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Alteplase is currently the only approved thrombolytic agent for treatment of acute ischaemic stroke, but interest is burgeoning in the development of new thrombolytic agents for systemic reperfusion with an improved safety profile, increased efficacy, and convenient delivery. Tenecteplase has emerged as a potential alternative thrombolytic agent that might be preferred over alteplase because of its ease of administration and reported efficacy in patients with large vessel occlusion. Ongoing research efforts are also looking at potential improvements in recanalisation with the use of adjunct therapies to intravenous thrombolysis. New treatment strategies are also emerging that aim to reduce the risk of vessel reocclusion after intravenous thrombolysis administration. Other research endeavors are looking at the use of intra-arterial thrombolysis after mechanical thrombectomy to induce tissue reperfusion. The growing implementation of mobile stroke units and advanced neuroimaging could boost the number of patients who can receive intravenous thrombolysis by shortening onset-to-treatment times and identifying patients with salvageable penumbra. Continued improvements in this area will be essential to facilitate the ongoing research endeavors and to improve delivery of new interventions.

The Red River Delta (RRD), including 11 provinces, is one of the four largest rice-growing areas in Vietnam. Tropical storms often occur and cause serious flooding from May to October annually in the RRD, which strongly affects the productivity of the summer–autumn rice, one of two main rice crops. Therefore, the rapid assessment of damaged rice area by flooding inundation is critical for farmers and the government. In this study, we proposed a methodology for quick estimation of rice areas damaged by flooding using Sentinel 1A (S1A) imagery. Firstly, the latest rice map was produced. Then, a Near Real-Time (NRT) flood map, which is estimated from S1A images at the closest time to a flooding event, was generated by excluding the yearly permanent map from the temporal water map. Our experiment was conducted for the assessment of damaged rice area by flooding from the tropical storm named Son-Tinh, which happened on 19–21 July 2018. A Support Vector Machine (SVM) classifier was applied on time-series of S1A VV with VH data (VVVH) to obtain a rice map for the winter-spring season of 2018 with 90.5% Overall Accuracy (OA) and 2.37% difference (12,544 ha) from the General Statistics Office (GSO) of Vietnam’s reports for the whole region. Then, the Otsu thresholding method was applied for permanent water surface extraction and NRT flood mapping. The estimated damaged area was compared to available provincial and communal statistics for validation and further analysis. Right after the Son-Tinh storm, the estimation of inundated rice was approximately 50% of the total rice area in the RRD (271,092 ha). As a result, rice damage level strongly corresponds to the inundation period. In addition, the rice-flooding frequency map over the RRD was estimated to show rice fields suffering a high risk of flooding during the rainy season in the RRD. Our experiment’s results highlight the potential of using Synthetic-Aperture Radar (SAR) imagery for fast monitoring and assessment of paddy rice areas affected by flooding at a large scale in the RRD region.

Purpose Circulating microRNAs (miRNAs) are potential diagnostic biomarkers for breast cancer (BC). The application of miRNA panels could improve the performance of screening tests. Here, we integrated bioinformatic tools and meta-analyses to select circulating miRNAs with high diagnostic accuracy and combined these markers to develop diagnostic panels for BC. Methods Analyses across databases were performed to identify potential BC-related circulating miRNAs. Next, a comprehensive meta-analysis was conducted for each miRNA following the PRISMA guidelines. An electronic and manual search for relevant literature was carried out by two reviewers through PubMed, ScienceDirect, Biomed Central, and Google Scholar. The quality of the included studies was assessed using the QUADAS-2, and the statistical analyses were performed using R software 4.1.1. Finally, the accurate biomarkers confirmed through meta-analyses were combined into diagnostic models for BC. Results Twenty-seven circulating miRNAs were identified as BC-related by bioinformatic tools. After screening, only 10 miRNAs presented in 45 studies were eligible for meta-analyses. By assessing pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio, 8 miRNAs (miR-21, miR-30b, miR-125b, miR-145, miR221 miR-222, and miR-335) were revealed as promising BC diagnostic biomarkers. Two panels constructed from these miRNAs showed excellent diagnostic accuracy for BC, with areas under the SROC curve of 0.917 and 0.944. Conclusion We identified 8 potential circulating miRNAs and 2 diagnostic models that are useful for diagnosing BC. However, the established miRNA panels have not been tested in any experimental studies and thus should be validated in large case–control studies for clinical use.

In a trial conducted in China, patients with large cerebral infarctions as determined by imaging criteria within 24 hours after onset had better outcomes with endovascular therapy than with medical therapy alone.

Objective Cerebral circulation time (CCT) and collateral score (CS) are associated with functional outcomes in acute ischemic stroke (AIS) patients after endovascular treatment (EVT), and may be related to each other. We aim to determine the relationship between CS and CCT on functional outcomes. Methods We retrospectively enrolled consecutive patients with anterior circulation large vessel occlusion (LVO) AIS who received EVT. CS and CCT were measured based on digital subtraction angiography (DSA). We defined CS 0–2 and 3–4 as poor and good collateral status, respectively, and used change of CCT (cCCT), which was defined as the change of stroke side CCT (sCCT) versus healthy side CCT (hCCT). Mediating analysis was used to evaluate the influence of cCCT on the association between CS and functional outcomes, and ROC curves were further used to explore the predictive ability of the interaction between cCCT and CS for functional outcomes. Results A total of 100 patients were enrolled in the final analysis. A higher cCCT (r = −0.239; p = 0.017) was associated with lower CS, and cCCT mediated the association of CS with functional outcome. Logistic regression analysis found that CS, cCCT and cCCT‐CS interactions were independently associated with functional outcome, and cCCT‐CS interaction has better predictive performance, with a higher area under curve value than CS or cCCT alone (0.79 vs. 0.75 or 0.75). Interpretation To our knowledge, this study provides the first report of the association of collateral status with cCCT, and their interaction effect on functional outcome in AIS‐LVO patients receiving EVT.

Endovascular thrombectomy is the standard treatment for ischaemic stroke, a leading cause of disability worldwide. Randomised trials in the past decade have expanded eligibility criteria to include broader patient populations, such as those with large ischaemic core stroke. However, many patients still have poor outcomes despite high rates of macrovascular reperfusion, underscoring the need for strategies that go beyond restoring large-vessel flow. Intra-arterial thrombolysis and cytoprotective agents are under investigation for their potential to reduce secondary complications during and after endovascular thrombectomy. These strategies target key mechanisms such as microvascular obstruction, excitotoxicity, oxidative stress, and inflammation. Their effectiveness depends on aligning the mechanism of action with the patient's underlying pathophysiology. Despite years of promising results limited by constrained clinical translation in cytoprotective trials, recent trials have provided hope and insights, helping to define crucial factors for translational success. Incorporating these lessons into refined inclusion criteria and future studies has the potential to transform our approach to caring for patients at the greatest risk of poor clinical outcomes, including severe disability or death.

Accurate estimate of ischemic core volume (ICV) and penumbra volume (PV) is important in decision-making for endovascular therapies (EVT) and predicting the patient’s clinical outcome. In this study, we compared the performance of a novel automated CT perfusion software UGuard and the Rapid Processing of Perfusion and Diffusion (RAPID). UGuard and RAPID had strong agreement with regard to ICV (ICC 0.92, 95% CI 0.89 – 0.94) and PV (ICC 0.8, 95% CI 0.73 – 0.85) measurements. ICVs measured by UGuard or RAPID were similar in predicting favorable outcome (AUC 0.72 vs. 0.70, P  = 0.43), with UGuard measurements having higher specificity. After adjusting for significant clinical covariates, the predictive performance of favorable outcome was excellent for each of the six models incorporating ICV and PV, and the model which incorporated ICV and PV measured by UGuard software package showed the best predictive performance. We concluded that the ICV and PV of CT perfusion images measured by UGuard software package, as well as the capacity to predict favorable outcome of patients following EVT, were comparable to RAPID.

This phase II, randomized, double blinded, multi-center study aims to explore whether intravenous edaravone dexborneol (ED) could improve clinical outcomes in patients with anterior circulation stroke with successful endovascular reperfusion (ClinicalTrials.gov: NCT04667637 ). Eligible patients were randomly (1:1) assigned into ED, which received intravenous ED (37.5 mg, 2/day, for 12 days) or control group, which received placebo. The primary endpoint was favorable functional outcome (a modified Rankin Scale [mRS] of 0–2 at 90 days). Two hundred patients were enrolled, including 97 in ED group and 103 in control group. The proportion of patients with 90-day mRS (0–2) was 58.7% (54/92) in ED group and 52.1% (49/94) in control group (unadjusted odds ratio 1.37, [95% CI 0.76-2.44], P  = 0.29). This work suggests that intravenous ED is safe, but do not statistically improve 90-day functional outcomes in patients with anterior circulation stroke with successful endovascular reperfusion. Endovascular thrombectomy (EVT) achieves high recanalization rates in acute stroke, but many patients still experience poor outcomes. Here, the authors show that intravenous edaravone dexborneol (ED) is safe and reduces early hemorrhage but does not significantly improve 90-day functional outcomes in stroke patients after EVT.

Background Delayed cerebral ischemia (DCI) is a major cause of morbidity after aneurysmal subarachnoid hemorrhage (SAH). Endovascular treatment (ET) has emerged as a rescue strategy, but its optimal timing, indication, and modality remain unclear. This study assessed international ET practices, focusing on treatment variability and clinical decision-making. Methods A 25-question survey was developed with input from specialists in interventional neuroradiology, neurosurgery, neurology, and neurocritical care. It was disseminated via professional societies to physicians involved in bedside decisions. Respondents reviewed clinical scenarios representing common DCI presentations, including proximal/distal vasospasm and conscious/unconscious patients. Descriptive analysis was performed. Results 179 respondents from 38 countries participated; 76.5% reported ET availability at their institution. The most common strategy was single or repeated intra-arterial spasmolysis (76.5%), followed by continuous intra-arterial vasodilator infusion (23.0%). In unconscious patients, 50% applied spasmolysis as first-line treatment. For refractory proximal vasospasm, a stepwise approach was preferred, starting with intra-arterial pharmacologic spasmolysis, then angioplasty. While angioplasty was widely used, 66.5% considered it riskier than spasmolysis. Conclusion This survey highlights marked variability in ET practices for DCI. Intra-arterial spasmolysis is the predominant strategy, with alternative approaches like continuous infusion and angioplasty also in use. These findings underscore the need for randomized trials to define optimal ET strategies and inform evidence-based protocols for DCI following SAH.