Journal of Investigative Medicine最新文献

{"title":"Associations of albumin, globulin and albumin-to-globulin ratio with cerebral small vessel disease.","authors":"Yufan Liu, Shan Li, Xueli Cai, Mengxing Wang, Qi Zhou, Jing Jing, Tiemin Wei, Yongjun Wang, Yilong Wang, Yuesong Pan, Yan He","doi":"10.1136/svn-2025-004162","DOIUrl":"https://doi.org/10.1136/svn-2025-004162","url":null,"abstract":"<p><strong>Background: </strong>Albumin (ALB), globulin (GLB) and albumin-to-globulin ratio (AGR) are linked to vascular diseases, but their relationships with cerebral small vessel disease (CSVD) remain inadequately explored. This study aimed to examine the associations between these biomarkers and CSVD burden.</p><p><strong>Methods: </strong>Participants from the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study were included. CSVD severity was assessed using total and modified CSVD burden scores derived from white matter hyperintensity (WMH), enlarged perivascular spaces in basal ganglia (BG-EPVS), lacunes and cerebral microbleeds. Logistic regression and two-sample Mendelian randomisation (MR) were employed to estimate associations and potential causal effects.</p><p><strong>Results: </strong>Among 3042 subjects (mean age 61.2 years), lower ALB, higher GLB and lower AGR were significantly associated with greater total and modified CSVD burden after adjusting for confounders. Specifically, the risk of total CSVD burden was significantly increased for the lowest ALB tertile (cOR 1.31, 95% CI 1.07 to 1.60), highest GLB tertile (cOR 1.33, 95% CI 1.09 to 1.63) and lowest AGR tertile (cOR 1.46, 95% CI 1.19 to 1.79) compared with their respective reference tertiles. Similar patterns were observed for WMH and BG-EPVS. MR analysis revealed that genetically predicted ALB was inversely associated with WMH volume (β -0.07, 95% CI -0.13 to -0.01), while genetically predicted GLB was positively associated with WMH volume (β 0.05, 95% CI 0.01 to 0.10).</p><p><strong>Conclusions: </strong>Lower ALB, higher GLB and lower AGR are associated with increased CSVD burden. Genetic evidence supports the causal roles of ALB and GLB in WMH development.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram with late neurological deterioration as a key predictor for poor functional outcomes after endovascular therapy in acute basilar artery occlusion beyond 24 hours.","authors":"Na Liu, Haodong Li, Qiuting Wang, Yuxin Chen, Shouchun Wang, Shimin Liu, Chunhua Li, Jin Zhang, Hongli Pang, Chun-Guang Chen, Yanbin Li, Huaiqiang Hu, Xiaolin Zhao, Lan Liu, Qing Zhang, Chuanjie Wu, Longfei Wu, Wenbo Zhao, Qingfeng Ma, Jian Chen, Xunming Ji, Chuanhui Li","doi":"10.1136/svn-2025-005071","DOIUrl":"https://doi.org/10.1136/svn-2025-005071","url":null,"abstract":"<p><strong>Background: </strong>Observational studies have shown that endovascular thrombectomy (EVT) benefits patients with acute basilar artery occlusion (aBAO) in the ultra-late window, yet subgroups at high risk of unfavourable outcome remain unclear. We sought to identify predictors and develop and validate a nomogram for identifying these patients.</p><p><strong>Methods: </strong>This observational, retrospective study enrolled patients with aBAO who underwent EVT beyond 24 hours between January 2019 and March 2025. Eight hospitals were assigned to the training cohort and seven hospitals to the validation cohort, with a 7:3 random allocation based on hospital geographical location. A nomogram was constructed to estimate the probability of 90-day unfavourable outcomes (modified Rankin Scale score, 4-6) and generate actionable risk categories. We assessed the performance of the nomogram and conducted external validation.</p><p><strong>Results: </strong>Overall, 203 patients were included in the analysis. Independent predictors, including late neurological deterioration (OR 3.12, 95% CI 1.22 to 8.02), National Institutes of Health Stroke Scale score (OR 1.10, 95% CI 1.04 to 1.17), Glasgow Coma Scale score ≤8 (OR 3.98, 95% CI 1.06 to 14.96), male (OR 5.75, 95% CI 1.59 to 20.74) and coronary heart disease (OR 6.53, 95% CI 1.40 to 30.55), were identified in the training cohort and entered into the nomogram. The area under the receiver operating characteristic curve of the nomogram was 0.798 (95% CI 0.727 to 0.870) and 0.721 (95% CI 0.587 to 0.856) in the training and external validation cohorts, respectively.</p><p><strong>Conclusion: </strong>We developed a nomogram that can identify patients with aBAO at high risk of unfavourable outcome following EVT in the ultra-late window.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term exposure to outdoor air pollution significantly associated with severity of acute ischaemic stroke: evidence from the 4S registry.","authors":"Nan Cao, Lan Hong, Kun Fang, Jialiang Feng, Ming Hu, Cheng Huang, Qingyan Fu, Yang Zheng, Qundi Yang, Yuzhuo Wang, Yuankai Xie, Shunyao Wang, Xin Cheng, Qiang Dong","doi":"10.1136/svn-2025-004525","DOIUrl":"https://doi.org/10.1136/svn-2025-004525","url":null,"abstract":"<p><strong>Background: </strong>While associations between exposure to air pollution and the prevalence of acute ischaemic stroke (AIS) have been investigated, only a few studies have reported the relationship between air pollution and stroke severity. This study aimed to assess the impact of air pollution on AIS severity based on hourly monitoring data and a stroke-specific registry from 2017 to 2021 in Shanghai.</p><p><strong>Methods: </strong>Hourly concentrations of particulate matter (PM_2.5 and PM₁₀), O₃, SO₂, CO and NO₂ were monitored from 2017 to 2021. A conditional logistic regression model and a Quasi-Poisson model, both coupled with a distributed lag non-linear model and a time-stratified case-crossover design, were used to evaluate a cohort of 106 623 AIS events documented within the Shanghai Stroke Service registry correspondingly. Counterfactual analyses were applied to reveal the potential reducible fractions (PRFs) of air pollution on baseline National Institute of Health Stroke Scale (NIHSS).</p><p><strong>Results: </strong>Conditional logistic regression model suggested that PM_2.5 (excessive risk (ER) 2.31% (95% CI 1.32% to 3.32%), p<0.001), PM₁₀ (ER 2.60% (95% CI 1.97% to 3.23%), p<0.001) and SO₂ (ER 4.53% (95% CI 3.37% to 5.70%), p<0.001) have the most significant effects on increased baseline NIHSS score, which remained robust in the two-pollutant model. Counterfactual analysis based on a conditional logistic regression model revealed PRFs (PM_2.5 1.77% (95% CI 0.86% to 2.68%), p<0.001; PM₁₀ 1.01% (95% CI 0.28% to 1.73%), p<0.001 and SO₂ 4.04% (95% CI 3.04% to 5.03%), p<0.001). Quasi-Poisson analysis showed similar results.</p><p><strong>Conclusions: </strong>Short-term exposure to ambient air pollution, particularly PM_2.5, PM₁₀ and SO₂, was shown to increase AIS severity. This finding underscored the need for targeted emission controls and stroke prevention strategies.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-FREquency Deep TRanscranial Magnetic Stimulation in ACute Ischaemic StrokE within 48 Hours (RETRACE-I): rationale and design of a randomised, multicentre, open-label, blinded endpoint trial.","authors":"Lingling Ding, Shuyu Lv, Wenjie Wang, Zishuo Ji, Xiping Gong, Qian Jia, Xiaomeng Yang, Yingzhuo Zang, Shuyun Huang, ZeFeng Tan, Yongjun Wang, Zixiao Li","doi":"10.1136/svn-2025-004778","DOIUrl":"https://doi.org/10.1136/svn-2025-004778","url":null,"abstract":"<p><strong>Background: </strong>Acute ischaemic stroke often leads to significant disability and mortality. Secondary brain injury caused by post-stroke immune and inflammatory responses worsens outcomes.</p><p><strong>Aim: </strong>To assess the efficacy and safety of low-frequency deep transcranial magnetic stimulation (LF-dTMS), delivered with an H4 coil to target the insular and prefrontal cortex, and its potential effects on neuroimmune activity and recovery.</p><p><strong>Design: </strong>This randomised, multicentre, open-label, parallel-group trial with blinded outcome assessment evaluates early LF-dTMS at 1 Hz using the H4 coil in adults with anterior-circulation acute ischaemic stroke treated within 48 hours of onset. Participants are randomly assigned in a 1:1 ratio to receive either standard care plus LF-dTMS or standard care alone. Active LF-dTMS is delivered as two sessions per day, 1200 pulses per session, for three consecutive days.</p><p><strong>Study outcomes: </strong>The primary efficacy outcome is the growth in infarct volume from baseline to day 3, measured by diffusion-weighted MRI. The primary safety outcome is symptomatic intracranial haemorrhage within 3 days of treatment. Secondary outcomes include the modified Rankin Scale and serious adverse events at 90 days. Exploratory analyses in a predefined subgroup will involve dynamic plasma proteomics and single-cell RNA sequencing of peripheral mononuclear cells to understand immune responses (days 0, 3, 7), as well as resting-state functional MRI to evaluate the effects of neuromodulation on brain network connectivity.</p><p><strong>Summary: </strong>This study will evaluate the feasibility, safety and preliminary efficacy of early LF-dTMS in acute stroke. It will provide proof-of-concept data on whether modulating post-stroke inflammation and neuroplasticity can improve outcomes. The findings will inform the design of a large definitive trial.</p><p><strong>Trial registration number: </strong>NCT06064734.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered gut microbiota and short-chain fatty acid in acute ischaemic stroke with active cancer.","authors":"Wei Song, Xiaofei Lin, Genghong Xia, Yueran Ren, Xuxuan Gao, Linling Shen, Qiheng Wu, Jia Yin","doi":"10.1136/svn-2025-004217","DOIUrl":"10.1136/svn-2025-004217","url":null,"abstract":"<p><strong>Background: </strong>Acute ischaemic stroke (AIS) in patients with active cancer presents unique etiological factors and correlates with worse outcomes. Although gut microbiota dysbiosis has been separately documented in stroke pathophysiology and cancer progression, gut microbial profiles in patients with concurrent conditions remain unexplored. We investigated gut microbiota composition and short-chain fatty acid (SCFA) levels in patients with AIS and active cancer.</p><p><strong>Methods: </strong>In this prospective observational study, we analysed consecutive patients with AIS admitted between 2018 and 2023. Gut microbiota profiles were characterised using 16S rRNA sequencing. Faecal SCFAs were quantified by gas chromatography-mass spectrometry, and serum biomarkers of intestinal barrier function were measured. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 180 days poststroke.</p><p><strong>Results: </strong>Among 942 consecutive AIS patients, 156 met inclusion criteria: 42 with active cancer and 114 matched controls. Patients with concurrent AIS and cancer demonstrated significant taxonomic alterations, characterised by elevated <i>Firmicutes</i>-to-<i>Bacteroidetes</i> ratio (F/B: 1.2 vs 0.6; p=0.010) and <i>Clostridiales</i>-to-<i>Bacteroidales</i> ratio (C/B: 1.1 vs 0.6; p=0.008) compared with controls. These patients exhibited enrichment of inflammation-associated bacteria, depletion of SCFA-producing microbes, reduced faecal SCFA levels and elevated markers of intestinal barrier dysfunction (all p<0.05). The abundance of inflammation-associated genera <i>Erysipelotrichaceae</i> and <i>Dorea</i> correlated with elevated D-dimer levels and worse 180-day mRS scores. Multivariate analysis identified <i>Clostridiales</i> abundance, F/B and C/B ratios as independent predictors of poor functional outcomes (mRS≥3) at 180 days.</p><p><strong>Conclusions: </strong>Patients with concurrent AIS and active cancer demonstrate distinct gut microbiota profiles and reduced SCFA production, associated with compromised intestinal barrier function and poor outcomes. These observations suggest perturbed gut-brain axis function and motivate exploratory research into microbiota-targeted approaches for this high-risk population.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"148-159"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and prevalence of vascular cognitive impairment in China: a systematic review and meta-analysis.","authors":"Su Zhen Liang, Shenyu Li, Ao Guan, Ruijia Xu, Mingxia Wei, Yingzhe Wang, Weiwei Shen, Yanfeng Jiang, Tiejun Zhang, Mei Cui","doi":"10.1136/svn-2025-004436","DOIUrl":"10.1136/svn-2025-004436","url":null,"abstract":"<p><strong>Objective: </strong>Given China's rapid population ageing and substantial stroke burden, understanding the epidemiology of vascular cognitive impairment (VCI) is critical. This study aimed to systematically evaluate VCI prevalence and incidence in China from 1980 to 2023, and explore demographic and geographic disparities.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of 81 observational studies (73 on prevalence, 10 on incidence) was conducted, analysing data from 784 846 participants for prevalence. Data were extracted from multiple databases, and studies were selected based on predefined inclusion criteria. Meta-analysis was performed using random-effects models due to high heterogeneity (I²>90%). Machine learning models (including gradient boosting machine, random forest) were employed to assess associations between demographic factors and VCI prevalence, with SHapley Additive exPlanations analysis for interpretability.</p><p><strong>Results: </strong>Overall pooled prevalence was estimated at 1.54% (95% CI: 1.14% to 1.93%), varying significantly with age, education and region, peaking at 2.91% in those ≥80 years. Temporal trends revealed increasing prevalence from 1980 to 2023, while incidence was estimated at 0.29 per 100 person-years (95% CI: 0.21% to 0.41%), with regional disparities. Machine learning identified age, sex and survey period as key determinants of prevalence, aligning with meta-regression findings.</p><p><strong>Conclusions: </strong>VCI poses a growing burden in China, particularly among older and less-educated populations. This analysis provides the most comprehensive assessment of VCI in China to date, underscoring demographic and regional variations. These findings highlight the need for targeted public health strategies, improved diagnostics and lifestyle interventions to address the growing burden of VCI, particularly amidst China's ageing population. Future longitudinal research integrating clinical data, biomarkers and potentially neuroimaging is warranted to better understand VCI progression and refine intervention efficacy.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"137-147"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of acute intracerebral haemorrhage with a Chinese herbal formula (Shengdi Dahuang Decoction): a multicentre, double-blind, randomised, placebo-controlled trial.","authors":"Zhihuan Sun, Xiaoyu Zhou, Jingyan Xiang, Feng Wang, Yan Han, Yongmei Guo, Zongqi Zhang, Fan Gong, Mingzhe Wang, Dezhi Liu, Weidong Pan, Haiyan Tang, Tingting Li, Jingsi Zhang, Shan Jiang, Jihan Huang, Xiaofei Yu","doi":"10.1136/svn-2024-003931","DOIUrl":"10.1136/svn-2024-003931","url":null,"abstract":"<p><strong>Importance: </strong>Per preliminary studies, Shengdi Dahuang Decoction (SDD) is potentially effective for acute intracerebral haemorrhage (ICH); however, its effectiveness has not been rigorously assessed in extensive randomised clinical trials.</p><p><strong>Objective: </strong>To evaluate whether SDD can improve 90-day functional outcomes in patients with ICH.</p><p><strong>Design: </strong>Randomised, double-blind, placebo-controlled clinical trial included patients with acute ICH within 4 hours of symptom onset at five hospitals in Shanghai, China.</p><p><strong>Interventions: </strong>Patients were randomised 1:1 to receive either SDD granules (each sachet contained 15 g of raw <i>Rehmannia glutinosa</i> and 5 g of raw rhubarb) or placebo granules orally or via a nasogastric tube (as soon as possible within 12 hours of onset, two times daily for 7 days), in addition to ICH guideline-directed treatments. Per our preclinical study, SDD reduces inflammatory injury after ICH in rats.</p><p><strong>Main outcomes: </strong>The primary outcome measure was the proportion of patients with a score ranging 0-1 on the modified Rankin Scale (mRS) on the 90th day.</p><p><strong>Results: </strong>Of the total 1211 participants with cerebral haemorrhage assessed for eligibility, 483 were enrolled. Of this, 242 participants were randomly assigned to receive SDD granules and 241 to receive placebo granules (mean age, 62.7 years; 72.9% male). Among these, 112 (46.3%) and 84 (34.9%) patients in the SDD and placebo groups, respectively, had an mRS score of 0-1 on the 90th day (adjusted relative risk 1.20, 95% CI 1.00 to 1.43; p=0.046) . The proportion of patients with poor clinical outcomes (mRS score of 5 or 6 at 90 days) was higher in the placebo group (11.2%) than in the SDD group (5.4%) (p=0.021). The 90-day mortality rate (p=0.299), 7-day National Institute of Health Stroke Scale score (p=0.583), 7-day Glasgow Coma Scale score (p=0.577), 24-hour haematoma enlargement rate (p=0.675) or 7-day relative perihaematomal oedema did not significantly differ (p=0.343) between the groups. The incidence of adverse events between the two groups did not differ significantly (p>0.05).</p><p><strong>Conclusions: </strong>In patients with acute ICH, incorporating SDD as a supplementary intervention alongside guideline-directed treatments may help enhance 90-day functional outcomes; however, more clinical trials are required to further prove its efficacy.</p><p><strong>Trial registration number: </strong>NCT04200781.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"174-181"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary stroke evaluation in patients admitted for CRAO in a large national inpatient sample.","authors":"Sahil Doshi, Jay B Bisen, Hanaina K Bains, Ariz Keshwani, Neena Cherayil, Rukhsana G Mirza","doi":"10.1136/svn-2024-003971","DOIUrl":"10.1136/svn-2024-003971","url":null,"abstract":"<p><strong>Background: </strong>Central retinal artery occlusion (CRAO) is an ophthalmic condition associated with cerebrovascular ischaemia. In patients with acute CRAO, the 2021 American Heart Association (AHA) scientific statement recommends a diagnostic evaluation for secondary stroke prevention, including cerebrovascular imaging, cardiac rhythm monitoring, echocardiogram and labs. This study aims to understand the national stroke evaluation rates for patients with CRAO before 2021.</p><p><strong>Methods: </strong>Retrospective, cross-sectional analysis of inpatient admissions from the National Inpatient Sample between 2016 and 2021. Echocardiogram, head and neck vessel imaging and temporal artery biopsy completion during hospital admissions with a principal diagnosis of CRAO were measured. Clustering analysis was performed to characterise differences in stroke evaluations.</p><p><strong>Results: </strong>9615 inpatient stays for CRAO were identified. Only 0.3% underwent carotid ultrasounds, 10% underwent echocardiograms, and 8.5% underwent cerebrovascular imaging. Echocardiograms (10%) were most frequently performed, followed by temporal artery biopsy (6.4%). Clustering analysis reveals a cluster of older females on non-Health Maintenance Organisation Medicare receiving temporal artery biopsies. Other clusters consisted of younger males, who were more likely to receive an echocardiogram or cerebrovascular imaging and be discharged home. Independent predictors increasing the odds of undergoing stroke evaluations include female sex, transfer from another facility, residence in zip codes with a median household income of >$79 000, concurrent diagnosis of cerebral stroke, carotid atherosclerosis and nicotine dependence through cigarette use.</p><p><strong>Conclusions: </strong>In this national cohort study, low percentages of patients with CRAO were evaluated for secondary stroke prevention before the 2021 AHA scientific statement on CRAO management. Notably, higher socioeconomic status patients underwent more comprehensive stroke evaluations.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"191-200"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Papaverine to Prevent Radial Artery Spasm During Transradial Cerebral Angiography (PASS): rationale and design.","authors":"Dong Pan, Jingwen Yang, Mengqi Liu, Yongteng Xu, Jiyun Feng, Huawen Li, Weili Luo, Baixuan He, Songhua Xiao, Xinguang Yang, Yamei Tang","doi":"10.1136/svn-2024-003659","DOIUrl":"10.1136/svn-2024-003659","url":null,"abstract":"<p><strong>Rationale: </strong>Radial artery spasm (RAS) is a common complication during transradial cerebral angiography (TRA), but currently, the optimal prevention strategy is not well established. Papaverine has anti-vasospasm, sedative and analgesic effects. However, the efficacy of papaverine in preventing RAS during TRA remains unknown.</p><p><strong>Aims: </strong>To assess the efficacy of papaverine in preventing RAS during TRA.</p><p><strong>Sample size estimates: </strong>240 participants will provide 80% power at a two-tailed significance level of 0.05 to test the superiority hypothesis with the assumption that the incidence of RAS is 4% and 14.62% in the intervention and control groups, respectively, allowing for a 5% drop-out rate.</p><p><strong>Methods and design: </strong>The Efficacy of Papaverine to Prevent Radial Artery Spasm During Transradial Cerebral Angiography is a multicentre, randomised, placebo-controlled, double-blind trial. Eligible participants scheduled for TRA are 1:1 randomised to the intervention group and the control group. The intervention group will be slowly injected with 10 mL of papaverine hydrochloride solution through the successfully implanted radial artery sheath and continuously dripped papaverine hydrochloride solution through the artery sheath during the procedure, and the control group will be given normal saline in the same manner.</p><p><strong>Study outcome: </strong>The primary outcome is the incidence of RAS during the procedure. The operator assessed RAS based on a questionnaire addressing the following five signs: persistent forearm pain, pain response on catheter manipulation, pain response to introducer withdrawal and difficult catheter manipulation after being 'trapped' by the radial artery with considerable resistance on withdrawal of the introducer. RAS was indicated by the presence of at least two of these five signs or by the presence of just one when the operator considered it necessary to administer other spasmolytic agents.</p><p><strong>Trial registration number: </strong>NCT05861765.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"261-266"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking status and the efficacy of remote ischaemic conditioning: a secondary analysis of the RICAMIS trial.","authors":"Xian-Wen Zhang, Yu Cui, Hui-Sheng Chen","doi":"10.1136/svn-2025-004349","DOIUrl":"10.1136/svn-2025-004349","url":null,"abstract":"<p><strong>Background: </strong>Remote ischaemic conditioning (RIC) is a potential non-invasive neuroprotective strategy, but it remains unclear whether its efficacy is influenced by smoking status. This study explored the impact of smoking status on the therapeutic effect of RIC in patients with acute moderate ischaemic stroke through a post hoc subgroup analysis.</p><p><strong>Methods: </strong>Based on the data from the Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke trial, 1717 patients with moderate stroke (National Institutes of Health Stroke Scale score 6-16) who did not undergo reperfusion therapy were included and categorised into current smokers (n=505) and non-smokers (n=1212) based on their smoking status. Patients were randomly assigned to receive either RIC (administered twice daily for 14 days) or standard treatment. The primary outcome was excellent functional prognosis at 90 days (modified Rankin Scale, mRS scores 0-1). Multivariable regression analysis was used to evaluate the interaction between smoking status and RIC.</p><p><strong>Results: </strong>Among non-smokers, RIC significantly increased the proportion of patients achieving mRS 0-1 at 90 days (69.1% vs 62.8%; adjusted OR 1.487, 95% CI 1.143 to 1.936; p=0.003). Among current smokers, there was no significant difference in the proportion of mRS 0-1 at 90 days compared with the control group (64.1% vs 62.1%; adjusted OR 1.154, 95% CI 0.791 to 1.684; p=0.46). The interaction analysis revealed no significant association between smoking status and RIC efficacy (P for interaction=0.50).</p><p><strong>Conclusions: </strong>In this analysis, RIC significantly improved the excellent functional prognosis of non-smoking stroke patients, but had no significant benefit for current smokers, suggesting that smoking may attenuate RIC efficacy.</p><p><strong>Trial registeration number: </strong>NCT03740971.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"182-190"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}