Journal of Investigative Medicine最新文献

{"title":"Incidence and impact of brain lesions and cognitive impairment after CABG with moderate or severe cerebral artery stenosis seen on low-field MRI.","authors":"Guitao Zhang, Yingjian Pei, Fei Xu, Yao Feng, Qilin Zhou, Yinghua Zhou, Wei Feng, Shujuan Li","doi":"10.1136/svn-2025-004132","DOIUrl":"10.1136/svn-2025-004132","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to assess the incidence and impact of brain lesions and cognitive impairment after coronary artery bypass grafting (CABG) in patients with moderate-to-severe cerebral artery stenosis using low-field MRI.</p><p><strong>Methods: </strong>110 patients with moderate-to-severe cerebral artery stenosis who underwent CABG between November 2023 and May 2024 were enrolled. Postoperative brain lesions were evaluated using low-field MRI. Cognitive decline was defined as a reduction of ≥3 points in the Montreal Cognitive Assessment score from baseline. Risk factors associated with postoperative brain lesions and cognitive impairment were identified in univariate and multivariate logistic regression analyses.</p><p><strong>Results: </strong>A total of 110 patients were enrolled, with a mean age of 65±7 years and 22 (20.0%) were female. New brain lesions were identified in 24 patients (21.8%). Logistic regression analysis identified operation time (OR 1.014, 95% CI 1.003 to 1.025, p=0.013) to be independently associated with brain lesions. 22.2% of the patients (20/90) experienced postoperative cognitive decline. New brain lesions were independently associated with cognitive decline (OR 4.651, 95% CI 1.158 to 18.676, p=0.030), particularly the new brain lesions impairing orientation ability (OR 4.534, 95% CI 1.438 to 14.289, p=0.010).</p><p><strong>Conclusions: </strong>Low-field MRI has proven effective in detecting new brain lesions after CABG. Both postoperative new brain lesions and CABG operation were significant contributors to cognitive decline.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"218-226"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041931","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":"Brain-targeted extracellular vesicles for anti-cuproptosis therapy in subarachnoid haemorrhage.","authors":"Pengcheng Xu, Jian Fang, Feiyun Qin, Dayong Xia, Jinlong Yuan, Bin Sheng, Niansheng Lai","doi":"10.1136/svn-2025-004248","DOIUrl":"10.1136/svn-2025-004248","url":null,"abstract":"<p><strong>Background: </strong>Subarachnoid haemorrhage (SAH) is primarily caused by ruptured aneurysms with high mortality worldwide. Cuproptosis is a copper-induced cell death that regulates lipoylated tricarboxylic acid cycle proteins. The link between cuproptosis and SAH is unclear. To inhibit cuproptosis for SAH treatment, we designed brain-targeted delivery of siRNA to inhibit cuproptosis.</p><p><strong>Methods: </strong>Transcriptome data of SAH related to cuprotosis were extracted from the Gene Expression Omnibus and defined using quantitative reverse transcription-PCR. We injected RVG-RBCEVs/siRNA (rabies virus glycoprotein-red blood cell extracellular vesicles/siRNA) peripherally to deliver LIAS (lipoyl synthase) siRNA to the brain tissues of SAH mice. The influences of RVG-RBCEVs/siRNA on copper levels, enrichment of cuproptosis functional proteins, glutathione and malondialdehyde content, mitochondrial respiration and membrane potential, transmission electron microscope, a neurological score, brain water content, blood-brain barrier injury and Fluoro-Jade C staining were examined.</p><p><strong>Results: </strong>Our findings revealed that three cuproptosis-related genes (CRGs) were differentially expressed. The RVG peptides were conjugated to the red blood cell extracellular vesicle surface by bio-orthogonal click chemistry reactions, and then the loading of siRNA was conducted. RVG-RBCEVs/siRNA was selectively taken up by neurons but not glial cells; it facilitated the downregulation of LIAS of CRGs, reduced the accumulation of reactive oxygen species, inhibited neuronal cuprotosis and exerted neuroprotective effects in vivo.</p><p><strong>Conclusions: </strong>These findings suggest that cuprotosis is critical for inducing neural injury after SAH. Neuron-targeted RVG-RBCEVs/siRNA treatment attenuated oxidative stress by inhibiting cuproptosis via suppressed LIAS expression. This innovative approach alleviates neurobehavioural impairments and represents a neuroprotective strategy following SAH.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"227-239"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070890","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":"Associations of new intracranial haemorrhage, ischaemic stroke and survival with dual antiplatelet therapy regimen or duration after endovascular treatment for ruptured cerebral aneurysm.","authors":"Pang-Shuo Perng, Yu Chang, Ming-Tsung Chuang, Chia-En Wong, Yuan-Ting Sun, Hao-Kuang Wang, Jung-Shun Lee, Liang-Chao Wang, Chih-Yuan Huang","doi":"10.1136/svn-2025-004362","DOIUrl":"10.1136/svn-2025-004362","url":null,"abstract":"<p><strong>Background: </strong>Dual antiplatelet therapy (DAPT) is often necessary following endovascular treatment for ruptured cerebral aneurysms; however, the optimal drug combination and treatment duration remain uncertain.</p><p><strong>Method: </strong>Patients with subarachnoid haemorrhage secondary to ruptured cerebral aneurysms were identified from the TriNetX database. Subjects were categorised based on DAPT regimen (aspirin+clopidogrel vs aspirin+ticagrelor) and duration (≥1 month, ≥3 months, ≥6 months). Propensity score matching was performed, and outcomes including new onset intracranial haemorrhage, ischaemic stroke and overall survival were compared.</p><p><strong>Results: </strong>A total of 2775 patients were included in the regimen analysis, with 725 matched in each group. At the 1-month follow-up, the ORs for new intracranial haemorrhage and ischaemic stroke in the aspirin+clopidogrel group were 1.11 (95% CI 0.71 to 1.75) and 0.97 (95% CI 0.59 to 1.59), respectively, with no significant differences at mid-term or long-term follow-up. However, survival analysis revealed a statistically significant difference at the 6-month follow-up favouring the clopidogrel group (OR 0.65; 95% CI, 0.44 to 0.97). In the duration analysis, 465 patients were matched for the 1-month versus 3-month groups, and 355 for the 3-month versus 6-month groups. ORs for ischaemic stroke were 1.06 (95% CI 0.67 to 1.67) and 1.24 (95% CI 0.76 to 2.01), respectively. No significant differences in survival were observed based on log-rank tests.</p><p><strong>Conclusion: </strong>Our real-world data analysis revealed no significant differences in ischaemic or haemorrhagic outcomes between the aspirin+clopidogrel and aspirin+ticagrelor regimens. However, the observed differences in survival suggest the need for more refined patient selection strategies. In addition, the appropriate duration of DAPT is still unknown, although our results suggest that a shorter DAPT duration may offer comparable safety and efficacy.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"201-207"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975244","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":"Neuronavigation-assisted stereotactic minimally invasive puncture with tenecteplase for the treatment of acute spontaneous deep intracerebral haemorrhage (NAS-TNK): rationale and design of a multicentre randomised trial.","authors":"Mingze Wang, Zhiyou Wu, Jingyi Tang, Xiudan Bai, Shaozhi Zhao, Yang Ni, Pengqi Wang, Duolao Wang, Yong Cao","doi":"10.1136/svn-2025-004234","DOIUrl":"10.1136/svn-2025-004234","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive puncture surgery followed by thrombolysis has been proven to be an effective approach for managing hypertensive intracerebral haemorrhage (ICH). Nevertheless, its impact on improving neurological outcomes remains controversial. The integration of neuronavigation-assisted stereotactic (NAS) technology will significantly help enhance the accuracy of catheter placement, while tenecteplase (TNK), a third-generation thrombolytic agent, offers stronger capabilities in breaking down platelet-rich clots and demonstrates increased fibrin selectivity, which could enhance the overall effectiveness of thrombolytic treatment. However, the efficacy and safety of combining NAS-assisted minimally invasive puncture with TNK (NAS-TNK) in reducing disability and mortality rates among patients with acute spontaneous deep ICH remain unknown.</p><p><strong>Aim: </strong>To describe the rationale and design of the NAS-TNK trial for the treatment of acute spontaneous deep ICH.</p><p><strong>Design: </strong>NAS-TNK is a randomised, open-label, outcome-blinded multicentre trial, involving 732 participants with acute basal ganglia or thalamic haemorrhage with a haematoma volume ranging from 20 to 50 mL. This study will evaluate the efficacy and safety of NAS-TNK, administered every 24 hours at a dose of 0.009 mg/mL of haematoma volume, compared with participants receiving standard medical care. Each patient will undergo follow-up evaluations for a period of 180 days.</p><p><strong>Study outcomes: </strong>The main measure of effectiveness is the percentage of participants achieving a modified Rankin Scale Score ranging from 0 to 3 at the 180-day mark. The primary safety outcome is the all-cause death at 30 days.</p><p><strong>Discussion and conclusion: </strong>The NAS-TNK study will help improve our understanding of the benefits of NAS-TNK in patients with acute spontaneous deep ICH.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"240-246"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876226","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":"Tongxinluo capsule in the treatment of cerebral small vessel disease: protocol of a randomised, double-blind, placebo-controlled, multicentre clinical study (TOPS-CSVD).","authors":"Yingzhe Wang, Xiaodi Xie, Jun Xu, Peng Lei, Kai Wang, Junjian Zhang, Jintai Yu, Mei Cui, Qiang Dong","doi":"10.1136/svn-2024-003929","DOIUrl":"10.1136/svn-2024-003929","url":null,"abstract":"<p><strong>Background: </strong>Tongxinluo capsule has demonstrated multiple beneficial effects on microcirculation, endothelial cells and inflammation. However, evidence supporting their efficacy in improving vascular cognitive decline is limited. This trial aims to investigate the potential benefits of Tongxinluo capsules in Chinese patients with cerebral small vessel disease (CSVD) who have been diagnosed with mild cognitive impairment.</p><p><strong>Design: </strong>Thistrail is a randomised, double-blind, placebo-controlled, multicentre study involving 1052 individuals aged 50-80 years with MRI-confirmed CSVD and a diagnosis of mild cognitive impairment. Participants were randomly assigned in a 1:1 ratio to receive either Tongxinluo capsules or placebo. The treatment period spans 12 months, with follow-up assessments conducted every 3 months to collect cognitive scale results and other relevant data.</p><p><strong>Study outcome: </strong>The primary outcome of this clinical trial is the change in the Vascular Dementia Assessment Scale-cognitive subscale from baseline to 12 months. The primary safety outcome focuses on the incidence of adverse vital signs, including abnormalities in body temperature, heart rate, respiration and blood pressure.</p><p><strong>Discussion: </strong>This trial has the potential to offer novel insights into the management of cognitive decline associated with CSVD through the application of traditional Chinese medicine.</p><p><strong>Trial registration number: </strong>NCT06061692.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"253-260"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042110","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":"Head-down position after reperfusion improves cerebral ischaemic injury in rat.","authors":"Qiong Wu, Nan-Nan Zhang, Ji-Ru Cai, Yi-Na Zhang, Hui-Sheng Chen","doi":"10.1136/svn-2025-004409","DOIUrl":"10.1136/svn-2025-004409","url":null,"abstract":"<p><strong>Background and aims: </strong>Preclinical and clinical studies found that head-down position (HDP) during ischaemic phase improved neurological function of acute ischaemic stroke, but the effect of HDP after reperfusion has never been investigated. This study aimed to investigate whether HDP after reperfusion can ameliorate cerebral ischaemic injury in rats.</p><p><strong>Methods: </strong>The middle cerebral artery occlusion/reperfusion (MCAO/R) model was established in rats, and different HDP interventions were performed. Survival rate, haemorrhage transformation rate, neurological deficit scores, infarct volume, weight loss and brain oedema were measured at 24 hours after surgery to explore the cerebroprotective effect of HDP. Immunohistochemistry, ELISA and western blot were used to determine the possible mechanisms.</p><p><strong>Results: </strong>Compared with MCAO/R group, HDP -20° immediately after reperfusion with 1 hour duration exerted a significant cerebroprotective effect including reducing brain infarction and oedema, and improving neurological impairment, with a favourable safety profile such as less haemorrhagic transformation and death. These protective effects were not observed under other HDP intervention conditions. Mechanistically, this HDP procedure may exert its effects by regulating microglial polarisation, inhibiting microglial activation and neuroinflammation, reducing brain oedema and blood-brain barrier (BBB) disruption, suppressing apoptosis and improving neurological function.</p><p><strong>Conclusion: </strong>This is the first study to demonstrate the cerebroprotective effect of HDP -20° with 1 hour duration immediately after reperfusion in MCAO/R model rats, which involved inhibition of neuroinflammation and apoptosis as well as protection of BBB.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"208-217"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001721","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":"Where are we going for the treatment in ischaemic stroke: a comprehensive study of investigator-sponsored randomised controlled trials, 1990-2024.","authors":"Xinya Li, Xue Xia, Meng Gao, Ruobing Tian, Xue Tian, Manqi Zheng, Anxin Wang","doi":"10.1136/svn-2025-004027","DOIUrl":"10.1136/svn-2025-004027","url":null,"abstract":"<p><strong>Background: </strong>Until recently, a comprehensive understanding of the current development status and emerging trends of investigator-sponsored randomised controlled trials (RCTs) for the treatment of ischaemic stroke (IS) on a global scale remains elusive, making it unclear where the research and innovation in the field are going.</p><p><strong>Methods: </strong>Following the design, registration, enrolment and publication (DREP) cycle, we conducted an observational study of investigator-sponsored RCTs enrolling patients with IS for therapeutic purposes using the International Clinical Trial Registry Platform. We analysed cumulative publication rates since registration and enrolment and explored the association of potential factors with publication status.</p><p><strong>Results: </strong>A total of 1518 trials were included. The number of registered, enrolment-commenced, published RCTs increased from 1990 to 2024 (p<0.001, for all). Of these, 66.5% were registered prior to their enrolment with the first subject. Among 435 trials that ended and were registered 5 years ago, 189 (43.4%) have been published. Multivariable Cox regression analysis revealed that endovascular therapy or surgery as intervention (compared with traditional medicine) (HR (95% CI), 2.02 (1.06 to 3.87)) was associated with trial publication. Also, there existed a positive association between target sample size and publication, when the sample size surpassed 274. In addition, the most frequent cause of the termination and withdrawal in trials is the difficulty in enrolment.</p><p><strong>Conclusion: </strong>Since 1990 to the present, investigator-sponsored RCTs of IS treatment have seen a significant increase worldwide. Nevertheless, a multitude of impediments in the DREP cycle still persists that necessitate resolution and enhancement. There is a pressing need for addressing issues such as retrospective registration, premature termination of enrolment and suppression of study results, to further expand the reach of research improvements to a wider patient community.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"160-173"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754935","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":"CerebrAlcare Pills on CereBral Small VesseL DiseasE (CABLE) trial: rationale and design.","authors":"Mengyuan Zhou, Yutian Gong, Shangrong Han, Meiping Wang, Wenping Gu, Hui-Sheng Chen, Wenxu Zheng, Kai Feng, Dan Wang, Hang Li, Zhidong Zheng, Yuesong Pan, Weiqi Chen, Yilong Wang","doi":"10.1136/svn-2024-003756","DOIUrl":"10.1136/svn-2024-003756","url":null,"abstract":"<p><strong>Rationale: </strong>Cerebral small vessel disease (CSVD) is responsible for 25% of ischaemic strokes and 45% of dementia cases. Currently, therapies targeting individual mechanisms have not shown significant efficacy. As CSVD involves multiple pathophysiological mechanisms, Cerebralcare pills, a traditional Chinese medicine with multiple pharmacological mechanisms, may be effective in treating cognitive dysfunction in CSVD.</p><p><strong>Aims: </strong>The objective of this study was to assess the efficacy of Cerebralcare pills in improving cognitive dysfunction (measured by Montreal Cognitive Assessment (MoCA)) in patients with CSVD.</p><p><strong>Sample size estimates: </strong>A sample size of 114 patients with CSVD (57 in each group) will allow 2.74 points (with an SE of 0.56 points) difference between two groups on the MoCA score with 5% significance, 80% power and assuming a 10% dropout rate.</p><p><strong>Methods and design: </strong>This is a randomised double-blind, multicentre, placebo-controlled trial involving individuals with mild cognitive impairment (MoCA score ranging from 16 to 24) associated with CSVD. CSVD was defined by the presence of white matter hyperintensities consistent with lacunar infarcts or the presence of more than two vascular risk factors. Participants were randomised 1:1 to orally take 5 g of Cerebralcare pills or placebo twice a day for 6 months.</p><p><strong>Study outcomes: </strong>The primary outcome measure is the change in MoCA score at 6 months. Secondary outcome measures include the assessment of clinical manifestations, cognitive performance, conventional MRI markers, blood-brain barrier permeability and proteomics over a follow-up period of 6 months and 12 months.</p><p><strong>Discussion: </strong>The objective of this trial is to evaluate the efficacy of Cerebralcare pills in improving cognitive dysfunction associated with CSVD. Additionally, the trial aims to provide insights into the pathological processes involved in this condition.</p><p><strong>Trial registration number: </strong>NCT05578521.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"247-252"},"PeriodicalIF":4.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975212","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":"Association of socioeconomic status with intracranial arterial plaque: mediated by cardiometabolic risk factors.","authors":"Naiqi Liu, Xinya Zheng, Ruinan Zhang, Zhuo Zhao, Xueli Cai, Anqi Zhang, Shan Li, Yongjun Wang, Yuesong Pan","doi":"10.1136/svn-2025-004457","DOIUrl":"https://doi.org/10.1136/svn-2025-004457","url":null,"abstract":"<p><strong>Background: </strong>Low socioeconomic status (SES) has been associated with atherosclerosis but few studies have explained its relationship with intracranial arterial plaque. The aim of this study is to investigate the association between SES and intracranial arterial plaque, as well as its possible pathogenetic mechanisms.</p><p><strong>Methods: </strong>Data were obtained from the baseline cross-sectional survey of the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events study in China. SES was assessed and categorised into three groups based on the participants' educational level, occupational class and income level. Intracranial arteries were evaluated using vascular MRI. Mediation analyses were performed to estimate the indirect and direct effects of systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood-glucose (FG) and waist-hip ratio (WHR) on the association between SES and intracranial arterial plaque.</p><p><strong>Results: </strong>A total of 3065 subjects were included. The mean age of participants was 61.2±6.7 years, and 53.5% (n=1639) were women. Compared with the high SES group, the intermediate and low SES groups were associated with higher odds of intracranial arterial plaques (OR: 1.85, 95% CI 1.37 to 2.49; OR: 1.68, 95% CI 1.24 to 2.28) and greater intracranial atherosclerotic burden (common OR (cOR): 1.79, 95% CI 1.33 to 2.40; cOR: 1.65, 95% CI 1.22 to 2.22) after adjusting for potential covariates. Cardiometabolic risk factors partially mediated the association between SES and intracranial arterial plaque (percentage mediated: 27.5%) and between SES and intracranial atherosclerotic burden (37.4%). Across both outcomes, SBP was the strongest mediator (23.29% for plaque; 30.33% for burden), followed by DBP (13.36% and 14.47%), FG (7.07% and 10.05%) and WHR (6.20% and 7.61%).</p><p><strong>Conclusion: </strong>SES was associated with higher odds of the presence of intracranial arterial plaque and atherosclerotic burden, with nearly one third of the association being explained by cardiometabolic risk factors.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786509","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":"Long-term clinical outcome after extracranial-intracranial bypass surgery for atherosclerotic vessel occlusion in patients with diminished cerebrovascular reserve capacity and recurrent ischaemic events despite medical management.","authors":"Sajjad Muhammad, Simon Schieferdecker, Daniel Haenggi","doi":"10.1136/svn-2025-004748","DOIUrl":"https://doi.org/10.1136/svn-2025-004748","url":null,"abstract":"<p><strong>Background: </strong>Controversy persists regarding flow-augmentation bypass for steno-occlusive atherosclerotic cerebrovascular disease (ACVD), especially after the divisive Carotid Occlusion Surgery Study (COSS) and Middle Cerebral Artery Occlusion Surgery Study (CMOSS) trials. High complication rates (COSS) and the selection of patients with stable disease under conservative management (CMOSS) yielded conflicting results. Despite conflicting evidence, some authors argue for the procedure's continued relevance, supported by reduced perioperative complication rates and a distinct contemporary patient cohort. This study contributes to the ongoing discourse by presenting our centre's experience.</p><p><strong>Methods: </strong>We analysed data (2007-2023) from our extracranial-intracranial bypass registry. Included were patients with ACVD, reduced cerebrovascular reserve and recurrent minor strokes/transient ischaemic attacks (TIAs) or progressive stroke despite maximal conservative therapy.</p><p><strong>Results: </strong>A total of 98 procedures were performed in 89 patients (mean age 61 years, median follow-up 27.4 months). Internal carotid artery (ICA) occlusion was most common (88.8%), with 27.6% showing additional intracranial stenoses. Isolated middle cerebral artery (MCA) and anterior cerebral artery (ACA) stenosis were rare. Presentations included single TIA (14.3%), multiple TIAs (44.9%), recurrent strokes (26.5%) and progressive stroke (14.3%). Preoperatively, 62.2% had unilateral and 37.8% bilateral cerebrovascular reserve capacity impairment. ICA stenosis with additional intracranial disease was more often linked to bilateral impairment. Postoperative bypass patency was 96.9% at 30 days; perioperative stroke occurred in 4.1%. Long-term patency was 96.3%, with 3.7% experiencing recurrent TIAs.</p><p><strong>Conclusion: </strong>Flow-augmentation bypass remains a valuable option in carefully selected ACVD patients with progressive disease, offering low perioperative risk and reduced stroke recurrence.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786478","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}