Acute symptomatic seizures as the main manifestation of contrast-induced encephalopathy are relatively uncommon. A 50-year-old woman was admitted to our hospital with an unruptured right middle cerebral artery bifurcation aneurysm and underwent elective endovascular stent-assisted coiling. The interventional procedure was uneventful; however, she developed generalized tonic-clonic seizures consistent with status epilepticus on the first postoperative day. A computed tomography scan obtained on postoperative day 1 revealed mild edema in the right cerebral hemisphere, suggestive of contrast-induced encephalopathy. Following prompt antiepileptic therapy and supportive care, the patient achieved complete neurological recovery without residual deficits. By reporting this case and reviewing relevant literature, we summarize the clinical characteristics of contrast-induced encephalopathy presenting primarily with seizures, thereby providing clinical evidence to assist clinicians in the early diagnosis and optimal management of this condition.

Background:The value of hemodynamics in intracranial atherosclerotic stenosis (ICAS) patients has not been fully studied. The purpose of this study was to analyze the correlation between fractional flow (FF) and hypoperfusion in patients with ICAS of the anterior circulation, and compare the performance differences between FF and diameter stenosis (DS) in distinguishing hypoperfusion. Methods:This study included patients with anterior circulation artery stenosis. The determination of cerebral perfusion stages and the calculation of perfusion parameters were based on the magnetic resonance imaging (MRI) perfusion images. The patients were divided into a normal perfusion group and a hypoperfusion group (stages I and II). DS and FF values were calculated on the basis of digital subtraction angiography images. Results:We analyzed 58 patients. FF was negatively correlated with relative time to peak (r=-0.41, P=0.002) and relative mean transit time (r=-0.27, P=0.037). In groups with a larger time to maximum tissue residue function, FF had a lower distribution interval. FF was significantly different between normal perfusion patients and hypoperfusion patients (0.71±0.17 vs. 0.52±0.18, P<0.05), while DS was not (0.66±0.17 vs. 0.54±0.13, P=0.087). Multivariate analysis indicated FF (odds ratio, 0.08; 95% confidence interval: 0.01-0.80) was the only independent factor. Receiver operating characteristic analysis revealed the area under the curve for differentiating hypoperfusion from normal perfusion. The areas under the curve were 0.739 (0.597-0.850) for DS and 0.772 (0.632-0.876) for FF. The accuracy, sensitivity and specificity at the optimal cutoff (FF=0.61) were 76.6% (58.8-92.1%), 76.4% (56.5-93.3%) and 78.7% (58.3-95.8%), respectively. Conclusions:There is a correlation between MRI perfusion and FF in patients with anterior circulation ICAS. A low FF may indicate a higher time to maximum tissue residue function and a poorer hypoperfusion stage. FF provides hemodynamic information that is distinct from and complementary to the anatomical assessment of DS. The ability to compute FF intraoperatively could, in the future, provide real-time feedback on physiological improvement following revascularization.

Importance Transradial access (TRA) has emerged as a promising alternative to standard transfemoral access (TFA) for interventional cardiac procedures, but its application for examination of the cerebral circulation has not been tested in a clinical trial. Objective To compare the efficacy and safety of TRA with TFA for diagnostic cerebral angiography. Design, Setting, and Participants This investigator-initiated, multicenter, open-label, noninferiority randomized clinical trial with a blinded outcome assessment was conducted at 13 sites in China. Patients eligible for cerebral angiography were randomized between September 15, 2023, and November 4, 2024, with final follow-up performed on November 27, 2024. The primary analysis was performed in the intention-to-treat population; secondary analyses were performed in the per-protocol population. Interventions Patients were randomly allocated to TRA (n = 431) or TFA (n = 430) for diagnostic cerebral angiography. Main Outcomes and Measures The primary outcome was the success of diagnostic cerebral angiography. Secondary outcomes were success in achieving an accurate diagnosis, duration of angiography and fluoroscopy, time in bed, and patient-reported satisfaction on an 11-point visual analog scale for pain (ranging from 0 [none] to 10 [worst possible]) within 24 hours after the procedure. The noninferiority margin was an absolute difference of 5% in success of angiographic diagnosis and success of accurate diagnosis. Results A total of 858 patients (median age, 58.4 [IQR, 52.0-67.0] years; 479 [55.8%] male) completed the trial. Success of diagnostic cerebral angiography in the TRA group was lower than that in the TFA group (392 of 431 [91.0%] vs 409 of 427 [95.8%]; difference, −4.8 percentage points [pp] [95% CI, −8.1 to −1.5 pp]; relative risk [RR], 0.95 [95% CI, 0.92-0.98]; P = .46 for noninferiority test). The success rate of accurate diagnosis was 78.9% in the TRA group vs 91.1% in the TFA group (difference, −12.2 pp [95% CI, −16.9 to −7.5 pp]; RR, 0.87 [95% CI, 0.82-0.92]; P = .99 for noninferiority test). Compared with the TFA group, the TRA group had longer median times for angiography (33.7 [IQR, 23.0-40.0] vs 38.7 [IQR, 26.0-47.0] minutes; P < .001) and fluoroscopy (10.6 [IQR, 5.6-12.9] vs 11.8 [IQR, 6.2-15.0] minutes; P = .02); the TRA group had significantly shorter median time in bed (188.4 [IQR, 3.0-180.0] vs 1079.0 [IQR, 842.0-1366.0] minutes; P < .001) and lower median pain scores (0.5 [IQR, 0.0-1.0] vs 0.7 [IQR, 0.0-1.0]; P < .001). Overall angiography complications were comparable between the groups (19 of 445 [4.3%] vs 25 of 413 [6.1%]; P = .28), but TRA had more radial artery puncture failures than TFA. Conclusions and Relevance In this randomized clinical trial of patients undergoing diagnostic cerebral angiography, TRA was not shown to be noninferior to TFA with regard to the success rate of diagnostic cerebral angiography. Additional research, including superiority trials, is needed to clearly define the comparative benefits of TRA and TFA. Trial Registration ClinicalTrials.gov Identifier: NCT05401669

Importance:Transradial access (TRA) has emerged as a promising alternative to standard transfemoral access (TFA) for interventional cardiac procedures, but its application for examination of the cerebral circulation has not been tested in a clinical trial. Objective:To compare the efficacy and safety of TRA with TFA for diagnostic cerebral angiography. Design, Setting, and Participants:This investigator-initiated, multicenter, open-label, noninferiority randomized clinical trial with a blinded outcome assessment was conducted at 13 sites in China. Patients eligible for cerebral angiography were randomized between September 15, 2023, and November 4, 2024, with final follow-up performed on November 27, 2024. The primary analysis was performed in the intention-to-treat population; secondary analyses were performed in the per-protocol population. Interventions:Patients were randomly allocated to TRA (n = 431) or TFA (n = 430) for diagnostic cerebral angiography. Main Outcomes and Measures:The primary outcome was the success of diagnostic cerebral angiography. Secondary outcomes were success in achieving an accurate diagnosis, duration of angiography and fluoroscopy, time in bed, and patient-reported satisfaction on an 11-point visual analog scale for pain (ranging from 0 [none] to 10 [worst possible]) within 24 hours after the procedure. The noninferiority margin was an absolute difference of 5% in success of angiographic diagnosis and success of accurate diagnosis. Results:A total of 858 patients (median age, 58.4 [IQR, 52.0-67.0] years; 479 [55.8%] male) completed the trial. Success of diagnostic cerebral angiography in the TRA group was lower than that in the TFA group (392 of 431 [91.0%] vs 409 of 427 [95.8%]; difference, -4.8 percentage points [pp] [95% CI, -8.1 to -1.5 pp]; relative risk [RR], 0.95 [95% CI, 0.92-0.98]; P = .46 for noninferiority test). The success rate of accurate diagnosis was 78.9% in the TRA group vs 91.1% in the TFA group (difference, -12.2 pp [95% CI, -16.9 to -7.5 pp]; RR, 0.87 [95% CI, 0.82-0.92]; P = .99 for noninferiority test). Compared with the TFA group, the TRA group had longer median times for angiography (33.7 [IQR, 23.0-40.0] vs 38.7 [IQR, 26.0-47.0] minutes; P < .001) and fluoroscopy (10.6 [IQR, 5.6-12.9] vs 11.8 [IQR, 6.2-15.0] minutes; P = .02); the TRA group had significantly shorter median time in bed (188.4 [IQR, 3.0-180.0] vs 1079.0 [IQR, 842.0-1366.0] minutes; P < .001) and lower median pain scores (0.5 [IQR, 0.0-1.0] vs 0.7 [IQR, 0.0-1.0]; P < .001). Overall angiography complications were comparable between the groups (19 of 445 [4.3%] vs 25 of 413 [6.1%]; P = .28), but TRA had more radial artery puncture failures than TFA. Conclusions and Relevance:In this randomized clinical trial of patients undergoing diagnostic cerebral angiography, TRA was not shown to be noninferior to TFA with regard to the success rate of diagnostic cerebral angiography. Additional research, including superiority trials, is needed to clearly define the comparative benefits of TRA and TFA. Trial Registration:ClinicalTrials.gov Identifier: NCT05401669.

Acute ischemic stroke is a major cause of death and disability, and post-stroke cognitive impairment remains a major clinical challenge. Cardioembolic stroke (CES), often associated with atrial fibrillation, is closely linked to cognitive decline. Increasing evidence suggests that vascular dysfunction contributes to both vascular cognitive impairment and Alzheimer's disease (AD), but the shared molecular basis remains unclear. This study aimed to identify shared molecular signatures and candidate biomarkers linking CES and AD. Gene expression datasets were obtained from the Gene Expression Omnibus database. Differentially expressed genes were identified using limma, and disease-related gene modules were constructed using weighted gene co-expression network analysis. Functional enrichment analyses were performed to explore shared pathways. Three machine learning algorithms-LASSO, SVM-RFE, and random forest-were used to prioritize candidate genes. Receiver operating characteristic analysis, nomogram modeling, single-gene gene set enrichment analysis, and external validation were performed to evaluate the potential relevance of the identified gene. Seven overlapping genes were identified between CES and AD. Among them, SCRIB was consistently selected by the integrated feature-selection workflow and showed moderate diagnostic performance in both internal datasets. Supportive validation was observed in an independent AD dataset and in an atrial fibrillation-related surrogate validation cohort. SCRIB may represent a shared transcriptomic biomarker candidate linking CES and AD. These findings provide preliminary transcriptomic evidence for a potential molecular link between cerebrovascular pathology and neurodegeneration, but further mechanistic and clinical validation is required.

Objective:To provide a solid foundation for the prevention, treatment, and reduction of the incidence of nerve injury, we explain and update the changes in the epidemiology of nerve injury from 1990 to 2021. Methods:We did our analysis employing the 2021 Global Burden of Disease, Injury and Risk Factor Study to calculate the incidence, prevalence and YLDs of nerve injury between 1990 and 2021 at the global, regional and national levels. The analysis was done according to gender, age group and region in layers. Results:In 2021, globally, there were 4.13 million [95% uncertainty interval (UI): 3.11-5.56] instances of nerve injury, featuring an age-standardized incidence and prevalence of 53 cases per 100,000 people, respectively (95% UI: 40-72) and 51 cases per 100,000 people (95% UI: 47-57). The global age-standardized incidence had an Average Annual Percent Change (AAPC) of -1.03% (95% UI: -1.38 - 0.68, p < 0.01), and the prevalence had an AAPC of -0.99% (95% UI, -1.06 - 0.93, p < 0.01), both showing a slightly decreasing trend. In 2021, nerve injury resulted in 440,000 (95% UI, 0.3-0.6) YLDs, with an age-standardized rate of 5.26 cases per 100,000 people (95% UI, 3.63-7.2). In 2021, the countries with relatively higher rates are predominantly located in the Caribbean and Oceania. The main causes of nerve injury are falls and exposure to mechanical forces. The global age-standardized incidence in 2021 is higher in men than in women. In most regions, changes in aging, epidemiological situations, and population characteristics are the main factors contributing to the variations in the incidence rate of nerve injury. Conclusion:This study focused on the occurrence of nerve injury from 1990 to 2021, and discovered that the global incidence rate went down a little, different SDI areas and regions had big differences, and the prevalence rate increased in some regions. It provides strong support for further exploring the causes of nerve injury and formulating future policies and protection measures.

OBJECTIVE:Fractional flow (FF) reserve has been developed as a gold standard for coronary intervention. Intracranial FF is also a valuable hemodynamic index to assess the severity of narrowing in intracranial atherosclerotic stenosis (ICAS). This study aims to investigate the predictive value of FF in assessing restenosis following endovascular treatment in patients with symptomatic ICAS. METHODS:This retrospective study recruited 67 patients with symptomatic ICAS who received intracranial stenting between March 2019 and January 2024. FF was measured by dedicated software (AccuICAD) before and after stenting. During follow-up, patients were categorized into two groups based on the occurrence of in-stent restenosis (ISR): ISR group and non-ISR group. Multivariate regression analysis and Kaplan-Meier survival analysis were performed to identify the predictive factors for ISR. RESULTS:Post-FF was significantly different between the ISR and non-ISR groups (0.84±0.09 vs 0.92±0.06, respectively, P<0.01). Univariate and multivariate Cox regression analyses identified post-FF (HR 0.0, 95% CI 0.0 to 0.08, P=0.005) and smoking (HR 3.06, 95% CI 1.02 to 9.19, P=0.047) as the two predictors of ISR. Receiver operating characteristic curve analysis confirmed the predictive value of post-FF for ISR (AUC=0.783, 95% CI 0.645 to 0.920, P=0.003), with a cut-off value of 0.94. Kaplan-Meier survival analysis further demonstrated that patients with a post-FF value >0.94 had a significantly lower incidence of ISR (P=0.001). CONCLUSION:In this study, post-FF effectively predicted ISR, providing an intraoperative evaluation value for stenting in ICAS.

BACKGROUND:Vertebral artery origin stenosis (VAOS) is a common cause of posterior circulation ischemic events, and endovascular treatment serves as an alternative treatment. However, conventional endovascular treatment methods are related to high risk of restenosis. It is unclear whether the drug-coated balloon (DCB) can reduce restenosis risk of VAOS. METHODS:This was a prospective, multicenter, randomized trial conducted from 6 January 2020 to 1 October 2023 in China. Symptomatic patients with severe VAOS were randomly allocated in a 1:1 ratio to undergo either DCB or bare-metal stent (BMS) and followed up for 12 months. The primary safety endpoint was the incidence of transient ischemic attack, stroke, or death related to target vessel within 30 days post-procedure. The primary efficacy endpoint was the rate of 12-month restenosis. RESULTS:A total of 179 patients were enrolled with 91 in the DCB group and 88 in the BMS group. No significant difference was observed in the rates of transient ischemic attack, stroke, or death related to target vessel within 30 days between the DCB and BMS groups (0 (0.0%) vs. 1 (1.1%); P = 0.49). The 12-month restenosis rate was significantly lower in the DCB group compared to the BMS group (10/76 (13.2%) vs. 27/76 (35.5%); risk ratio = 0.37; 95% confidence interval = 0.19 to 0.71; P = 0.001). CONCLUSION:This trial demonstrated that DCB may reduce restenosis risk in symptomatic patients with severe VAOS compared to BMS. REGISTRATION:URL: https://clinicaltrials.gov (unique identifier: NCT03910166).

Background: The neutrophil percentage-to-albumin ratio (NPAR) is an emerging inflammatory biomarker that has demonstrated a significant association with poor outcomes in patients with cardiovascular diseases. However, the existing evidence regarding its prognostic value in ischemic stroke (IS) patients remains limited. Our study aimed to investigate the potential of the NPAR as a prognostic indicator for all-cause mortality in patients with IS. Methods: This study screened IS patients from the Medical Information Mart for Intensive Care (MIMIC-IV) database and categorized them into two groups based on NPAR values, employing propensity score matching to mitigate confounding factors. The primary outcome assessed was 90‒day mortality, and the secondary outcomes included in-hospital mortality, ICU mortality, and mortality at 30‒day and 1‒year after admission. Cox proportional hazards regression analysis and restricted cubic splines were used to explore the relationship between the NPAR and all-cause mortality in critically ill IS patients, whereas Kaplan‒Meier analysis was used to estimate survival curves. Subgroup analysis and interaction tests were performed to evaluate the robustness of the results. Receiver operating characteristic curves were computed to assess the diagnostic value of the NPAR in predicting outcomes. Results: A total of 706 patients (53.3% male) were included in the study, with in-hospital and ICU mortality rates of 18.2% and 12.6%, respectively. The mortality rates at 30‒day, 90‒day, and 1‒year were 19.2%, 29.7%, and 37.8%, respectively. Restricted cubic splines indicated a nonlinear increase in all-cause mortality as the NPAR increased. Multivariate Cox regression analysis revealed a significant association between a high NPAR and all-cause mortality at 90‒day (hazard ratio [HR]: 1.99; 95% confidence interval [95% CI]: 1.44-2.76, p < 0.001), 30‒day (HR: 2.09; 95% CI: 1.39-3.13, p < 0.001), and 1‒year (HR: 1.77; 95% CI: 1.32-2.37, p < 0.001). The subgroup analysis indicates that a significant interaction was observed between hypertension and mortality risk in IS patients (p for interaction = 0.012), suggesting that hypertension may be an important predictor of poor prognosis in these patients. Receiver operating characteristic curves demonstrated that the NPAR provides a modestly greater ability to predict the risk of death in patients with IS compared to the individual indices of neutrophil percentage and albumin levels, although the specificity (0.567) and sensitivity (0.684) of NPAR were not outstanding overall. Conclusion: Our study revealed an independent association between a high NPAR and increased all-cause mortality at 30‒day, 90‒day, and 1‒year and during hospitalization in patients with IS, reinforcing its status as an independent determinant of mortality risk.

OBJECTIVE:Cerebral small vessel disease (CSVD) impairs cognitive function, yet its treatment remains challenging due to the variability in MRI findings. This study aimed to investigate the heterogeneous mechanisms underlying CSVD by integrating whole-brain vessel wall imaging (WB-VWI) and blood biomarkers. METHODS:A retrospective analysis was conducted on patients who underwent WB-VWI between January 2020 and September 2024. Vessel wall characteristics and CSVD manifestations, including white matter hyperintensities (WMH), lacunes, and enlarged perivascular spaces (EPVS), were evaluated using MRI. Correlation and regression analyses examined the associations between vessel wall characteristics and CSVD manifestations, while mediation analysis explored the role of vessel wall characteristics in linking blood biomarkers to CSVD. RESULTS:206 patients were analyzed finally. After adjusting for confounders, a higher plaque burden index was associated with greater WMH burden (β = 1.916, padj < 0.001), more lacunes (β = 1.980, padj = 0.013), and increased basal ganglia EPVS (Estimate = 2.910, padj = 0.035). Multivariable regression revealed that only vessel wall enhanced ratio was positively correlated with WMH burden (β = 0.568, padj < 0.001). Additionally, neutrophil percentage correlated with both plaque burden index (r = 0.233, p = 0.001) and WMH burden (r = 0.308, p < 0.001), with plaque burden index mediating the relationship between neutrophils and WMH burden (β = 0.0061, Bootstrapped 95 % CI: 0.0019-0.0105). CONCLUSION:Atherosclerosis may be a common underlying factor in the imaging manifestations of CSVD, with inflammation contributing to its heterogeneity. Further research is needed to clarify these mechanisms.

BackgroundLow-density lipoprotein cholesterol (LDL-C) is a public health concern linked to ischemic stroke. The study aimed to describe the epidemiological characteristics of ischemic stroke attributable to high LDL-C from 1990 to 2021.MethodsIn this study, we analyzed data from the Global Burden of Disease 2021 to present trends in ischemic stroke related to high LDL-C over the past 30 years. The relationship between disease burden and the Socio-Demographic Index (SDI) was examined. To assess international health disparities, we applied the Slope Index of Inequality (SII) and the Concentration Index (CI). Furthermore, we conducted a frontier analysis to identify areas for improvement and developmental gaps among nations, and employed the Bayesian Age-Period-Cohort (BAPC) model to forecast the disease burden for the next 15 years.ResultsIn 2021, the incidence of ischemic stroke attributed to high LDL-C significantly increased compared to 1990, with a more pronounced growth rate in males. The burden mainly affects individuals aged 70 to 84. Analysis using the age-period-cohort model indicates that mortality rates and DALYs rise with age, while period and cohort effects exhibit a gradual decline. Across different SDI regions, trends generally follow a similar downward path, with a narrowing gap in disease burden among regions with varying SDI levels. However, the disease burden in high SDI countries remains significant, indicating potential for reduction. Predictions for the next 15 years suggest that while the global disease burden will decrease, there may be an increase among individuals under 55.ConclusionCompared to 1990, the overall age-standardized burden of ischemic stroke related to high LDL-C has been controlled. However, disparities persist across different SDI regions. We have observed an increasing burden among younger populations. Consequently, countries and regions must adopt new measures tailored to their SDI levels, with a specific emphasis on younger individuals. It is essential to develop prevention and treatment strategies aimed at high-risk groups.

OBJECTIVES To conduct a comprehensive comparative assessment of clinical performance between the novel TaminoVIA intracranial stent system and the established LVIS for endovascular aneurysm reconstruction in unruptured intracranial aneurysms (UIAs). METHODS This prospective, multi-center, randomized, open-label, parallel positive-controlled, non-inferiority trial was conducted by 13 centers in China. Patients with unruptured IAs were randomized in a 1:1 ratio to receive EVT with the TaminoVIA stent or the LVIS stent. The primary outcome was successful occlusion at 6-month follow-up, assessed by a blinded core laboratory. The non-inferiority boundary was set at 12%. Secondary outcomes included immediate procedural success, recanalization rates, and safety endpoints. RESULTS Between March 2022 and April 2024, 203 patients were enrolled and randomized. Per-protocol set (PPS) analysis revealed that a 6-month successful occlusion rate of 98.89% (89/90) in the TaminoVIA stent group, compared to 95.60% (87/91) in the LVIS stent group, with a difference of +3.28% (95% CI, -1.45% to 8.02%; P<0.01). Full Analysis Set (FAS) analysis showed a 6-month successful occlusion rate of 89.90% (89/99) in the TaminoVIA stent group, compared to 87.00% (87/100) in the LVIS stent group, with a difference of +2.90% (95% CI, -5.97% to 11.77%; P<0.01). Both PPS and FAS analyses exceeded the non-inferiority boundary. Immediate occlusion rates were comparable (68.89% vs. 61.54%; P=0.35), and recanalization rates at 6 months were identical (1.11% vs. 1.10%; P>0.99). CONCLUSIONS The TaminoVIA stent demonstrated non-inferiority to LVIS in both efficacy and safety for IA embolization, with superior 6-month occlusion rates. These findings support its clinical adoption, though long-term durability requires further validation.Clinical Trial registration number: ChiCTR2400092436

OBJECTIVE:To investigate the efficacy and safety of flow diverters (FDs) guided by AneuGuide software in treating complex intracranial aneurysms. METHODS:A retrospective analysis was conducted on 45 patients diagnosed with 48 complex intracranial aneurysms from August 2019 to December 2023. Among these, 21 aneurysms were treated with FDs implantation guided by AneuGuide software (ArteryFlow Technology, Hangzhou, China), and 27 aneurysms received FDs treatment without AneuGuide assistance. Immediate postoperative embolization rates, complication incidences, and clinical and imaging follow-up results were compared between the 2 groups. RESULTS:A total of 49 FDs were implanted for the 48 aneurysms in the 45 patients, with 10 patients receiving additional coil embolization. No perioperative complications occurred. At 1-year follow-up, angiography showed: 9 aneurysms (18.8%) were grade B (partially visible), and 39 aneurysms (81.3%) were grade C or D (near-total occlusion), of which 37 (77.1%) were completely occluded (grade D). Multivariate cox regression analysis revealed that the AneuGuide group had a significantly higher complete occlusion rate at follow-up compared to the non-AneuGuide group (hazard ratio = 2.290, P = 0.044). One patient in the non-AneuGuide group developed in-stent stenosis without clinical symptoms. No new neurological deficits were observed in any of the patients during the follow-up period. CONCLUSIONS:FD placement for complex intracranial aneurysms assisted by AneuGuide software is a safe and effective treatment. Further prospective studies are needed to validate these findings.

Non-traumatic intracerebral hemorrhage (ICH) is the most common type of hemorrhagic stroke. The therapeutic effects of dexamethasone in ICH patients remain unclear. This study aimed to examine the association of dexamethasone use with the all-cause mortality rate in critically patients with ICH. This was a retrospective cohort study based on the Medical Information Mart for Intensive Care (MIMIC-IV) database. Eligible ICH patients were selected and divided into two groups on the basis of whether they received dexamethasone treatment during their hospitalization. A 1:1 propensity score matching was applied. The relationship between dexamethasone and mortality was analyzed using the Kaplan-Meier method. LASSO regression was used to select covariates for the Cox regression model, and the proportional hazards assumption of the Cox model was assessed using the Schoenfeld residuals test. Time-dependent covariates were applied to variables that did not meet the proportional hazards assumption. Sensitivity analysis and subgroup analyses, along with interaction tests, were conducted to account for potential confounding factors. A restricted cubic spline analysis and subsequent survival analysis were performed to explore the dose-dependent relationship between dexamethasone use and mortality in ICH patients. A total of 3214 patients were included in the study. Among them, 529 patients received dexamethasone treatment. Kaplan-Meier analysis confirmed substantial differences of survival rates in dexamethasone group and non-dexamethasone group. The fully adjusted multivariate Cox proportional hazards regression analysis revealed that the dexamethasone has a robust effect in reducing short-term mortality in critically patients with ICH, but there is no evidence of its benefit for long-term survival. Subgroup analysis revealed differences based on sex, with a weaker protective effect of dexamethasone in female patients and a stronger protective effect in male patients. Restricted cubic spline analysis demonstrated a nonlinear relationship between dexamethasone and the risk of all-cause mortality. Low-dose dexamethasone may reduce mortality risk, whereas higher doses are associated with increased mortality risk. Our study suggests that low-dose dexamethasone use may be associated with a reduction in all-cause mortality in ICH patients. However, future prospective randomized controlled trials are needed to further validate these findings.

BackgroundOver the past 30 years, the prevalence of kidney disease has increased, underscoring the need to address the stroke burden linked to kidney dysfunction. This study aims to analyze trends and factors underlying the stroke burden and its subtypes attributable to kidney dysfunction from 1990 to 2021.MethodsIn this study, we used Global Burden of Disease data to assess stroke burden attributable to kidney dysfunction within the GBD framework. Methods included joinpoint models, decomposition analysis, age-period-cohort models, Bayesian models, and health inequality analysis.ResultsThe burden of stroke attributable to kidney dysfunction remains significant, with aging as a key factor. By 2021, such strokes caused 676.1×103 (95% CI: 467.78×103, 896.74×103) deaths and 15,009.65×103 (95% CI: 10,939.08×103, 19,133.72×103) DALYs globally. Males experience a higher burden (ASMR of 9.16 and ASDR of 200.83 per 100,000) compared to females (ASMR of 7.17 and ASDR of 150.63 per 100,000). The burden is concentrated in low SDI countries, with trends intensifying for total and ischemic strokes. Projections suggest a decline in overall burden, but an increase in ischemic stroke among younger populations.ConclusionsThe global stroke burden attributable to kidney dysfunction remains significant, with regional disparities. Public health authorities should create targeted guidelines considering economic levels, stroke subtypes, gender, and age to effectively mitigate this burden.

Hypertension is usually accompanied by elevated sympathetic tonicity, but how sympathetic hyperactivity is triggered is not clear. Recent advances revealed that microglia-centered neuroinflammation contributes to sympathetic excitation in hypertension. In this study, we performed a temporospatial analysis of microglia at both morphological and transcriptomic levels and found that microglia in the hypothalamic paraventricular nucleus (PVN), a sympathetic center, were early responders to hypertensive challenges. Vasculature analyses revealed that the PVN was characterized by high capillary density, thin vessel diameter, and complex vascular topology relative to other brain regions. As such, the PVN was susceptible to the penetration of ATP released from the vasculature in response to hemodynamic disturbance after blood pressure increase. Mechanistically, ATP ligation to microglial P2Y12 receptor was responsible for microglial inflammatory activation and the eventual sympathetic overflow. Together, these findings identified a distinct vasculature pattern rendering vulnerability of PVN pre-sympathetic neurons to hypertension-associated microglia-mediated inflammatory insults.

Background:Hemorrhagic stroke (HS), accounting for over 40% of stroke-related deaths, imposes a severe global health burden due to high mortality and disability rates. The triglyceride-glucose-body mass index (TyG-BMI), integrating lipid-glucose metabolism and obesity, has shown prognostic value in cardiovascular diseases but remains underexplored in HS populations. Methods:This retrospective cohort study analyzed 413 HS patients from the MIMIC-IV database. Multivariable Cox regression, Kaplan-Meier analysis, and restricted cubic spline models assessed mortality risks at 30-day, 90-day, and 1-year intervals. Subgroup analysis and interaction tests were performed to evaluate the robustness of the results. Results:Compared with the intermediate TyG-BMI group, the low TyG-BMI group exhibited a significantly increased risk of death at 30 days (adjusted hazard ratio [aHR] = 1.836, p = 0.010), 90 days (aHR = 1.694, p = 0.016), and 1 year (aHR = 1.642, p = 0.014). Similarly, the high TyG-BMI group also showed higher mortality risk at 30 days (aHR = 1.584, p = 0.039), 90 days (aHR = 1.571, p = 0.024), and 1 year (aHR = 1.484, p = 0.030). Kaplan-Meier analysis revealed the highest survival rate in the middle tertile group. Restricted cubic spline curve showed a U-shaped relationship emerged between TyG-BMI and mortality. No interactions between TyG-BMI and the stratified variables, except for coronary artery disease. Conclusion:Patients with intermediate TyG-BMI levels have a lower 30-day mortality risk. As a composite metabolic-nutritional marker, TyG-BMI aids risk stratification in intensive care unit settings.