Journal of Investigative Medicine最新文献

{"title":"Obesity and brain volumes: mediation by cardiometabolic and inflammatory measures.","authors":"Qi Zhou, Wanlin Zhu, Xueli Cai, Jing Jing, Mengxing Wang, Suying Wang, Aoming Jin, Xia Meng, Tiemin Wei, Yongjun Wang, Yuesong Pan","doi":"10.1136/svn-2023-003045","DOIUrl":"10.1136/svn-2023-003045","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the relationship between overall obesity, central obesity and brain volumes, as well as to determine the extent to which cardiometabolic and inflammatory measures act as mediators in the association between body mass index (BMI), waist-hip ratio (WHR) and brain volumes.</p><p><strong>Methods: </strong>In the context of counterfactual framework, mediation analysis was used to explore the potential mediation in which cardiometabolic and inflammatory measures may mediate the relationship between BMI, WHR, and brain volumes.</p><p><strong>Results: </strong>Among 2413 community-dwelling participants, those with high BMI or WHR levels experienced an approximately brain ageing of 4 years. Especially, individuals with high WHR or BMI under the age of 65 exhibited white matter hyperintensity volume (WMHV) differences equivalent to around 5 years of ageing. Conversely, in the high-level WHR population over the age of 65, premature brain ageing in gray matter volume (GMV) exceeded 4.5 years. For GMV, more than 45% of the observed effect of WHR was mediated by glycaemic metabolism indicators. This proportion increases to 78.70% when blood pressure, triglyceride, leucocyte count, and neutrophil count are jointly considered with glycaemic metabolism indicators. Regarding WHR and BMI's association with WMHV, cardiometabolic and inflammatory indicators, along with high-density lipoprotein cholesterol, mediated 35.50% and 20.20% of the respective effects.</p><p><strong>Conclusions: </strong>Overall obesity and central obesity were associated with lower GMV and higher WMHV, a process that is partially mediated by the presence of cardiometabolic and inflammatory measures.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005608","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":"New rat model of spinal cord infarction with long-lasting functional disabilities generated by intraspinal injection of endothelin-1.","authors":"Masayuki Otani, Yoshihiro Kushida, Yasumasa Kuroda, Shohei Wakao, Yo Oguma, Keisuke Sasaki, Shintaro Katahira, Ryohei Terai, Rie Ryoke, Hiroi Nonaka, Ryuta Kawashima, Yoshikatsu Saiki, Mari Dezawa","doi":"10.1136/svn-2023-002962","DOIUrl":"10.1136/svn-2023-002962","url":null,"abstract":"<p><strong>Background: </strong>The current method for generating an animal model of spinal cord (SC) infarction is highly invasive and permits only short-term observation, typically limited to 28 days.</p><p><strong>Objective: </strong>We aimed to establish a rat model characterised by long-term survival and enduring SC dysfunction by inducing selective ischaemic SC damage.</p><p><strong>Methods: </strong>In 8-week-old male Wistar rats, a convection-enhanced delivery technique was applied to selectively deliver endothelin-1 (ET-1) to the anterior horn of the SC at the Th13 level, leading to SC infarction. The Basso, Beattie and Bresnahan (BBB) locomotor score was assessed for 56 days. The SC was examined by a laser tissue blood flowmeter, MRI, immunohistochemistry, triphenyl tetrazolium chloride (TTC) staining, Western blots and TUNEL staining.</p><p><strong>Results: </strong>The puncture method was used to bilaterally inject 0.7 µL ET-1 (2.5 mg/mL) from the lateral SC into the anterior horns (40° angle, 1.5 mm depth) near the posterior root origin. Animals survived until day 56 and the BBB score was stably maintained (5.5±1.0 at day 14 and 6.2±1.0 at day 56). Rats with BBB scores ≤1 on day 1 showed stable scores of 5-6 after day 14 until day 56 while rats with BBB scores >1 on day 1 exhibited only minor dysfunction with BBB scores >12 after day 14. TTC staining, immunostaining and TUNEL staining revealed selective ischaemia and neuronal cell death in the anterior horn. T2-weighted MR images showed increasing signal intensity at the SC infarction site over time. Western blots revealed apoptosis and subsequent inflammation in SC tissue after ET-1 administration.</p><p><strong>Conclusions: </strong>Selective delivery of ET-1 into the SC allows for more precise localisation of the infarcted area at the targeted site and generates a rat SC infarction model with stable neurological dysfunction lasting 56 days.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437622","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":"PRCP is a promising drug target for intracranial aneurysm rupture supported via multi-omics analysis.","authors":"Jinghao Wu, Yunyun Mei, XinYu Li, Wen-Kai Yu, Zi Han Zhou, Yinghao Yang, Pengpeng Niu, Yunchao Wang, Chang-He Shi, Hanghang Zhu, Wenjun He, Yuan Gao, Yuming Xu, Yusheng Li","doi":"10.1136/svn-2023-003076","DOIUrl":"10.1136/svn-2023-003076","url":null,"abstract":"<p><strong>Background: </strong>Cerebral aneurysms are life-threatening cerebrovascular disorders. Currently, there are no effective treatments for preventing disease progression. Mendelian randomisation (MR) is widely used to repurify licensed drugs and identify new therapeutic targets. Therefore, this study aims to investigate effective drug targets for preventing the formation and rupture of cerebral aneurysms and analyse their potential mechanisms.</p><p><strong>Methods: </strong>We performed a comprehensive study integrating two-sample MR analysis, colocalisation analysis and summary data-based Mendelian randomisation (SMR) to assess the causal effects of blood and brain druggable cis-expression quantitative trait loci (cis-eQTLs) on intracranial aneurysm (IA), unruptured intracranial aneurysm (UIA) and subarachnoid haemorrhage of IA rupture (SAH). Druggable genes were obtained from the study by Chris Finan <i>et al</i>, cis-eQTLs from the eQTLGen and PsychENCODE consortia. Results were validated using proteomic and transcriptomic data. Single-gene functional analyses probed potential mechanisms, culminating in the construction of a drug-gene regulation network.</p><p><strong>Results: </strong>Through the MR analysis, we identified four potential drug targets in the blood, including prolylcarboxypeptidase (PRCP), proteasome 20S subunit alpha 4 (PSMA4), LTBP4 and GPR160 for SAH. Furthermore, two potential drug targets (PSMA4 and SLC22A4) were identified for IA and one potential drug target (KL) for UIA after accounting for multiple testing (P(inverse-variance weighted)<8.28e-6). Strong evidence of colocalisation and SMR analysis confirmed the relevance of PSMA4 and PRCP in outcomes. Elevated PRCP circulating proteins correlated with a lower SAH risk. PRCP gene expression was significantly downregulated in the disease cohort.</p><p><strong>Conclusions: </strong>This study supports that elevated PRCP gene expression in blood is causally associated with the decreased risk of IA rupture. Conversely, increased PSMA4 expression in the blood is causally related to an increased risk of IA rupture and formation.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056959","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":"Why non-human primates are needed in stroke preclinical research.","authors":"Xiya Long, Jinsheng Zeng","doi":"10.1136/svn-2024-003504","DOIUrl":"10.1136/svn-2024-003504","url":null,"abstract":"<p><p>Numerous seemingly promising cerebroprotectants previously validated in rodents almost all have failed in stroke clinical trials. The failure of clinical translation strikes an essential need to employ more ideal animal models in stroke research. Compared with the most commonly used rodent models of stroke, non-human primates (NHPs) are far more comparable to humans regarding brain anatomy, functionality and pathological features. The aim of this perspective was to summarise the advantages of NHPs stroke models over rodents, discuss the current limitations of NHPs models, and cast an outlook on the future development of NHPs in stroke preclinical research.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113762","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":"Peripheral blood <i>GATA2</i> expression impacts <i>RNF213</i> mutation penetrance and clinical severity in moyamoya disease.","authors":"Yohei Mineharu, Takahiko Kamata, Mei Tomoto, Noriaki Sato, Yoshinori Tamada, Takeshi Funaki, Yuki Oichi, Kouji H Harada, Akio Koizumi, Tetsuaki Kimura, Ituro Inoue, Yasushi Okuno, Susumu Miyamoto, Yoshiki Arakawa","doi":"10.1136/svn-2024-003970","DOIUrl":"https://doi.org/10.1136/svn-2024-003970","url":null,"abstract":"<p><strong>Background: </strong>The p.R4810K founder mutation in the <i>RNF213</i> gene confers susceptibility to moyamoya disease (MMD) and non-MMD intracranial artery disease. However, penetrance is incomplete, and the underlying molecular mechanism remains unknown.</p><p><strong>Methods and results: </strong>Transcriptome analysis of peripheral blood was conducted with nine MMD patients and five unaffected mutation carriers from four familial MMD pedigrees. Bayesian network analysis identified upregulated gene modules associated with lipid metabolism and leucocyte development (including <i>GATA2</i> and <i>SLC45A3</i>), and epidermal growth factor receptor (EGFR) signalling (<i>UBTD1</i>). It also identified downregulated gene modules related to mitochondrial ribosomal proteins (<i>RPS3A</i> and <i>RPL26</i>), and cytotoxic T cell immunity (<i>GZMA</i> and <i>TRGC1</i>). The <i>GATA2</i> network was replicated through weighted gene co-expression network analysis and further examined in a case-control study, comprising 43 MMD patients, 16 non-MMD patients, 19 unaffected carriers and 35 healthy controls. <i>GATA2</i> exhibited a significant linear correlation with <i>SLC45A3</i> and was significantly higher in MMD patients compared with age-matched and sex-matched unaffected carriers or wild-type controls. Among patients with the p.R4810K mutation, higher <i>GATA2</i> expression was associated with an earlier age of onset, bilateral involvement and symptomatic disease onset.</p><p><strong>Conclusions: </strong>Peripheral blood <i>GATA2</i> expression was associated with increased penetrance of the <i>RNF213</i> mutation and more severe clinical manifestations in MMD.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056365","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":"Efficacy of immediate anti-hypertensive treatment in patients with acute ischaemic stroke stratified by mean arterial pressure and pulse pressure: a secondary analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial.","authors":"Ming Wang, Shiguang Zhu, Jiayi Long, Mengyue Cao, Yanbo Peng, Jing Chen, Tan Xu, Jiang He, Yonghong Zhang, Chongke Zhong","doi":"10.1136/svn-2024-003896","DOIUrl":"https://doi.org/10.1136/svn-2024-003896","url":null,"abstract":"<p><strong>Background: </strong>Whether mean arterial pressure (MAP) and pulse pressure (PP), two indicators of cerebral perfusion, could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remains uncertain. Our study was to explore the impact of early anti-hypertensive intervention on adverse clinical outcomes following ischaemic stroke stratified by the levels of MAP and PP based on the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS).</p><p><strong>Methods: </strong>The trial randomised 4071 acute ischaemic stroke patients with elevated systolic blood pressure (SBP) to receive anti-hypertensive treatment (targeting a 10%-25% reduction in SBP during the 24 hours postrandomisation, reaching a BP level <140/90 mm Hg in 7 days, further keeping these levels throughout hospitalisation) or discontinue anti-hypertensive treatment during hospitalisation. The primary outcome was death or major disability at 14 days or hospital discharge. Study outcomes were analysed by comparing the BP-lowering intervention group and control group, stratified by tertiles of MAP or PP levels.</p><p><strong>Results: </strong>No significant difference was observed in the primary outcome between the intervention and control groups across all MAP (p=0.69 for homogeneity) and PP (p=0.78 for homogeneity) categories. The corresponding odds ratios (95% CIs) were 1.08 (0.85-1.36), 0.92 (0.74-1.15) and 1.00 (0.81-1.25) for participants with low, intermediate, and high MAP and were 0.99 (0.79-1.25), 1.06 (0.84-1.34) and 0.95 (0.77-1.18) for participants in PP subgroups, respectively. Furthermore, early anti-hypertensive intervention was not associated with secondary outcomes (including neurological deterioration, recurrent stroke, vascular events and all-cause mortality) by MAP and PP (all p>0.05).</p><p><strong>Conclusions: </strong>Early anti-hypertensive therapy neither decreased nor increased the odds of major disability, mortality, recurrent stroke or vascular events in patients with acute ischaemic stroke regardless of different MAP and PP levels.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov identifier: NCT01840072.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021521","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":"Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study.","authors":"Lucio D'Anna, Soma Banerjee, Viva Levee, Katherine Chulack, Fahad Sheikh, Feras Fayez, Tsering Dolkar, Nina Mansoor, Matthew Fallon, Adelaida Gartner, Robert Simister, Liqun Zhang","doi":"10.1136/svn-2024-003915","DOIUrl":"https://doi.org/10.1136/svn-2024-003915","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) improves outcomes in patients who had an acute ischaemic stroke due to large vessel occlusion (LVO). However, socioeconomic status (SES) can influence recovery and prognosis. This study investigated the effect of SES, assessed via the Index of Multiple Deprivation (IMD), on MT outcomes in a multicentre London cohort.</p><p><strong>Methods: </strong>This retrospective study included patients with anterior circulation LVO treated with MT between 2021 and 2023 at three London hospitals. Patients were grouped into IMD_1-5 (more deprived) and IMD_6-10 (less deprived). Inverse probability weighting balanced baseline characteristics. Primary outcomes were 90-day functional independence (modified Rankin Scale (mRS) 0-2) and 90-day mRS shift. Secondary outcomes included recanalisation, early neurological changes, 90-day mortality, symptomatic intracerebral haemorrhage (sICH) and haemorrhagic transformation (HT). Subgroup analyses explored interactions between IMD and demographic or clinical factors. LASSO (Least Absolute Shrinkage and Selection Operator) regression identified predictors of functional independence, while receiver operating characteristic analysis evaluated IMD's predictive value.</p><p><strong>Results: </strong>Among 1219 patients with acute LVO ischemic stroke treated with MT, 533 (43.7%) were in IMD_1-5 and 686 (56.3%) in IMD_6-10. IMD_1-5 patients had lower odds of functional independence at 90 days (RR 0.79, 95% CI 0.70 to 0.90) and worse mRS shift (OR 1.29, 95% CI 1.06 to 1.58). They also had higher risks of sICH (RR 2.07, 95% CI 1.54 to 2.67) and HT (Risk Ratio 1.47, 95% CI 1.21 to 1.80). Subgroup analysis highlighted IMD's predictive importance in Asian or mixed ethnicity groups. A model incorporating IMD, age, sex, hypertension and National Institutes of Health Stroke Scale (area under the curve 0.656) demonstrated predictive accuracy for 90-day functional independence.</p><p><strong>Conclusions: </strong>Lower SES correlates with worse outcomes and higher complications post-MT, even within a universal healthcare system. Addressing SES disparities could improve stroke care equity.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035245","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":"Intracerebral haemorrhage laterality and associations with mood and pain: a MISTIE III substudy.","authors":"Dawson C Cooper, Efrat Abramson, Wendy C Ziai, Matthew L Flaherty, Vishank A Shah, Radhika Avadhani, Noeleen Ostapkovich, Lourdes Carhuapoma, Issam Awad, Mario Zuccarello, Daniel Hanley, Lauren H Sansing","doi":"10.1136/svn-2024-003755","DOIUrl":"https://doi.org/10.1136/svn-2024-003755","url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of the affected hemisphere in haemorrhagic stroke remains uncertain. We aimed to determine the relationship between the affected hemisphere (right or left) and differences in non-motor outcomes, including mood and pain, in patients with acute, supratentorial intracerebral haemorrhage (ICH). These non-motor outcomes are often overlooked in studies following ICH but impact patient recovery and well-being.</p><p><strong>Methods: </strong>A secondary prespecified analysis of the Minimally Invasive Surgery with Thrombolysis in Intracerebral Hemorrhage Evacuation (MISTIE) III study-a randomised, international, multicentre, placebo-controlled trial of participants with spontaneous, non-traumatic, supratentorial ICH of 30 mL or more that evaluated minimally invasive surgery with thrombolysis compared with standard medical care. Outcomes included EQ-5D three-level version (EQ-5D-3L, composite and individual non-motor components) and modified Rankin scale (mRS) scores at days 30, 180 and 365 post-ICH.</p><p><strong>Results: </strong>A total of 493 participants were eligible for analysis at day 30 following ICH. In multivariable analyses, patients with right hemispheric ICH were more likely to report problems with pain and discomfort at days 30 (β=0.257 (95% CI 0.131, 0.383)), 180 (β=0.213 (95% CI 0.090, 0.336)) and 365 (β=0.209 (95% CI 0.090, 0.328)) post-ICH. Patients with right hemispheric ICH were also more likely to report problems with anxiety and depression at days 30 (β=0.160 (95% CI 0.030, 0.291)) and 180 (β=0.171 (95% CI 0.049, 0.293)) following ICH. There were no differences in mRS scores between patients with left or right-sided haemorrhages.</p><p><strong>Conclusions: </strong>Right hemispheric lesions were associated with increased reports of mood-related symptoms (depression, anxiety) and pain in patients with acute ICH over time.</p><p><strong>Trial registration number: </strong>NCT01827046.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035768","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":"Effect of intravenous alteplase before endovascular therapy for atherothrombotic stroke-related large vessel occlusion: subanalysis of the RESCUE AT-LVO registry.","authors":"Hirotaka Hayashi, Satoshi Namitome, Seigo Shindo, Shinichi Yoshimura, Manabu Shirakawa, Mikiya Beppu, Nobuyuki Sakai, Hiroshi Yamagami, Kazutaka Uchida, Kazunori Toyoda, Yuji Matsumaru, Yasushi Matsumoto, Kenichi Todo, Mikito Hayakawa, Shinzo Ota, Masafumi Morimoto, Masataka Takeuchi, Hirotoshi Imamura, Hiroyuki Ikeda, Kanta Tanaka, Hideyuki Ishihara, Hiroto Kakita, Takanori Sano, Hayato Araki, Tatsufumi Nomura, Fumihiro Sakakibara, Mitsuharu Ueda, Makoto Nakajima","doi":"10.1136/svn-2024-003983","DOIUrl":"https://doi.org/10.1136/svn-2024-003983","url":null,"abstract":"<p><strong>Background: </strong>Whether intravenous thrombolysis (IVT) should be administered prior to endovascular therapy (EVT) in patients with atherothrombotic stroke-related large vessel occlusion (AT-LVO) remains unclear. This study aimed to assess the efficacy and safety of IVT administered before EVT in this patient population.</p><p><strong>Methods: </strong>We analysed the data from a multicentre registry of patients who underwent EVT for AT-LVO. Patients were categorised based on presumed mechanism of occlusion: in situ occlusion (intracranial group) or embolism from cervical artery occlusion/stenosis (tandem group). We compared the efficacy and safety of IVT before EVT in patients who received IVT (IVT stratum) and those who did not (non-IVT stratum). The primary outcome was a modified Rankin Scale score of 0-2 at 90 days.</p><p><strong>Results: </strong>Among the 336 patients in the intracranial group, 99 patients underwent IVT. The rate of favourable functional outcomes did not differ between IVT and non-IVT strata (51.1% vs 47.6%; adjusted ORs (aORs) (95% CI), 1.18 (0.66 to 2.09)); whereas any intracranial haemorrhage (ICH) (10.1% vs 3.8%; aOR, 2.98 (1.01 to 9.26)) and mortality at 90 days (6.4% vs 1.3%; aOR, 4.66 (1.02 to 26.73)) were significantly higher in the IVT stratum. Among the 233 patients in the tandem group, 88 patients underwent IVT, with no significant differences in efficacy or safety outcomes between the strata.</p><p><strong>Conclusion: </strong>In patients with AT-LVO, IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion. IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039754","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":"Functional outcomes of minimally invasive surgery treatment for patients with small supratentorial spontaneous intracerebral haematoma less than 30 mL: a propensity score matching study.","authors":"Hanyu Sun, Xinqun Luo, Zhang Guo, Lingyun Zhuo, Dekui Cheng, Zhuyu Gao, Qiu He, Zheng Yan, Dezhi Kang, Wenhua Fang, Fuxin Lin","doi":"10.1136/svn-2024-003893","DOIUrl":"https://doi.org/10.1136/svn-2024-003893","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the efficacy of frameless robot-assisted stereotactic aspiration coupled with catheter thrombolysis (SA-CT) in treating supratentorial spontaneous intracerebral haemorrhage (sICH) with small haematoma volumes (<30 mL).</p><p><strong>Methods: </strong>We analysed the clinical and long-term outcome data for patients who had haematoma volumes <30 mL and underwent SA-CT between August 2019 and June 2023. Then, we matched the patients receiving conservative treatment during the same period from a multicentre intracerebral haemorrhage database using propensity score matching. The outcomes included the restoration of independent standing ability and mortality within 1 year after onset.</p><p><strong>Results: </strong>340 patients were included in the final analysis. A greater proportion of patients in the surgery group regained the ability to stand independently within 1 year (89.1% vs 78.1%, p=0.049). The Kaplan-Meier curve showed that the cumulative standing rate in the surgery group was higher than that in the conservative group (90.4% vs 82.0%, p=0.007) within 1 year, and the median time to regain standing was shorter in the surgery group (30 days vs 34 days). The mortality rates were lower in the surgery group (p<0.05). Multivariate Cox regression analysis revealed that frameless robot-guided SA-CT (adjusted HR 1.80; 95% CI 1.37 to 2.38; p<0.001), age, haematoma volume, the severe Glasgow Coma Scale scores and pneumonia were independent factors associated with standing recovery within 1 year after onset.</p><p><strong>Conclusions: </strong>Frameless robot-guided SA-CT for small supratentorial haematoma with contralateral hemiplegia seems safe and potentially facilitates the recovery of independent standing ability and reduces the mortality rates.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033077","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}