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In this paper, the crystal structure, microstructure, and deformation behavior in the Ti-33Nb alloy under furnace-cooling (FC) and water-quenching (WQ) conditions after holding at 950 °C for 0.5 h are reviewed. The stable and metastable phases obtained under FC and WQ heat treatments have significantly different influences on the mechanical properties of this alloy. The furnace-cooling specimens possess a β and α phase at room temperature, while water-quenched specimens are composed of a metastable β phase and martensite α″ phase. According to the results of the nanoindentation test, the hardness value of the FC specimens is 2.66 GPa, which is lower than that of the WQ specimens. It can be attributed to the presence of a large number of α phases. The indentation depth recovery ratio (ηh) and work recovery ratio (ηw) of the WQ specimens are 19.02% and 19.54%, respectively, indicating a better superelastic response than the FC specimens. In addition, the wear resistance (H/Er) and yield pressure (H3/Er2) of the WQ specimens are 0.0282 and 0.0030 GPa, respectively, suggesting a better wear resistance and resistance of plastic deformation.

Despite extensive research on the relationship between choline and cardiovascular disease (CVD), conflicting findings have been reported. We aim to investigate the relationship between choline and CVD. Our analysis screened a retrospective cohort study of 14,663 participants from the National Health and Nutrition Examination Survey conducted between 2013 and 2018. Propensity score matching and restricted cubic splines was used to access the association between choline intake and the risk of CVD. A two-sample Mendelian randomization (MR) analysis was conducted to examine the potential causality. Additionally, sets of single cell RNA-sequencing data were extracted and analyzed, in order to explore the role of choline metabolism pathway in the progression and severity of the CVD and the underlying potential mechanisms involved. The adjusted odds ratios and 95% confidence intervals for stroke were 0.72 (0.53–0.98; p = 0.035) for quartile 3 and 0.54 (0.39–0.75; p < 0.001) for quartile 4. A stratified analysis revealed that the relationship between choline intake and stroke varied among different body mass index and waist circumference groups. The results of MR analysis showed that choline and phosphatidylcholine had a predominantly negative causal effect on fat percentage, fat mass, and fat-free mass, while glycine had opposite effects. Results from bioinformatics analysis revealed that alterations in the choline metabolism pathway following stroke may be associated with the prognosis. Our study indicated that the consumption of an appropriate quantity of choline in the diet may help to protect against CVD and the effect may be choline-mediated, resulting in a healthier body composition. Furthermore, the regulation of the choline metabolism pathway following stroke may be a promising therapeutic target.

The paper deals with the effect of the morphology characteristics, grain size, and the volume fraction of AlN- and NbC-precipitated particles on the prior austenite grain growth behavior in the Al- and Nb-microalloying 20MnCr gear steel during pseudo-carburizing heat treatments. The results indicate that the Nb addition in 20MnCr gear steel have a better effect on preventing austenite grain growth. The coarsening time after pseudo-carburizing in the Nb-microalloyed 20MnCr steel are improved by about 4 h compared with the Al-microalloyed steel. The precipitated particles coarsen and the number decreases with the pseudo-carburization temperature increasing, resulting in a reduction in the pinning pressure of the precipitated particles on the austenite grain boundaries. When the pseudo-carburization temperature reaches 1150 °C, the precipitated particles no longer have the ability to pin the austenite grain boundaries. In addition, the kinetics model for austenite grain growth under the process of the pinning and coarsening of the precipitated particles was established.

BackgroundClinical evidence of the potential influence of stress hyperglycemia ratio (SHR) for patients with large ischemic stroke whether or not receiving endovascular therapy is not clear.MethodsThis study was a subanalysis of a prospective, multicenter registry, and included 745 patients with large ischemic stroke across 38 centers in China. A total of 427 patients were included in this study, with 285 received endovascular therapy (EVT) and 142 received standard medical therapy (SMT). SHR was defined as glucose (mmol/L)/(1.59 × HbA1C)–2.59. The primary outcome was a moderate neurological outcome (modified Rankin Scale (mRS) score ≤3) at 90 days.ResultsA significant interaction was observed between SHR and whether received EVT (p=0.017). Among patients who received EVT (adjusted OR (aOR) 0.46; 95% CI 0.23 to 0.92; p=0.029), patients in the highest tertile of SHR were significantly less likely to achieve a moderate neurological outcome at 90 days compared with those in the lowest tertile. However, this association was not observed in patients receiving SMT (aOR 2.46; 95% CI 0.74 to 8.21; p=0.142). EVT patients with higher SHR had a significantly higher incidence of symptomatic intracranial hemorrhage compared with lower SHR (aOR 3.29; 95% CI 1.08 to 10.06; p=0.036), while such an association was not observed in the SMT group (aOR 1.52; 95% CI 0.56 to 4.12; p=0.410).ConclusionsIn patients with large ischemic stroke treated with EVT, SHR is associated with a reduced likelihood of achieving a moderate neurological outcome, as well as an increased risk of symptomatic intracranial hemorrhage.Trial registration numberChiCTR2100051664.

ObjectiveSome patients with large core infarctions who underwent endovascular treatment (EVT) still achieved favorable long-term outcomes despite the absence of neurological improvement in the acute phase. The underlying reasons for this phenomenon remain unclear. This study aimed to investigate the incidence and predictors of delayed neurological improvement (DNI) in this patient population.MethodsPatients with large core infarctions who received EVT were derived from a prospective, observational, nationwide multicenter registry. Acute phase neurological improvement (APNI) was defined as a decrease of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score between admission and day 5–7. DNI was defined as achieving 90-day favorable outcomes in the absence of APNI. Multivariate logistic regression was used to analyze independent predictors of DNI.ResultsAmong 490 patients with large core infarctions who underwent EVT, 277 (56.5%) did not experience APNI. Of these, 39 (14.1%) patients achieved favorable long-term clinical outcomes and constituted the DNI group. Younger age, male sex, lower baseline NIHSS score, good collateral circulation, and shorter puncture to reperfusion time were independent predictors of DNI.ConclusionDNI occurred in 14.1% of patients with large core infarctions undergoing EVT. Optimizing modifiable factors, such as reducing puncture to reperfusion time and improving collateral circulation, is crucial for enhancing patient outcomes. These findings have important implications for refining clinical management strategies and improving prognosis in this patient population.

BackgroundThe optimal anesthetic method for endovascular therapy in acute large core stroke remains unclear. This study aimed to evaluate the impact of anesthetic methods on outcomes in patients with large core stroke.MethodsThis study was a subanalysis of a prospective, multicenter registry at 38 stroke centers in China. Patients with large core stroke, defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 0–5 within 24 hours of witnessed symptom onset, were analyzed. The primary outcome was favorable functional outcome (modified Rankin Scale score 0–3) at 90 days.Results484 eligible patients were included in this analysis. General anesthesia (GA) was used in 84 patients (17.4%), while non-general anesthesia (non-GA) was used in 400 patients (82.6%). Non-GA was comparable to GA in the primary outcome (37.8% vs 32.1%; adjusted odds ratio (aOR) 1.07, 95% confidence interval (95% CI) 0.60 to 1.91, P=0.83). Mortality at 90 days was 40% in the non-GA and 52.4% in the GA (aOR 0.71, 95% CI 0.41 to 1.22, P=0.21). The proportion of symptomatic intracranial hemorrhage at 48 hours was 13.8% in the non-GA and 11.9% in the GA (aOR 1.25, 95% CI 0.62 to 2.77, P=0.56). The results remained consistent in the propensity score-matched cohort and inverse probability of treatment weighting cohort.ConclusionIn this cohort study of patients with large core stroke, no significant differences were found in functional and safety outcomes between non-GA and GA.

In this work, the effects of the micro-alloying of Mn, Ni, and Si on the microstructure and mechanical properties of high-carbon pearlite steels were investigated. The results indicated that the addition of solely Ni to high-carbon pearlitic steel can enhance the strength through the refinement of interlamellar spacing, but work-hardening in the ferrite of the pearlite colony may be delayed, leading to a reduction in area. The multiple additions of Ni and the increase in Mn and Si contents in high-carbon pearlitic steel were beneficial to obtaining a balance between ultimate tensile strength and reduction in area. Three-dimensional atom probe tomography results showed Si partitioning into ferrite and Mn and Ni elements partitioning into cementite. The addition of Si inhibited the formation of a continuous network of grain-boundary cementite, leading to high strength and high ductility through optimization of the microstructure.

To investigate the relationship between intravenous tirofiban, the number of retrieval attempts and symptomatic intracranial hemorrhage (sICH) in patients with successful EVT. We used the data from the Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) Trial. The primary outcome was sICH, which was defined according to the Heidelberg Bleeding Classification. The association between the number of retrieval attempts and the rate of sICH was investigated using multivariable logistic regression. A total of 866 patients were included in our analysis. In overall cohort, tirofiban (OR: 1.853, 95% CI: 1.039-3.307) and more than 2 passes (3 versus 0-1: OR: 2.482, 95% CI: 1.124-5.481; 2 versus 0-1: OR: 0.813, 95% CI: 0.389-1.696) were significantly associated with the occurrence of sICH. A significant interaction between the use of tirofiban and the increasing number of attempts was found (p for interaction = 0.02), whereby the presence of sICH was significantly associated with tirofiban (OR: 5.534, 95% CI: 1.586-19.315) in the subgroup of multiple passes (>2 passes group), while none was seen in the subgroup of 0-2 passes. The results of the sensitivity analysis also showed that more than 2 passes (3 versus 1: OR: 2.841, 95% CI: 1.102-7.323; 2 versus 1: OR: 0.852, 95% CI: 0.346-2.097) were significantly associated with the occurrence of sICH in the tirofiban group but not in the placebo group. In patients with multiple attempts, intravenous tirofiban may increase the risk of sICH. Further research and individualized risk assessment are necessary to determine the most appropriate strategy of intravenous tirofiban for EVT patients, especially considering details of thrombectomy procedures. : URL: http:// www.chictr.org.cn; Unique identifier: ChiCTR-INR-17014167.

This study aimed to analyze the association of HbA1c levels and outcomes in patients with large vessel occlusion (LVO) undergoing endovascular treatment (EVT). Patients with recorded HbA1c values were enrolled from The Endovascular Treatment With vs Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) trial. We defined the high HbA1c levels as a plasma level of HbA1c > 6.5%. The primary outcome was good outcome (defined as a modified Rankin Scale score (mRS) of 0-2) at 90 days, secondary outcomes included other clinical outcomes (excellent outcome, mRS 0-1) at 90 days, mortality at 90 days, symptomatic intracerebral hemorrhage (sICH) within 48h, and any intracerebral hemorrhage (ICH). Among the 560 patients with HbA1c values, 133 (23.7%) patients were in the HbA1c > 6.5% group, and 427 (76.3%) patients were in the HbA1c ≤ 6.5% group. In multivariable analysis, the HbA1c > 6.5% group showed a significant negative association with good outcomes at 90 days (mRS 0-2; adjusted odds ratio [aOR], 0.57; 95% CI 0.37-0.88; = 0.01), and the HbA1c > 6.5% group was significantly associated with increased mortality (aOR, 2.06; 95% CI 1.20-3.54; = 0.009). There were no significant differences in the incidence of sICH between the two groups. Additionally, the subgroup analysis showed an interaction effect between high HbA1c levels and age. Our results demonstrated that elevated HbA1c levels were associated with poor clinical outcomes in LVO patients who underwent EVT.

Many patients who gained successful recanalization by endovascular treatment (EVT) with acute large vessel occlusion (LVO) did not have the favorable outcome. The study aimed to assess the association between H-type hypertension and clinical prognosis in patients with LVO after receiving EVT. Our study enrolled patients from the Endovascular Treatment With versus Without Tirofiban for Stroke Patients with Large Vessel Occlusion (RESCUE BT) Trial. H-type hypertension is defined as patients with hypertension and homocysteine (Hcy) ≥10µmol/L. The primary outcome was a favorable functional outcome, defined as a score of 0-2 on the modified Rankin Scale (mRS) at 90 days. The secondary outcomes were mortality, successful recanalization, futile recanalization, and symptomatic intracerebral hemorrhage (sICH). The plasma homocysteine level was recorded for 215 patients with hypertension in our study. Among those patients, 172 patients (80%) were founded with Hcy ≥10µmol/L (H-type hypertension), and 43 patients (20%) with Hcy <10µmol/L (non-H-type hypertension). The probability of favorable outcome decreased with homocysteine increasing in patients with hypertension. H-type hypertension was associated with a low probability of favorable outcome (adjusted odds ratio (aOR), 0.38 [95% confidence interval (CI), 0.18-0.80]; = 0.01) at 90 days. The effects of H-type hypertension on mortality (aOR, 1.90 [95% CI, 0.67-5.39]; = 0.23) and sICH (aOR, 0.55 [95% CI, 0.13-2.29]; = 0.41) were not significant. Our findings suggest that patients with H-type hypertension have a lower likelihood of achieving favorable outcomes but do not have an increased mortality rate within 90 days.