This study aimed to develop a machine learning (ML)-based tool for early and accurate prediction of in-hospital mortality risk in patients with spontaneous intracerebral hemorrhage (sICH) in the intensive care unit (ICU). We did a retrospective study in our study and identified cases of sICH from the MIMIC IV (n = 1486) and Zhejiang Hospital databases (n = 110). The model was constructed using features selected through LASSO regression. Among five well-known models, the selection of the best model was based on the area under the curve (AUC) in the validation cohort. We further analyzed calibration and decision curves to assess prediction results and visualized the impact of each variable on the model through SHapley Additive exPlanations. To facilitate accessibility, we also created a visual online calculation page for the model. The XGBoost exhibited high accuracy in both internal validation (AUC = 0.907) and external validation (AUC = 0.787) sets. Calibration curve and decision curve analyses showed that the model had no significant bias as well as being useful for supporting clinical decisions. XGBoost is an effective algorithm for predicting in-hospital mortality in patients with sICH, indicating its potential significance in the development of early warning systems.

Abstract Background Mechanical thrombectomy (MT) has been established as the first-line treatment for acute ischemic stroke (AIS) from large vessel occlusions. However, the benefits of MT to the patients over 80 years old is not yet clear, for the elderly with AIS were usually excluded from large randomized controlled stroke clinical trials for their poor prognosis. Methods This study enrolled 187 adult patients with acute ischemic stroke from large vessel occlusions, including 53 patients ≥ 80 years old. Propensity score matching was used to match the patients༜80 years old with those ≥ 80 years old in a ratio of 1:1. The elderly patients were divided into bridging therapy subgroup and direct MT subgroup. The baseline characteristics and outcome were compared between younger patients and older patients, and elderly patients in two subgroups by multivariate logistic regression analysis. Results The good functional status at 90 days occurred in 44 (32.8%) younger patients, 12 (22.6%) in older patients, but the difference was not statistically significant (adjusted OR, 1.244[95%CI,0.520–2.882], P = 0.644). A higher mortality rate was observed in older patients (43% vs 16%, OR,0.245[95%CI,0.104–0.578], P = 0.001). After propensity score matching, the similar results were found in the good functional prognosis and mortality in the two groups. Moreover, in elderly patients, no significant difference was found in the outcome between the two subgroups. Conclusions Elderly patients with AIS from large vessel occlusions who received MT had similar good functional status and successful reperfusion to patients༜80 years old. MT is effective and relatively safe for the elderly.

BackgroundIn-stent restenosis (ISR) is an adverse and notable event in the treatment of intracranial atherosclerotic stenosis (ICAS) with percutaneous transluminal angioplasty and stenting (PTAS). The incidence and contributing factors have not been fully defined. This study was performed to evaluate factors associated with ISR after PTAS.Data sourceWe identified studies on ISR after PTAS from an electronic search of articles in PubMed, Ovid MEDLINE, and the Cochrane Central Database (dated up to July 2022).ResultsA total of 19 studies, including 452 cases of ISR after 2,047 PTAS, were included in the meta-analysis. The pooled incidence rate of in-stent restenosis was 22.08%. ISR was more likely to occur in patients with coronary artery disease (OR = 1.686; 95% CI: 1.242–2.288; p = 0.0008), dissection (OR = 6.293; 95% CI: 3.883–10.197; p < 0.0001), and higher residual stenosis (WMD = 3.227; 95% CI: 0.142–6.311; p = 0.0404). Patients treated with Wingspan stents had a significantly higher ISR rate than those treated with Enterprise stents (29.78% vs. 14.83%; p < 0.0001).ConclusionsThe present study provides the current estimates of the robust effects of some risk factors for in-stent restenosis in intracranial atherosclerotic stenosis. The Enterprise stent had advantages compared with the Wingspan stent for ISR. The significant risk factors for ISR were coronary artery disease, dissection, and high residual stenosis. Local anesthesia was a suspected factor associated with ISR.

Background: Fractional flow reserve is widely used for the functional evaluation of coronary artery stenosis. Some studies have similarly used the translesional pressure ratio measurements for the functional evaluation of intracranial atherosclerotic stenosis. In this paper, we aimed to investi-gate the relationship between pressure ratio and cerebral tissue perfusion by MR perfusion im-aging and provided a non-invasive method for evaluating the functional significance of intracranial atherosclerotic stenosis.Methods: A total of 18 consecutive patients with intracranial atherosclerotic stenosis patients including 19 stenotic vessels were recruited. The pressure was measured using a pressure guidewire, the pressure ratio before and after the endovascular intervention was calculated and compared with the severity of diameter stenosis and perfusion-derived MR (the time to maximum tissure residue function (Tmax)). Moreover, the DSA-derived pressure ratio was computed using a novel computational fluid dynamics-based model, termed CFD-PR, and was compared with the actual pressure ratio to assess its diagnostic accuracy.Results: The pressure ratio increased after percutaneous transluminal angioplasty or stenting, while the correlation between pressure ratio and diameter stenosis was not significant. The pressure ratio was negatively correlated with Tmax (r =-0.73, P < 0.01), and a 95% confidence interval for the cutoff value of pressure ratio = 0.67 (95% confidence interval: 0.58-0.76) was suggested. There was a good correlation (mean = 0.02, Spearman's correlation coefficient r = 0.908, P < 0.001) and agreement (limits of agreement:-0.157 to 0.196, P = 0.954) between CFD-PR and the actual pressure ratio.

心脑梗死（cardio-cerebral infraction，CCI）由Omar等学者在2010年首次提出 [1]，指同时或短时间内相继发生急性缺血性脑卒中（acute ischemic stroke, AIS）和急性心肌梗死（acute myocardial infraction，AMI）的疾病状态。两者发病间隔的确切时间尚无统一定义，de Castillo等 [2]将AMI发作后12 h内出现AIS或AIS发作后6 h内出现AMI的情况定义为同步性CCI；超过这一时限而两者相邻时间小于72 h则定义为异时性CCI。临床上以异时性CCI更为常见，据文献报道，异时性CCI的发病率为0.9%~12.7% [3,4,5]，同步性CCI的发生率仅为0.009% [6]。虽然临床少见，但由于CCI病情凶险且紧急，治疗时间窗口狭窄，治疗决策复杂，临床预后差，需要引起临床医生的高度重视。

Background We aimed to evaluate the predictive power of systemic inflammation response index (SIRI), a novel biomarker, to predict all-cause mortality in patients with traumatic brain injury (TBI) in the intensive care unit (ICU). Methods Clinical data were retrieved from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Kaplan-Meier (KM) methods and cox proportional hazard models were performed to examine the association between SIRI and all-cause mortality. The predictive power of SIRI was evaluated compared to other leukocyte-related indexes including neutrophils, lymphocytes, monocytes and white blood cells (WBC) by the Receiver Operating Characteristic (ROC)curve for 30-day mortality. In addition, propensity score matching (PSM) was conducted to reduce confounding. Results A total of 350 TBI patients were enrolled overall in our study. The optimal cutoff point of SIRI was determined at 11.24 × 109/L. After 1:1 PSM, 66 matched pairs (132 patients) were generated. During the 30-day, in-hospital and 365-day follow-up periods, patients with low SIRI level were associated with improved survival (p < 0.05) compared with patients with high SIRI level. Cox regression analysis identified that higher SIRI values was an independent risk factor for all-cause mortality and results were stable on multiple subgroup analyses. Furthermore, ROC analysis indicated that the area under the curve of SIRI [0.6658 (95% Confidence Interval, 0.5630–0.7687)] was greater than that of neutrophils, monocytes, lymphocytes and WBC. The above results were also observed in the matched cohort. Conclusion It was suggested that TBI patients with high SIRI level would suffer from a high risk of 30-day, in-hospital and 365-day mortality. SIRI is a promising inflammatory biomarker for predicting TBI patients' prognosis with relatively better predictive power than other single indicators related to peripheral differential leukocyte counts.