Yajie Liu

Aims: We aim to explore the predictive value of admission blood glucose to serum albumin ratio (AAR) for futile recanalization after successful interventional recanalization of acute cerebral infarction.Methods: We retrospectively collected the data of patients suffered from acute cerebral infarction due to anterior circulation large vessel occlusion and received successful interventional recanalization from January 2019 to November 2023. Statistical analysis of clinical data was conducted using SPSS 26.0.Results: A total of 452 patients were included in the study. There were statistically significant differences in mRS score and futile recanalization rates among the three groups of patients at 3 months after surgery according to AAR tertile. In the multiple logistic regression analysis, there were statistically significant differences in Diabetes, grade of NIHSS score at admission, AAR tertiles, good collateral circulation and Pathogenesis. The Receiver Operating Characteristic curve (ROC) curve of AAR predicting futile recanalization was drawn with an AUC of 0.582 and a 95% confidence interval of 0.529–0.634. After combining grade of NIHSS score at admission, AAR tertiles and good collateral circulation, a ROC curve was drawn to predict futile recanalization, with an AUC of 0.907 and a 95% confidence interval of 0.879–0.936.Conclusion: AAR is a new composite indicator for predicting futile recanalization in patients with acute cerebral infarction with anterior circulation large vessel occlusion. The combination of grade of NIHSS score at admission, AAR tertiles and good collateral circulation has a high predictive power for futile recanalization.

Introduction: Successful reperfusion does not always lead to good neurological outcomes and impaired microcirculation can be one of the underlying causes. Intra-arterial alteplase after mechanical thrombectomy (MT) may improve microcirculation contributing to neurological recovery, but prospective randomised studies are still needed to validate its efficacy and safety. We aim to assess the efficacy and safety of intra-arterial alteplase after MT for acute ischaemic stroke (AIS) with large-vessel occlusion (LVO). Methods and analysis: The Intra-arterial Alteplase for Acute Ischaemic Stroke After Mechanical Thrombectomy (PEARL) study is a multicentre, prospective, open-label, blinded-endpoint, randomised controlled trial. We consecutively screen AIS patients with anterior circulation LVO and National Institute of Health Stroke Scale of 6–25, who reach stable expanded Thrombolysis in Cerebral Infarction scores of 2b50-3 on angiography after MT. Eligible participants are 1:1 randomly assigned to the experimental group and the control group. Participants in the experimental group will receive intra-arterial alteplase (0.225 mg/kg and a maximum dose of 20 mg) after MT and standard medical treatment, while those in the control group will receive standard medical treatment alone after the procedure. The primary outcome is the proportion of patients with a 90-day modified Rankin scale of 0–1. A total of 324 participants are required to test the superiority hypothesis with 80% power at a two-tailed significance level of 0.05. Ethics and dissemination: This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University (SYSKY-2023-390-02) and will be conducted following the Declaration of Helsinki. Ethical approvals have been obtained separately for all centres participating in the study. Study results will be published in peer-reviewed academic journals. Trial registration number: NCT05856851 .

The novel coronavirus disease 2019 (COVID‐19) causes severe respiratory illness and is involved in ischemic stroke. Aimed to investigate the inflammatory markers and possible prognosis of COVID‐19‐related ischemic stroke in a special outbreak period after lifting of COVID‐19 control measures in China, we conducted a multicenter retrospective analysis in southern China at three centers in Shenzhen. We included patients diagnosed with acute ischemic stroke or transient ischemic attack after infection with COVID‐19 as the COVID‐19‐related ischemic stroke group and those only diagnosed with acute ischemic stroke or transient ischemic attack as the control group. In this study, the proportion of female patients, admission heart rate, and comorbid coronary heart disease and the proportion of cryptogenic stroke were higher, while the history of prior stroke was lower in the COVID‐19‐related ischemic stroke group. The COVID‐19‐related ischemic stroke group also exhibited elevated levels of monocytes, fibrinogen, alanine aminotransferase, direct bilirubin, monocyte‐to‐lymphocyte ratio (MLR), and fibrinogen‐to‐albumin ratio (FAR) but decreased levels of lymphocytes, albumin, and high‐density lipoprotein. However, there were no statistically significant differences in the modified Rankin scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and mortality rate between the two groups at discharge. Our study is the first to show the alteration in inflammatory markers but no difference in discharge prognosis between the non‐COVID‐19 and the COVID‐19‐related ischemic stroke patients, during China’s COVID‐19 relaxation period.

Cervical artery dissection (CeAD), a special cerebrovascular disease and the main cause of stroke in young people, can present with ischemic stroke, headache, subarachnoid hemorrhage, and other symptoms, increasing the possibility of misdiagnosis. As a special class of non-coding RNAs, circRNAs are commonly found in organisms and can play regulatory roles in transcription and post-transcription processes, affecting gene expression.CircRNAs have reported to be associated with neurological diseases; however, their role in CeAD has not been discerned. In this study, we aimed to elucidate the pathophysiological changes in patients with CeAD and identify biomarkers. Peripheral blood mononuclear cells from patients with CeAD and healthy controls were sequenced using high-throughput sequencing. We detected 460 differently expressed circRNAs in patients with CeAD (p < 0.5, fold difference ≥ 2), of which 240 were upregulated and 220 were downregulated. Four circRNAs showed significant differences in expression, which were validated using qRT-PCR. These results suggested that three circRNAs were consistent with high-throughput sequencing results. Bioinformatics analysis demonstrated that these differentially expressed circRNAs were involved in protein metabolism, regulation, synapses, and other pathophysiological processes during CeAD-induced stroke. Additionally, various pathways related to inflammation were closely associated with circRNAs. Based on our results, we suggest that the aberrant expression of circRNAs in CeAD may serve as a biomarker for its diagnosis and as a potential therapeutic target.

Since the Corona Virus Disease 2019 (COVID-19) pandemic, there has been increasing evidence that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with acute cerebrovascular events such as cerebral infarction, cerebral hemorrhage, and cerebral venous thrombosis. Although the mechanism of cerebrovascular complications among COVID-19 patients has not been adequately elucidated, the hypercoagulable state, excessive inflammation and ACE-2-associated alterations in the renin-angiotensin-aldosterone system after SARS-CoV-2 infection probably play an essential role. In this overview, we discuss the possible mechanisms underlying the SARS-CoV-2 infection leading to acute cerebrovascular events and review the characteristics of COVID-19-related acute cerebrovascular events cases and treatment options available worldwide.

Background It is unknown whether balloon angioplasty can be a first-choice treatment for intracranial atherosclerosis-related emergent large vessel occlusion (ICAS-ELVO) with small clot burden. The microcatheter “first-pass effect” is a valid predictor of ICAS-ELVO with small clot. Objective To determine balloon angioplasty’s efficacy as first-choice treatment for ICAS-ELVO involving the microcatheter “first-pass effect” during endovascular treatment (EVT). Methods This continuous retrospective analysis assessed ICAS-ELVO patients presenting with the microcatheter “first-pass effect” during EVT. Patients were divided into two first-choice treatment-based groups: preferred balloon angioplasty (PBA) and preferred mechanical thrombectomy (PMT). Efficacy and safety outcomes were compared between groups. Results Seventy-six patients with ICAS-ELVO involving the microcatheter “first-pass effect” during EVT were enrolled. Compared with patients in PMT group, patients in PBA group were associated with (i) a higher rate of first-pass recanalization (54.0% vs. 28.9%, p=.010) and complete reperfusion (expanded thrombolysis in cerebral ischemia≥2c; 76.0% vs. 53.8%, p=.049), (ii) a shorter puncture-to-recanalization time (49.5 min vs. 56.0 min, p<.001), (iii) less operation costs (48,499.5¥ vs. 99,086.0¥, p<.001),and (iv) more excellent functional outcomes (modified Rankin scale:0-1; 44.0% vs. 19.2%, p=.032) at 90 days. No significant differences in symptomatic intracranial hemorrhage (12.0% vs. 15.4%, p>.999) and mortality (10.0% vs. 7.7%, p>.999) were noted. Logistic regression analysis revealed that first-choice treatment was an independent predictor of 90-day excellent functional outcomes (adjusted odds ratio [aOR] =0.10, 95% CI: 0.02–0.66, p=.017). Conclusion Balloon angioplasty, as the first-choice treatment, potentially improves 90-day functional outcomes for ICAS-ELVO patients with microcatheter “first-pass effect” during EVT. What is already known on this topic Compared with large vessel occlusion caused by embolization, mechanical thrombectomy has lower recanalization rate, longer procedure time, and poorer prognosis for patients with intracranial atherosclerosis-related emergent large vessel occlusion(ICAS-ELVO). What this study adds This study revealed that balloon angioplasty, as the first-choice treatment, potentially improves 90-day outcomes, shortens procedure time, and reduces operation costs for patients with ICAS-ELVO involving the microcatheter “first-pass effect” during endovascular treatment. How this study might affect research, practice or policy We believe that our study makes a significant contribution to the literature because its findings suggest that rapid and accurate methods of diagnosing the etiology and clot burden of ELVO as well as the development of an individualized EVT strategy based on etiology and clot burden need to be established.

Background: Cerebral small vessel disease (CSVD) is a group of clinical syndromes covering all pathological processes of small vessels in the brain, which can cause stroke and serious dementia. However, as the pathogenesis of CSVD is not clear, so the treatment is limited. Endothelial cell dysfunction is earlier than clinical symptoms, such as hypertension and leukosis. Therefore, the treatment of endothelial cells is expected to be a new breakthrough. Quercetin, a flavonoid present in a variety of plants, has the function of anti-inflammation and anti-oxidation. This study aimed to investigate the protective effect of quercetin on endothelial cell injury and provide a basic theory for subsequent application in the clinic.Methods: Human brain microvascular endothelial cells (HBMECs) were cultured in vitro, and the injury model of endothelial cells was established by hypoxia and reoxygenation (H/R). The protective effects of quercetin on HBMECs were studied from the perspectives of cell viability, cell migration, angiogenesis and apoptosis. In order to further study the mechanism of quercetin, oxidative stress and endoplasmic reticulum stress were analyzed. What’s more, blood-brain barrier (BBB) integrity was also studied.Results: Quercetin can promote the viability, migration and angiogenesis of HBMECs, and inhibit the apoptosis. In addition, quercetin can also activate Keap1/Nrf2 signaling pathway, reduce ATF6/GRP78 protein expression. Further study showed that quercetin could increase the expression of Claudin-5 and Zonula occludens-1.Conclusions: Our experiments show that quercetin can protect HBMECs from H/R, which contains promoting cell proliferation, cell migration and angiogenesis, reducing mitochondrial membrane potential damage and inhibiting cell apoptosis. This may be related to its antioxidation and inhibition of endoplasmic reticulum stress. At the same time, quercetin can increase the level of BBB connexin, suggesting that quercetin can maintain BBB integrity.

Background: Nucleic acid detection and CT scanning have been reported in COVID-19 diagnosis. Here, we aimed to investigate the clinical significance of IgM and IgG testing for the diagnosis of highly suspected COVID-19.Methods: A total of 63 patients with suspected COVID-19 were observed, 57 of whom were enrolled (24 males and 33 females). The selection was based on the diagnosis and treatment protocol for COVID-19 (trial Sixth Edition) released by the National Health Commission of the People's Republic of China. Patients were divided into positive and negative groups according to the first nucleic acid results from pharyngeal swab tests. Routine blood tests were detected on the second day after each patient was hospitalized. The remaining serum samples were used for detection of novel coronavirus-specific IgM/IgG antibodies.Results: The rate of COVID-19 nucleic acid positivity was 42.10%. The positive detection rates with a combination of IgM and IgG testing for patients with COVID-19 negative and positive nucleic acid test results were 72.73 and 87.50%, respectively.Conclusions: We report a rapid, simple, and accurate detection method for patients with suspected COVID-19 and for on-site screening for close contacts within the population. IgM and IgG antibody detection can identify COVID-19 after a negative nucleic acid test. Diagnostic accuracy of COVID-19 might be improved by nucleic acid testing in patients with a history of epidemic disease or with clinical symptoms, as well as CT scans when necessary, and serum-specific IgM and IgG antibody testing after the window period.

Quick, simple and accurate diagnosis of suspected COVID-19 is very important for the screening and therapy of patients. Although several methods were performed in clinical practice, however, the IgM and IgG diagnostic value evaluation was little performed. 57 suspected COVID-19 infection patients were enrolled in our study. 24 patients with positive and 33 patients with negative nucleic acid test. The positive rate of COVID-19 nucleic acid was 42.10%. The positive detection rate of combination of IgM and IgG for patients with COVID-19 negative and positive nucleic acid test was 72.73% and 87.50%. The results were significantly higher than the nucleic acid or IgM, IgG single detection. hsCRP in the COVID-19 nucleic acid negative group showed significantly higher than the positive groups ( P =0.0298). AST in the COVID-19 IgM negative group showed significantly lower than the positive groups ( P =0.0365). We provided a quick, simple, accurate aided detection method for the suspected patients and on-site screening in close contact with the population.