The stress hyperglycemia ratio (SHR) demonstrates mortality associations across various populations; however, its nonlinear relationship with mortality in the specific subgroup of sepsis with atrial fibrillation (AF) remains insufficiently characterized.

Retrospective cohort of sepsis patients with AF from Medical Information Mart for Intensive Care (MIMIC) -IV version 3.1 database. SHR was calculated as the ratio of admission glucose to estimated average glucose derived from hemoglobin A1c (HbA1c). Nonlinear associations between SHR and 30-day/365-day mortality were assessed using restricted cubic spline (RCS) and threshold effect analyses with multivariable adjustment and entropy balancing weighting.

Among 2,297 participants (median age 73.64 years, 63.2% male), 337 (14.67%) and 629 (27.38%) experienced 30-day and 365-day mortality. Nonlinear associations were identified between SHR and mortality, with inflection points at 0.70 (30-day) and 0.89 (365-day). Below thresholds, SHR was inversely associated with 30-day (HR = 0.10, 95% CI: 0.02-0.47, P = 0.003) and 365-day mortality (HR = 0.40, 95% CI: 0.20-0.78, P = 0.008). Above thresholds, mortality risk increased (30-day HR = 3.24, 95% CI: 2.19-4.80, P < 0.001; 365-day HR = 2.60, 95% CI: 1.80-3.76, P < 0.001). Entropy balancing weighting confirmed these threshold effects.

A nonlinear relationship exists between SHR and mortality in sepsis patients with AF, where both extremely low and high SHR values may increase mortality risk.

The atherogenic index of plasma (AIP), calculated as log₁₀(triglycerides/HDL-C), reflects atherogenic dyslipidemia and is associated with insulin resistance. Its continuous dose-response relationship and incremental predictive value for non-alcoholic fatty liver disease (NAFLD) beyond traditional risk factors remain undefined in community-dwelling older adults-a population with a high metabolic comorbidity burden where low-cost, integrated risk markers are urgently needed.

From 5,783 residents aged ≥65 years without significant alcohol consumption recruited in Zhanjiang, western Guangdong (2023-2024), 4,390 were enrolled after exclusions. NAFLD was diagnosed by ultrasonography. AIP was examined using multivariable logistic regression, restricted cubic splines, subgroup analyses, and trend tests with comprehensive confounder adjustment. Incremental predictive value was assessed through a multidimensional evaluation framework comprising ROC curves, calibration, decision curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

NAFLD prevalence was 42.7%, rising stepwise across AIP quartiles (22.4%, 36.9%, 50.1%, 61.3%; P for trend < 0.001). Each 1-unit increment in AIP was associated with a 6.13-fold higher NAFLD risk (OR 6.13, 95% CI 4.55-8.28) after full adjustment. Restricted cubic splines revealed a strictly linear, threshold-free association (P for nonlinearity = 0.714), consistent across age, residence, hypertension, and diabetes subgroups, with a statistically significant interaction by sex (P for interaction = 0.042). Adding AIP to a baseline clinical model improved discrimination (AUC from 0.786 to 0.811), calibration, clinical net benefit, and risk reclassification (categorical NRI 0.0997, IDI 0.0487; P< 0.001).

AIP demonstrates an independent, linear relationship with NAFLD risk in community-dwelling older adults, exhibiting no discernible safe threshold. This low-cost, routine lipid-derived marker supports a "single-indicator, dual-prevention" strategy for simultaneous NAFLD screening and cardiometabolic risk stratification in primary care, challenging the conventional practice of relying solely on discrete lipid cut-offs.

This aimed to evaluate the risk of severe cerebral venous sinus thrombosis (SCVST) progression after anticoagulation using clinical and radiological data.

Clinical and radiological data from 199 SCVST patients were collected and analyzed in this study. Univariate and multivariate logistic regression analyses were conducted for several factors, including age, gender, pregnancy and puerperium, oral contraceptive use, coma state, hemiplegia, sensory dysfunction, cerebral infarction, cerebral hemorrhage, and sinus involvement. Subsequently, an evaluation system was developed based on the odds ratio (OR), and the receiver operating characteristic (ROC) curve was used to determine the prediction accuracy of this evaluation system in another cohort of 32 SCVST patients.

Pregnancy and puerperium (OR = 5.525, p = 0.001), oral contraceptive use (OR = 28.720, p = 0.003), coma at admission (OR = 3.890, p < 0.001), cerebral hemorrhage (OR = 2.151, p = 0.038), and number of occluded sinuses (OR = 1.708, p < 0.001) were found to be independent risk factors predicting the SCVST progression. The CHOPS score comprising the five independent factors (coma at admission (C), cerebral hemorrhage (H), oral contraceptive use (O), pregnancy and puerperium (P), and the number of occluded sinuses (S)) was constructed, which achieved an area under the curve of 0.873.

Pregnancy and puerperium, oral contraceptive use, coma at admission, cerebral hemorrhage, and the number of occluded sinuses are independent risk factors predicting the SCVST progression after anticoagulation. The developed CHOPS score can accurately predict SCVST progression; thus, endovascular or surgical treatment may be considered after anticoagulation when clinically necessary.

Immune checkpoint inhibitor (ICI)-associated myocarditis (ICI-M) is a rare but potentially lethal immune-related adverse event (irAE). Early identification of fulminant (severe) cases remains challenging, and the peripheral immune derangements underlying ICI-M are incompletely characterized.

The disproportionality analysis was performed using the FDA Adverse Event Reporting System (FAERS) database (2015-2026) for patients treated with eight ICIs. A retrospective cohort of 100 patients who developed ICI-M was stratified into severe and non-severe groups. Peripheral blood cells and their derived ratio index were analyzed. A severity-predictive nomogram was developed using features selected by three machine learning methods, and was evaluated by calibration, receiver operating characteristic, and decision curve analyses. Single-cell RNA-seq data from peripheral blood mononuclear cells were analyzed to explore immune landscape alterations for ICI-M.

FAERS analysis revealed strong signals for ICI-M across all eight ICIs, with >80% of cases occurring within three months of therapy. Associations between peripheral blood cells/derived ratio indexes and ICI-M were identified: the (neutrophil + monocyte) to lymphocyte ratio (NMLR), cTnI, and NT-proBNP were identified as key predictors of severe ICI-M. The 3-feature-based exploratory nomogram demonstrated a relatively good predictive performance (Area under curve = 0.849) with internal validation performed via 1000 bootstrap samples. Single-cell profiling identified monocyte expansion and lymphocyte contraction for ICI-M and its severity. The pseudotime ordering, ligand-receptor inference, subcluster differential abundance analysis, and pathway enrichment analyses associated a distinct FCGR3A + monocyte subset with a potential role in ICI-M development.

This study provides a multi-dimensional view of ICI-M, integrating clinical and single-cell immune profiling analysis of peripheral blood cells as well as pharmacovigilance data. The developed nomogram may serve as a potential tool for identifying severe ICI-M, although external validation in independent cohorts is warranted. Insight into the immune landscape may inform future therapeutic strategies targeting specific cell-cell interactions in ICI-M.

Selective serotonin reuptake inhibitors (SSRIs) are recognized for their antidepressant effects and their potential role in promoting neuroplasticity. This systematic review and meta-analysis aimed to evaluate whether SSRIs improve prognostic outcomes in patients with stroke compared with placebo or no intervention.

We systematically searched the Cochrane Library, PubMed, and Embase databases to identify randomized controlled trials comparing SSRIs with placebo or no intervention in patients with stroke. Continuous outcomes were pooled using weighted mean differences (WMDs), and dichotomous outcomes were pooled using risk ratios (RRs), both with 95% confidence intervals (CIs). Fixed-effect or random-effects models were selected according to the degree of statistical heterogeneity for each outcome.

Eleven reports from nine unique randomized controlled trials, involving 7,604 unique participants, were included. In exploratory analyses stratified by follow-up duration, SSRI use at 3 months was associated with better modified Rankin Scale (mRS) responder status and a greater absolute reduction in National Institutes of Health Stroke Scale score (absNIHSS) (RR 2.46, 95% CI 1.74-3.48; WMD 0.57, 95% CI 0.11-1.03). However, the 3-month mRS finding was derived from a single trial and should therefore be interpreted with particular caution. At 6 months, SSRI use was associated with a smaller absolute reduction in NIHSS score (WMD -0.23, 95% CI-0.45 to -0.02), but this finding should also be interpreted cautiously because the absNIHSS analysis showed substantial heterogeneity. At 12 months, SSRI use was associated with a lower risk of recurrent stroke (RR 0.65, 95% CI 0.47-0.89), particularly recurrent ischemic stroke (RR 0.57, 95% CI 0.40-0.80). These findings suggest that the observed associations between SSRI use and stroke outcomes varied across follow-up-duration subgroups. However, these subgroup patterns should be interpreted cautiously because they may reflect differences in study populations, follow-up designs, attrition, rehabilitation strategies, and trial weighting rather than a confirmed biological time-dependent effect. No statistically significant differences were observed in thrombotic events, bleeding events, mortality, cardiac adverse events, or drug-specific subgroup analyses.

SSRI use after stroke may be associated with selected exploratory short-term functional signals and a lower long-term risk of recurrent stroke, particularly recurrent ischemic stroke. However, the apparent short-term mRS benefit was driven by a single trial and should not be interpreted as a robust or generalizable clinical effect. The mid-term absNIHSS findings did not support a sustained functional benefit and were accompanied by substantial heterogeneity. Therefore, the functional outcome findings should be interpreted as exploratory rather than definitive. The observed associations should be interpreted cautiously because they were derived from exploratory follow-up-duration-stratified analyses and represent subgroup-level associations rather than evidence of a causal temporal or biological effect of SSRIs. Further well-designed randomized controlled trials are needed to clarify the optimal timing, duration, and safety of SSRI therapy after stroke.

Brainstem hemorrhage is a severe subtype of spontaneous intracerebral hemorrhage, characterized by high mortality and disability rates, and is closely associated with systemic inflammatory responses. The systemic immune-inflammation index (SII), as a comprehensive inflammatory marker, reflects the balance between immunity and inflammation. However, its dynamic changes and clinical significance in patients with brainstem hemorrhage remain unclear.

This study aimed to investigate the early dynamic changes in SII in patients with brainstem hemorrhage and to evaluate its association with 30-day mortality and 90-day functional outcomes, thereby providing a potential biomarker for clinical risk assessment.

We retrospectively enrolled 140 patients with brainstem hemorrhage admitted to the Department of Neurosurgery. SII was calculated from complete blood counts on days 1, 3, and 7 after admission. Patients were divided into high and low SII groups based on the median SII on day 1. Demographic data, medical history, admission GCS score, and blood pressure were collected. Outcomes included 30-day mortality, 90-day modified Rankin Scale (mRS) score, and complications. Linear mixed-effects models were used to analyze SII trajectories, multivariable logistic regression to identify independent predictors, and ROC curve analysis to evaluate predictive performance.

SII was significantly elevated on day 1, peaked on day 3, and declined by day 7. The linear mixed-effects model revealed a significant group-by-time interaction (p < 0.001), indicating a more intense and slower-resolving inflammatory response in the high-SII group. The high-SII group had significantly higher rates of 90-day poor functional outcome (p < 0.001) and 30-day mortality (p = 0.004). Multivariable logistic regression identified Day 3 SII as an independent predictor of both 90-day poor outcome (p = 0.011) and 30-day mortality (p < 0.001). ROC analysis showed that Day 3 SII predicted 30-day mortality with an AUC of 0.878, and the combined model achieved an AUC of 0.920.

In patients with brainstem hemorrhage, SII is markedly elevated in the early phase, showing a dynamic pattern of rapid rise on day 1, peak on day 3, and gradual decline by day 7. High SII is closely associated with increased mortality and poor functional outcomes, suggesting that SII can serve as an early prognostic biomarker and guide clinical risk stratification and treatment decisions.

To estimate the prevalence and severity of post-stroke depression (PSD) and identify factors independently associated with PSD among stroke survivors.

This cross-sectional analysis was conducted within a prospectively assembled hospital-based cohort at King Fahd University Hospital between January 2021 and November 2025. Adults with ischemic stroke, transient ischemic attack, intracerebral hemorrhage, or cerebral venous sinus thrombosis (CVST) underwent PSD assessment at least 3 months after the index event. PSD was established through structured clinical assessment based on DSM-5-TR and ICD-11 criteria together with the clinician-administered 17-item Hamilton Depression Rating Scale. Factors associated with PSD were evaluated using forced-entry multivariable logistic regression.

Among 403 participants, the mean age was 57.3 ± 13.8 years, and 69.2% were male. PSD was identified in 172 participants (42.7%): 71 (17.6%) had mild, 61 (15.1%) moderate, and 40 (9.9%) severe or very severe depression. The complete-case multivariable analysis included 398 participants. Higher NIHSS score was independently associated with PSD [adjusted odds ratio (aOR) per 1-point increase, 1.35; 95% CI, 1.22-1.49; p < 0.001], as was unfavorable functional status at discharge (mRS 3-5 vs. 0-2: aOR, 6.51; 95% CI, 3.19-13.29; p < 0.001). The overall stroke-subtype test was nonsignificant (p = 0.067), although the category-specific CVST coefficient indicated higher odds of PSD (aOR, 5.73; 95% CI, 1.34-24.50; p = 0.018). The model demonstrated excellent apparent discrimination (AUC, 0.89; bootstrap 95% CI, 0.86-0.92), with 72.5% sensitivity and 90.5% specificity at a cutoff of 0.50.

PSD affected approximately two-fifths of participants and was most consistently associated with neurological severity and functional disability. Standardized depression screening should be integrated into post-stroke care, particularly for patients with greater neurological impairment or functional dependence. The CVST finding was exploratory and requires confirmation.

To evaluate the safety and efficacy of Edaravone Dexborneol in the treatment of acute ischemic stroke (AIS).

Randomized clinical trials (RCTs) and Prospective cohort study on Edaravone Dexborneol for AIS were retrieved from PubMed, Embase, Cochrane Library, Web of Science, and CNKI. The quality of included studies was assessed using the Cochrane risk of bias tool. Meta-analysis was performed using RevMan 5.2. Efficacy evaluation is based on the changes in the National Institutes of Health Stroke Scale (NIHSS) and mRS scores from baseline to 10-14 days after treatment, as well as the proportion of patients achieving a modified Rankin Scale (mRS) score of 0-1 at 90 days. Safety evaluation is based on the incidence of adverse events during treatment or within 3 months.

The meta-analysis included 54 studies. For efficacy evaluation: 1. Compared with the control group, the edaravone dexborneol (ED) treatment group showed a reduction in NIHSS score of 2.27, which was statistically significant (I ² = 93%, MD = -2.27, 95% CI:-2.61 to-1.94, p < 0.00001). Subgroup analysis based on the mean baseline NIHSS score categorized patients into mild-to-moderate, moderate-to-severe, and severe stroke subgroups. In the mild-to-moderate stroke subgroup: (I ² = 91%, MD = -1.92, 95% CI:-2.30 to-1.54, p < 0.00001.). In the moderate-to-severe stroke subgroup: (I ² = 94%, MD = -2.76, 95% CI: -3.72 to -1.79, p < 0.00001). In the severe stroke subgroup: (I ² = 80%, MD = -3.50, 95% CI: -4.76 to -2.24, p = 0.04). Patients with higher baseline NIHSS scores may have more pronounced functional improvement after ED treatment. 2. At 2 weeks after treatment, the ED group showed a reduction in mRS score of 0.93 compared with the control group, with statistical significance (I ² = 98%, MD = -0.93, 95% CI:-1.23 to-0.63, p < 0.00001). 3. For the proportion of patients achieving mRS = 0-1 at 90 days after treatment, 7 studies were included, with 4,925 patients in the ED group and 3,289 in the control group (I ² = 57%, RR = 1.10, 95% CI: 1.02 to 1.18, p = 0.01). The results indicate a statistically significant functional improvement at 90 days after ED treatment for acute cerebral infarction. Therefore, ED may achieve both short-term and long-term neurological improvement in acute ischemic stroke. For safety evaluation, there was no statistically significant difference in the incidence of adverse events between the ED group and the control group (RR = 0.99, 95% CI: 0.95 to 1.03, p = 0.60).

This meta-analysis provides evidence supporting the efficacy and safety of Edaravone Dexborneol for both short- and long-term treatment of acute ischemic stroke. It significantly reduced NIHSS and mRS scores at 10-14 days post-treatment and increased the proportion of patients achieving an mRS score of 0-1 at 90 days. Patients with higher baseline NIHSS scores may derive greater prognostic benefit from edaravone dexborneol therapy. Future multicenter, large-sample clinical studies are still needed to further validate the efficacy and safety of Edaravone Dexborneol.

Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are the two principal revascularization strategies for carotid stenosis, but their comparative safety and efficacy remain debated, particularly across different symptom statuses and follow-up periods.

To conduct an updated umbrella meta-analysis (UMA) of published meta-analyses (MAs) comparing the efficacy and safety of CAS versus CEA in patients with carotid stenosis, and to examine whether treatment effects differed according to symptom status and timing of outcome assessment.

A systematic literature search was performed in PubMed, Embase, Web of Science, and the Cochrane Library from January 2014 to July 2026. Meta-analyses comparing CAS with CEA based on randomized controlled trials or cohort studies were included. Methodological quality was assessed using AMSTAR 2. Random-effects models were applied for second-order pooled analyses. Prespecified subgroup analyses were conducted according to symptom status and temporal stratification, including 30-day postoperative and long-term follow-up periods. Primary-study overlap was quantified separately for each outcome using citation matrices and the corrected covered area (CCA). Leave-one-out and post hoc overlap-reduced sensitivity analyses were performed to assess robustness.

Twenty-one MAs were included. In the overall pooled analyses, CAS was associated with higher risks of death (OR: 1.13, 95% CI: 1.07 ~ 1.19), stroke (OR: 1.53, 95% CI: 1.41 ~ 1.65), and restenosis (OR: 1.56, 95% CI: 1.19 ~ 2.04), but lower risks of myocardial infarction (MI) (OR: 0.52, 95% CI: 0.46 ~ 0.59) and cranial nerve palsy (CNP) (OR: 0.06, 95% CI: 0.03 ~ 0.11) compared with CEA. No significant differences were observed for ipsilateral stroke or disabling stroke. The excess risks of death and stroke with CAS were numerically greater during the 30-day postoperative period than during long-term follow-up. Outcome-specific CCA values ranged from 12 to 38%, indicating high-to-very-high primary-study overlap. Conclusions remained unchanged in leave-one-out and overlap-reduced sensitivity analyses.

Among patients undergoing carotid revascularization, CEA was associated with lower pooled risks of stroke and restenosis, whereas CAS was associated with lower risks of MI and cranial nerve palsy. The small mortality difference should be interpreted cautiously because of heterogeneity in follow-up, symptom status, outcome definitions, and substantial primary-study overlap. The higher stroke risk associated with CAS appeared to be driven mainly by non-disabling events. These findings support individualized procedural selection after an indication for revascularization has been established.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024627431, Identifier CRD42024627431.

Accurate early prediction of long-term functional outcomes in acute ischemic stroke (AIS) remains challenging. We aimed to develop and validate an interpretable machine learning model integrating baseline multimodal CT perfusion and clinical data to predict 9-month poor functional outcome [modified Rankin Scale (mRS) 3-6] in AIS patients undergoing endovascular or surgical intervention.

This retrospective study included 371 AIS patients who underwent endovascular or surgical intervention. We integrated clinical variables, laboratory markers, CT perfusion parameters (Tmax, cerebral blood flow, and cerebral blood volume), and quantitative CT density measurements [Hounsfield units on the affected and healthy sides, normalized water uptake (NWU), Alberta Stroke Program Early CT Score (ASPECT score)]. Feature selection was performed using LASSO regression followed by SHAP-based refinement. Four algorithms-Logistic Regression, Random Forest, Support Vector Machine, and XGBoost-were compared. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, F1-score, Brier score, calibration curves, and decision curve analysis (DCA). SHAP analysis was used to enhance model interpretability.

Eleven predictors were selected by LASSO; after SHAP-based refinement, ten remained in the final model. The XGBoost model achieved the best performance, with an AUC of 0.956 (95% CI 0.917-0.995), sensitivity of 0.932, specificity of 0.897, F1-score of 0.938, and Brier score of 0.0713 (95% CI 0.0438-0.1135). SHAP analysis identified door-to-intervention interval (DTI) (mean SHAP = 0.95) as the most influential predictor, followed by HU_affected (0.88), CBV < 42% (0.82), NLR (0.78), blood glucose (0.74), age (0.70), gender (0.68), ASPECT score (0.66), HU_healthy (0.50), and NWU (0.48). Calibration curves demonstrated excellent agreement between predicted and observed outcomes, and DCA confirmed superior net benefit of the XGBoost model across clinically relevant thresholds (0.01-0.60).

We developed an interpretable XGBoost-based model integrating baseline multimodal CT perfusion and clinical data that accurately predicts 9-month functional outcomes in AIS patients undergoing endovascular or surgical intervention. DTI, HU_affected, and CBV < 42% emerged as the dominant predictors, highlighting the prognostic importance of time-to-reperfusion and baseline tissue injury. After external validation, this model may serve as a practical tool for early risk stratification and individualized rehabilitation planning.