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Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with premorbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), associated workflow, and poststroke outcomes among patients with vs without premorbid disability. We used national registry data on thrombolysis/EVT for the Czech Republic from 1 January 2016 to 31 December 2020. Premorbid disability was defined as prestroke modified Rankin Scale score (mRS) &#x2265;3. We compared proportions of patients with vs without premorbid disability who received EVT and examined workflow times. We compared &#x394;mRS-change in mRS from prestroke to 3 months-in patients with vs without premorbid disability, in addition to intracerebral hemorrhage (ICH), mortality, and discharge NIHSS (National Institutes of Health Stroke Scale score), adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score weighting (PSW) and matching for differences in treatment assignment. We stratified by age group (<65, 65-74, 75-84, &#x2265;85 years) to explore outcome heterogeneity with vs without premorbid disability. Among 22,405 patients with ischemic stroke who received thrombolysis/EVT/both, 1,712 (7.6%) had prestroke mRS &#x2265; 3. Patients with prestroke disability were less likely to receive EVT vs those without (10.1% vs 20.7%, aOR: 0.30, 95% CI 0.24-0.36). When treated, they had longer door-to-arterial puncture times (median: 75 minutes, IQR: 58-100 vs 54, IQR: 27-77, adjusted difference: 12.5, 95% CI 2.68-22.3). Patients with prestroke disability receiving thrombolysis/EVT/both had worse &#x394;mRS (adjusted rate ratio, aIRR on PSW: 1.57, 95% CI 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW [mortality]: 2.54, 95% CI 1.92-3.34), while ICH did not significantly differ. 32.1% of patients with prestroke disability receiving thrombolysis/EVT/both successfully returned to prestroke state, but this proportion ranged from 19.6% for those older than 85 years to 66.0% for those younger than 65 years. Regardless of premorbid disability, EVT was associated with better outcomes including lower &#x394;mRS (aIRR-PSW: 0.87, 95% CI 0.83-0.91) and mortality, with no interaction of treatment effect by premorbid disability status (e.g., mortality pinteraction = 0.73). EVT recipients with premorbid disability did not differ significantly for several outcomes including &#x394;mRS (aIRR: 0.99, 95% CI 0.84-1.17) but were more likely to have 3-month mRS 5-6 (70.1% vs 39.5% without premorbid disability, aOR: 1.85, 95% CI 1.12-3.04). Patients with premorbid disability were less likely to receive EVT, had slower treatment times, and had worse outcomes compared with patients without premorbid disability. However, regardless of premorbid disability, patients fared better with EVT vs medical management and one-third with prestroke disability returned to their prestroke status.

No method of monitoring drug-induced hepatic steatosis has been established, which is a concern in drug development. Hepatic steatosis is divided into diffuse and non-diffuse forms according to the pattern of fat deposition. Diffuse hepatic steatosis was reported as evaluable by 1H-magnetic resonance spectroscopy (1H-MRS), which is used as an adjunct to the MRI examination. Blood biomarkers for hepatic steatosis have been also actively investigated. However, there are few reports to conduct 1H-MRS or blood test in human or animal non-diffuse hepatic steatosis with reference to histopathology. Therefore, to investigate whether non-diffuse hepatic steatosis can be monitored by 1H-MRS and/or blood samples, we compared histopathology to 1H-MRS and blood biochemistry in a non-diffuse hepatic steatosis rat model. Non-diffuse hepatic steatosis was induced by feeding rats the methionine choline deficient diet (MCDD) for 15 days. The evaluation sites of 1H-MRS and histopathological examination were three hepatic lobes in each animal. The hepatic fat fraction (HFF) and the hepatic fat area ratio (HFAR) were calculated from 1H-MRS spectra and digital histopathological images, respectively. Blood biochemistry analyses included triglycerides, total cholesterol, alanine aminotransferase, and aspartate aminotransferase. A strong correlation was found between HFFs and HFARs in each hepatic lobe (r&#xa0;=&#xa0;0.78, p&#xa0;<&#xa0;0.0001) in rats fed the MCDD. On the other hand, no correlation was found between blood biochemistry values and HFARs. This study showed that 1H-MRS parameters correlated with histopathological changes but blood biochemistry parameters didn't, so that it is suggested that 1H-MRS has the potential to be a monitoring method for non-diffuse hepatic steatosis in rats fed the MCDD. Given that 1H-MRS is commonly used in preclinical and clinical studies, 1H-MRS should be considered a candidate method for monitoring drug-induced hepatic steatosis.

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BackgroundIn areas with high population spread such as Saskatchewan, it can be challenging to provide timely endovascular stroke treatment (EVT) to patients living far away from comprehensive stroke centres (CSC). We assessed the association of geography, stroke timing and weather conditions on EVT workflow times and clinical outcomes in Saskatchewan.MethodsWe included patients who underwent EVT between January 2017 and December 2022 in the province of Saskatchewan, Canada. Univariable and multivariable associations of time from last known well-to-CSC arrival, CSC arrival-to-reperfusion, and 90-day modified Rankin Score (mRS) with driving distance from patient home to CSC, transport mode, outdoor temperature and stroke timing (day & time) were assessed using descriptive statistics and multivariable regression.ResultsThree-hundred-three patients in the province of Saskatchewan underwent EVT between January 2017 and December 2022. Distance from patient home to CSC (beta-coefficient per 10&#x2005;km increase&#x2009;=&#x2009;0.02, 95% CI: 0.01-0.03) and direct to CSC transport (beta-coefficient&#x2009;=&#x2009;-0.76, 95% CI&#x2009;=&#x2009;-1.01-[-0.51]) were associated with last known well to CSC arrival time. In-hospital stroke (beta-coefficient&#x2009;=&#x2009;0.37, 95% CI: 0.16-0.58), direct-to-CSC transfer (beta-coefficient&#x2009;=&#x2009;0.27, 95% CI: 0.13-0.41) and daytime stroke onset (beta-coefficient&#x2009;=&#x2009;-0.15, 95% CI: -0.28-[-0.04]) were associated with time from CSC arrival to reperfusion. No association with 90-day mRS was seen.ConclusionGeographic factors and stroke timing were associated with EVT workflow times. However, no association with clinical outcomes was seen, suggesting that EVT patients living remote areas of Saskatchewan have similar benefit from EVT compared to urban areas. Every effort should be made to offer timely EVT to patients from remote areas.

Early National Institutes of Health Stroke Scale (NIHSS) assessment may provide practical benefits over 90-day modified Rankin Scale (mRS), but it is unclear how it compares in adjudicating randomized clinical trial (RCT) results in acute ischemic stroke. We searched Ovid Medline (inception to April 1, 2023) and included RCTs of acute therapies for acute ischemic stroke with data for both 90-day mRS and NIHSS within 7&#x2009;days. Primary outcome was agreement between trial results (classified as positive, negative, or neutral) based on 24-hour NIHSS and 90-day mRS scores. We additionally assessed agreement for 2-hour, 48-hour, 72- to 96-hour, and 5- to 7-day NIHSS scores. We aimed to validate our findings using individual patient data from the ESCAPE (Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke) and ESCAPE-NA1 (Safety and Efficacy of Nerinetide [NA-1] in Subjects Undergoing Endovascular Thrombectomy for Stroke) RCTs. We included 116 trials (44&#x2009;387 patients), contributing 165 NIHSS assessments. The 24-hour NIHSS scores resulted in the same classification as 90-day mRS scores in 61/73 (83.6%) trials (Cohen's kappa, 0.64 [95% CI: 0.45-0.83] and Gwet's agreement coefficient 1, 0.79 [95% CI: 0.67-0.90]). Agreement was not statistically different by timing of NIHSS assessments (range 75%-100%, P=0.33). Individual patient data showed higher agreement for assessments between 48 hours and 7&#x2009;days, varying by NIHSS dichotomization cutoffs (NIHSS score, 0-2; 2 hours, 56.6%; 24 hours, 66.6%; 48 hours, 71.8%; 5-7&#x2009;days: 76.5%, P<0.01; NIHSS score, 0-7; 2 hours, 72.8%; 24 hours, 80.5%; 48 hours, 83.1%; 5-7&#x2009;days: 84.7%, P<0.01). The 24-hour NIHSS scores aligned with 90-day mRS scores in 84% of RCT results, indicating intermediate-to-good agreement. However, individual patient data showed that early NIHSS risks misclassifying around 1/4 patients. These data contribute to a better understanding of the nuances of early NIHSS score as an outcome in acute ischemic stroke RCTs.

JC virus (JCV) reactivation causing progressive multifocal leukoencephalopathy (PML) is a complication in patients with multiple sclerosis (MS) treated with disease-modifying therapies (DMTs). Although natalizumab (NTZ) is most frequently involved, PML also occurs less commonly with sphingosine-1-phosphate receptor modulators (S1P-RM), dimethyl fumarate (DMF), and ocrelizumab. This study aimed to identify factors predicting worse outcomes, focusing on the influence of PML-immune reconstitution inflammatory syndrome (PML-IRIS), plasma exchange (PlEx), corticosteroids, and DMT reintroduction. This retrospective multicenter cohort study analyzed patients with MS who had JCV-associated pathology (PML or granule cell neuronopathy) from 42 centers (2009-2022). The primary outcome was disability at 12 months, measured by the modified Rankin Scale (mRS). Multivariable analyses identified predictors of poor outcomes, PML-IRIS development, and recurrent MS activity. Of 96 identified patients, 94 were analyzed. Most cases occurred under NTZ (77%), followed by S1P-RM (22%) and DMF (1%). Twelve-month survival was 91.5%, with a median mRS of 3 [IQR: 2-4]. Multivariable analysis showed that higher pre-PML disability (OR: 1.95 [95% CI 1.46-2.60], p < 0.001), elevated CSF JCV viral load (OR: 2.45 [95% CI 1.55-3.87], p < 0.001), and symptomatic presentation at onset (OR: 3.93 [95% CI 1.23-12.55], p = 0.021) were associated with worse outcomes. Conversely, PML-IRIS was associated with better outcomes (OR: 0.28 [95% CI 0.09-0.86], p = 0.025). PlEx and corticosteroid use had no negative effect. This study provides valuable insights into the management of iatrogenic PML in patients with MS. The findings may guide clinicians in making informed decisions, particularly regarding the use of PlEx, corticosteroids, and the management of PML-IRIS.

To investigate the value of baseline CT imaging for the prediction of functional outcome and benefit of endovascular thrombectomy (EVT) for anterior large vessel occlusion (LVO). We used individual patient data from seven randomized EVT trials and included patients with available baseline CT imaging and outcome data. We developed a model to predict functional outcome and benefit of EVT, including baseline stroke-related and brain frailty CT imaging features alone. We compared the discriminative performance of our model for predicting good functional outcome (modified Rankin Scale [mRS] 0-2) and treatment benefit (difference between the probability of mRS 0-2 with vs without EVT) with MR PREDICTS by calculating the difference in C-statistics (delta C and delta C-for-benefit). We included 1391 patients (median age, 67 years, interquartile range 59-76; 53% male). Discrimination of the model based on CT imaging alone was substantial for the prediction of good functional outcome (C-statistic 0.700, 95% CI: 0.666-0.731) and treatment benefit (C-for-benefit 0.640, 95% CI: 0.586-0.690). After adding the known strongest clinical predictors namely age and National Institutes of Health Stroke Scale score, discrimination improved to slightly lower than MR PREDICTS for prediction of good functional outcome (C-statistic 0.733 vs 0.750; delta C, -0.017 [95% CI: -0.037 to 0.003]) and treatment benefit (C-for-benefit 0.675 vs 0.692; delta C-for-benefit -0.017 [95% CI: -0.084 to 0.050]). Baseline CT imaging holds considerable predictive value with regard to functional outcome and treatment benefit, but a combination of clinical and imaging features offers the best predictive performance. Question The predictive value of baseline CT imaging for the prediction of functional outcome and benefit of EVT for anterior LVO stroke is uncertain. Findings Discrimination of a model based on CT imaging alone is substantial, but can further be improved by the addition of limited clinical characteristics. Clinical relevance Baseline CT imaging holds considerable predictive value with regard to functional outcome and treatment benefit. The addition of limited clinical information is needed to achieve predictive performance similar to an established prediction model.

Anatomical taxonomy is a practical tool that has successfully guided clinical decision-making for patients with brain arteriovenous malformations and brainstem cavernous malformations (CMs). Deep CMs are similarly complex lesions that are difficult to access and highly variable in size, shape, and position. The authors propose a novel taxonomy for deep CMs in the basal ganglia based on clinical presentation (syndromes) and anatomical location. The taxonomy system was developed and applied to an extensive 2-surgeon experience over 19 years (2001-2019). Lesions involving the basal ganglia were identified and subtyped on the basis of the predominant superficial presentation identified on preoperative MRI. Three subtypes of basal ganglia CMs were defined: caudate (31, 57%), putaminal (16, 30%), and pallidal (7, 13%). Neurological outcomes were assessed using the modified Rankin Scale (mRS). Postoperative mRS scores &#x2264; 2 were defined as a favorable outcome, and scores > 2 were defined as a poor outcome. Clinical and surgical characteristics and neurological outcomes were compared among subtypes. Fifty-four basal ganglia lesions were identified in 54 patients. Each basal ganglia CM subtype was associated with a recognizable constellation of neurological symptoms. The most common symptoms at presentation were severe or worsening headaches (25, 43%), mild hemiparesis (13, 24%), seizures (7, 13%), and dysmetria or ataxia (6, 11%). Patients with caudate CMs were the most likely to present with headaches and constitutional symptoms. Patients with putaminal CMs were the most likely to present with hemibody sensory deficits and dysmetria or ataxia. Patients with pallidal CMs were the most likely to present with mild hemiparesis and visual field deficits. A single surgical approach was preferred (> 80% of cases) for each basal ganglia subtype: caudate (contralateral transcallosal-transventricular, 28/31, 90%), putaminal (transsylvian-anterior transinsular, 13/16, 81%), and pallidal (transsylvian supracarotid-infrafrontal, 7/7, 100%). Most patients with follow-up had stable or improved mRS scores postoperatively (94%, 44/47); mRS scores of > 2 at final follow-up did not differ among the 3 basal ganglia subtypes. The study confirms the authors' hypothesis that this taxonomy for basal ganglia CMs meaningfully guides the selection of surgical approach and resection strategy. Furthermore, the proposed taxonomy can increase the diagnostic acumen at the patient bedside, help identify optimal surgical approaches, enhance the consistency of clinical communications and publications, and improve patient outcomes.

Additive manufacturing (AM) of dense pastes is attracting interest across many fields and while the combination of a high loading of functional particles with a flowable continuous phase is promising, the heterogeneous system makes material and process design difficult. Prior work has focused on assessing printability by examining their extrudability and shape retention. However, for dense pastes, the inks are susceptible to separation of particles from binder, so we consider composition consistency as a critical quality attribute. This composition consistency attribute provides a framework for quality assessment of material extrusion AM inks and processes. The online version contains supplementary material available at 10.1557/s43579-026-00936-9.

Beyond pulmonary veins isolation (PVI), the ablation strategy that has prevailed over the past two decades remains controversial: (1) the left atrium partition using linear lesions ("cox-maze" strategy); (2) the mapping of the left atrium in atrial fibrillation (AF) to identify and localize the arrhythmia sources. Both methods have failed to demonstrate superiority compared to PVI alone. Whether the addition of a systematic vein of Marshall (VOM) ethanol infusion and empirical linear ablation to PVI (Marshall-Plan) improves outcomes in patients with persistent AF remains to be demonstrated. To compare the 2-year freedom from any atrial arrhythmia (atrial fibrillation [AF]/atrial tachycardia [AT]) between the Marshall-Plan approach and the PVI approach in patients with persistent AF. The Marshall Plan is a multicenter, prospective, randomized, parallel- group, controlled clinical trial of superiority conducted in nine tertiary care centers across Europe (8 centers in France, 1 center in Belgium). A total of 262 patients will be randomized in two arms: Marshall-Plan, consisting of PVI with additional ablation, including vein of Marshall ethanol infusion, and lines of block at the mitral, dome, and cavotricuspid isthmuses versus PVI alone. The main outcome will be the 2-year freedom from any arrhythmia AF/AT <30 seconds) after a single ablation procedure with or without antiarrhythmic medication. This randomized trial aims to determine the success and safety of adjunctive VOM ethanol infusion and linear ablation to PVI in patients with persistent AF. URL: https://www. gov; Unique identifier: NCT04681872.

Point-resolved spectroscopy is commonly used for magnetic resonance spectroscopy (MRS) due to widespread clinical availability, yet its accuracy can be compromised by chemical shift displacement error (CSDE) and sensitivity to magnetic field inhomogeneities, particularly near cerebrospinal fluid (CSF)-rich areas. Semi-localization by adiabatic selective refocusing (sLASER) mitigates these issues through superior voxel localization, reducing susceptibility to CSDE and B1 inhomogeneity. However, direct clinical comparisons between PRESS and sLASER, especially under matched acquisition conditions, remain scarce. This study aimed to directly compare PRESS and sLASER sequences regarding metabolite quantification accuracy and spectral quality in brain regions adjacent to CSF, under identical water suppression scheme. Thirty healthy adult volunteers (17 men; mean age, 40&#x2009;&#xb1;&#x2009;9.6&#xa0;years) were recruited between January and July 2023. MRS data were acquired with PRESS and sLASER sequences at the left medial thalamus (near the third ventricle), using identical voxel placement and water suppression scheme of VAPOR. Metabolite concentrations were quantified using LCModel, and spectral quality metrics including residual water peak height, spectral signal-to-noise ratio (SNR), and spectral linewidth were also analyzed. As a result, compared to PRESS, sLASER yielded significantly higher concentration of NAA&#x2009;+&#x2009;NAAG, whereas Gly&#x2009;+&#x2009;mI were significantly lower (all, FDR adjusted q&#x2009;<&#x2009;0.05). Spectral SNR was significantly higher (+&#x2009;24%, P&#x2009;<&#x2009;0.001), but residual water peak height and spectral linewidth did not differ significantly (P&#x2009;>&#x2009;0.05). Variability analysis indicated significantly higher coefficient of variation for Glu&#x2009;+&#x2009;Gln with sLASER (P&#x2009;<&#x2009;0.05). In conclusion, in CSF-adjacent region, sLASER significantly increased spectral SNR but also exhibited greater variability in concentration for specific J-coupled metabolite. Therefore, although sLASER improved certain spectral quality aspects, caution is warranted due to higher variability in metabolite quantifications.

Dark field X-ray microscopy (DFXM) has emerged as a powerful technique for characterizing dislocations in bulk crystalline materials, whose high penetration depth and non-destructive evaluation offer unique advantages over traditional electron microscopy methods. The interpretation and analysis of the DFXM data presents significant challenges that have limited its broader adoption. Here we review our recent advances using artificial intelligence (AI) methods to enhance DFXM analysis, particularly focusing on dislocation characterization. We discuss the development of physics-informed AI approaches that combine theoretical understanding with data science techniques to enable both time-resolved dislocation dynamics studies and dimensional reduction of complex DFXM datasets. Our work demonstrates how semi-automated workflows, guided by dislocation theory and employing techniques such as wavelet transforms and Bayesian inference, can effectively track and analyze dislocation behavior across multiple time scales. These methodologies have been successfully applied to various materials science challenges, from studying thermally activated dislocation motion to characterizing dislocation networks. By presenting our works that integrate physics-based modeling into AI capabilities, we demonstrate how our and other works can extract new important quantitative dislocation data from DFXM measurements.

Rigid intramedullary nailing (RIMN) is increasingly used to treat tibia fractures in skeletally immature patients; however, the volume of injury to the proximal tibial physis and subsequent risk of abnormal growth is unknown. This study aimed to determine volume of proximal tibial physeal injury during RIMN of the tibia in skeletally immature adolescents. The volume of injury to the proximal tibial physis was measured through computer simulation modeling of RIMN using three-dimensional (3D) models. Sixteen normal pediatric knee CT scans (ages 10 to 13&#xa0;y) with open physes were reconstructed and tibial tubercle ossification stage (TTOS) determined. Opening reamers of 9.75&#xa0;mm, 11.0&#xa0;mm, and 12.0&#xa0;mm diameters were virtually simulated from a standardized suprapatellar starting point and trajectory. Boolean intersection modeling quantified the reamed physeal volume as a percentage of the total physis. A secondary analysis simulated &#xb1;10 degrees sagittal trajectory variation for reamer insertion. Simulated reaming demonstrated increasing physeal injury with larger reamer diameters. The average percentage of total physeal volume injury simulated by the 9.75&#xa0;mm, 11.0&#xa0;mm, and 12.0&#xa0;mm reamers, respectively, was 3.32%, 4.26%, and 5.15% in the TTOS 0 group; 3.17%, 3.99%, and 4.73% in the TTOS 1 group; and 2.26%, 2.89%, and 3.46% in the TTOS 2 group. Trajectory variation demonstrated that a 10-degree more vertical reamer trajectory change in the sagittal plane increased the volume of physeal injury 1.09 times more than the standard reference trajectory in the TTOS 1 group, while trajectory variations in the TTOS 0 and TTOS 2 groups resulted in minimal volume changes. Computer simulation modeling can quantify the volume of injury to the proximal tibial physis during RIMN in skeletally immature patients. The volume of physeal injury appears to remain below the classically described level of concern of 7%. These findings provide a foundation for further investigation into physeal injury thresholds and growth modulation. This simulation study informs surgical decision-making and provides insights on growth plate violation when using RIMN to treat skeletally immature tibia fractures.

We introduce synchronized modulation Kelvin probe force microscopy (SM-KPFM), an in-operando technique that synchronizes external stimulus modulation, such as illumination or bias, with the scanning direction of the atomic force microscope to minimize artifacts from drift, thermal effects, and probe degradation. In synchronized illumination KPFM, the sample is illuminated during retrace and dark during trace, enabling real-time comparison of surface potentials within a single raster frame. At the example of a silicon photodiode and a molybdenum disulfide bilayer on gold, these superior properties are demonstrated, yielding drift-free, accurate surface photovoltage maps and clearer insights into photovoltaic effects. The online version contains supplementary material available at 10.1557/s43579-025-00899-3.

Carotid artery webs are an underappreciated cause of recurrent ischemic stroke, and may represent a significant portion of cryptogenic stroke. Evidence-based guidelines for the management of symptomatic carotid webs do not exist. The goal of this study is to audit our local experience for patients with symptomatic carotid artery webs undergoing carotid stenting as a treatment option, along with describing the hypothesized dynamic physiology of carotid webs. All patients undergoing stenting for symptomatic carotid artery web at two comprehensive regional stroke centers with high endovascular thrombectomy volume from January 1, 2012 to March 1, 2021 were included. The modified Rankin Scale (mRS) score was used to define functional outcome at 3 months after stenting. Fourteen consecutive patients with symptomatic carotid artery webs underwent stenting. Twelve patients were female (86%), with a median age of 54 (IQR, 48-64) years across all patients. Stroke was the qualifying event in 12 (86%) patients and TIA in 2. Eleven patients (11/14, 79%) achieved a mRS score of 0-2 at 90 days, 2 (14%) were mRS 3-5, and one patient was lost to follow-up. The median follow-up was 12 months (IQR, 10-12). There was no recurrent stroke or TIA like symptoms in any patients. Carotid stenting appears to be safe at preventing recurrent stroke/TIA with a median follow-up of 12 months in this retrospective multicenter observational study.

Time-domain terahertz (THz) emission spectroscopy provides a direct method to probe transient photo-currents by recording the emitted terahertz electric field. Although the basic principles of THz surface emission have been understood for more than 30 years, the constant progress in ultrafast laser science to ever shorter pulses, the development of new materials and enhanced sensitivity promote THz emission spectroscopy as a reliable method to gain insights into charge carrier dynamics with unprecedented precision. It provides a versatile tool to study ultrafast processes, such as plasmon-driven hot carriers, dynamics of Dirac fermions, interfacial charge transfer, coherent phonon emission and quantum beating, to name only a few. However, despite the rapidly growing body of research on van der Waals materials, especially in their low-dimensional limit, THz emission spectroscopy has only been applied to a limited extent in these material systems. In this prospective, we review time-domain THz emission spectroscopy as a complementary approach to probe ultrafast charge carrier dynamics and the material's nonlinear response. After a description of the experimental method, we report on THz emission spectroscopy of bulk and 2D van der Waals materials with special focus on graphene and transition metal dichalcogenide layers.

The effect of endovascular therapy (EVT) for large vessel occlusion stroke on cognitive outcomes is not well understood. We evaluated the effect of EVT on cognitive function in the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial. Patient data from the ESCAPE randomized trial were analyzed. Cognitive assessments completed at 90 days after stroke were the Montreal Cognitive Assessment (MoCA), the Sunnybrook Neglect Assessment Procedure (SNAP), the Boston Naming Test (BNT), Trail-making test A (Trails A), and Trail-making test B (Trails B). We used logistic regression to evaluate the association between EVT and favorable cognitive outcome on the 5 separate tests, adjusting for demographic and clinical factors. We used generalized estimating equations and ordinal regression to determine the odds of favorable outcome with EVT on global cognition incorporating the 5 tests. We added final infarct volume (FIV) to the models to assess the relationship of FIV with cognitive outcome. The ESCAPE trial included 315 patients, 165 randomized to EVT and 150 randomized to control. There was higher odds of favorable outcome with EVT for MoCA (adjusted odds ratio [aOR] 2.32, 95% CI 1.30-4.16), SNAP (aOR 3.85, 95% CI 2.00-7.45), BNT (aOR 2.33, 95% CI 1.30-4.17), trails A (aOR 3.50, 95% CI 1.93-6.36), and trails B (aOR 2.56, 95% CI 1.46-4.48). There was higher odds of favorable outcome with EVT on global binary (aOR 2.57, 95% CI 1.67-3.94) and ordinal analyses (aOR 2.83, 95% CI 1.68-4.76) of cognitive function. After adding FIV to the models, both FIV and EVT were significantly associated with cognitive outcome. There was a significant correlation between global cognitive performance and mRS at day 90 (r = -0.78, p < 0.001), with the largest reductions in favorable cognitive outcome from mRS score 4 to 5 and from mRS 2 to 3. In this secondary analysis of the ESCAPE trial, EVT was associated with favorable outcome on 5 separate cognitive tests and in global analyses of cognitive benefit. These results provide novel evidence for the effect of EVT on cognition and support the global benefit of treatment with EVT. This study provides Class II evidence that in patients with acute ischemic stroke due to intracranial internal carotid artery (ICA) or M1 segment MCA occlusion, including tandem extracranial ICA occlusions, EVT compared with best medical therapy increased odds of favorable cognitive outcome.

The recent efforts to increase the proportion of women in urology have demonstrated success; it is equally important to evaluate success of these efforts in urologic sub-specialized fields as well. This study aims to evaluate the impact of these efforts and the representation of women urologists in the sexual medicine literature. Original research manuscripts from three prominent sexual medicine journals from 2013 to 2023 were collected. Manuscripts submitted under Paraphilia subsections, as well as systematic reviews, meta-analyses, communications, commentaries, replies, and those involving psychometrics were excluded. Proportion of women authors in these journals' literature was determined by searching names of first and last authors on the Internet. This study evaluates whether authorship by women in sexual medicine literature has increased following recent efforts to enhance their representation in urology and related fields. 1065 of 2701 (39%) collected manuscripts meeting criteria were from first (FA) or last authors (LA). Women were significantly less likely to be FA or LAs across these manuscripts (P<&#x2009;0.001).Further, variables such as author degree, field, profession, and institution type all demonstrated significant gender disparities in FA and LA as well. Representation of women FAs and LAs was lowest in urology (15%, 5%) compared to obstetrics and gynecology (64%, 55%) and psychology (68%, 63%). These disparities in sexual medicine publications have important consequences for women urologists; these opportunities often impact future career advancement in academia. Gender identification relied on traditional markers (such as names and pronouns), which may not fully capture the diversity of gender identities, we sought to mediate that by using a binary identification method. The analysis was also limited to first and last authorship, which may not capture contributions from middle authors. Although the push to increase the proportion of women urologists has shown success, there are still significant disparities seen in publication of sexual medicine literature. Potential avenues for improvement include mentorship and targeted institutional support.

Global patterns of immune cell communications in the immune microenvironment of skin cutaneous melanoma (SKCM) haven't been well understood. Here we recognized signaling roles of immune cell populations and main contributive signals. We explored how multiple immune cells and signal paths coordinate with each other and established a prognosis signature based on the key specific biomarkers with cellular communication. The single-cell RNA sequencing (scRNA-seq) dataset was downloaded from the Gene Expression Omnibus (GEO) database, in which various immune cells were extracted and re-annotated according to cell markers defined in the original study to identify their specific signs. We computed immune-cell communication networks by calculating the linking number or summarizing the communication probability to visualize the cross-talk tendency in different immune cells. Combining abundant analyses of communication networks and identifications of communication modes, all networks were quantitatively characterized and compared. Based on the bulk RNA sequencing data, we trained specific markers of hub communication cells through integration programs of machine learning to develop new immune-related prognostic combinations. An eight-gene monocyte-related signature (MRS) has been built, confirmed as an independent risk factor for disease-specific survival (DSS). MRS has great predictive values in progression free survival (PFS) and possesses better accuracy than traditional clinical variables and molecular features. The low-risk group has better immune functions, infiltrated with more lymphocytes and M1 macrophages, with higher expressions of HLA, immune checkpoints, chemokines and costimulatory molecules. The pathway analysis based on seven databases confirms the biological uniqueness of the two risk groups. Additionally, the regulon activity profiles of 18 transcription factors highlight possible differential regulatory patterns between the two risk groups, suggesting epigenetic event-driven transcriptional networks may be an important distinction. MRS has been identified as a powerful tool to benefit SKCM patients. Moreover, the IFITM3 gene has been identified as the key gene, validated to express highly at the protein level via the immunohistochemical assay in SKCM. MRS is accurate and specific in evaluating SKCM patients' clinical outcomes. IFITM3 is a potential biomarker. Moreover, they are promising to improve the prognosis of SKCM patients.