Background Penetrating neck trauma poses a considerable threat to life due to the densely packed anatomy of vital neurovascular and aerodigestive structures. Accurate preoperative delineation of the spatial relationship between a penetrating object and adjacent critical structures is essential for surgical decision-making. Method In this report, we present two patients with complex penetrating injuries. Patient 1 sustained a stab wound to the neck and was managed with conventional non-contrast CT, which could not definitively exclude vascular contact, necessitating surgical exploration. Patient 2 sustained a transcranial-cervical-thoracic penetrating injury from a falling iron rod. Preoperative assessment included non-contrast multidetector CT and contrast-enhanced CTA with three-dimensional reconstruction, enabling visualization of the foreign body trajectory and its spatial relationship to major vessels, bones, and soft tissues within a unified three-dimensional model. Results In Patient 2, CTA confirmed vascular integrity, and three-dimensional reconstruction demonstrated that the iron rod was not in contact with major arteries. This preoperative spatial assessment guided the multidisciplinary team to adopt a direct extraction strategy under controlled conditions, thereby avoiding unnecessary cervical exploration. In Patient 1, the absence of contrast-enhanced vascular imaging precluded definitive exclusion of vascular contact, and surgical exploration was performed to verify vascular integrity. Conclusions Preoperative CTA with three-dimensional reconstruction may serve as a useful adjunct for surgical planning in selected, complex penetrating injuries by providing spatial information on the relationship between foreign bodies and critical neurovascular structures. Our illustrative cases suggest that comprehensive preoperative imaging assessment can support selective, multidisciplinary management strategies; however, its impact on clinical outcomes requires validation in larger cohorts.

RATIONALE AND OBJECTIVES:Incomplete occlusion after endovascular treatment (EVT) of intracranial aneurysms (IAs) increases the risks of re-rupture and retreatment. We aimed to develop and validate an interpretable multimodal machine learning model integrating quantitative digital subtraction angiography (QDSA) and radiomics features. MATERIALS AND METHODS:This dual-center study included an internal retrospective cohort (n = 1212), a prospective cohort (n = 246), and an external cohort (n = 327). The internal cohort was randomly divided into training and internal test sets at an 8:2 ratio. Clinical, morphological, QDSA-derived hemodynamic, and radiomics features were analyzed. Feature selection, SMOTE (Synthetic Minority Over-sampling Technique), five-fold cross-validation, and hyperparameter optimization were restricted to the training data. Eight algorithms were compared, and the incremental value of multimodal feature integration was assessed using DeLong tests. The primary performance metric was the area under the receiver operating characteristic curve (ROC-AUC), supplemented by the area under the precision-recall curve (PR-AUC), calibration measures, and decision curve analysis. Shapley Additive Explanations (SHAP) analysis was used for model interpretation, and the final model was implemented as a web-based decision-support calculator. RESULTS:The multimodal random forest model achieved ROC-AUCs of 0.861, 0.853, and 0.835 and PR-AUCs of 0.589, 0.657, and 0.439 in the internal test, prospective, and external cohorts, respectively. Sensitivity ranged from 0.550 to 0.683 and specificity from 0.847 to 0.881. The model outperformed the clinical and clinical-morphological models across all cohorts and showed generally preserved discrimination across clinical subgroups. Overall prediction error remained low, with Brier scores ranging from 0.117 to 0.148, while decision curve analysis demonstrated positive net benefit. SHAP analysis identified ruptured status, hypertension, cerebral blood flow ratio, Radscore, and treatment modality as important predictors. CONCLUSION:The multimodal model demonstrated stable discrimination across three cohorts. The web-based calculator provides individualized risk estimates from manually entered clinical and precomputed imaging-derived variables and may support risk-stratified surveillance planning.

Objective The objective of this study is to analyze a case of trigeminal neuralgia (TN) secondary to intracranial arteriovenous malformation (AVM), summarize reported cases of TN associated with cerebral vascular malformations, and discuss the experience with endovascular and other therapeutic modalities. Methods We analyzed our institutional case of cerebral AVM-induced TN and reviewed relevant literature on trigeminal neuralgia and AVM published between 1968 and 2022. A total of 47 consecutive cases of brain arteriovenous malformations (bAVMs) complicated by TN were identified through retrospective analysis of 47 treated bAVM cases. Clinical data, angiographic findings, and outcomes following endovascular and other treatments were evaluated. Results Among the 47 patients with TN associated with bAVMs, 11 underwent endovascular embolization: 10 achieved pain relief, and 1 showed initial symptomatic remission. Arterialization and ectasia of the superior petrosal vein (SPV) and its tributaries, which could explain trigeminal nerve compression, were observed in 24 cases. Venous hypertension in the ponto-trigeminal vein (a tributary of the SPV) appears to be one of the etiological factors of TN. Conclusions Consistent with previous publications, we propose that venous reflux into tributaries of the SPV—particularly the ponto-trigeminal vein—represents a key mechanism of TN caused by nerve compression. Currently, there is no consensus on the optimal treatment for cerebellar AVM-related TN; however, partial interventional embolization of the AVM nidus is considered a viable strategy to reduce blood flow and alleviate symptoms.

Purpose This study systematically evaluated five deep learning models to validate their consistency in deriving clinical morphological and quantitative digital subtraction angiography (QDSA) hemodynamic biomarkers. Method In this dual-center retrospective study (2,777 images; 1,539 patients), five models—UNet, VNet, DeepLabV3, SwinUNet, and TransUNet—were trained on an internal cohort (n = 1,212; split 6:4) and validated on an external cohort (n = 327). Beyond Dice coefficients, a comprehensive framework assessed algorithmic robustness and clinical reliability in deriving morphology and QDSA parameters—specifically cerebral blood flow, cerebral blood volume, mean transit time, and time-to-peak—using the Intraclass Correlation Coefficient (ICC). Results TransUNet achieved the highest Dice scores internally (0.839) and externally (0.878), significantly outperforming other models (all P < 0.001). TransUNet delivered consistent performance across imaging systems and remained the top-performing model in preoperative, postoperative, and coil-treated scenarios. Regarding morphological assessment, TransUNet yielded high agreement for height, width, and max dome diameter (ICC > 0.95), but it uniquely achieved high reliability for neck width (ICC > 0.82 externally), whereas other models exhibited instability. Furthermore, TransUNet achieved superior hemodynamic consistency, with ICCs ranging from 0.774 to 0.961 across all preoperative and postoperative hemodynamic parameters. Conclusion TransUNet establishes a new benchmark for automated angiographic analysis by combining local precision with global context. Its capability to generate reliable functional and geometric biomarkers suggests high potential for real-time intraoperative guidance.

OBJECTIVE:To describe a high resolution computed tomography (HRCT) guided, individualized planning technique for posterior internal auditory canal (IAC) wall drilling during retrosigmoid microsurgical resection of unilateral acoustic neuroma and to report anatomical and surgical outcomes in a retrospective observational case series. METHODS:This retrospective observational surgical techniques included 256 patients with unilateral acoustic neuroma who underwent preoperative and postoperative HRCT. Imaging data were acquired and analyzed using a workstation, and evaluation of the IAC and individualized surgical planning were based on preoperative HRCT. RESULTS:To preserve labyrinth integrity, the posterior IAC wall drilling angle (α) was planned on a patient-specific basis using preoperative HRCT. Across the cohort, the mean planed angle was 42.3° ± 7.6°. In this series, the IAC resection rate was 76.3% and the gross total resection rate was 94.1%, while labyrinth integrity was maintained in all patients. CONCLUSION:In this retrospective observational surgical techniques study, HRCT-based preoperative planning provided a practical framework for microsurgical resection of the posterior wall of the IAC in acoustic neuroma surgery. This approach is hearing-preservation-oriented and may support facial and vestibulocochlear nerve-preservation-oriented surgery; however, standardized postoperative audiometric outcomes were not uniformly available for formal hearing outcome analysis.

Background Stroke burden is unequally distributed, but global estimates do not show whether socially patterned cardiovascular-kidney-metabolic (CKM) risk contributes to this inequality. We linked country-level and individual-level evidence to examine geographic inequality, educational patterning of CKM risk, and CKM-stroke associations. Methods We analysed Global Burden of Disease Study 2023 estimates for stroke incidence, prevalence, deaths, disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2023 in 204 countries and territories. We calculated estimated annual percentage changes in age-standardized rates and, for 191 countries with 2023 Human Development Index (HDI) data, the slope index of inequality, relative index of inequality (RII), and concentration index. Individual-level analyses used CHARLS (China, 2011–2018), HRS (United States, 2006–2020), and NHANES (United States, 2005–2018). We estimated CKM prevalence and CKM-stroke associations across education groups; NHANES analyses incorporated examination weights, strata, and primary sampling units. Results In 2023, stroke accounted for 6.78 million deaths and 156.4 million DALYs. Age-standardized death and DALY rates declined from 1990 to 2023 (estimated annual percentage changes, -2.36% and − 2.15%), while incidence declined more slowly (-1.10%). Stroke mortality was concentrated in lower-HDI countries (RII, 0.30; concentration index, -0.156). Adjusted CKM stage 2 or higher prevalence was greater in the lowest than highest education groups in HRS (71.8% vs 66.1%) and NHANES (71.8% vs 65.9%); the CHARLS contrast was smaller and imprecise (66.8% vs 64.5%). CKM stage 2 or higher was associated with subsequent self-reported stroke in CHARLS (odds ratio (OR), 2.52; 95% confidence interval (CI), 2.11 to 3.00), subsequent stroke indicators in HRS (OR, 1.54; 95% CI, 1.35 to 1.76), and prevalent stroke in weighted NHANES (OR, 3.87; 95% CI, 2.70 to 5.55). Conclusions Global stroke mortality rates have fallen, yet mortality and disability remain concentrated in lower-development settings. Educational gradients in CKM risk were evident in US datasets but not clearly in CHARLS. Unequal CKM risk accumulation may be relevant to prevention, although these observational findings do not establish mediation.

Background : Cardiovascular-kidney-metabolic (CKM) syndrome links adiposity, metabolic dysfunction, chronic kidney disease, and cardiovascular disease within a single prevention framework. In older populations, stroke and death occur as competing and sequential outcomes, but conventional time-to-first-event models do not show whether CKM stage mainly accelerates incident stroke, death before stroke, or death after stroke. We examined modified CKM stages in relation to stroke-death transitions in middle-aged and older Chinese adults. Methods : We used data from the China Health and Retirement Longitudinal Study, with baseline in 2011 and follow-up through the 2013, 2015, 2018, and 2020 survey waves. Participants aged 45 years or older with baseline stroke were excluded. The primary cohort also excluded baseline clinical heart disease, allowing conservative analysis of modified CKM stages 0 to 3 without overlap between clinical cardiovascular disease and incident stroke. A three-state continuous-time multistate Markov model was fitted with stroke-free status, alive with stroke, and death as states. Allowed transitions were stroke-free to stroke, stroke-free to death, and stroke to death. The primary model adjusted for age, sex, education, marital status, current smoking, alcohol drinking, and urban hukou. Results : The primary Markov analysis cohort included 14,458 participants. In the primary adjusted model, 14,384 participants contributed 49,748 observation intervals, with 1,062 stroke-free to stroke transitions, 1,815 stroke-free to death transitions, and 110 stroke to death transitions. Compared with modified CKM stage 0, stage 2 and stage 3 were associated with higher transition intensities from stroke-free status to stroke, with intensity rate ratios of 1.84 (95% CI 1.51 to 2.24) and 3.30 (95% CI 2.57 to 4.24), respectively. Modified CKM stage was not materially associated with stroke-free to death transition after adjustment. Stage 3 was associated with higher post-stroke mortality intensity (IRR 2.73, 95% CI 1.34 to 5.59). Sensitivity analyses gave similar results. Conclusions : Advanced modified CKM stages were strongly associated with movement from stroke-free survival to incident stroke. The association was not explained by competing death before stroke, supporting modified CKM staging as a clinically interpretable framework for stroke prevention in ageing Chinese adults.

Insulin resistance and skeletal muscle depletion are recognized as synergistic contributors to vascular pathogenesis, yet their combined prognostic value for cerebrovascular outcomes has not been established. This study investigated the longitudinal association between the triglyceride-glucose muscle-loss index (TyG-MLI), a novel composite biomarker integrating these two pathological dimensions, and the risk of incident stroke and its subtypes. We analyzed 400,624 UK Biobank participants free of stroke at baseline. TyG-MLI was derived from fasting triglycerides, glucose, cystatin C, and creatinine. Primary endpoints were incident overall stroke, acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Multivariable cause-specific Cox regression was used to estimate hazard ratios (HRs) and 95

OBJECTIVE:Brainstem cavernous malformations (BSCMs) are associated with higher morbidity and mortality than cavernous malformations in other locations, and surgical management remains technically challenging. This study aims to evaluate the clinical manifestations, surgical decision-making, operative techniques, and postoperative outcomes of BSCMs, with emphasis on defining the value of an individualized approach based on lesion location, surgical timing, and intraoperative monitoring. METHODS:A retrospective analysis was conducted on 50 consecutive patients with BSCMs who underwent surgical treatment between January 2008 and December 2020. All patients had experienced one or more hemorrhagic events. Surgical indications, approaches, timing, and microsurgical techniques were individualized based on lesion characteristics. Clinical outcomes were assessed using the modified Rankin Scale (mRS) preoperatively and at 3, 6, 12, and 24 months postoperatively. Favorable outcome was defined as mRS 0-2. RESULTS:Among 50 patients (30 female, 20 males; mean age 41 years, range 14-56), the number of preoperative hemorrhages was 1 in 38 patients, 2 in 10 patients, and 3 in 2 patients. Lesion locations were midbrain (n = 12), pons (n = 25), and medulla oblongata (n = 13). Surgical approaches were selected based on lesion location and safe entry zones: suboccipital (n = 32), retrosigmoid (n = 8), subtemporal (n = 5), and far lateral (n = 5). Gross-total resection (GTR) was achieved in 48 patients (96%), and subtotal resection (STR) in 2 patients (4%). Two patients with initial GTR experienced rehemorrhage and underwent repeat surgery. No perioperative mortality occurred. At 24-month follow-up, all 50 patients achieved favorable outcomes (mRS 0-2). Median mRS scores improved from preoperative to 24-month follow-up across all locations. CONCLUSIONS:Surgical treatment of BSCMs can achieve favorable long-term outcomes with appropriate patient selection, individualized surgical approach, meticulous microsurgical technique, and intraoperative neurophysiological monitoring. Gross-total resection should be the goal when safely achievable, but individualized decision-making remains paramount.

Background: In the Carotid or Middle cerebral artery Occlusion Surgery Study (CMOSS), we found no significant difference between the bypass surgery group and the medical group with respect to the primary composite outcome of stroke or death within 30 days or any subsequent ipsilateral ischemic stroke within 2 years of follow-up. We now extend the long-term follow-ups to 10 years. Methods: We randomly assigned symptomatic patients with hemodynamically compromised internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion to extracranial-intracranial (EC-IC) bypass surgery plus medical treatment or medical treatment alone at 13 centers in China. We extended the follow-ups from the original 2 years to 10 years to assess long-term outcomes. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days after randomization. Results: 324 patients were assigned to the surgery (n=161) or medical group (n=163); the median duration of follow-up was 7.6 years (interquartile range [IQR], 2.3 to 9.2). The primary outcome occurred in 18 of 161 patients (11.2%) in the surgical group, significantly lower than that in the medical group (32 out of 163 patients [19.6%]; relative risk [RR], 0.57; 95% confidence interval [CI], 0.33 to 0.97; P=0.04). The risk of any stroke was 16.1% in the surgical group vs 23.3% in the medical group (RR, 0.76; 95% CI, 0.52 to1.13; P=0.15); the all-cause mortality was 8.1% in the surgical group vs. 8.6% in the medical group (RR, 0.94; 95% CI, 0.46 to 1.94]; P=0.93). Conclusions: Among symptomatic ICA or MCA occlusion patients with hemodynamic insufficiency, the addition of extracranial-intracranial bypass surgery to medical treatment was safe and led to a lower risk of recurrent stroke through 7 years of follow-up than medical treatment alone. (ClinicalTrials.gov number, NCT01758614.)

This study examines extracranial-intracranial bypass surgery plus medical treatment vs medical treatment alone in symptomatic patients with hemodynamically compromised internal carotid artery or middle carotid artery occlusion.

OBJECTIVE:In managing patients with unruptured intracranial aneurysms (UIAs), neurosurgeons primarily focus on assessing rupture risk and selecting appropriate treatment strategies. However, limited attention has been given to patients' preoperative psychological status and the prevalence of mental health disorders. This study aims to investigate the levels of preoperative anxiety and depression in patients scheduled for endovascular embolization for UIAs and identify potential risk factors contributing to these conditions. METHODS:A total of 121 patients diagnosed with UIAs and scheduled for embolization between January 2021 and June 2023 were enrolled. Preoperative evaluations were conducted using the Hospital Anxiety and Depression Scale (HADS), with demographic and clinical data, as well as anxiety and depression scores, systematically recorded. Chi-square tests and t-tests were used for univariate analyses, and logistic regression models were constructed to identify independent risk factors associated with preoperative anxiety and depression. RESULTS:Among the 121 participants, 42 (34.7 %) demonstrated borderline or clinical anxiety, while 40 (33.1 %) exhibited borderline or clinical depression. Logistic regression analysis identified age (OR: 0.945, 95 % CI: 0.906-0.986, P = 0.008), type of interventional therapy (OR: 2.706, 95 % CI: 1.124-6.516, P = 0.026), and preoperative clinical symptoms (OR: 4.188, 95 % CI: 1.780-9.852, P = 0.001) as independent risk factors for significant abnormalities in HADS-Anxiety (HADS-A). For preoperative depression, higher body mass index (BMI) (OR: 1.256, 95 % CI: 1.042-1.515, P = 0.017), preoperative clinical symptoms (OR: 3.597, 95 % CI: 1.532-8.444, P = 0.003), and ASA grade (OR: 1.897, 95 % CI: 1.113-3.233, P = 0.019) were identified as independent predictors of abnormal HADS- Depression (HADS-D) scores. CONCLUSIONS:A substantial proportion of patients with UIAs scheduled for endovascular treatment exhibit preoperative anxiety and depression. Independent risk factors for preoperative anxiety include age, type of interventional therapy, and preoperative symptoms. For depression, preoperative symptoms, BMI, and ASA grade are key contributors. These findings underscore the importance of targeted psychological assessment and support in this patient population.

Ischemic stroke (IS) is a severe disease. The altered activation states of microglia play important roles in IS. In present study, a total of 125 C57BL/6 mice was used (N = 6 per group). Middle cerebral artery occlusion (MCAO) and oxygen-glucose deprivation (OGD) were performed for in vivo and in vitro model construction. The infarct size was detected using TTC staining. The nerve injury was evaluated by a neurological deficit score. OGD-treated brain microvascular endothelial cells (BMECs) were co-cultured with BV2 cells. Cell viability was determined by CCK-8 assay, and the apoptosis rate was identified by flow cytometry analysis. Transendothelial electronic resistance (TEER) of the cells was measured by TEER measurement. Molecular interactions were analyzed using dual-luciferase reporter gene, ChIP, and Co-IP assays. All in vitro experiments were conducted with three replicates, and each experiment was performed in triplicate. We found that Src Homology 2B Adaptor Protein 3 (SH2B3) was overexpressed in the cerebral cortex tissues of MCAO treated mice (P < 0.01), and BMECs co-cultured with BV-2 cells under OGD conditions (P < 0.01). SH2B3 knockdown or Myocyte Enhancer Factor 2 A (MEF2A) overexpression reduced infarct size and improved neurological function in MCAO mice. SH2B3 knockdown enhanced OGD-treated cell viability (P < 0.05), inhibited cell apoptosis (P < 0.05) in BMECs, and ameliorated BBB (P < 0.01). Moreover, SH2B3 knockdown changed the activation status of microglia. MEF2A promoted the transcriptional activation of WW Domain Containing E3 Ubiquitin Protein Ligase 2 (WWP2) and WWP2 promoted the ubiquitination and degradation of SH2B3. SH2B3 overexpression reversed the effects of MEF2A overexpression on microglia states, BMECs injury and BBB function. In summary, MEF2A promoted the ubiquitination-mediated degradation of SH2B3 via transcription up-regulating WWP2, then changed the activation status of microglia, thus ameliorating BMEC injury, and finally ameliorating IS injury.

Background: Evidence from large, prospective studies in treating ruptured intracranial aneurysms (RIAs) using stent-assisted coiling (SAC) technique is lacking, biases and uncertainty regarding the safety of SAC persist. We aimed to evaluate the safety and efficacy of SAC compared to coiling alone (CA) for treatment RIAs. Methods: We conducted an observational registry of patients with subarachnoid hemorrhages (SAH) caused by RIAs treated with endovascular treatment at 33 centers from 20 provinces at China between April 2021 and February 2024. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at one-year follow-up. Multivariable logistic regression and propensity-score matching were performed to evaluate favorable functional outcome, perioperative complications and angiographic results. Results: Among the 3353 enrolled patients, the median age of patients is 58 years old (IQR, 50 - 66), 66.7% were female. After adjustment for confounders, there was no significant difference between SAC and CA in the rate of favorable functional outcomes (87.9% vs. 88.1%; adjusted odds ratio [aOR], 1.020 [95% CI, 0.820?1.270]). Compared with the CA group, the SAC group had a higher incidence of intraprocedural thrombosis (4.2% vs. 1.8%; aOR, 3.097 [95% CI, 1.950?4.920]) and postoperative cerebral infarction (9.7% vs. 8.2%; aOR, 1.293 [95% CI, 1.007?1.660]). At angiographic follow-up, the SAC group demonstrated a higher rate of complete occlusion (80.3% vs. 63.8%; aOR, 2.848 [95% CI, 2.344?3.460]) and a lower recurrence rate (7.7% vs. 20.4%; aOR, 0.289 [95% CI, 0.224?0.373]). Conclusions: Despite a more than two-fold increase in intraoperative thrombosis risk, SAC for RIAs achieved comparable functional and superior immediate and long-term angiographic outcomes to CA, supporting its status as a safe and effective strategy. Registration: https://www.chictr.org.cn, ChiCTR2000032657 Key points: Subarachnoid hemorrhage, intracranial aneurysms, Stent-assisted coiling, Complication ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial https://www.chictr.org.cn, ChiCTR2000032657 ### Funding Statement This work was supported by Natural Science Foundation of China ( 82171290, 81771233 ), Research and Promotion Program of Appropriate Techniques for Intervention of Chinese High-risk Stroke People ( GN-2020R0007 ), Beijing Natural Science Foundation ( 7222050, L192013 ), Beijing Municipal Science & Technology Commission Administrative Commission of Zhongguancun Science Park (20220484167), Ningxia Key Scientific and Technological Achievement Transformation Program (2024CJE09005) and Ningxia Nature Fund Key Program(2024AAC02066). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Beijing Tiantan Hospital, Capital Medical University I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data requests should be submitted to AL for consideration at liuaihuadoctor{at}163.com. Access to anonymised data may be granted following review.

Carotid atherosclerosis (CAS) is a significant factor in cerebrovascular disease; however, the lack of novel and reliable biomarkers hinders the current assessment of this condition. This study focuses on integrins in CAS to offer fresh ways for knowing about the disease. qRT-PCR was implemented to quantify the expression levels of intergrins in CAS. Subsequently, we used STRING and Friend analyses to identify integrin molecules from the differentially expressed genes and analyzed the correlation of these integrin molecules with immune. Finally, we examined immune subgroups of CAS and explored the roles of immune and integrin molecules in different subgroups. Immune analysis enunciation, macrophage was the predominant immune cell types in CAS plaques. Additionally, most immune checkpoint molecules possessed higher expression levels in CAS than in control group. Two subtypes, namely, C1 immune subtype and C2 nonimmune subtype, were classified across carotid atherosclerotic plaques. Through STRING and Friend analyses, ITGAX, ITGAM, and ITGB7 were intended to be pivotal molecules of CAS, and these integrin molecules were more highly expressed in the C1 subgroup. Furthermore, these integrin molecules were interrelated with the soakage of immunological cells and the immune regulatory molecules in CAS. Our findings identify several promising genes related to CAS and immune subtypes, offering new therapeutic targets for immunotherapy in CAS.

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening disease with high morbidity and mortality. The triglyceride–glucose (TyG) index, a marker of insulin resistance (IR), has been linked to adverse outcomes in cerebrovascular conditions; however, its influence on functional prognosis in aSAH remains unclear. This study aimed to elucidate the relationship between the TyG index and functional outcomes in aSAH patients. A retrospective cohort study included consecutive aSAH patients. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 3 months and categorized as favorable (mRS 0–2) or unfavorable (mRS 3–6). Univariate and multivariate logistic regression analyzed the association between the TyG index and functional outcomes. Propensity score matching (PSM) was used to mitigate confounding. Non-linear relationships were explored with restricted cubic splines (RCS), and subgroup analyses were performed. A nomogram integrating the TyG index and traditional prognostic scales was developed, and model predictive performance was compared using the area under the curve (AUC) on a test set. A total of 470 patients (61.7

BACKGROUND: Previous trials have failed to demonstrate the benefits of extracranial-intracranial (EC-IC) bypass surgery for patients with carotid or middle cerebral artery occlusion. However, little evidence has focused on the effect of age on prognosis. This study aimed to explore whether EC-IC bypass surgery can provide greater benefits than medical therapy alone in specific age groups. METHODS: A post hoc analysis was performed of the CMOSS (Carotid or Middle Cerebral Artery Occlusion Surgery Study), which was a randomized, open-label, outcome assessor-blinded trial conducted at 13 centers in China between June 2013 and March 2018. A total of 324 patients with internal carotid artery or middle cerebral artery occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency were randomized into a surgical group (n=161) that underwent EC-IC bypass surgery with medical therapy, and a medical group (n=163) that received antiplatelet therapy and stroke risk factor control alone. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days up to 2 years after randomization. Receiver operating characteristic curves were drawn to explore the optimal age boundary, and survival analyses were used to explore differences between groups. RESULTS: Among the 324 patients (median age, 52.7 years; 79.3% men), an age cutoff of 55.5 years predicted the primary outcome in the surgical group (area under the curve, 0.649 [95% CI, 0.530-0.769]). Patients were further divided into an older group (>55.5 years) and a younger group (<= 55.5 years). Younger patients who underwent bypass surgery showed a lower risk of the primary outcome (log-rank P=0.001) than older patients. Patients who underwent EC-IC bypass surgery had a lower risk than patients with medical therapy alone in the younger group (3.2% versus 11.6%; hazard ratio, 0.255 [95% CI, 0.071-0.916]; P=0.036), but not in the older group (17.5% versus 13.3%; adjusted hazard ratio, 0.597 [95% CI, 0.225-1.580]; P=0.298). CONCLUSIONS: In patients aged 55.5 years or younger with symptomatic atherosclerotic occlusion of the internal carotid artery or middle cerebral artery and hemodynamic insufficiency, the addition of EC-IC bypass surgery to medical therapy significantly improved prognosis. These findings suggest that the clinical application of EC-IC bypass surgery needs more research to explore refined patient selection criteria incorporating more clinical features.

The incidence of intracranial aneurysms (IAs) is markedly elevated in postmenopausal women compared to men and premenopausal women, a disparity historically linked to declining estrogen levels. Emerging evidence, however, suggests that the expression and functional roles of estrogen receptors (ERs), including ERα, ERβ, and GPER1, in vascular tissues may implicate estrogen-independent pathways in vascular aging and related pathologies. An integrative bioinformatics approach, combining three IA datasets (GSE75436, GSE122897, GSE54083) and two vascular endothelial cell senescence (VECS) datasets (GSE214476, GSE102397) from the Gene Expression Omnibus (GEO) database, was employed to investigate this hypothesis and define shared molecular mechanisms. This cross-disease differential expression analysis identified 452 significantly downregulated genes, suggesting conserved pathogenic pathways in IA and VECS. Among ERs, GPER1 was uniquely downregulated in both conditions. Subsequent weighted gene co-expression network analysis and subsequent module clustering revealed ACACB as a hub gene co-expressed with GPER1 and inversely correlated with IA and VECS progression. In vitro validation confirmed that GPER1 expression was reduced during VECS and that GPER1 silencing decreased ACACB expression and accelerated endothelial senescence, supporting its estrogen-independent role in vascular homeostasis. Computational pharmacological screening further identified PD0325901, SCH772984, and selumetinib as potential therapeutic agents targeting both GPER1 and ACACB, offering a dual-pathway therapeutic strategy. The identification of GPER1 and ACACB as potential target genes associated with IA and VECS provides a framework for developing therapies that circumvent hormone dependency, addressing an unmet need in the treatment of IA and age-related vascular pathologies.

Abnormal glycemic variability (GV), defined as acute fluctuations in blood glucose, is a prevalent phenomenon observed in critically ill patients and has been linked to unfavorable outcomes, including elevated mortality. However, the impact of this factor on patients with non-traumatic subarachnoid hemorrhage (SAH) remains unclear. The aim of this study is to explore the relationship between GV and all-cause mortality (ACM) in patients with non-traumatic SAH. All blood glucose measurements taken within the initial 72-h period following intensive care unit (ICU) admission for non-traumatic SAH patients were extracted. The coefficient of variation (CV) was employed to quantify GV, defined as the ratio of the standard deviation (SD) to the mean blood glucose. Patients were stratified into tertiles based on their GV. Furthermore, we assessed ACM at multiple timepoints, including at ICU, in-hospital, 30 days, 90 days, 180 days, and 1 year. The relationship between GV and ACM was analyzed using Cox proportional hazards regression models and restricted cubic splines (RCS). Kaplan–Meier survival curves were used to estimate survival across different GV groups. Subgroup analyses were performed to evaluate the robustness of the findings. The study cohort comprised a total of 1056 patients, of whom 55.6