Aim To investigate whether the traditional Chinese medicine (TCM) heat syndrome score (HSS), alone or in interaction with the National Institutes of Health Stroke Scale (NIHSS), provides additional prognostic information for 90-day functional outcomes in patients with large-artery atherosclerotic acute ischemic stroke (AIS). Methods A total of 149 patients with large-artery atherosclerotic AIS admitted to Xuanwu Hospital, Capital Medical University, between December 2017 and December 2023 were retrospectively included. Demographic characteristics, medical history, laboratory parameters, clinical scores, and inflammatory indices, the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation response index (SIRI), were collected or calculated. Multivariable logistic regression was used to evaluate factors associated with poor 90-day functional outcome (mRS ≥3). An interaction term (NH), defined as the product of mean-centered NIHSS and HSS, was evaluated in the prognostic model. Firth penalized logistic regression, subgroup and sensitivity analyses, ROC analysis, bootstrap internal validation, and restricted cubic spline analysis were additionally performed. Results Among 149 patients, 55 (36.9%) had a poor functional outcome at 90 days. HSS alone was not independently associated with poor outcome, whereas lnNLR remained independently associated with outcome after multivariable adjustment. NH was significantly associated with poor functional outcome in the primary model (OR = 1.072, P = 0.005), and the association remained robust in Firth penalized regression and sensitivity analyses. Adding NH to the Base model resulted in a modest numerical increase in discrimination (AUC = 0.795 vs. 0.760), although the difference was not statistically significant by DeLong’s test ( P = 0.098). Exploratory mediation analysis provided no evidence that C-reactive protein (CRP) mediated the association between NH and poor functional outcome. Conclusion The interaction between NIHSS and HSS was associated with 90-day functional outcome in patients with large-artery atherosclerotic AIS and may provide additional prognostic information beyond conventional clinical factors. However, its incremental predictive value was modest and requires confirmation in larger independent external validation cohorts before clinical implementation.
Background Patients with lower extremity fractures (LEF) are at high risk of preoperative venous thromboembolism (VTE). However, existing risk assessment models are not specifically developed and validated for this population. Objective To develop and validate a prediction model for preoperative VTE in emergency LEF patients, and to compare the performance of traditional logistic regression (LR) with that of machine learning (ML) algorithms. Design Retrospective cohort study. Setting Peking University Shenzhen Hospital, China. Participants 486 patients with LEF admitted between January 2022 and July 2025. Methods Two modeling strategies were compared: 1) a traditional LR nomogram using backward stepwise selection, and 2) nine ML algorithms with Least Absolute Shrinkage and Selection Operator (LASSO)-based feature selection. Model performance was evaluated using discrimination (area under the curve, AUC), calibration, classification metrics (accuracy, sensitivity, specificity) and decision curve analysis. Results Of 486 enrolled patients, 79 (16.3%) developed preoperative VTE. Among the ML models, LASSO-LR and multilayer perceptron (MLP) achieved the highest validation AUCs (0.709 each), the best calibration and highest net benefit. The traditional LR nomogram showed an identical AUC of 0.709 (95% CI: 0.691–0.718), with superior calibration (Hosmer-Lemeshow p = 0.738, calibration intercept = -0.109, slope = 0.921) and better stability. Therefore, this simple five-predictor traditional LR nomogram, incorporating age ≥ 65 years, hemoglobin, glucose, external immobilization, and pre-injury anticoagulant or antiplatelet use, was selected as the optimal model. Conclusion The traditional LR nomogram appears promising for preoperative VTE risk prediction in LEF patients. External validation is warranted before clinical implementation.
Background Serum albumin (ALB) and neutrophil-to-lymphocyte ratio (NLR) are linked to adverse cardiovascular outcomes, but few studies have used ALB/NLR (ANLR) to assess mortality risk in atherosclerotic cardiovascular disease (ASCVD). This study evaluated the nonlinear association between ANLR and all-cause mortality (ACM) and cardiovascular mortality (CVM) in ASCVD patients. Methods This study was grounded in data from the National Health and Nutrition Examination Survey spanning 1999 to 2018. Results The study cohort comprised 2,918 participants. During the follow-up period, 1,231 all-cause deaths and 454 cardiovascular deaths occurred. Kaplan-Meier survival analysis showed that a lower ANLR (Q1) was associated with worse survival outcomes (ACM and CVM: log-rank test P < 0.001). Multivariate Cox regression showed a significant inverse association between ANLR and the risk of ACM (hazard ratio [HR] = 0.883, 95% confidence interval [CI]: 0.810-0.964, P = 0.005). After ANLR was grouped according to quartiles, the risk of CVM in the Q2-Q4 groups was significantly lower than that in the Q1 group. Restricted cubic spline analysis further revealed a nonlinear negative link between ANLR and the risk of ACM (P for nonlinear < 0.001), and the risk rose sharply when ANLR < 1.8, suggesting this value may be a practical cutoff for identifying high-risk individuals. Additionally, the elevated risk observed at ANLR > 3.816 may reflect a U-shaped association rather than measurement error alone. Conclusions ANLR was significantly and negatively associated with the risk of ACM and CVM in ASCVD, and there was a nonlinear threshold effect. This finding provides an economical biomarker for identifying high-risk individuals and assessing the prognosis of ASCVD. Nonetheless, longitudinal studies are needed to verify these findings.
Background Survivors of spontaneous intracranial hemorrhage (ICH) with atrial fibrillation (AF) face competing risks of thromboembolism and recurrent bleeding. Evidence directly comparing individual direct oral anticoagulants after resumption is limited. Methods Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of adults with AF who restarted apixaban or rivaroxaban after spontaneous ICH. The index date was DOAC resumption, and cohorts were matched 1:1 using propensity scores. Recurrent spontaneous ICH was assessed at 30, 90, 180, and 365 days. One-year secondary outcomes were ischemic stroke, all-cause mortality, major bleeding, and gastrointestinal bleeding. Cox models produced hazard ratios (HRs) with 95% confidence intervals, with log-rank testing. Results At 1 year, recurrent spontaneous ICH occurred in 141 (34.9%) apixaban-treated and 135 (33.4%) rivaroxaban-treated patients (HR 1.076, 95% CI 0.850-1.363; P = 0.542). No significant differences were detected at 30, 90, or 180 days. One-year ischemic stroke (HR 1.109, 95% CI 0.863-1.424), all-cause mortality (HR 1.336, 95% CI 0.937-1.903), major bleeding (HR 1.074, 95% CI 0.861-1.339), and gastrointestinal bleeding (HR 1.480, 95% CI 0.844-2.597) also did not differ. A day 31-365 sensitivity analysis was consistent (HR 1.02, 95% CI 0.77-1.36; P = 0.868) . Conclusions In this propensity score-matched real-world cohort, no statistically significant differences were detected between apixaban and rivaroxaban for recurrent spontaneous ICH or major clinical outcomes after anticoagulation resumption. These findings concern the choice of agent among patients in whom resumption has already been decided; anticoagulation after spontaneous ICH remains an unproven strategy, and enrolment in randomized trials is preferred where available.
We read the study by Walczewski et al. The authors used the LATTEE registry to evaluate left atrial appendage (LAA) thrombus predictors. They call for comprehensive echocardiographic evaluation. We agree. Their analysis covers both sexes. Building on this, we highlight a shared diagnostic pitfall. The issue arises during the initial transthoracic echocardiography (TTE). Clinicians can misidentify the “Coumadin Ridge” (fold of Marshall) as a thrombus. This anatomical illusion affects men and women alike. It happens primarily in dilated left atria.
