Preoperative anaemia is a well-established risk factor for poor outcomes. However, the impact of postoperative haemoglobin (Hb) levels on long-term outcomes, including mortality and cardiovascular events, remains uncertain. This study aims to assess the independent association between postoperative nadir Hb levels and long-term outcomes, considering the potential interaction with preoperative anaemia status.

This study is a secondary analysis of data from the Myocardial Injury in Noncardiac Surgery in Sweden study, which included patients aged ≥50 years undergoing elective noncardiac surgery. Postoperative Hb levels were measured daily for up to 3 days or until discharge, and the lowest recorded value was used as the primary exposure variable. Multivariable logistic regression analysis was employed to explore the independent association of postoperative nadir Hb with the primary outcome of a composite endpoint comprising all-cause mortality and cardiovascular complications over a one-year period, adjusting for a range of perioperative risk factors, including preoperative anaemia. To account for a potential interaction with preoperative anaemia, an interaction term was added to the model. Secondary outcomes were one-year mortality and one-year cardiovascular morbidity.

A total of 1284 patients were included, of whom 521 (40.6%) had preoperative anaemia. The median postoperative nadir Hb level was 102 g·L^-1 (interquartile range 92-114). Postoperative nadir Hb was not independently associated with the composite primary outcome; however, it showed a weak but statistically significant association with one-year mortality (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.95-0.99). No significant interaction was found between preoperative anaemia and postoperative nadir Hb. Independent predictors of the primary outcome included university hospital status (aOR 2.83, 95% CI 1.96-4.10), age (aOR 1.05, 95% CI 1.03-1.07), and unplanned postoperative intensive care (aOR 3.17, 95% CI 1.08-9.28).

Postoperative nadir Hb levels, within the observed range well above 70 g·L^-1, were not independently associated with the long-term composite outcome. However, they were weakly associated with one-year mortality. No significant interaction was found between preoperative anaemia and postoperative nadir Hb. These findings highlight the need for further investigation into the clinical significance of postoperative Hb levels in high-risk patients.

Acute ischemic stroke is a major cause of cognitive dysfunction. Early identification of post-stroke cognitive impairment (PSCI) is crucial for improving patient prognosis. While there has been extensive research on prognostic models for acute ischemic stroke, the selection of predictive factors remains heavily reliant on neuroimaging parameters. This study aims to create and compare the eXtreme gradient boosting (XGBoost) and logistic regression (LR) models based on serum biomarkers for predicting the risk of PSCI following acute ischemic stroke.

The study enrolled 261 adult patients with acute ischemic stroke within 7 days of onset. Their baseline characteristics, serum markers, and scores anthe National Institutes of Health Stroke Scale (NIHSS) and the Montreal Cognitive Assessment (MoCA) were collected. Cognitive function assessment was completed 3 months (±2 weeks) after stroke, with PSCI diagnosis based on a MoCA score < 26. Patients were randomly assigned to the training dataset (n = 183) and testing dataset (n = 78) in a ratio of 7:3. Significant features for predicting the risk of PSCI were selected via LassoCV in R. The accuracy, F1 score, Cohen's kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured to assess the accuracy of the XGBoost and LR prediction models. Finally, the performance of the optimal prediction model was evaluated by SHapley additive exPlanations (SHAP) beeswarm and force plots.

The incidence of PSCI and other baseline characteristics were comparable between the training and testing datasets (all P > 0.05). Vascular endothelial cadherin (VE-Cad), NIHSS score, age, drink history, C-reactive protein (CRP), and education years were features associated with the risk of PSCI. The XGBoost model was superior in accuracy, F1 score and sensitivity in predicting the risk of PSCI than the LR model. Beeswarm and force plots displayed the excellent ability of the XGBoost model in predicting the risk of PSCI in patients with acute ischemic stroke.

Based on serum biomarkers, the XGBoost model can accurately predict the risk of PSCI in patients with acute ischemic stroke, with superior performance than the LR model, and may serve as a reliable tool for early identification to improve the diagnosis.From 261 acute ischemic stroke patients (training n = 183, testing n = 78), we collected demographic data, cognitive assessments, and serum indicators. LassoCV identified sensitive predictors including VE-Cad, NIHSS score, CRP, age, drinking history, and education years. The XGBoost model demonstrated superior performance over LR in predicting PSCI risk. SHAP analysis revealed how these variables influenced model predictions. Based on serum biomarkers, the XGBoost model accurately predicts PSCI risk and may serve as a reliable tool for early identification to improve diagnosis.

Chronic kidney disease (CKD) is a growing global public health concern. This study aimed to identify and compare demographic factors and blood biomarkers associated with CKD in hypertensive and non-hypertensive individuals. A cross-sectional analysis was conducted using data from the 2009 China Health and Nutrition Survey. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/l.73 m². After propensity score matching, 1,823 hypertensive and 1,823 non-hypertensive participants were included. The prevalence of CKD was higher in hypertensive individuals (14.7%) than in non-hypertensive individuals (10.8%). Although age, female sex, hyperuricemia, elevated total protein, soluble transferrin receptor, blood urea nitrogen, and low transferrin were shared factors across groups, logistic regression and decision tree analyses revealed different group-specific variables: urban residence and low education level were more relevant in hypertensive individuals, while elevated glucose was more important in non-hypertensives. The extreme gradient boosting (XGBoost) with SHapley Additive exPlanations (SHAP) analyses further showed that triglyceride and residence had greater importance in hypertensive individuals, whereas glucose and magnesium were more influential in non-hypertensive individuals. The area under the receiver operating characteristic curve (AUC) values of the XGBoost model in hypertensive and non-hypertensive individuals using the top 10 variables were 0.930 (95% CI: 0.915-0.945) and 0.945 (95% CI: 0.933-0.958), respectively. In conclusion, although CKD shares several common factors across groups, the relative importance and distribution of predictors differ between hypertensive and non-hypertensive individuals. Stratified monitoring based on hypertension status may enhance early detection and targeted prevention of CKD.

To observe the effect of auricular electroacupuncture on the success rate of tracheal extubation in patients undergoing tracheotomy after stroke, and to explore its potential neuromodulatory mechanism.

A total of 84 patients with post-stroke tracheotomy were randomly divided into an observation group (42 cases, 2 cases were eliminated and 2 cases dropped out) and a control group (42 cases, 5 cases were eliminated). The routine treatment was administered in both groups. Additionally, swallowing electrical stimulation was operated, 20 min each session in the control group. In the observation group, the auricular electroacupuncture was supplemented at Fei (lung, CO₁₄) and Yanhou (pharynx larynx, TG₃), with intermittent wave, a frequency of 5 Hz and a current of 1 mA, and with needles retained for 20 min in each session. The treatment was administered once daily, and the duration of treatment was composed of 4 weeks at the interval of 1 day after 6 consecutive days of intervention in the two groups. The extubation success rate and extubation time of tracheotomy tube were compared between the two groups. Before and after treatment, the involuntary cough peak flow (ICPF), the score of tracheal cough reflex grading scale (TCRGS), pharyngeal transit time (PTT) and the score of Rosenbek penetration-aspiration scale (PAS) were observed, and the intervention safety was evaluated in the two groups.

The extubation success rate of tracheotomy tube was 89.5% (34/38) in the observation group, higher than that in the control group (59.5% [22/37], P < 0.01); the extubation time of tracheotomy tube in the observation group was shorter than that in the control group (P<0.001). After treatment, ICPF in both groups increased in comparison with that before treatment (P<0.01), and ICPF in the observation group was higher when compared with the control group (P<0.01). The scores of TCRGS and PAS in both groups decreased in comparison with those before treatment (P<0.01, P<0.05), and the scores in the observation group were lower than those in the control group (P<0.01, P<0.05). PTT in both groups was shortened in comparison with that before treatment (P<0.01), and PTT in the observation group was shorter than that in the control group (P<0.01). No obvious adverse reactions were reported in either group.

Auricular electroacupuncture can increase the extubation success rate of tracheotomy tube and shorten the extubation time in patients with post-stroke tracheotomy, which may be associated with activating the auricular vagus nerve, enhancing the cough reflex and improving swallowing function.

To explore the clinical efficacy of abdominal acupuncture in combination with transcranial direct current stimulation on post-stroke depression (PSD) and the influence on the levels of autophagy-related proteins based on the brain-gut axis theory.

A total of 126 PSD patients were randomly assigned to an observation group and a control group, with 63 patients in each one. After propensity score matching (PSM) at a ratio of 1 to 1, 45 patients from each group were selected for final analysis. The routine treatment for stroke was administered in each group. Additionally, the patients in the control group underwent transcranial direct current stimulation, while in the observation group, besides the treatment as the control group, abdominal acupuncture was delivered at Zhongwan (CV12), Xiawan (CV10), Guanyuan (CV4), etc. Intervention in each group was administered once daily, 5 times per week, for 4 weeks. Before treatment, and in 2 and 4 weeks of treatment, separately, the scores of Hamilton depression scale (HAMD), National Institutes of Health stroke scale (NIHSS), activities of daily living scale (ADL), Pittsburgh sleep quality index (PSQI), and TCM syndromes were compared between the two groups; the serum levels of brain-gut peptides such as 5-hydroxytryptamine (5-HT), gastrin (GAS), neuropeptide Y (NPY), substance P (SP), and calcitonin gene-related peptide (CGRP) were detected, as well as the serum levels of autophagy-related proteins such as microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ), Beclin1, and sequestosome 1 (SQSTM1/p62) in the two groups. After treatment completion, the clinical efficacy was observed in each group. Using linear regression, the correlations were analyzed among brain-gut peptide levels, the score of each scale and the levels of autophagy-related proteins.

In 2 and 4 weeks of treatment, both groups exhibited the decrease in the scores of HAMD, NIHSS, PSQI and TCM syndromes, the serum levels of SP and CGRP, and the serum levels of LC3-Ⅱ and Beclin1 compared to before treatment (P<0.05). In 4 weeks of treatment, these indexes were lower than those in 2 weeks of treatment (P<0.05); the observation group demonstrated lower levels of the above indexes compared with the control group at the same time point (P<0.05). In 2 and 4 weeks of treatment, ADL scores, the serum levels of 5-HT, GAS, NPY and p62 increased in comparison with before treatment in both groups (P<0.05), and these indexes were elevated in 4 weeks of treatment when compared with those in 2 weeks of treatment (P<0.05); and the indexes in the observation group were superior to those in the control group (P<0.05). The total effective rate in the observation group was 91.1% (41/45), higher than that in the control group (73.3% [33/45], P<0.05). The scores of HAMD, NIHSS, PSQI and TCM syndromes, and the levels of LC3-Ⅱ and Beclin1 were negatively correlated with the levels of 5-HT, GAS, and NPY (P<0.01, P<0.001) and positively correlated with the levels of SP and CGRP (P<0.001, P<0.01). ADL score and p62 level were positively correlated with the levels of 5-HT, GAS, and NPY (P<0.001, P<0.01), and negatively correlated with the levels of SP and CGRP (P<0.01, P<0.001).

Abdominal acupuncture combined with transcranial direct current stimulation can effectively alleviate the depressive symptoms of PSD patients. Its effect may be related to the regulation of brain-gut peptide levels and the expression of autophagy-related proteins.

To observe the effect of acupuncture at Lianquan (CV23) with different frequencies of twirling manipulation on post-ischemic stroke aphasia.

A total of 105 patients with post-ischemic stroke aphasia were randomly divided into a low-frequency twirling acupuncture group (LT group, 35 cases, 1 case dropped out), a high-frequency twirling acupuncture group (HT group, 35 cases, 3 cases dropped out) and a sham acupuncture group (SA group, 35 cases, 2 cases dropped out). All three groups received conventional stroke treatment. On this basis, the LT group was treated with Xingnao Kaiqiao acupuncture (regaining consciousness and opening orifices), and low-frequency twirling stimulation (60 times/min) was performed at Lianquan (CV23); the HT group was treated with Xingnao Kaiqiao acupuncture, and high-frequency twirling stimulation (120 times/min) was performed at Lianquan (CV23); and the SA group was treated with shallow needling at non-meridian and non-acupoint points. The frequency of treatment was once a day, 5 times per week for a total of 6 weeks. Before and after treatment, the Western aphasia battery (WAB), Boston diagnostic aphasia examination (BDAE), National Institutes of Health stroke scale (NIHSS) and stroke and aphasia quality of life scale-39 (SAQOL-39) were used to evaluate the language function, neurological function and quality of life, and the clinical efficacy was evaluated in the three groups.

After treatment, except for the communication and psychosocial scores of SAQOL-39 in the SA group, the WAB scores, BDAE grade, and SAQOL-39 scores were increased compared with those before treatment (P<0.05), and the NIHSS scores were decreased compared with those before treatment (P<0.05) in the three groups. After treatment, except for the physiological score of SAQOL-39, the WAB scores, BDAE grade, and SAQOL-39 scores in the LT group were higher than those in the SA group (P<0.05), and the NIHSS score in the LT group was lower than that in the SA group (P<0.05); the WAB-aphasia quotient (WAB-AQ) score, auditory comprehension score of WAB, BDAE grade, and communication score of SAQOL-39 in the HT group were higher than those in the SA group (P<0.05); the WAB-AQ score, spontaneous speech score of WAB, and communication score of SAQOL-39 in the LT group were higher than those in the HT group (P<0.05), and the NIHSS score in the LT group was lower than that in the HT group (P<0.05). The total clinical effective rate of the LT group was 82.35% (28/34), that of the HT group was 71.88% (23/32), and that of the SA group was 54.55% (18/33), the total clinical effective rates of the LT group and the HT group were higher than that of the SA group (P<0.05).

Compared with the high-frequency twirling manipulation acupuncture at Lianquan (CV23), the low-frequency twirling manipulation acupuncture has a better effect in improving the language function, neurological function and quality of life in patients with post-ischemic stroke aphasia.

Silent cerebral infarctions are common after aortic arch surgery; however, the predictive value of preoperative computed tomography (CT)-derived plaque characteristics remains unclear. We investigated the incidence, distribution, and risk factors for new cerebral infarction lesions (NCILs) after total aortic arch replacement (TAR), focusing on low-attenuation plaque (LAP, 0-60 Hounsfield units [HU], a surrogate of lipid-rich vulnerable plaque) burden.

Among 82 consecutive TAR patients, 41 underwent both pre- and postoperative brain diffusion-weighted magnetic resonance imaging (MRI). Clinical profiles, CT-derived atheroma grade and plaque attenuation, operative details, and outcomes were compared between NCIL-positive and NCIL-negative groups. The primary multivariable model simultaneously included arch atheroma grade and LAP area, adjusted for age and sex.

NCILs were detected in 25/41 patients (61%): 23 silent and 2 symptomatic. All NCILs exhibited embolic imaging features without watershed or hypoperfusion patterns. NCIL-positive patients had significantly greater arch LAP area (63.9 vs. 17.7 mm², p <0.01). On multivariable analysis, arch LAP remained the only independent predictor (OR per 10 mm², 3.01; 95% confidence interval [CI] 1.50-8.75; p = 0.012), whereas atheroma grade was not.

More than half of TAR patients developed MRI-detected, predominantly silent NCILs. Preoperative arch LAP was the sole independent predictor. LAP assessment may refine intraoperative risk stratification and guide tailored neuroprotective strategies.

Adrenaline has been the principal vasoactive drug in cardiac arrest for decades. It reliably increases return of spontaneous circulation but has not shown a consistent improvement in long-term survival with favourable neurological outcome. High cumulative doses are associated with poorer neurological outcomes among survivors. Unreliable systemic delivery of intravenous adrenaline during the low-flow state of cardiopulmonary resuscitation (CPR) may be responsible for this disconnect. When return of spontaneous circulation follows multiple doses, abrupt mobilisation of accumulated adrenaline may be deleterious and contribute to post-resuscitation shock. We describe the "Adrenaline Dilemma": patients with the lowest coronary perfusion pressure are most in need of vasoconstriction to improve blood flow, yet they are also those in whom intravenous adrenaline is least likely to circulate promptly; conversely, patients with adequate coronary perfusion pressure may be exposed to excessive dosing. Thoracic aortic catheterisation via femoral arterial access provides rapid systemic arterial drug delivery and real-time haemodynamic feedback. Continuous aortic pressure monitoring allows optimisation of CPR mechanics and rapid titration of intra-aortic adrenaline as small, diluted boluses or continuous infusion targeting an observed physiological endpoint. Preclinical experiments and early prehospital clinical experience have shown favourable results. Haemodynamically guided intra-aortic adrenaline administration during CPR is a plausible, testable endovascular adjunct and warrants prospective evaluation within modern resuscitation pathways.

Recent evidence suggests that empiric prehospital administration of tenecteplase in out-of-hospital cardiac arrest is associated with decreased survival and lower rates of return of spontaneous circulation. While diagnostic uncertainty is a primary factor, operational hazards in austere environments must also be examined. This comment explores an underappreciated and potentially lethal operational hazard: the immediate chemical incompatibility between tenecteplase and dextrose-containing solutions. In chaotic pre-hospital settings, clinicians often rely on the cognitive heuristic of using dextrose lines to limit sodium intake, especially during cardiac emergencies. However, mixing tenecteplase with dextrose triggers instant crystallization and line occlusion. This effectively denies the patient the fibrinolytic agent while simultaneously compromising a critical intravenous access. To mitigate this risk, we propose three clinical safety barriers: physical segregation of dextrose from acute coronary syndrome kits, the mandatory implementation of a 20-mL normal saline flush before and after administration, and the use of point-of-care cognitive aids on drug packaging.

Addressing the complex outcomes of prehospital thrombolysis requires mitigating simple, yet catastrophic, chemical errors. Environmental design and strict operational protocols are essential to ensure the safe delivery of tenecteplase in the field.

Spontaneous cerebellar hemorrhage (sCH) is associated with high mortality, but favorable outcomes can be achieved with appropriate surgical management. We evaluated treatment strategies, complications, outcomes, and prognostic factors in sCH patients at a tertiary center.

Adults with primary sCH treated at the neurointensive care unit in Uppsala, Sweden, between 2008 and 2024 were retrospectively included. Clinical and radiological data were collected. Patients were managed conservatively or surgically according to institutional protocols. Outcomes were mortality at discharge and 6 months, and functional outcome at NIC discharge assessed with the Glasgow Outcome Scale-Discharge (GODS). Predictors of 6-month mortality and favorable outcome (GODS > 3) were analyzed.

A total of 194 patients were included; 50% underwent surgery. Surgically treated patients had lower admission Glasgow Coma Scale motor scores, larger hematoma volumes, and more infratentorial mass effect. Among awake patients with hematomas > 15 mL initially managed conservatively, 78% did not require delayed surgery and most achieved favorable outcomes. Combined hematoma evacuation, suboccipital decompression, and external ventricular drainage (EVD) was associated with low complication rates and low early mortality. Selected patients with hydrocephalus and smaller hemorrhages were successfully treated with EVD alone. Overall mortality was 11% at discharge and 28% at 6 months. Age, neurological status, and hematoma volume independently predicted mortality.

Favorable outcomes after sCH are achievable, including in elderly patients. Conservative management is appropriate in neurologically stable patients with moderate hematoma volumes, while EVD alone may suffice in selected cases with isolated hydrocephalus.