pressure (BP) at 24–72 h and the clinical outcomes after acute ischemic stroke (AIS) in patients treated with reperfusion therapy. The primary outcome was measured using the modified Rankin Scale (mRS) at 3 months after AIS, and was based on the mean systolic BP at 24–72 h post-AIS. Favorable outcome was defined as mRS scores of 0–2. A total of 1,540 patients treated with reperfusion therapy were enrolled in the study. Favorable outcomes occurred more frequently in patients with BP ≤ 130/80 mmHg, and the risks of symptomatic intracranial hemorrhage and early neurological deterioration were lower in this optimal BP group. Multivariable analysis showed a significant association between mean BP ≤ 130/80 mmHg at 24–72 h and favorable outcomes at 3 months after AIS (odds ratio 2.95, 95% confidence interval 2.32–3.77, p