Cerebrovascular diseases pose a serious threat to human survival and quality of life and represent a major cause of human death and disability. Recently, the incidence of cerebrovascular diseases has increased yearly. Rapid and accurate diagnosis and evaluation of cerebrovascular diseases are of great importance to reduce the incidence, morbidity and mortality of cerebrovascular diseases. With the rapid development of medical ultrasound, the clinical relationship between ultrasound imaging technology and the diagnosis and treatment of cerebrovascular diseases has become increasingly close. Ultrasound techniques such as transcranial acoustic angiography, doppler energy imaging, three-dimensional craniocerebral imaging and ultrasound thrombolysis are novel and valuable techniques in the study of cerebrovascular diseases. In this review, we introduce some of the new ultrasound techniques from both published studies and ongoing trials that have been confirmed to be convenient and effective methods. However, additional evidence from future studies will be required before some of these techniques can be widely applied or recommended as alternatives.

Nanobubbles are nanometer size bubbles having different constituents of varying physicochemical characteristic for the inner core and outer shell. Nanobubbles are mainly fabricated to improve the stability, bioavailability and improve the biodistribution of the delivered drug to the specific targeted site. Their small sizes bubbles allow the possibility of extravasation from blood vessels into the surrounding tissues and ultrasound-targeted site-specific release with minimal invasiveness. Nanobubbles are developing as important contrast agents for imaging and carriers for drug delivery at targeted region. Sonication is the primary method for preparation of nanobubbles followed by thin-layer evaporation, high shear emulsification, mechanical agitation and coacervation or coalescence. With exposure to ultrasound/extracorporeal shock waves, the drug is liberated from the nanobubbles into the target cells. This review paper is an effort to reveal the different formulation development techniques briefly and varying shell and core content for developing nanobubbles.

OBJECTIVE: Large vessel occlusion in acute ischemic stroke is associated with low recanalization rates under intravenous thrombolysis. We evaluated the safety and efficacy of the Solitaire AB stent in treating acute ischemic stroke. METHODS: Patients presenting with acute ischemic stroke were prospectively evaluated. The neurological outcomes were assessed using the National Institutes of Health Stroke Scale and the modified Rankin Scale. Time was recorded from the symptom onset to the recanalization and procedure time. Recanalization was assessed using the thrombolysis in cerebral infarction score. RESULTS: Twenty-one patients were evaluated. The mean patient age was 65, and the National Institutes of Health Stroke Scale scores ranged from 7 to 28 (average 17±6.36) at presentation. The vessel occlusions occurred in the middle cerebral artery (61.9%), distal internal carotid artery (14.3%), tandem carotid occlusion (14.3%), and basilarartery (9.5%). Primary thrombectomy, rescue treatment and a bridging approach represented 66.6%, 28.6%, and 4.8% of the performed procedures, respectively. The mean time from symptom onset to recanalization was 356.5±107.8 minutes (range, 80-586 minutes). The mean procedure time was 60.4±58.8 minutes (range, 14-240 minutes). The overall recanalization rate (thrombolysis in cerebral infarction scores of 3 or 2b) was 90.4%, and the symptomatic intracranial hemorrhage rate was 14.2%. The National Institutes of Health Stroke Scale scores at discharge ranged from 0 to 25 (average 6.9±7). At three months, 61.9% of the patients had a modified Rankin Scale score of 0 to 2, with an overall mortality rate of 9.5%. CONCLUSIONS: Intra-arterial thrombectomy with the Solitaire AB device appears to be safe and effective. Large randomized trials are necessary to confirm the benefits of this approach in acute ischemic stroke.

Background: Stroke is a major global public health problem, affecting 13.7 million people worldwide. Previous studies have found a neuroprotective effect of hypothermia therapy and the efficacy and safety of combined hypothermia and mechanical thrombectomy or thrombolysis in the treatment of ischemic stroke have also attracted attention. Objective: In the present research, the authors conducted a meta-analysis to comprehensively assess the safety and efficacy of hypothermia combining mechanical thrombectomy or thrombolysis in the treatment of ischemic stroke. Methods: Articles published from January 2001 to May 2022 were searched from Google Scholar, Baidu Scholar and PubMed to evaluate the clinical significance of hypothermia treatment in ischemic stroke. Complications, short-term mortality, and the modified Rankin Scale (mRS) in the full text was extracted. Results: 89 publications were selected and 9 among them were included in this study with sample size of 643. All selected studies are in accordance with the inclusion criteria. Forest plot of clinical characteristics was as follows: complications (RR = 1.132, 95% CI 0.942‒1.361, p = 0.186, I2 = 37.2%), mortality within 3 months (RR = 1.076, 95% CI 0.694‒1.669, p = 0.744, I2 = 0.00%), mRS ≤ 1 at 3 months (RR = 1.138, 95% CI 0.829‒1.563, p = 0.423, I2 = 26.0%), mRS ≤ 2 at 3 months (RR = 1.672, 95% CI 1.236‒2.263, p = 0.001, I2=49.6%) and mRS ≤ 3 at 3 months (RR = 1.518, 95% CI 1.128‒2.043, p = 0.006, I2 = 0.00%). The funnel plot suggested that there was no significant publication bias in the meta-analysis on complications, mortality within 3 months, mRS ≤ 1 at 3 months and mRS ≤ 2 at 3 months. Conclusion: In summary, the results showed that hypothermia treatment was correlated with mRS ≤ 2 at 3 months, but not linked with complications and mortality within 3 months.

Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

OBJECTIVES: We aim to assess the impact of early nocturnal blood pressure (BP) variation in the functional outcome of patients after an acute ischemic stroke. MATERIALS AND METHODS: We included consecutive stroke patients treated with intravenous thrombolysis (IVrtPA) in a tertiary stroke center. BP measurements were performed at regular intervals throughout day and night during the first 48 h after stroke onset, and subjects were divided into four dipping categories (extreme dippers, dippers, non-dippers, and reverse dippers). Recanalization was assessed by transcranial color-coded Doppler and/or angiographic CT. Hemorrhagic transformation was evaluated at 24 h follow-up CT scan. Functional outcome was evaluated at 3 months after stroke using the modified Rankin Scale. RESULTS: A total of 304 patients were included, mean age 72.80 ± 11.10 years. After 24 h of systolic BP monitoring, 30.59% were classified as reverse dippers, 39.14% as non-dippers, 19.10% as dippers, and 11.18% as extreme dippers. Multivariate analysis did not show an independent association of any dipping class with 3-month functional outcome. Hemorrhagic transformation was not uniform between dipping classes: 25.81% for reverse dippers, 14.29% for non-dippers, 15.52% for dippers, and 5.88% for extreme dippers, P = 0.033. CONCLUSIONS: Nocturnal BP dipping pattern is not associated with functional outcome at 3 months in acute stroke patients treated with IVrtPA. Hemorrhagic transformation was more frequent in reverse dippers.

Background: Ischemic stroke is a frequent neurologic complication of infective endocarditis. This systematic review aims to evaluate the efficacy and safety of thrombectomy in comparison to thrombolysis and to combined treatment in patients with infective endocarditis associated acute ischemic stroke. Methods: A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review included case reports, cases series, cross-sectional studies, case control studies, randomized controlled trials or nonrandomized controlled trials, which reported the treatment of endocarditis-related acute ischemic stroke with mechanical thrombectomy, intravenous or intra-arterial thrombolysis in adult patients. Data sources: Scielo, b-on, Pubmed and Cochrane, from inception to April 2019. Reference lists were also checked. We compared the efficacy (independence, neurological improvement) and safety (intracranial bleeding, death) of acute ischemic stroke treatment with thrombolysis, thrombectomy and combined therapy. Results: Through systematic review 37 articles describing 52 patients met criteria. The risk of intracranial hemorrhage was 4.14 times higher in patients treated with intravenous thrombolysis (P = .001) and 4.67 times higher in patients treated with combined treatment (P = .01). There was trend for independence (P = .09) and neurological improvement (P = .07) in favor of thrombectomy, when comparing this group to the group treated with intravenous thrombolysis. Conclusions: With the limitation of the low quality of the available evidence, thrombectomy in infective endocarditis associated stroke appears to be safer than thrombolysis, or combined treatment. These results may be useful to guide clinical decisions, in selected patients.

Introdução: O presente Relatório de Estágio surge no âmbito da Unidade Curricular Rela- tório, parte integrante do 6o Mestrado em Enfermagem em Associação, na área de especiali- dade Enfermagem Médico-Cirúrgica: A Pessoa em Situação Crítica. Objetivo: Descrever as atividades e estratégias desenvolvidas durante o percurso académico e Estágio Final e o seu contributo para o desenvolvimento e aquisição de competências comuns e específicas do enfermeiro especialista em Enfermagem Médico- Cirúrgica: A Pes- soa em Situação Crítica e de Mestre em Enfermagem. Metodologia: Método descritivo e análise crítico-reflexiva das atividades desenvolvidas du- rante a Unidade Curricular Estágio Final. O Projeto de Intervenção Profissional desenvolvido é igualmente descrito, com recurso à Metodologia de Projeto e baseado no Modelo para Mu- dança da Prática Baseada em Evidências de June Larrabee. . Resultados: Análise crítico-reflexiva de aquisição e desenvolvimento de competências so- bre as atividades desenvolvidas durante o Estágio Final em contexto de Unidade de Cuidados Intensivos. Promoção da qualidade e segurança dos cuidados prestados à Pessoa em Situação Crítica, em contexto do desenvolvimento de um Projeto de Intervenção Profissional, através da elaboração de um Protocolo de Atuação, Instrumento de Registo e produção de um Do- cumento de Consulta prático sobre o doente com AVC Isquémico submetido a trombólise. Conclusão: Promover a uniformização e uma melhoria da qualidade e segurança dos cuida- dosdeenfermagemprestadosaodoentecríticocomAVCIsquémicosubmetidoatrombólise, baseados em evidência científica. A elaboração deste relatório permitiu descrever todo o percurso formativo e realizar uma análise crítico-reflexiva fundamentada do processo de aquisição e desenvolvimento de competências.

Introdução: A isquémia mesentérica aguda é uma causa de ventre agudo associada a altas taxas de morbimortalidade. As recomendações atuais para tratamento inicial desta patologia incluem a revascularização endovascular ou cirúrgica, no entanto estas recomendações são baseadas em estudos retrospetivos com pequenas amostras. O objetivo deste trabalho é fazer uma revisão da literatura das técnicas de tratamento endovascular disponíveis, avaliando os seus resultados.Materiais e métodos: Em agosto de 2020 foi realizada uma pesquisa dos últimos 15 anos nas bases de dados PubMed e EMBASE, com recurso às palavras-chave "Mesenteric Ischemia [MeSH]", "Acute Disease [MeSH]", "Endovascular Procedures [MAJR]”, "Thrombectomy [MeSH]” e “Thrombolysis”. Foram excluídos artigos de revisão, revisões sistemáticas e meta-análises, guidelines, estudos de caso e artigos de opinião, estudos que não apresentassem pelo menos um dos outcomes pretendidos (sucesso técnico, sucesso clínico, taxa de recorrência, complicações e taxas de mortalidade) e artigos referentes a isquemia mesentérica de etiologia arterial com amostra inferior a 10 (n < 10).Resultados: De 482 registos inicialmente pesquisados foram incluídos 19 estudos nesta revisão, 14 referentes a isquémia mesentérica aguda de etiologia arterial e 5 a etiologia venosa. As taxas de sucesso técnico variaram entre 81 e 100% na etiologia arterial e foram de 100% na etiologia venosa, com sucesso clínico de 53 a 71,4% na etiologia arterial e de 87,5% a 100% na etiologia venosa. As taxas de mortalidade precoce variaram entre 9,5% e 44,7% na etiologia arterial e entre 0% a 12,5% na etiologia venosa.Conclusão: O uso de técnicas endovasculares mostrou ser uma opção viável no contexto de isquémia mesentérica aguda, contribuindo para uma melhoria nos outcomes desta patologia que continua a estar assocada a um prognóstico sombrio.

Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. Objectives: We compared the prognostic impact of MDCT-derived indices regarding mediumterm mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis. Methods: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. Results: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Followup all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term allcause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60---0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. Conclusions: MDCT gives the possibility, in a single imaging procedure, of diagnosing and assessing the prognosis of patients with intermediate- to high-risk PE. Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE.