Maintaining stable arterial blood pressure during endovascular embolization of intracranial aneurysms is of great importance due to impaired cerebrovascular autoregulation and the risk of ischemic or hemorrhagic complications. Intraoperative blood pressure variability has been associated with adverse postoperative outcomes. This study aimed to compare the effects of remimazolam and propofol on intraoperative arterial blood pressure variability during endovascular embolization of intracranial aneurysms.

A prospective randomized controlled trial with blinded patients and outcome assessors was conducted in 63 patients undergoing endovascular embolization of intracranial aneurysms. Patients were randomly assigned to receive either remimazolam or propofol for general anesthesia. Mean arterial pressure (MAP) was recorded at 5-minute intervals. The primary outcome was intraoperative blood pressure variability, quantified by the average real variability (ARV) of MAP. Secondary outcomes included additional indices of blood pressure variability (standard deviation [SD], coefficient of variation [CV], and MAP range), intraoperative hypotension, norepinephrine use, and postoperative clinical outcomes.

MAP-ARV was significantly lower in the remimazolam group than in the propofol group (P < 0.001). Similarly, MAP-SD, MAP-CV, and MAP range were all reduced in the remimazolam group (P < 0.001). The incidence of hypotension was lower in the remimazolam group (31.3% vs 71.0%, P = 0.002), with fewer hypotensive episodes, shorter duration of hypotension, and reduced norepinephrine use (P < 0.05). Surgeon satisfaction was higher in the remimazolam group (P = 0.015). No significant differences were observed in postoperative neurological outcomes, complications, or length of hospital stay.

In patients undergoing endovascular embolization of intracranial aneurysms, remimazolam was associated with reduced intraoperative arterial blood pressure variability and improved hemodynamic stability compared with propofol. However, no significant differences were observed in postoperative neurological or functional outcomes between the two groups.

Hypertension is one of the major modifiable cardiovascular risk factors in China. Persistent and poorly controlled hypertension contributes to a wide spectrum of adverse cardiovascular outcomes, yet public awareness and understanding of the condition remain suboptimal. With the rapid expansion of digital media, social platforms have emerged as important channels for disseminating health information. This study evaluates the quality of hypertension-related content presented in short-video formats on widely used social media platforms.

Newly registered accounts were used to retrieve the top 100 videos from Douyin, Bilibili, and Kwai based on each platform's default comprehensive ranking algorithm. The collected videos were subsequently screened following predefined criteria, which included removal of duplicates, silent clips, advertisements, irrelevant content, and non-Chinese language videos. In addition, videos produced by the same creator on the same platform were consolidated into a single entry to avoid redundancy. The reliability of the videos was assessed using the DISCERN instrument, and their overall quality was evaluated with the Global Quality Scale (GQS). A comparative analysis was further performed to examine differences in video characteristics and quality across the three short-video platforms.

A total of 267 videos from various creators were included in the analysis, with Douyin contributing 36.3% (140/267), Bilibili 31.1% (83/267), and Kwai 32.6% (87/267). With respect to video sources, non-specialist physicians produced the largest proportion of content (52.4%, 140/267), followed by specialist physicians (31.5%, 84/267). In the assessment of overall video quality, Bilibili demonstrated the highest completeness scores (p < 0.001). Douyin and Bilibili demonstrated comparable Global Quality Scores (GQS) and both performed significantly better than Kwai (p < 0.001). Nevertheless, all three platforms exhibited uniformly low DISCERN scores. When comparing creators with different professional backgrounds, videos produced by non-profit organizations and specialist physicians showed significantly higher overall quality than those generated by non-specialist physicians and individual users.

Overall, the quality of the videos was suboptimal. Although hypertension-related content produced by nonprofit organizations and cardiovascular specialists achieved higher scores in overall quality, the presentation of these videos was relatively uniform. This homogeneity limited the breadth of hypertension-related knowledge that viewers could obtain from short-video platforms.

Early neurological deterioration (END) is a frequent and devastating clinical feature of branch atheromatous disease (BAD). The napkin-ring sign (NRS) on computed tomography angiography (CTA) has emerged as a surrogate imaging marker of vulnerable atherosclerotic plaques. This study aimed to investigate the association between carotid NRS plaque burden and END in patients with lenticulostriate artery (LSA)-territory BAD.

We retrospectively enrolled 247 consecutive patients with LSA-territory BAD. Patients were categorized into END and non-END groups. Carotid NRS plaque presence and area were assessed using CTA. Intracranial arterial stenosis (ICAS) in non-culprit vessels was also evaluated. Associations between carotid NRS plaques, END, and ICAS were analyzed using multivariable logistic regression and receiver operating characteristic (ROC) curve analyses.

END occurred in 25.9% of patients. The prevalence and area of carotid NRS plaques were significantly higher in patients with END than in those without END, both ipsilaterally and contralaterally (all p < 0.05). These associations remained significant after adjustment for age, sex, and baseline NIHSS score. ROC analysis demonstrated moderate predictive performance of NRS plaque area for END (AUC = 0.778 ipsilateral; AUC = 0.692 contralateral). Furthermore, patients with ICAS exhibited a significantly higher prevalence of carotid NRS plaques.

Increased carotid NRS plaque burden is independently associated with END and ICAS in patients with LSA-territory BAD. Carotid NRS plaques may serve as a potential imaging biomarker for identifying BAD patients at high risk of neurological deterioration.

Neuroinflammation plays a critical role in the prognosis of acute ischemic stroke (AIS). Soluble CD163 (sCD163), a marker of monocyte/macrophage activation, has been linked to stroke severity, but its independent prognostic value and clinical utility remain uncertain. This study aimed to evaluate whether serum sCD163 measured within 24 hours of admission predicts 3_month poor functional outcome in AIS patients without reperfusion therapy, and to construct and externally validate a prognostic model incorporating sCD163.

This prospective, dual_cohort study enrolled 664 first_ever AIS patients (training cohort, 2021 -2023) and 300 patients from an independent center (external validation cohort, 2024). All patients did not receive intravenous thrombolysis or mechanical thrombectomy. Serum sCD163 levels were measured at admission by ELISA. The primary outcome was poor functional outcome at 3 months, defined as modified Rankin Scale (mRS) > 2. Multivariable logistic regression with LASSO variable selection was used to identify independent predictors. Model performance was assessed by discrimination (AUC), calibration (Hosmer_Lemeshow test), and decision curve analysis (DCA), with internal bootstrap validation and external validation.

Poor outcome occurred in 34.1% (226/664) of the training cohort and 34.0% (102/300) of the validation cohort. Serum sCD163 levels were significantly higher in poor_outcome patients (820 ± 110 ng/mL vs. 650 ± 80 ng/mL, P < 0.001). The optimal cutoff was 742.5 ng/mL. After multivariable adjustment, high sCD163 (≥ 742.5 ng/mL) was an independent predictor of poor outcome (adjusted OR = 7.52, 95% CI: 4.42 -12.78, P < 0.001), along with baseline NIHSS score, DWI infarct volume, and atrial fibrillation. The combined model achieved an internal bootstrap_validated AUC of 0.877 (95% CI: 0.829 -0.926) and an external validation AUC of 0.867 (95% CI: 0.815 -0.921), with good calibration (Hosmer_Lemeshow P = 0.868 and 0.680, respectively) and superior net clinical benefit on DCA. Adding sCD163 significantly improved model performance over clinical predictors alone (ΔAUC = 0.118, P < 0.001).

Serum sCD163 within 24 hours of admission is a robust, independent biomarker for predicting 3_month poor functional outcome in AIS patients without reperfusion. The prognostic model combining sCD163 with traditional clinical and imaging variables demonstrates excellent discrimination, calibration, and clinical utility in an independent external cohort. Our findings support the early measurement of sCD163 for individualized risk stratification, though further mechanistic and multi_center studies are needed to confirm generalizability and causality.

This study aimed to investigate the characteristics of eye movements and their correlation with cognition in patients with cerebral small vessel disease (CSVD).

This was a cross-sectional study enrolling a total of 120 patients with CSVD admitted to Hebei General Hospital from January 2022 to October 2023. The videonystagmography (VNG) was completed, and the Montreal Cognitive Assessment (MoCA) was used to evaluate the patients' cognitive function. Patients were stratified into mild (0), moderate (1-2), and severe (3-4) groups based on a 4-point MRI score integrating white matter hyperintensities, lacunar infarcts, enlarged perivascular spaces, and cerebral microbleeds.

Decreased right saccade accuracy (OR = 0.923, 95% CI: 0.890 ~ 0.959, p < 0.001), decreased left saccade accuracy (OR = 0.938, 95% CI: 0.908 ~ 0.968, p < 0.001), prolonged right saccade latency (OR = 1.015, 95% CI: 1.008 ~ 1.023, p < 0.001), and prolonged left saccade latency (OR = 1.014, 95% CI: 1.007 ~ 1.022, p < 0.001) were independently associated with increased total CSVD burden. Decreased right saccade accuracy (OR = 0.924, 95% CI: 0.876 ~ 0.973, p = 0.004), decreased left saccade accuracy (OR = 0.944, 95% CI: 0.903 ~ 0.988, p = 0.012), decreased right peak velocity (OR = 0.988, 95% CI: 0.978 ~ 0.998, p = 0.030), decreased left peak velocity (OR = 0.986, 95% CI: 0.976 ~ 0.996, p = 0.007) and increased rightward slow-phase velocity values (OR = 4.668, 95% CI: 1.669 ~ 13.066, p = 0.003) were independently associated with cognitive impairment.

Eye movement characteristics in CSVD patients were significantly correlated with the total MRI load and cognitive function. This provides an important reference value for the early identification and assessment of CSVD severity.

Despite the success of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS), a subset of older adults experience poor functional recovery. We aimed to develop and validate a pragmatic clinical risk score to predict poor 6-month functional outcomes in this population.

We conducted a retrospective cohort study of 204 elderly patients (≥65 years, 106 males and 98 females) with severe AS who underwent TAVR at our center between March 2021 and March 2024. The primary endpoint was poor functional outcome at 6 months, defined as a composite of failure to improve left ventricular ejection fraction (LVEF) by >10% and failure to increase 6-minute walk test (6MWT) distance by >50 meters. Patients were randomly split into a training cohort (n=143) and a validation cohort (n=61). LASSO regression was used in the training cohort to identify predictors and construct the TAVR-PRO (Transcatheter Aortic Valve Replacement - Poor Recovery Outcome) risk score. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots. A secondary endpoint of 1-year all-cause mortality was analyzed using Kaplan-Meier curves.

Five independent predictors were incorporated into the TAVR-PRO score: advanced age (≥80 years), Clinical Frailty Scale (CFS) >4, NT-proBNP >3000 pg/mL, coronary artery disease, and chronic kidney disease (eGFR < 45 mL/min/1.73m²). The score demonstrated good discrimination in both the training (AUC = 0.88) and validation cohorts (AUC = 0.86), with excellent calibration. Higher scores were significantly associated with poor functional outcome and increased 1-year all-cause mortality (P < 0.001).

The TAVR-PRO score, based on five readily available variables, is a simple and effective tool for predicting poor functional outcomes and mortality after TAVR in older adults. This score can aid in shared decision-making, patient counseling, and identifying high-risk individuals for targeted interventions.

The predictive value of carotid intraplaque neovascularization (IPN), assessed by the novel AngioPLUS technique, for recurrent anterior circulation ischemic stroke (ACIS) remains unclear. This study aimed to evaluate the prognostic value of IPN for stroke recurrence in patients with ACIS and to develop a parsimonious prediction model by screening core predictors using Lasso regression, with subsequent assessment of its discrimination, calibration, and clinical utility.

Consecutive patients admitted for ACIS who underwent IPN assessment using AngioPLUS ultrasound between August 2020 and February 2025 were prospectively enrolled. Independent predictors of recurrent ischemic stroke were identified using Cox proportional hazards regression models. Least absolute shrinkage and selection operator (Lasso) regression was employed to screen core predictors for constructing a parsimonious Cox model. Model discrimination was evaluated using time-dependent receiver operating characteristic (ROC) curves, and internal validation was performed with Bootstrap resampling B = 1000 to calculate the concordance index (C-index). Model calibration was assessed using calibration plots. Risk stratification was conducted based on the optimal cut-off value of the total nomogram score, and differences in survival between groups were compared using the Kaplan-Meier method and the log-rank test.

A total of 143 patients (93 males, 65.0%; mean age 67.6 ± 11.7 years) with a median follow-up of 21 months (range 6-56 months) were enrolled, during which 26 patients experienced recurrent ischemic stroke. The recurrence rate was significantly higher in the high IPN group compared to the low IPN group (35.0% vs. 6.0%, p < 0.001). Lasso regression identified two core predictors: IPN Grades 2 (HR = 5.30, 95% CI 1.99-14.08, p < 0.001) and LDL-C (HR = 2.23, 95% CI 1.41-3.52, p < 0.001). The parsimonious model yielded a concordance index (C-index) of 0.786 (95% CI 0.707-0.866), with time-dependent AUC values of 0.716, 0.809, and 0.815 at 12, 24, and 36 months, respectively. Calibration plots closely approximated the ideal diagonal line. Nomogram-based risk stratification demonstrated that patients in the high-risk group had significantly lower recurrence-free survival rates at 12, 24, and 36 months (80.46, 36.40, and 28.31%, respectively) compared to those in the low-risk group (97.73, 90.80, and 88.21%, respectively). The median survival time was 23.0 months in the high-risk group and was not reached in the low-risk group (log-rank p < 0.001).

Carotid IPN is an independent predictor of ACIS recurrence. A parsimonious Cox model incorporating IPN Grades 2 and LDL-C demonstrated favorable discrimination and calibration. The nomogram based on this model effectively identifies individuals at high risk of recurrence, offering a simple and practical tool for guiding individualized secondary prevention strategies in clinical practice.

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly termed non-alcoholic fatty liver disease) and hypertension frequently coexist within the same cardiometabolic context. The metabolic score for insulin resistance (METS-IR), which is derived from body mass index, fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol without requiring insulin measurement, may serve as a practical auxiliary indicator of metabolic dysfunction.

This study investigated the association between METS-IR and MASLD among adults with hypertension and evaluated the dose-response pattern, non-linear features, discrimination, and effect modification.

This secondary cross-sectional analysis used publicly available data from a Chinese single-center health check-up cohort. A total of 943 adults with hypertension were included. MASLD was operationally defined as ultrasonographically detected hepatic steatosis in adults with hypertension after exclusion of excessive alcohol intake and other known causes of liver disease. The primary multivariable model was adjusted for age group, sex, tobacco use, alcohol use, and diabetes; an extended model additionally included uric acid, total cholesterol, low-density lipoprotein cholesterol, and fat-to-muscle ratio. Logistic regression, quartile analysis, restricted cubic spline analysis, sensitivity analyses, receiver operating characteristic analysis, and subgroup interaction analyses were performed.

Among the 943 participants, 640 had MASLD, corresponding to a prevalence of 67.9%. The prevalence of MASLD increased across METS-IR quartiles from 40.7% to 67.2%, 74.6%, and 89.0%. After adjustment for age group, sex, tobacco use, alcohol use, and diabetes, each 1-standard deviation increase in METS-IR was associated with higher odds of prevalent MASLD (odds ratio [OR] = 2.78, 95% confidence interval [CI]: 2.24-3.44, P < 0.001). Compared with quartile 1, the ORs for quartiles 2, 3, and 4 were 2.99, 4.01, and 9.72, respectively. In the extended model, the corresponding OR per 1-standard deviation increase was 2.47 (95% CI: 1.91-3.18, P < 0.001). Restricted cubic spline analysis suggested mild non-linearity. Exploratory ROC analysis yielded an area under the curve of 0.738 (95% CI: 0.705-0.772); the data-derived METS-IR cut-point of 42.40 had a sensitivity of 53.0% and a specificity of 81.8%. A borderline interaction by sex was observed (P for interaction = 0.046), whereas interactions by age group and diabetes status were not statistically significant.

Among adults with hypertension in a Chinese single-center health check-up population, higher METS-IR was associated with a higher likelihood of prevalent MASLD and showed a graded, mildly non-linear pattern. METS-IR may serve as an accessible auxiliary metabolic indicator, but its data-derived cut-point and possible sex-specific association require independent validation.

This study aimed to explore a machine learning (ML) model for predicting the long-term prognosis of Cerebral Venous Thrombosis (CVT). We conducted a comprehensive retrospective analysis on CVT patients admitted to Fujian Medical University Fuzhou General Hospital and The Affiliated Zhongshan Hospital of Xiamen University from January 1, 2020 to December 31, 2023. The retrospective cohort of 350 patients was used for model development using a 5-fold nested cross-validation framework. To address class imbalance, the Borderline-SMOTE technique was applied within the internal training folds. A total of 31 clinical and laboratory variables were evaluated as potential predictors. Lasso and Elastic Net (cv-Enet) were employed for preliminary variable selection, and the intersection of these two methods yielded 11 key variables. Random Forest was then applied to further reduce dimensionality, resulting in a final set of 5 crucial variables. These variables were ranked by importance using SHapley Additive exPlanation (SHAP) analysis. In internal validation using nested cross-validation, the SVM model achieved an area under the receiver operating characteristic curve (AUROC) of 0.870, with a sensitivity of 0.784 and a specificity of 0.897. This performance was corroborated in an independent, prospectively collected external cohort of 152 patients from the First Hospital of Shanxi Medical University (January 1, 2023 to December 31, 2025) where the model demonstrated robust discrimination with an AUROC of 0.862 (95% CI: 0.829-0.884). However, calibration analysis indicated a slight overestimation of risk (calibration-in-the-large ≈ 9%), suggesting that the model currently serves best as a risk stratification adjunct rather than a definitive outcome predictor. Bootstrap resampling confirmed the stability of the discriminative performance. Exploratory subgroup and fairness analyses suggested stable model performance across key demographic subgroups. Our study focused on the development and validation of an ML-based model for long-term CVT prognosis prediction, highlighting the significant role of inflammatory markers. These findings indicate that the SVM model, with further calibration and prospective validation, could serve as a useful adjunct for risk stratification in CVT.

The study aimed to determine the prevalence of obesity and metabolic syndrome (MS) and analyze the cardiovascular outcomes in pediatric kidney transplant recipients from a single center in India.

Determinants of MS, including weight, height, body mass index (BMI), blood pressure, fasting blood sugar, triglyceride, and high-density lipoprotein (HDL) were collected for children with at least 1 year follow-up post-transplant. Cardiovascular outcomes were hypertension, left ventricular hypertrophy (LVH), and carotid intima medial thickness (cIMT). Muscle strength was evaluated by measuring hand grip strength (HGS). Diagnosis of obesity and MS was done by applying recommendations from the Pediatric Renal Nutrition Task Force.

The median age of the cohort (32 recipients, 71% male) was 14.0 years (IQR 12.0, 15.9). At a median 21.5 months (IQR 17, 37.5) after first kidney transplantation, 9 (28.1%) had MS. Hypertriglyceridemia was present in 17 children (53.1%), low HDL cholesterol in 10 (31.2%), hypertension in 22 (68.8%), and fasting hyperglycemia in 7 (21.9%). The ΔBMI height-age Z-score was significantly higher in the MS group (p = 0.003). There was no difference in eGFR, LVMI, Triglyceride index and HGS between the MS and Non-MS groups. In multivariate regression analysis, the ΔBMI height-age Z-score and Acute rejection were independent predictors of MS and LVH, respectively. MS was not an independent predictor of LVH. All patients had elevated cIMT.

MS was found in about a third of the cohort. Graft function and LVH were similar between the groups. Post-transplant weight gain was a key determinant of MS.