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Abstract BACKGROUND Delayed cerebral vasospasm is a feared complication of aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE To investigate the relationship of systemic inflammation, measured using the systemic immune-inflammation (SII) index, with delayed angiographic or sonographic vasospasm. We hypothesize that early elevations in SII index serve as an independent predictor of vasospasm. METHODS We retrospectively reviewed the medical records of 289 SAH patients for angiographic or sonographic evidence of delayed cerebral vasospasm. SII index [(neutrophils × platelets/lymphocytes)/1000] was calculated from laboratory data at admission and dichotomized based on whether or not the patient developed vasospasm. Multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed to determine the ability of SII index to predict the development of vasospasm. RESULTS A total of 246 patients were included in our study, of which 166 (67.5%) developed angiographic or sonographic evidence of cerebral vasospasm. Admission SII index was elevated for SAH in patients with vasospasm compared to those without (P < .001). In univariate logistic regression, leukocytes, neutrophils, lymphocytes, neutrophil-lymphocyte ratio (NLR), and SII index were associated with vasospasm. After adjustment for age, aneurysm location, diabetes mellitus, hyperlipidemia, and modified Fisher scale, SII index remained an independent predictor of vasospasm (odds ratio 1.386, P = .003). ROC analysis revealed that SII index accurately distinguished between patients who develop vasospasm vs those who do not (area under the curve = 0.767, P < .001). CONCLUSION Early elevation in SII index can independently predict the development of delayed cerebral vasospasm in aneurysmal SAH.

Background/Objective Subarachnoid hemorrhage (SAH) is a devastating neurological injury, further complicated by few available methods to objectively predict outcomes. With the recent shift in focus to neuroinflammation as a potential cause of adverse outcomes following SAH, we investigated the inflammasome-derived enzyme, caspase-1, as a potential biomarker for poor functional outcome. Methods SAH patients were recruited from a regional stroke referral center. Cerebrospinal fluid (CSF) samples from 18 SAH subjects were collected via an external ventricular drain and obtained as close as possible to admission (within 72 h). For control subjects, we collected CSF from 9 patients undergoing lumbar puncture with normal CSF. Caspase-1 activity was measured using commercially available luminescence assays. SAH subjects were categorized at hospital discharge into those with good outcomes (Glasgow Outcome Scale, GOS, of 4–5) and poor outcomes (GOS of 1–3). Results CSF analysis demonstrated a nearly seven-fold increase in caspase-1 activity in SAH patients compared to controls ( p  < 0.0001). Within the SAH group, 10 patients (55.6%) had good outcomes and 8 patients (44.4%) had poor outcomes. Mean caspase-1 activity in the poor outcome group was approximately three-times higher than the good outcome group ( p  = 0.001). Caspase-1 activity was significantly correlated with GOS score ( r  = − 0.705, p  = 0.001). Receiver operating characteristic curve analysis showed that caspase-1 activity can accurately differentiate between patients with good versus poor functional outcome (area under the curve 0.944, p  = 0.002). Conclusions Inflammasome-derived caspase-1 activity is elevated in the CSF of SAH patients compared to controls and higher levels correlate with worse functional outcome.

Stroke is a leading cause of death and disability worldwide. Inflammation and microvascular dysfunction have been associated with brain injury and long-term disability after both ischemic and hemorrhagic stroke. Recent studies have suggested a potential role of extracellular vesicles (EVs) as a link underlying these pathogenic processes. EVs are cell-derived particles enveloped by a lipid bilayer, containing proteins, lipids, and nucleic acids. From a functional standpoint, EVs can facilitate intercellular communication, including across the blood–brain barrier (BBB). Recent advances in EV research have shown a preferential release of EVs from specific cell types in the context of stroke, some of which were associated with increased neuroinflammation, microvascular dysfunction, and neuronal cytotoxicity while others offered a degree of neuroprotection. However, one historic challenge in the studies of EVs in stroke is the lack of consistent definitions and methods to analyze EVs, only recently updated in the MISEV2018 guidelines. Given limitations and complexity in the treatment of stroke, particularly delivery of therapeutics across the BBB, increasing attention has been paid towards manipulating EVs as one vehicle that can permit targeted therapeutic delivery to the central nervous system. These discoveries point towards a future where a better understanding of EVs will advance our knowledge of stroke-associated mechanisms of cerebral and systemic injury and contribute to the development of novel treatments. Here, we review the role that EVs play in ischemic and hemorrhagic stroke.

What did happen was that the boys were playing, went into the river, and were carried away by the current. Albanian newspapers and leaders perpetuated the lie that they were chased by Serbs. The rioting that ensued was an opportunity for extremist Albanians to erase any record of the Christian presence in Kosovo; 35 Orthodox churches and monasteries were destroyed or damaged and 4,000 more Serbs were cleansed out of Kosovo. The author also says: \"True, the 1999 attempt to cleanse Kosovo of ethnic Albanians was thwarted.\" There was no effort to \"cleanse\" Kosovo of Albanians; for the media to keep repeating this NATO mantra is just silly. The Yugoslav army tried to restore some semblance of law and order in 1999. Does any thinking person imagine it could have \"cleansed\" the province of Albanians when they made up approximately 80% of the population? Yes, there were deaths on both sides. NATO estimated 10,000 massacred Albanians. To date only about 2,000 bodies from both sides have been found. NATO caused the mass exodus of Albanians by bombing Kosovo. All the Albanians returned. But 200,000 of the Serbs were permanently \"cleansed\" out of their ancestral home of Kosovo.

Sir, - In his column of May 14, \"One-dimensional Jews,\" Yossi Klein Halevi continues his self-righteous campaign against what he calls \"the hard Right,\" but as usual, he fails to address the issues at hand. For example, in praising unilateral withdrawal, he says \"...it will end the temptation of a comprehensive agreement that would require far-reaching Israeli concessions in exchange for worthless Palestinian promises.\" He goes on to say that \"the Right should show some humility\" and stop \"limiting our options.\" It would be wise for Halevi to \"show some humility\" and examine his own arguments for unilateral withdrawal. Unilateral withdrawal, by nature, entails far-reaching Israeli concessions in exchange for nothing. Such a withdrawal would give the terror groups a free hand to upgrade their bomb and weapons factories, so that their rockets will fall not on Gush Katif, but on Ashkelon and Sderot. The logical next step would be withdrawal from the \"isolated settlements\" in Judea and Samaria. Perhaps Halevi thinks that his fence will stop rockets from the strategic mountain ridge of Samaria from eventually reaching the \"centrist, patriotic, pragmatic, mainstream\" cities of Kfar Saba, Petah Tikva, and Tel Aviv? * Who says Halevi's \"national agenda\" is Israel's national agenda? If, according to all accepted democratic rules and forms, a majority of the Likud party members decided that their party's agenda is different from Halevi's, does this have no validity at all in a democratic state? And if the Likud is the largest and therefore the leading party in the country, does its collective decision mean \"veto power over the national agenda\" or veto power over Halevi's (and Labor's) agenda? Perhaps the Likud's agenda is the national agenda?

Sir, - Ten years ago, on December 30, 1993, the Vatican recognized the State of Israel. Among the reasons the Holy See waited so long was the question of the status of Jerusalem. After the Oslo agreement was signed in 1993, Jerusalem was put on the agenda of the future discussions. As soon as this became known, the Holy See requested of the Israeli government the right to participate in these negotiations. Israel responded that it would not accede to such a request as long as the Vatican refused to recognize the State of Israel. The Vatican then initiated the process which lead to the recognition of Israel. Less than a month later, on July 9, the Vatican's foreign minister, Jean-Louis Tauran, announced in Amman: \"Before territorial problems are resolved, we have to find international guarantees to safeguard the uniqueness of the city and assurances that never again one party should claim Jerusalem as its possession.\" In other words, the Vatican was refusing to accept the principle of Israeli sovereignty over the Old City of Jerusalem.

Noninvasive optical imaging modalities can probe patient's tissue in 3D and over time generate gigabytes of clinically relevant data per sample. There is a need for AI models to analyze this data and assist clinical workflow. The lack of expert labelers and the large dataset required (>100,000 images) for model training and tuning are the main hurdles in creating foundation models. In this paper we introduce FoundationShift, a method to apply any AI model from computational pathology without retraining. We show our method is more accurate than state of the art models (SAM, MedSAM, SAM-Med2D, CellProfiler, Hover-Net, PLIP, UNI and ChatGPT), with multiple imaging modalities (OCT and RCM). This is achieved without the need for model retraining or fine-tuning. Applying our method to noninvasive in vivo images could enable physicians to readily incorporate optical imaging modalities into their clinical practice, providing real time tissue analysis and improving patient care.

Measurements of the beta-neutrino correlation coefficient (a\\(_{\\beta\\nu}\\)) in nuclear beta decay, together with the Fierz interference term (b\\(_F\\)), provide a robust test for the existence of exotic interactions beyond the Standard Model of Particle Physics. The extraction of these quantities from the recoil ion spectra in \\(\\beta\\)-decay requires accurate knowledge, decay branching ratios, and high-precision calculations of higher order nuclear effects. Here, we report on a new measurement of the \\(^{23}\\)Ne \\(\\beta\\)-decay branching ratio, which allows a reanalysis of existing high-precision measurements. Together with new theoretical calculations of nuclear structure effects, augmented with robust theoretical uncertainty, this measurement improves on the current knowledge of a\\(_{\\beta\\nu}\\) in \\(^{23}\\)Ne by an order of magnitude, and strongly constrains the Fierz term in beta decays, making this one of the first extractions to constrain both terms simultaneously. Together, these results place bounds on the existence of exotic tensor interactions and pave the way for new, even higher precision, experiments.