LncRNA-mRNA co-expression network in the mechanism of butylphthalide treatment for ischemic stroke

BACKGROUND

Butylphthalide has shown significant potential in the treatment of ischemic stroke, but its precise mechanisms of action remain unclear. Long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) play crucial roles in the pathogenesis of ischemic stroke and may serve as potential therapeutic targets. This study investigated the effects of butylphthalide treatment on the lncRNA-mRNA co-expression network in ischemic stroke patients.

METHODS

Peripheral blood samples were collected from ischemic stroke patients treated with butylphthalide and from control subjects. mRNA and lncRNA expression profiles were obtained using microarray scanning, and differentially expressed lncRNAs (DElncRNAs) were validated by qRT-PCR. Target genes interacting with DElncRNAs were predicted using the miRTargetLink database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on both DElncRNAs and differentially expressed mRNAs (DEmRNAs). A protein-protein interaction (PPI) network was constructed for proteins encoded by DEmRNAs. Co-expression analysis, based on Pearson correlation coefficients, identified the top five mRNAs and lncRNAs with high connectivity. Finally, molecular docking was performed to investigate the binding interaction between butylphthalide and key mRNAs.

RESULTS

A total of 86 differentially expressed mRNAs (69 upregulated, 17 downregulated) and 35 DElncRNAs (all upregulated) were identified. DEmRNAs were primarily associated with pathways related to cell receptors, signal transduction, cell proliferation, migration, and glucose metabolism, while DElncRNAs were involved in processes such as embryonic development, neuronal connectivity, and energy metabolism. Co-expression analysis identified key mRNA nodes (SETD9, ZNF718, AOC2, MPND, ODF1) and lncRNA nodes (IDH2-DT, CLEC12A-AS1, CARD8-AS1, LINC01275, ZNF436-AS1). Molecular docking analysis suggested that MT-CO1, SETD9, and ZNF718 could be potential targets of butylphthalide.

CONCLUSION

Butylphthalide may exert its therapeutic effects by regulating the LncRNA-mRNA co-expression network, influencing energy metabolism and neuronal development. This provides new insights into its mechanism of action and potential therapeutic targets.

Investigating the impact of glycated hemoglobin levels on stroke severity in patients with acute ischemic stroke

Stroke is a sudden neurological decline caused by cerebrovascular diseases or impaired blood circulation. Research investigating the connection between glycated hemoglobin A1c (HbA1c) levels and stroke severity is limited. This study examined the connection between HbA1c levels and stroke severity in patients with acute ischemic stroke. A retrospective cross-sectional analysis of the medical records of 1103 patients with acute ischemic stroke from January 2020 to January 2024 was conducted. Patients were divided into seven groups on the basis of their HbA1c levels. Stroke severity within these groups was assessed via the National Institutes of Health Stroke Scale (NIHSS), with the aim of identifying correlations between stroke severity and glycemic status. This study examined the impact of various HbA1c levels on a range of demographic and clinical characteristics in stroke patients. The patients were grouped into seven categories on the basis of their HbA1c levels, and characteristics such as age; body mass index (BMI); LDL, HDL, and creatinine levels; and NIHSS scores at hospital admission were compared across these groups. Significant differences were observed in age, LDL levels (F = 3.999, P < 0.001), and creatinine levels (F = 1.303, P = 0.253) among the HbA1c categories. However, there were no significant differences in BMI, HDL levels, or length of hospital stay. A positive correlation was found between HbA1c levels and NIHSS scores, indicating that higher HbA1c levels are associated with greater stroke severity. This study revealed that the risk of severe stroke increases significantly when HbA1c levels exceed 6.5%. In contrast, maintaining HbA1c levels below 6.5% is linked to a reduced risk of severe stroke and lower mortality. Additionally, older adults are at greater risk and tend to experience more severe strokes.

Metabolic diseases in the East Asian populations

East Asian populations, which account for approximately 20% of the global population, have become central to the worldwide rise of metabolic diseases over the past few decades. The prevalence of metabolic disorders, including type 2 diabetes mellitus, hypertension and metabolic dysfunction-associated steatotic liver disease, has escalated sharply, contributing to a substantial burden of complications such as cardiovascular disease, chronic kidney disease, cancer and increased mortality. This concerning trend is primarily driven by a combination of genetic predisposition, unique fat distribution patterns and rapidly changing lifestyle factors, including urbanization and the adoption of Westernized dietary habits. Current advances in genomics, proteomics, metabolomics and microbiome research have provided new insights into the biological mechanisms that might contribute to the heightened susceptibility of East Asian populations to metabolic diseases. This Review synthesizes epidemiological data, risk factors and biomarkers to provide an overview of how metabolic diseases are reshaping public health in East Asia and offers insights into biological and societal drivers to guide effective, region-specific strategies.

Effect of DU meridian acupuncture and temporal three-needle on vascular protection mechanisms in patients with acute cerebral infarction: a randomized controlled evaluator-blinded clinical trial

Background

The incidence of acute ischemic stroke has been rising steadily in China and globally, with its high mortality and disability rates significantly affecting quality of life. As an important adjunct therapy, acupuncture has been widely implemented in stroke management. Emerging studies have investigated the effects of DU meridian and Chong Mai acupuncture on ischemic hemiparesis; however, the vascular protective mechanisms of electroacupuncture therapy targeting these meridians require further elucidation in stroke rehabilitation research.

Objective

This prospective cohort study aims to investigate the clinical efficacy and limitations of DU meridian acupuncture combined with Temporal Triple Needling (Sanjian) therapy in stroke rehabilitation. The intervention's therapeutic potential is evaluated through its modulatory effects on CD14+/CD14- monocyte subpopulations within peripheral blood mononuclear cells (PBMCs), with particular focus on angiogenesis-mediated vascular protection mechanisms.

Methods

Sixty-six patients with acute ischemic stroke will be randomly assigned 1:1 to control (conventional basal therapy, n = 33) and acupuncture (conventional standard stroke care + acupuncture, n = 33) groups for 10 days of intervention. The primary outcome is NIHSS score. The secondary outcomes: BMI and mRS scores, the level of TNF-A and IL-1B in serum, vascular endothelial growth factor (VEGF), Endocan ES, CD14+ and CD14- levels of peripheral blood mononuclear cells.

Discussion

The aim of this study is to investigate whether electroacupuncture targeting the DU meridian combined with Temporal Triple Needling (Sanjian) improves cerebrovascular endothelial function in acute ischemic stroke patients, thereby reducing the NIHSS score and preventing further disease progression. This study also aims to contribute positively to the development of relevant clinical treatment protocols and to facilitate further research into the underlying mechanisms of these effects.

Clinical trial registration

International Traditional Medicine Clinical Trial Registry ITMCTR2024000508.

Causal effects of Annexin A1 and Annexin A2 on ischemic stroke and its subtypes: A two-sample Mendelian randomization study

BACKGROUND

Preclinical studies have suggested that Annexin A1 and Annexin A2 act as anti-inflammatory agents, slowing the progression of atherosclerosis and further potentially reducing the risk of ischemic stroke. Since the causality of Annexins and ischemic stroke remains uncertain, this study aimed to investigate the causal effects of both using a two-sample Mendelian randomization (MR) method.

METHODS

The genetic instruments associated with Annexin A1 and Annexin A2 originated from a European-descent genome-wide association study (GWAS) of 50,000 participants from the INTERVAL study. Summary statistics for ischemic stroke and ischemic stroke subtypes were derived from the MEGASTROKE consortium's GWAS dataset, involving 40,585 cases and 406,111 controls of European ancestry. The inverse-variance weighted method was utilized in the main analysis, followed by a series of sensitivity analyses for robustness validation.

RESULTS

In the primary analysis, genetically predicted high Annexin A1 levels were associated with decreased risks of ischemic stroke (OR = 0.96; 95 % CI = 0.93-0.99; p = 0.023) and large artery stroke (OR = 0.88; 95 % CI = 0.81-0.96; p = 0.004). Similarly, genetically predicted high Annexin A2 levels also had significant associations with decreased risks of ischemic stroke (OR = 0.97; 95 % CI = 0.95-1.00; p = 0.019) and large artery stroke (OR = 0.90; 95 % CI = 0.85-0.96; p = 0.001).

CONCLUSION

In this two-sample MR study, we found that Annexins had causal protective effects against ischemic stroke, especially large artery stroke. Further basic mechanistic studies should be conducted to investigate the biological roles of these genes.

Alpha‑Asarone Ameliorates Neuronal Injury After Ischemic Stroke and Hemorrhagic Transformation by Attenuating Blood-Brain Barrier Destruction, Promoting Neurogenesis, and Inhibiting Neuroinflammation

Recombinant tissue-type plasminogen activator (rt-PA), the primary drug for acute ischemic stroke (IS), has a narrow therapeutic window and carries a potential risk of hemorrhagic transformation (HT). Without rt-PA administration, patients may suffer permanent cerebral ischemia. Alpha-asarone (ASA), a natural compound derived from Acorus tatarinowii Schott, exhibits diverse neuropharmacological effects. This study aims to investigate whether ASA could improve outcomes in IS and be used to mitigate HT induced by rt-PA. We employed models of permanent middle cerebral artery occlusion (pMCAO) and photothrombotic cortical injury (PCI) to investigate both the therapeutic efficacy and underlying mechanisms of ASA during the acute and recovery periods following IS, respectively. Additionally, Sprague-Dawley rats were subjected to rt-PA treatment at 6-h post-PCI to mimic HT (rt-PA-HT). Our results revealed three key findings: (1) ASA demonstrated therapeutic effects in the acute phase of pMCAO rats by alleviating blood-brain barrier damage through inhibition of glial cell-mediated neuroinflammation; (2) administration of ASA 24 h after stroke ameliorated the neurological damage during the recovery phase in PCI mice by promoting neurogenesis via activation of the BDNF/ERK/CREB signaling pathway; (3) ASA attenuated rt-PA-HT injury by modulating the NLRP3/Caspase1/IL-1β and IL-18 pathways. Overall, our findings suggest that ASA mitigates neuronal injury following IS and HT, positioning it as a promising candidate for treating these conditions.

Behaviour change techniques used in interventions targeting dementia risk factors amongst older adults in rural and remote areas: A systematic review and meta-analysis

Behavioural interventions targeting health risk factors within rural areas are often not tailored to effectively address the needs and socio-environmental barriers to access and behaviour change faced by these communities. Little is known about the underlying behaviour change mechanisms that contribute to reducing dementia risk for communities living in regional and rural areas. This systematic review and meta-analysis aimed to summarise the effectiveness of behavioural interventions targeting late-life single modifiable dementia risk factors (physical inactivity, poor diet, social isolation and depression) and the mechanisms used to contribute to behaviour change. Six databases were searched to identify regional and rural behavioural interventions targeting modification of late-life dementia risk behaviours between 2000 and 2024. Behaviour change techniques (BCTs) and outcomes for each intervention were extracted. Where possible, meta-analyses were performed to assess the effectiveness of the behavioural intervention on outcomes related to dementia risk. Out of 42,529 articles, 49 studies were included: 22 on physical inactivity, 6 on poor diet, 9 on social isolation, and 12 on depression. Many BCT categories were applied (M = 14.8, SD = 10), with high use of goals and planning (49/49 interventions; 100 %), shaping knowledge (47/49 interventions; 95.9 %), social support (43/49 interventions; 87.8 %) and comparison of outcomes (38/49 interventions; 77.6 %). Social isolation interventions used the most BCTs (M = 18.3; SD = 8.5), followed by depression (M = 17.6; SD = 10.7), physical inactivity (M = 16.0; SD = 11.5), and poor diet (M = 5.2; SD = 3.1). Although effectiveness was limited across interventions, apart from cognitive behavioural therapy for depression (SMD -0.39, 95 % CI -0.55 to -0.24), future programs targeting dementia risk factors would benefit from incorporation of BCTs. Simultaneously, consideration of the socio-environmental context, accessibility, and community involvement in rural and regional areas may improve the sustainability of interventions.

Identifying effective obesity prevention intervention components: An umbrella review mapping systematic review evidence

This overview of reviews synthesizes the effectiveness of obesity prevention interventions in children and adults on BMI/zBMI, following JBI and Cochrane Handbook guidelines. The protocol was prospectively registered in OSF in September 2020. Searches for eligible reviews were run in five databases and gray literature in May 2022. Systematic reviews published in 2010 and assessed BMI/zBMI outcomes of obesity prevention interventions were eligible. Screening, data extraction, and quality assessment were performed independently and in duplicate using standardized tools. For similar interventions, the more recent, higher-quality review was included. Thirty reviews reporting on 60 discrete interventions (i.e., a specific intervention component), mapped to 14 of 21 IOM sub-domains, were included. Nine interventions were classified as effective in improving BMI outcomes, including digital health or counseling interventions for adults in 'healthcare environments', behavioral interventions for children (broadly nutrition education), physical education curriculum modifications, and policies targeting food and beverages in 'School environments'. This review extends on previous reviews by consolidating evidence from high-quality, recent reviews to identify effective intervention components. Thus, this review provides direction for implementation efforts and highlights research gaps, where future research is warranted. However, as primary studies were not directly analyzed, gaps may reflect a lack of systematic reviews rather than primary research.

Dual-tDCS Ameliorates Cerebral Injury and Promotes Motor Function Recovery via cGAS-STING Signaling Pathway in a Rat Model of Ischemic Stroke

Ischemic stroke is one of the leading causes of death and disability. Dual transcranial direct current stimulation (dual-tDCS) is a promising intervention to treat ischemic stroke, but its efficacy and underlying mechanism remain to be verified. Cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway has recently emerged as a key mediator in cerebral injury. However, little is known about the effect of cGAS-STING on neuronal damage in ischemic stroke, and it remains to be studied whether the cGAS-STING pathway is involved in tDCS intervention for ischemic stroke. Therefore, we aimed to investigate whether dual-tDCS can alleviate ischemic brain injury in a rat model of ischemic stroke and if so, whether via cGAS-STING pathway. Middle cerebral artery occlusion (MCAO) was employed to induce a rat model of ischemic stroke. Male SD rats weighing 250-280 g were randomly assigned to the Sham, MCAO, Dual-tDCS, Dual-tDCS + RU.521, and Dual-tDCS + 2'3'-cGAMP groups, with 10 rats in each group completing the experiment. Behavioral, morphological, MRI, and molecular biological methods were performed. We found that the cGAS-STING pathway was activated and expressed in neurons after MCAO. Dual-tDCS improved motor function and infarct volume, inhibited neuronal apoptosis, promoted the expression of neurotrophins (BDNF and NGF), CD31, and VEGF, and suppressed inflammation reaction after MCAO via the cGAS-STING pathway. Taken together, dual-tDCS may improve MCAO-induced brain injury and promote the recovery of motor function, resulting from the inhibition of neuronal apoptosis and inflammation reaction, as well as promotion of the expression of nerve plasticity- and angiogenesis-related proteins, via cGAS-STING pathway.

Data-Driven Subtypes of Parkinson Disease Based on Dopamine Responsiveness

AIMS

Parkinson disease (PD) is highly heterogeneous in response to antiparkinsonian drugs. We herein aimed to identify PD subtypes based on dopamine responsiveness in three key motor signs (resting tremor, rigidity, and bradykinesia).

METHODS

The acute levodopa challenge test was performed. Improvement rates in resting tremor, rigidity, and bradykinesia were calculated. A total of 228 PD patients were included for further analysis. Subtypes were determined by k-means clustering based on the improvement rates.

RESULTS

Four subtypes were identified: rt-r-b, moderate improvement in resting tremor, rigidity, and bradykinesia; RT-r-b, marked improvement in resting tremor but moderate improvement in rigidity and bradykinesia; RT-R-B, marked improvement in resting tremor, rigidity, and bradykinesia; rt-R-B, moderate improvement in resting tremor but marked improvement in rigidity and bradykinesia. These subtypes also differed in other motor and nonmotor symptoms.

CONCLUSION

Our study reveals four distinct subtypes in PD patients based on dopamine responsiveness. Our findings provide a novel insight into understanding PD heterogeneity and facilitate precision treatment.

Stroke Prognosis: The Impact of Combined Thrombotic, Lipid, and Inflammatory Markers

AIM

D-dimer, lipoprotein (a) (Lp(a)), and high-sensitivity C-reactive protein (hs-CRP) are known predictors of vascular events; however, their impact on the stroke prognosis is unclear. This study used data from the Third China National Stroke Registry (CNSR-III) to assess their combined effect on functional disability and mortality after acute ischemic stroke (AIS).

METHODS

In total, 9,450 adult patients with AIS were enrolled between August 2015 and March 2018. Patients were categorized based on a cutoff value for D-dimer, Lp(a), and hs-CRP in the plasma. Adverse outcomes included poor functional outcomes (modified Rankin Scale (mRS score ≥ 3)) and one- year all-cause mortality. Logistic and multivariate Cox regression analyses were performed to investigate the relationship between individual and combined biomarkers and adverse outcomes.

RESULTS

Patients with elevated levels of all three biomarkers had the highest odds of functional disability (OR adjusted: 2.01; 95% CI (1.47-2.74); P＜0.001) and mortality (HR adjusted: 2.93; 95% CI (1.55-5.33); P＜0.001). The combined biomarkers improved the predictive accuracy for disability (C-statistic 0.80 vs.0.79, P＜0.001) and mortality (C-statistic 0.79 vs.0.78, P=0.01).

CONCLUSION

Elevated D-dimer, Lp(a), and hs-CRP levels together increase the risk of functional disability and mortality one-year post-AIS more than any single biomarker.

Associations Between Metals and Nonmetals in Drinking Water, Cardiovascular Events, and Diet

BACKGROUND

Metals and nonmetals in drinking water could potentially influence cardiovascular health. The relationship between poor-quality drinking water, major adverse cardiovascular events (MACE), and diet is not well studied.

OBJECTIVES

The aim of this study was to determine whether long-term exposure to metals (copper, manganese, aluminum, zinc, and cadmium) and nonmetals (selenium, sulfate, and nitrate-nitrogen) in drinking water was associated with MACE outcomes, and whether the dietary patterns could modify the association between long-term exposure to low-quality drinking water and MACE.

METHODS

Data from a prospective population-based cohort from Yinzhou District, Ningbo (follow-up between 2016 and 2022) were linked to Yinzhou Health Information System. MACE endpoints included acute myocardial infarction (AMI), heart failure, stroke, angina, and cardiovascular death. Effect modification of the associations between exposure and MACE by dietary factors was determined.

RESULTS

In the final cohort of 24,212 participants, 57 had an AMI; 886 developed heart failure; 733 had a stroke; 23 had angina; and 134 had a cardiovascular death. An increased risk of: 1) AMI was seen with exposure to copper, aluminum, cadmium, and selenium; 2) stroke with exposure to zinc, copper, and selenium; 3) angina with exposure to zinc and copper; and 4) cardiovascular death with exposure to zinc and aluminum in drinking water. Consuming fish, white meat, and grain products attenuated MACE outcomes induced by metals and nonmetals in drinking water.

CONCLUSIONS

In this study, long-term exposure to higher metallic and nonmetallic elements in drinking water was associated with an increased risk of MACE. Specific dietary patterns modified the associations. Further studies are needed in this area.

Exploring the role of parthanatos in CNS injury: Molecular insights and therapeutic approaches

BACKGROUND

Central nervous system (CNS) injury causes severe organ damage due to both damage resulting from the injury and subsequent cell death. However, there are currently no effective treatments for countering the irreversible loss of cell function. Parthanatos is a poly (ADP-ribose) polymerase 1 (PARP-1)-dependent form of programmed cell death that is partly responsible for neural cell death. Consequently, the mechanism by which parthanatos promotes CNS injury has attracted significant scientific interest.

AIM OF REVIEW

Our review aims to summarize the potential role of parthanatos in CNS injury and its molecular and pathophysiological mechanisms. Understanding the role of parthanatos and related molecules in CNS injury is crucial for developing effective treatment strategies and identifying important directions for future in-depth research.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Parthanatos (from Thanatos, the personification of death according to Greek mythology) is a type of programmed cell death that is initiated by the overactivation of PARP-1. This process triggers a cascade of reactions, including the accumulation of poly(ADP-ribose) (PAR), the nuclear translocation of apoptosis-inducing factor (AIF) after its release from mitochondria, and subsequent massive DNA fragmentation caused by migration inhibitory factor (MIF) forming a complex with AIF. Secondary molecular mechanisms, such as excitotoxicity and oxidative stress-induced overactivation of PARP-1, significantly exacerbate neuronal damage following initial mechanical injury to the CNS. Furthermore, parthanatos is not only associated with neuronal damage but also interacts with various other types of cell death. This review focuses on the latest research concerning the parthanatos cell death pathway, particularly considering its regulatory mechanisms and functions in CNS damage. We highlight the associations between parthanatos and different cell types involved in CNS damage and discuss potential therapeutic agents targeting the parthanatos pathway.

Patient activation during the first 6 months after the start of spinal cord injury rehabilitation: a cohort study

BACKGROUND

Spinal cord injury (SCI) is a serious injury that leads to motor and sensory disorders and ultimately affects people's physiological, psychological, and social well-being.

AIM

To test patient activation from discharge from the department of spinal surgery until 6-month follow-up.

DESIGN

Longitudinal inception cohort study.

SETTING

This study was conducted at the Spinal Surgery Department of the Third Affiliated Hospital of Soochow University in China.

POPULATION

A total of 367 participants with traumatic SCI received community-based or hospital-based rehabilitation between October 2020 and November 2023 and were recruited using convenience sampling.

METHODS

Patient activation was evaluated using the short version of the Patient Activation Measure (PAM). Assessments were conducted at baseline, 3-month, and 6-month follow-up.

RESULTS

At baseline, the mean PAM score was 53.2, with the number of participants in PAM levels 1, 2, 3, and 4 being 92, 142, 114, and 19, respectively. Between baseline and 6-month, 164 participants remained at the same PAM level, 85 participants increased, 86 participants decreased. The multivariate mixed-effects model analysis showed that the PAM score decreased significantly over time (P=0.007). Older age had a positive effect on improvement over time (P=0.023). Higher self-efficacy, resilience, health literacy, and Modified Barthel Index (MBI) remained significantly related with higher PAM scores over time (P<0.001, P<0.001, P<0.001, and P=0.010, respectively). Fewer symptoms of depression remained significantly related with higher PAM scores over time (P<0.001).

CONCLUSIONS

PAM scores decreased slightly over time from the start of rehabilitation up to the 6-month follow-up. Furthermore, about two-third of participants remained at low levels of patient activation, which suggests that patient-centered care interventions during rehabilitation to improve patient activation might be of value.

CLINICAL REHABILITATION IMPACT

This study examined the course of patient activation from the start of SCI rehabilitation to the 6-month follow-up period. These findings provide the necessary basis for the development and evaluation of effective interventions to promote patient activation levels and enhance self-management in people with SCI.

Implementation of a coach-supported mHealth intervention for dementia prevention in China: a qualitative study among Chinese participants and coaches in the PRODEMOS trial

Background

Modifiable risk factors have been linked to 45% of dementia cases. Mobile health (mHealth) interventions targeting lifestyle-related risk factors with remote coaching have the potential to reach underserved high-risk populations globally. To date, little is known about the implementation of such interventions in China.

Methods

Fifty semi-structured interviews were conducted with 14 participants and 11 health coaches involved in the PRODEMOS trial. This trial investigated whether a coach-supported mHealth application intervention can reduce dementia risk in people aged 55-75 years with multiple risk factors. Interviews were conducted three months and 12-18 months into the intervention, focusing on implementation outcomes among Chinese participants using thematic analysis.

Results

Participants found the PRODEMOS app easy to use and remote coaching convenient, although coach responses were sometimes perceived as slow due to not logging into the mHealth platform simultaneously, thus delaying text chat communication. The intervention's appropriateness was shaped by its effectiveness in enhancing health awareness and meeting participants' needs. Feasibility depended on integration into daily routines, participant progress, partner support, coach attention, smartphone literacy, and time availability. Challenges for the coaches included remote motivational interviewing and sustained participant-coach engagement, influenced by participant-coach relationships, social environment, and the COVID-19 pandemic. Participants generally adhered to goals, but fidelity varied. Integration into primary care was endorsed.

Conclusions

This first qualitative study of the Chinese arm of the PRODEMOS intervention demonstrates that it is an acceptable and implementable approach for promoting lifestyle changes in individuals at increased risk of dementia. While coaching is crucial for sustained engagement, it presents challenges when delivered remotely. Despite significant variability in participants' adherence, positive feedback underscores its potential for integration into primary care and large-scale implementation, provided issues with coaching and engagement are addressed. These findings offer valuable insights for practitioners and policymakers seeking to incorporate mHealth solutions into public health strategies for dementia prevention.

Registration

PRODEMOS: ISRCTN15986016.

Ticagrelor or dipyridamole plus aspirin may be a promising antiplatelet therapy in patients with minor stroke or transient ischemic attack: a bayesian network meta-analysis

Background

The efficacy and safety of different antiplatelet in minor strokes or transient ischemic attacks (TIAs) remains controversial.

Methods

We searched PubMed, Embase, Web of Science and the Cochrane Library to identify all eligible articles until 12 September 2024. Efficacy outcomes were all-cause mortality, excellent outcome, functional independence and recurrent stroke. Safety outcomes were any types of bleeding and intracerebral hemorrhage (ICH). The associations were calculated for the overall data by using the odds ratios (ORs).

Results

12 high-quality studies with 10 RCTs and 2 Non-RCTs were included, involving 61,281 patients with minor strokes or TIAs. Ticagrelor + Aspirin was significantly more effective than Clopidogrel + Aspirin in preventing post-stroke neurological dysfunctions (mRS 0-1), recurrent stroke and major vascular events for up to 90 days. But Ticagrelor + Aspirin is associated with an increased risk of any bleeding and mild bleeding at 90 days, and there is no significant difference in other bleeding risks. The risk of any bleeding in Dipyridamole + Aspirin is not significantly different from that in Aspirin, and is even significantly lower than in Ticagrelor. Compared with other dual antiplatelet therapies (DAPTs), Dipyridamole + Aspirin had no significant difference in the risk of all-cause mortality and major vascular events during follow-up.

Conclusion

For minor strokes or TIAs with a low bleeding risk or CYP2C19 loss-of-function alleles, Ticagrelor + Aspirin may be a better choice than Clopidogrel + Aspirin. Due to limited studies, the superiority of Dipyridamole + Aspirin is still difficult to conclude, and further high-quality studies are needed to verify the benefits of Dipyridamole + Aspirin in minor stroke or TIAs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024537462.

Relationship between preoperative high arterial blood lactate level and delirium after deep brain stimulation surgery in Parkinson's disease

Introduction: We performed the retrospective study to investigate the relationship between preoperative arterial blood lactate level and postoperative delirium (POD) in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) surgery. Methods: Perioperative data of patients undergoing DBS surgery under total intravenous anesthesia were collected in the study. In addition, mini-mental state exam score for assessing cognitive function and confusion assessment method for assessing perioperative delirium in the PD patients were collected. The relationship between preoperative lactate level and POD was analyzed using binary logistic regression analysis. Results: A total of 156 patients were included, of whom 29 (17.6%) patients developed POD. Multivariable logistic regression analysis showed that preoperative lactate level was independently associated with POD regarding of continuous variable [odds ratio (OR) = 12.46, 95% confidence interval (CI)=3.12-49.71, P<0.001] or categorical variable (OR= 3.58, 95% CI =1.20-10.65, P=0.022 for lactate≥1.41). Receiver operating characteristic curve analysis showed that preoperative arterial blood lactate level was a significant predictive biomarker for POD, with an area under the curve of 0.708(95%CI=0.606-0.809, P<0.05). Subgroup analysis indicated that high preoperative lactate levels were an independent risk factor for delirium after DBS surgery (OR=10.71,95%CI=1.17-97.87, P=0.036) in female Parkinson's disease patients. Discussion: Preoperative high level of lactate is an independent factor for delirium after DBS surgery in patients with Parkinson's disease.

Molecular epidemiological study of exosomes circZNF609, circPUM1, IGF2 with ischemic stroke

BACKGROUND

Ischemic stroke (IS) is a common cardiovascular disease (CVD). Insulin-like growth factor 2 (IGF2), circZNF609, and circPUM1 are involved in metabolic regulation, vascular health, neuroprotection, and inflammation modulation and are relevant to IS mechanisms. This study investigated the effects of plasma exosomal expression of circZNF609, circPUM1, and IGF2 on IS.

METHODS

The expression of circZNF609, circPUM1, and IGF2 mRNA in exosomes was detected in 145 patients with IS and 290 controls using real-time qPCR in a cross-sectional study. Q1-Q4 represents the quartile groups based on the target gene expression levels.

RESULTS

There was no significant difference in the expression levels of circZNF609 and circPUM1 in the plasma exosomes between the IS and control groups (P > 0.05). However, a nonlinear relationship between the expression levels of circZNF609 in the IS group (P < 0.05). Exosomal IGF2 mRNA expression in the IS group was significantly lower than that in the control group (P = 0.043). The multifactorial adjusted results showed that in the case-control study of IS, circZNF609 in plasma exosomes was associated with a reduced risk of disease in group Q2 (adjusted OR: 0.565; P = 0.035) compared to that in group Q1, the low-expression group. In plasma exosomes, circZNF609 expression in group Q4 was associated with a reduced risk of disease in group Q1 (adjusted OR: 0.654; P = 0.004) compared to that in group Q1 (low expression). Plasma exosomes with IGF2 showed a reduced risk in the Q4 group with high IGF2 expression compared to that in the Q1 group with low IGF2 expression (adjusted OR: 0.543; P = 0.042).

CONCLUSIONS

This study suggests that the low expression of circZNF609, circPUM1, and IGF2 in peripheral blood plasma exosomes could pose a potential risk for IS and serve as biomarkers for clinical treatment.

Behavioral Interventions for Tobacco Cessation in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

INTRODUCTION

An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers, including upper aero-digestive tract cancer, stomach cancer, ischemic heart disease and stroke, with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high-income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially.

METHODS

We synthesized the effectiveness of behavioral interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioral intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at 6 months postintervention follow-up.

RESULTS

For continuous abstinence at 6 months, the intervention was superior to the active comparator (RR 2.32; 95% CI 1.78 to 3.02) and usual care (RR 4.39; 95% CI 2.38 to 8.11). For point prevalence abstinence at six months, the intervention was superior to the active comparator (RR 1.76; 95% CI 1.28 to 2.44), and usual care (RR 2.37; 95% CI 1.47 to 3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons except for 6-month continuous outcomes.

CONCLUSIONS

Implementation research is needed to understand factors for programme sustainability and equity of the impact of behavioral interventions in reducing tobacco use in LMICs.

IMPLICATIONS

Our review is an important step towards understanding the effectiveness of behavior interventions for tobacco cessation suited for LMICs and which are responsive to the contextual needs of such countries.

Neutrophil-to-lymphocyte ratio as a predictor of prognosis in patients with spontaneous intracerebral hemorrhage: a systematic review and meta-analysis

Objective

To evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for prognosis spontaneous intracerebral hemorrhage (ICH) patients.

Methods

PubMed, EMBASE, Cochrane Library, Web of Science were used for screening literature on NLR predicting ICH prognosis from database up to January 2024. Case-control or cohort studies that provided statistical analysis data on NLR predicting ICH prognosis were included. Data were combined using odds ratio (OR) and standard mean differences (SMD) for categorical variables and continuous variables, respectively. Meta-analysis, subgroup analyses, and sensitivity analyses were performed by Review Manager 5.4 and Stata 15.0.

Results

Meta-analysis of 21 studies with a total of 7,176 patients confirmed that NLR has a significant predictive value for mortality (SMD: 0.80, 95% CI: 0.58-1.02; OR: 1.10, 95% CI: 1.04-1.17) and neurological function outcomes (SMD: 0.66, 95% CI: 0.50-0.81; OR: 1.29, 95% CI: 1.17-1.41). NLR also significantly predicted the occurrence of stroke-associated pneumonia (SAP) (SMD: 0.54, 95% CI: 0.21-0.87). Subgroup analysis suggested that NLR had good predictive value for mortality in ICH patients aged ≥60 years, with hematoma volume > 15 mL, and NLR cut-off >7.5, and for neurological function in ICH patients, Asian patients, and those with NLR cut-off >7.5. The stability of the results was confirmed by sensitivity analysis.

Conclusion

NLR can significantly predict mortality, neurological function outcomes, and SAP occurrence in ICH patients. NLR cut-off >7.5 has good predictive value for both mortality and neurological function in ICH patients. Considering the limitations of this study, such as small sample size and potential heterogeneity, prospective studies with larger sample sizes are needed to confirm the findings of this article.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024544506.

Effect of hospital-community-home collaborative health management on symptoms, cognition, anxiety, and depression in high-risk individuals for stroke

BACKGROUND

Effective health management for high-risk stroke populations is essential. The hospital-community-home (HCH) collaborative health management (CHM) model leverages resources from hospitals, communities, and families. By integrating patient information across these three domains, it facilitates the delivery of tailored guidance, health risk assessments, and three-in-one health education.

AIM

To explore the effects of the HCH-CHM model on stroke risk reduction in high-risk populations.

METHODS

In total, 110 high-risk stroke patients screened in the community from January 2019 to January 2023 were enrolled, with 52 patients in the control group receiving routine health education and 58 in the observation group receiving HCH-CHM model interventions based on routine health education. Stroke awareness scores, health behavior levels, medication adherence, blood pressure, serum biochemical markers (systolic/diastolic blood pressure, total cholesterol, and triglyceride), and psychological measures (self-rating anxiety/depression scale) were evaluated and compared between groups.

RESULTS

The observation group showed statistically significant improvements in stroke awareness scores and health behavior levels compared to the control group (P < 0.05), with notable enhancements in lifestyle and dietary habits (P < 0.05) and reductions in postintervention systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, self-rating anxiety scale, and self-rating depression scale scores (P < 0.05).

CONCLUSION

The HCH-CHM model had a significant positive effect on high-risk stroke populations, effectively increasing disease awareness, improving health behavior and medication adherence, and appropriately ameliorating blood pressure, serum biochemical marker levels, and negative psychological symptoms.

Novel Hypochlorous Acid-Activated Near-Infrared Probe Monitors the Dynamic Changes of Myeloperoxidase Activity in Ischemic Brain

Myeloperoxidase (MPO) contributes to the progression of ischemic damage. To fully understand MPO biology, highly sensitive and specific probes that can trace the activity of endogenous MPO fluxes are indispensable. Here, we developed two hypochlorous acid (HClO)-activated near-infrared probes to image MPO activity in a noninvasive manner. The probe MPO-NIR-II could track MPO-induced HClO in real time and in situ upon various stimuli with high sensitivity and specificity. Furthermore, MPO-NIR-II could monitor the MPO activity by in vivo fluorescence imaging and confocal laser scanning microscopy in mice with ischemic stroke. Moreover, a high-content screening system for MPO inhibitors was established by combining MPO-NIR-II with MPO-overexpressed cells and mouse brain slices with ischemic stroke, and the candidate compound AZD5904 was found to effectively attenuate ischemic brain injury. Overall, this work provides a versatile fluorescence tool that holds great promise for visualizing endogenous MPO fluxes of brain ischemia.

Structured follow-up pathway to address unmet needs after transient ischaemic attack and minor stroke (SUPPORT TIA): Feasibility study and process evaluation

BACKGROUND

Care following transient ischaemic attack (TIA) and minor stroke is variable and often leaves patients feeling abandoned and uncertain. We developed a theoretically-informed, multifaceted intervention which comprised nurse-led, structured follow-up at 4 weeks after TIA/minor stroke to identify and address patient needs. This study evaluated the feasibility and acceptability of both the intervention and procedures to inform a future randomised controlled trial.

METHOD

We conducted a multicentre, randomised feasibility study with mixed-methods process evaluation (ISRCTN registry reference: ISRCTN39864003). We collected patient reported outcome measures (PROMs) at 1, 12 and 24 weeks and clinical data at baseline and 24 weeks. The process evaluation comprised qualitative interviews with a sub-sample, feedback questionnaires, and observations of intervention delivery.

RESULTS

We recruited 54 patients over 12 months, achieving 90% of the target sample size (n = 60). PROMs return rates were 94.4% (51/54), 85.2% (46/54) and 71.1% (27/38) at 1, 12, and 24-weeks, respectively. Intervention fidelity was high and the intervention largely aligned with the theoretical underpinnings. The process evaluation illustrated how patients benefitted from the intervention through support they would not have received through usual care. This included direct referral or signposting to support services, information and education, actionable advice, and reassurance about and normalisation of recovery. The trial design was feasible and acceptable for both patients and clinicians.

CONCLUSION

Nurse-led, structured follow-up after TIA and minor stroke is feasible, acceptable and valued by patients and clinicians. Our intervention can identify and help address unmet needs. A definitive randomised trial to evaluate intervention effectiveness and cost-effectiveness is feasible and acceptable.

Association of visceral adiposity index (VAI) with prognosis in patients with metabolic syndrome and heart failure with reduced ejection fraction

BACKGROUND

Visceral Adiposity Index (VAI) is an effective predictor of metabolic syndrome (MetS) and serves as a marker of visceral adiposity. The association between the VAI index and poor prognosis in patients with MetS and Heart failure with reduced ejection fraction (HFrEF) remains unclear. The aim of this study is to evaluate the relationship between VAI and endpoint events in patients with metabolic syndrome and HFrEF.

METHODS

This study was a single-center retrospective cohort study. A total of 809 patients with MetS and HFrEF admitted to Hangzhou Hospital of Zhejiang Medical Group from January 2014 to September 2021 were consecutively included. The VAI index was calculated based on anthropometric measurements and laboratory examination results at admission, and patients were grouped according to tertiles of VAI index. All patients were followed for 24 months, and the incidence of cardiac death and readmission for heart failure was recorded.

RESULTS

For different clinical endpoint events, there were significant differences in event-free survival between tertiles of VAI index. The risk of cardiac death [hazard ratio (HR):3.402, 95%CI:2.123-5.449, P < 0.001] and heart failure readmission (HR:4.862, 95%CI:3.605-6.557, P < 0.001) increased with the increase of tertile of VAI index. Multivariate COX regression analysis adjusted for other confounding factors showed that VAI was an independent predictor of clinical adverse endpoint events. The predictive value of VAI for cardiac death [Area under curve (AUC):0.649, 95%CI:0.602-0.697, P < 0.001] and heart failure readmission (AUC:0.693, 95%CI:0.656-0.729, P < 0.001) was higher than that of other variables.

CONCLUSIONS

In patients with HFrEF at risk for comorbid metabolic diseases, baseline VAI levels on admission were associated with the occurrence of adverse outcomes during follow-up.

Association between oxidative balance score and all-cause mortality in stroke survivors

Stroke is the second leading cause of death globally. Oxidative stress plays a critical role in the development of stroke. The Oxidative Balance Score (OBS) is a tool used to assess the combined impact of diet and lifestyle on the body's antioxidant capacity. The study included stroke survivors from the National Health and Nutrition Examination Survey (1999-2018), with a total of 1,781 participants and a median follow-up duration of 6.5 years, during which 786 participants (39.59%) died. The relationship between OBS and all-cause mortality was assessed using the Cox proportional hazards model. The results indicated that individuals in higher OBS quartiles had lower mortality rates. Specifically, patients in the fourth quartile had a 41% reduced risk of all-cause mortality compared to those in the first quartile (HR = 0.59, 95% CI = 0.42-0.84, p = 0.003). Restricted cubic spline analysis revealed a linear inverse relationship between OBS and all-cause mortality. Subgroup analysis further demonstrated that the inverse association persisted across various population subgroups. Overall, our study suggests that higher levels of OBS can reduce the risk of all-cause mortality in stroke survivors and provides new evidence for their diet and lifestyle.

J-shaped association of neutrophil-to-lymphocyte ratio with all-cause mortality and linear association with cardiovascular mortality in stroke survivors

Background

The correlation between systemic inflammation and stroke has been well-established. Notably, the neutrophil-to-lymphocyte ratio (NLR) has been linked to poor outcomes and increased short-term mortality in acute ischemic stroke (AIS). This study aims to explore the association between NLR and long-term mortality among stroke survivors.

Methods

This study analyzed data from 1,229 stroke survivors enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. The participants were categorized according to quartiles of NLR level. Multivariate Cox regression and restricted cubic splines (RCS) were applied to evaluate the relationship between NLR and all-cause and cardiovascular disease (CVD) mortality.

Results

Over a median follow-up of 6.41 years, 485 deaths were recorded. After multivariate adjustment, individuals in the highest NLR quartile (Q4) demonstrated significantly higher risks of all-cause mortality (hazard ratio [HR] = 1.58, 95% confidence interval [CI]: 1.06-2.34) and CVD mortality (HR = 1.90, 95% CI: 1.07-3.37) compared to those in the lowest quartile (Q1). RCS analysis revealed a J-shaped relationship between NLR and all-cause mortality and a linear relationship with CVD mortality.

Conclusion

These findings suggest a J-shaped association between NLR and all-cause mortality, along with a linear relationship between NLR and CVD mortality in stroke survivors.

Pre-hospital delay intention and its associated factors in the high-risk population of stroke: a latent profile analysis

AIMS

To explore the possible latent classifications of pre-hospital delayed intention at high risk of stroke and to analyse the characteristics of different profiles.

METHODS AND RESULTS

A cross-sectional study was conducted in one community in Shanghai, China. Four hundred and seventy individuals at high risk of stroke were recruited, and self-reported questionnaires (including socio-demographic, stroke knowledge, health belief, and pre-hospital delay behaviour intention scale) were distributed between April and June 2023. A latent profile analysis was employed to identify the delay intention clusters, and multinomial logistic regression was utilized to ascertain the factors influencing the latent classes of delay intention. Four hundred and fifty-seven high-risk populations with a response rate of 97.23% were finally enrolled in this study. Four distinct classes were identified: high warning signs-low delay intention (26.3%), low warning signs-low delay intention (17.7%), moderate level of delay intention (37.3%), and high level of delay intention (18.7%). The influencing factors included stroke knowledge, health belief, age, education background, the nearest distance to the medical institution, and household income.

CONCLUSION

The pre-hospital delay intention among high-risk populations of stroke was classified into four distinct classes. It is crucial for individuals at high risk to remain vigilant towards stroke symptoms and to take prompt action. Health promotion education may be explored as a strategy to bridge the gap between the recognition of stroke symptoms and the low pre-hospital delay intention.

Mechanisms of polygalasaponin F against brain ischemia-reperfusion injury by targeting NKCC1

Stroke is a serious threat to human health and current clinical therapies remain unsatisfactory. Elevated expression of Na+-K+-2Cl- cotransporter 1 (NKCC1) following stroke can disrupt the blood-brain barrier (BBB) and result in brain edema, indicating that NKCC1 may be a potential therapeutic target for improving stroke outcomes. Polygalasaponin F (PGSF) is a triterpenoid saponin isolated from Polygala japonica Houtt, which has showed neuroprotective effects in previous studies. The present study aimed to assess the protective effects of PGSF on cerebral ischemia-reperfusion injury (CIRI) in vivo and elucidate its underlying mechanism by targeting NKCC1. Experimental results revealed that following CIRI, rats displayed neurological deficits, cerebral infarction and brain edema, concurrent with increased NKCC1 mRNA and protein expression in the cerebral tissue. Notably, the administration of PGSF at both 10 mg/kg and 20 mg/kg effectively mitigated these adverse outcomes. To explore the mechanism of PGSF, pyrosequencing was used to find that CIRI reduces the methylation of the NKCC1 promoter, while PGSF enhances it. It was thereby demonstrated that PGSF could reduce NKCC1 expression in this manner. Simultaneously, we also observed that the protein expression of DNA methyltransferase 1 (DNMT1) in the ischemic penumbra was augmented after CIRI, whereas PGSF reduced the expression of DNMT1, which was contrary to the trend of NKCC1 methylation under the treatment of PGSF. These results imply that the enhancement of NKCC1 methylation by PGSF may not be catalyzed by DNMT1 and that the reduction of NKCC1 methylation level after CIRI may not be related to DNMT1. Finally, we discovered that PGSF can decrease the leakage of the BBB and enhance the expression of the BBB structural proteins occludin and ZO-1. In conclusion, PGSF can target NKCC1 as an epigenetic target and downregulate its expression following CIRI by enhancing DNA methylation of NKCC1, thereby safeguarding the structure and function of brain tissue.

High b-Value and Ultra-High b-Value Diffusion Weighted MRI in Stroke

PURPOSE

To explore the application value of high-b-value and ultra-high b-value DWI in noninvasive evaluation of ischemic infarctions.

STUDY TYPE

Prospective.

SUBJECTS

Sixty-four patients with clinically diagnosed ischemic lesions based on symptoms and DWI.

FIELD STRENGTH/SEQUENCE

3.0 T/T2-weighted fast spin-echo, fluid-attenuated inversion recovery, pre-contrast T1-weighted magnetization prepared rapid gradient echo sequence, multi-b-value trace DWI and q-space sampling sequences.

ASSESSMENT

Lesions were segmented on standard b-value DWI (SB-DWI, 1000 s/mm2), high b-value DWI (HB-DWI, 4000 s/mm2) and ultra-high b-value DWI (UB-DWI, 10,000 s/mm2), and cumulative segmented areas were the final abnormality volumes. Normal white matter (WM) areas were obtained after binarization of segmented brain. In 47 patients, fractional anisotropy (FA) and apparent diffusion coefficients (ADCs) at b values of 1000, 4000, and 10,000 s/mm2 were extracted from symmetrical WM masks and lesion masks of contralateral WM (CWM) and lesion-side WM (LWM).

STATISTICAL TESTS

Wilcoxon matched-pairs signed-rank test and Pearson correlation analysis. Two-tailed P-values <0.05 were considered statistically significant.

RESULTS

Various signals of HB-/UB-DWI (hypo-, iso- or hyper-intensity) were observed in strokes compared with SB-DWI, and some areas with iso-intensity of SB-DWI manifested with hyper-intensity on HB-/UB-DWI. Abnormality volumes from SB-DWI were significantly smaller than those from HB-DWI and UB-DWI (10.32 ± 16.45 cm3, vs. 12.25 ± 19.71 cm3 and 11.83 ± 19.41 cm3), while no significant difference exist in volume between HB-DWI and UB-DWI (P = 0.32). In CWM, FA significantly correlated with ADC4000 and ADC10,000 (maximum r = -0.51 and -0.64), but did not significantly correlate with ADC1000 (maximum r = -0.20, P = 0.17). ADC1000 or ADC4000 of LWM not significant correlated with FA of CWM (maximum r = -0.28, P = 0.06), while ADC10,000 of LWM significantly correlated with FA of CWM (maximum r = -0.46).

DATA CONCLUSION

HB- and UB-DWI have potential to be supplementary tools for the noninvasive evaluation of stroke lesions in clinics.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 2.

Yangyin Yiqi Huoxue Decoction improves the mechanism of microglia activation against CIS-induced neuroinflammatory injury by regulating the Wnt signaling pathway

BACKGROUND

Ischemic stroke is a predominant cause of neurological disability, characterized by neuroinflammation and neuronal apoptosis. The Wnt signaling pathway plays a critical role in brain repair. Yangyin Yiqi Huoxue Decoction, a traditional Chinese herbal formula, has shown potential in alleviating neuroinflammatory injury, yet, the precise mechanism underlying its effects remains unclear.

PURPOSE

This study aims to explore the therapeutic efficacy of Yangyin Yiqi Huoxue Decoction on ischemic stroke and its potential mechanism of action, particularly focusing on its modulation of the Wnt signaling pathway and impact on neuroinflammation and neural stem cells activity.

STUDY DESIGN AND METHODS

The middle cerebral artery occlusion (MCAO) rat model and an Oxygen glucose deprivation/re-oxygenation (OGD/R) cell model were employed. In vivo experiments were conducted to investigate the therapeutic effects of the Yangyin Yiqi Huoxue Decoction at high, medium, and low dosages (3.3, 1.65, and 0.83 g/kg). The effects of Yangyin Yiqi Huoxue Decoction on neuroinflammatory cytokine levels, microglial activation, and neural stem cells proliferation and differentiation were assessed in vivo experiments. Wnt signaling components were evaluated through Quantitative Real-Time PCR and Western blot in both vivo and vitro. Additionaly, the Wnt inhibitor Dickkopf-related protein 1(DKK1) was used to confirm the pathway's involvement.

RESULTS

The high-dose group(3.3 g/kg) of the Yangyin Yiqi Huoxue Decoction exhibited the most pronounced therapeutic effects. Yangyin Yiqi Huoxue Decoction significantly reduced pro-inflammatory cytokine levels, inhibited microglial overactivation, and enhanced neural stem cells proliferation and differentiation. It also modulated the Wnt pathway by upregulating Wnt Family Member 3A(Wnt3a) and β-catenin, while downregulating Wnt Family Member 5A(Wnt5a) and glycogen synthase kinase-3β(GSK-3β). The inhibition of Wnt signaling by Dickkopf-related protein 1(DKK1) reversed these beneficial effects, confirming Yangyin Yiqi Huoxue Decoction 's mechanism.

CONCLUSIONS

Yangyin Yiqi Huoxue Decoction exerts neuroprotective effects by suppressing neuroinflammation and promoting neural-stem-cell-mediated brain repair through the Wnt signaling pathway, positioning it as a potential candidate for ischemic stroke treatment.

Retinal vascular alterations are associated with cognitive function and neuroimaging in white matter hyperintensities

AIM

To reveal alterations in retinal structure, vessels, and function, and their association with cognitive function and neuroimaging in white matter hyperintensities (WMH).

METHODS

This study enlisted WMH and age-matched healthy controls (HC). All participants underwent six different tests: magnetic resonance imaging (MRI) of the brain, the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), fundus photography, optical coherence tomography (OCT), and visual field testing. Visual field can reflect the function of optic nerve and retina. The peripapillary retinal nerve fiber layer (p-RNFL) was analyzed using OCT. Image J software was employed to measure retinal vascular caliber in fundus photographs and to compute the central retinal artery equivalent (CRAE), central retinal venous equivalent (CRVE) and arteriole-to-venule ratio (AVR).

RESULTS

A total of 90 WMH patients and 93 HC participants. In comparison with the HC, the WMH group exhibited reduced cognitive function scores (MoCA: P < 0.001; MMSE: P < 0.001), narrower retinal arteries (P < 0.001), smaller AVR (P < 0.001) and thinner p-RNFL thickness (total: P = 0.026; temporal: P = 0.006). About visual field, both univariate and multivariate analysis showed that mean sensitivity decreased, and mean defect increased in WMH group (P < 0.05). Additionally, correlation analysis indicated a positive correlation between CRAE and AVR with MMSE and MoCA score (r = 0.424-0.57, P < 0.001) and a negative correlation with Fazekas score (CRAE: r = -0.515, P < 0.001; AVR: r = -0.554, P < 0.001), and p-RNFL was negatively correlated with Fazekas score (total p-RNFL: r = -0.192, P = 0.009; temporal p-RNFL: r = -0.217, P = 0.003). Notably, no significant correlation was found between cognitive function and p-RNFL.

CONCLUSION

WMH group exhibit narrower retinal arteries, smaller arteriole-to-venule ratio, damaged p-RNFL and visual function. These alterations in retinal vessels are associate with both neuroimaging and cognitive function. Our results suggest that retinal imaging could serve as a valuable instrument for evaluating WMH and provides some new approaches to study the characteristic markers of WMH.

Unravelling the impact of QRICH1 modulation on endoplasmic reticulum stress and neuronal apoptosis in traumatic brain injury

BACKGROUND

Traumatic brain injury (TBI) is a major public health concern with high morbidity and mortality rates. Secondary brain injury, marked by inflammatory responses and apoptosis, worsens TBI outcomes. The endoplasmic reticulum stress (ERS) response has been implicated in secondary brain injury, with Glutamine Rich 1 Gene (QRICH1) emerging as a potential mediator. However, the precise role of QRICH1 in TBI pathogenesis and its therapeutic implications remain unclear.

METHODS

Controlled cortical impact mouse and Lipopolysaccharide-stimulated primary neuron models were used. Behavioral assessments, including the modified Garcia score, Y-maze test, and open-field test, were used to evaluate postoperative recovery in mice. QRICH1 neuron conditional knockout (cKO) mice were used to assess QRICH1 function, whereas adeno-associated virus (AAV)-mediated gene manipulation was used to modulate QRICH1 expression in cortical neurons.

RESULTS

QRICH1 expression was upregulated in the brain tissue of TBI mice, particularly 24 h post-injury, as shown by western blot analysis and immunofluorescence staining. QRICH1 is localized within neuronal nuclei, suggesting a role in cellular stress responses. QRICH1 cKO improved behavioral outcomes post-TBI, whereas AAV-mediated QRICH1 overexpression exacerbated secondary brain injury, characterized by increased ERS-related protein expression and neuronal death. Conversely, AAV-mediated QRICH1 knockdown reduced secondary brain injury as evidenced by decreased ERS-related protein expression and neuronal death.

CONCLUSION

QRICH1 plays a critical role in exacerbating ERS and apoptosis, and influences neuronal fate in secondary brain injury. Its involvement in the ERS pathway and in the induction of neuronal apoptosis post-TBI highlights QRICH1 as a potential therapeutic target for TBI treatment.

Neutrophil membrane-coated multifunctional biomimetic nanoparticles for spinal cord injuries

Spinal cord injury (SCI) is one of the most complex diseases. After SCI, severe secondary injuries can cause intense inflammatory storms and oxidative stress responses, leading to extensive neuronal apoptosis. Effective regulation of inflammation and oxidative stress after SCI remains an unresolved challenge. In this study, resveratrol-loaded nanoparticles coated with neutrophil membranes (NMR) were prepared using the emulsion-solvent evaporation method and membrane encapsulation technology. Multifunctional biomimetic nanoparticles retain neutrophil membrane-related receptors and possess a strong adsorption capacity for inflammatory factors. As a drug carrier, NMR can sustainably release resveratrol for >72 h. Moreover, co-culture studies in vitro show that the NMR help regulate macrophage polarization to relieve inflammatory response, reduce intracellular reactive oxygen species by approximately 50%, and improve mitochondrial membrane potential to alleviate oxidative stress. After injecting NMR into the injury site, it reduces early apoptosis, inhibit scar formation, and promote neural network recovery to improve motor function. This study demonstrates the anti-inflammatory, antioxidant, and neuroprotective effects of NMR, thus providing a novel therapeutic strategy for SCI.

Neuroprotective effect and possible mechanisms of the extract of ginkgo biloba for spinal cord injury in experimental animal: a meta-analysis and systematic review

Spinal cord injury (SCI) is a major challenge in the medical community because of its difficulty in treatment and poor prognosis. Extract of ginkgo biloba (EGb) has been widely used in the prevention and treatment of age-related neurosensory disease, which is considered to have the effect of neuroprotection. We performed a systematic review to evaluate the neurobiological roles of EGb for treating SCI in rats. Pubmed, Embase, Sinomed and China National knowledge Infrastructure were searched from their inception dates to April 2024, and 30 articles were included. The quality score of the included studies ranged from 4 to 7 out of 10 points, and all of them were randomization. It was shown that after SCI, EGb administration could significantly improve motor function (WMD = 2.09 [1.59, 2.59], p < 0.00001). Subgroup analysis concluded that EGb at the doses of 10-50 mg/kg improved the motor function to the greatest extent. In comparison with the control group, EGb administration could reduce lipid peroxidation and inhibit inflammation (MDA: SMD = -1.43 [-5.05,2.20], p < 0.00001; iNOS: WMD = -22.17 [-35.45, -8.90], p < 0.00001). In addition, this review suggested that EGb can antagonize inflammation, reduce oxidative stress to inhibit the lipid peroxidation and resistance to apoptosis, promote nerve growth and reduce myelin loss on SCI. Preclinical grade suggests that, collectively, EGb may be a promising natural neuroprotective agent on SCI with unique advantages and mechanisms of action. More clinical randomized, blind controlled trials are also needed to confirm the neuroprotective effect of EGb on SCI.

Application of Neurophysiological Monitoring and Ultrasound Guidance in Intramedullary Decompression for Acute Spinal Cord Injury

Objective

To explore the clinical application value of neurophysiological monitoring combined with ultrasound guidance in Acute spinal cord injury.

Methods

Ten patients with acute spinal cord injury underwent intramedullary decompression surgery under neurophysiological monitoring and intraoperative ultrasound guidance. ASIA (American Spinal Injury Association) classification and JOA (Japan Orthopaedic Association) scoring were performed preoperatively and postoperatively.

Results

The preoperative, 1-week postoperative, and 1-year postoperative JOA scores for the ten patients were (6.2 ± 1.55), (7 ± 1.58), and (11.8 ± 1.60), respectively. The JOA improvement rates at 1 week and 1 year postoperation were 7.4% and 51.9%, respectively. Among the patients, one patient had severe thoracic spinal cord injury upon admission, and their ASIA classification remained at Grade A after 1 year postoperation, while the remaining nine patients showed varying degrees of neurological function improvement.

Conclusion

Intraoperative neurophysiological monitoring combined with intraoperative ultrasound not only allows for timely monitoring of spinal cord function but also enables observation of whether decompression is adequate during surgery. It represents a very good surgical option for patients with spinal cord injuries.

Evolution of sarcopenia status and risk of incident cardiovascular disease

AIMS

Sarcopenia is an emerging risk factor for cardiovascular disease (CVD). However, previous studies did not take into consideration the cardiovascular impact of the changes in sarcopenia status. We investigated the relationship between changes in sarcopenia status and incident CVD.

METHODS

Participants from two prospective cohorts: the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS) were included. Changes in sarcopenia status were assessed by sarcopenia status at the initial two surveys. CVD was ascertained by self-reported physician-diagnosed heart disease or stroke.

RESULTS

A total of 6,608 and 4,316 adults from CHARLS (mean age: 59.2 years, female: 53.6%) and HRS (mean age: 63.2 years, female: 60.2%) were analyzed, with a median follow-up of 5.0 years and 7.5 years, respectively. Meta-analysis showed a significant relationship between sarcopenia and CVD risk. Bidirectional MR analysis supported the robustness and causality, and no reverse association was found between CVD and sarcopenia. Compared with stable no sarcopenia participants, multivariable-adjusted incidence rate ratio (IRR) and 95% confidence interval (95% CI) for incident CVD in those who progressed from no sarcopenia to possible sarcopenia/sarcopenia were 1.29 (1.02-1.64) and 1.39 (1.11-1.74) in both cohorts. In contrast, sarcopenia participants who recovered to no sarcopenia/possible sarcopenia had lower incidence of CVD (CHARLS, IRR 0.61, 95% CI 0.43-0.87; HRS, IRR 0.20, 95% CI 0.11-0.39) than stable sarcopenia participants did.

CONCLUSIONS

The progression of sarcopenia status increases the risk of CVD, while the recovery of sarcopenia status reduces the risk of incident CVD.

The association between inflammatory markers, walking speed, and metabolic syndrome in older Chinese adults

OBJECTIVE

As China's ageing process accelerates, the annual prevalence of Metabolic Syndrome (MetS) among older Chinese adults continues to rise. This study seeks to assess the relationship between inflammatory markers, walking pace, and MetS in old Chinese adults.

METHODS

This study utilised a cross-sectional design, drawing on data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted by Peking University, encompassing 3587 older adults aged over 60. Data regarding inflammatory markers (CRP), walking speed, and variables associated with MetS (including waist circumference and blood pressure) were gathered. Multiple linear regression analysis was used to evaluate the relationship between CRP, walking speed, and MetS.

RESULTS

In a cohort of 3587 older Chinese adults, slower walking speed (β = 0.414) and elevated CRP levels (β = 0.209) were significantly correlated with MetS, with the association persisting after controlling for confounding variables. Furthermore, females, urban residents, individuals with a higher BMI, and smokers exhibited an increased risk of developing MetS.

CONCLUSION

Walking speed and CRP levels are critical determinants in evaluating the risk of MetS in older adults; improving walking speed and mitigating inflammation may contribute to a decreased risk of MetS.

Low Serum Vitamin D Levels Are Associated with Reduced Muscle Strength in Women with Breast Cancer

Vitamin D insufficiency has been frequent in women with breast cancer (BC), as well as impaired muscle strength (MS), and a possible relationship between these conditions has been investigated in different populations, except in women with BC. This study aimed to analyze the association between serum vitamin D levels and MS in women with BC. Observational cross-sectional study carried out with adult women with BC, without metastasis/recurrence, with up to 12 months of diagnosis. Serum 25(OH)D concentration was categorized as insufficient (<30 ng/mL) or sufficient (≥30 ng/mL). MS was assessed by the Handgrip Strength test and divided into strength tertiles of the population itself: 1st tertile (6-21 kg), 2nd tertile (22-26 kg), and 3rd tertile (27-39 kg). Adjusted multinomial logistic regression models verified the association of serum vitamin D levels in MS tertiles, with a significance of 5%. A total of 151 women were evaluated. Most women had insufficient levels of vitamin D (70%). Insufficient serum vitamin D levels were associated with the 1st and 2nd tertile of MS (odds ratio [OR]: 5.74, 95% confidence interval [CI]: 1.77-18.64, P = 0.004; OR: 4.48, 95% CI: 1.34-14.97, P = 0.015, respectively). Serum vitamin D insufficiency incresed the probability to present lower tertiles of MS in women with BC.

Development and validation of a prognostic nomogram for predicting poor outcomes following intravenous rt-PA in patients with acute ischemic stroke

Background

Intravenous administration of recombinant tissue plasminogen activator (rt-PA) within 4.5 h of symptom onset is a standard treatment for acute ischemic stroke (AIS). However, certain patients continue to develop unfavorable outcomes despite timely rt-PA therapy. Identifying those at high risk is essential for developing individualized care plans and establishing appropriate follow-up.

Methods

This retrospective study included AIS patients treated with intravenous rt-PA at 0.9 mg/kg at our center. Outcomes at three months were evaluated using the modified Rankin Scale (mRS). Patients with mRS scores ≤2 were considered to have favorable outcomes, and those with scores >2 were considered to have poor outcomes. Univariable analysis and stepwise logistic regression were used to identify independent predictors of poor prognosis, and a nomogram was subsequently developed. The model's discriminative power was assessed with area under the receiver operating characteristic curves (AUC-ROC), and its calibration was examined using calibration plots. Decision curves and clinical impact curves were applied to determine clinical utility.

Results

Among 392 enrolled patients, 77 had poor outcomes three months after rt-PA therapy. Fibrinogen (Fg), baseline NIHSS, and a history of hypertension emerged as independent predictors of poor prognosis. The nomogram achieved an AUC of 0.948 (95% CI [0.910-0.985]), with sensitivity of 0.900 and specificity of 0.916 in the training dataset, and an AUC of 0.959 (95% CI [0.907-1.000]), with sensitivity of 0.943 and specificity of 0.947 in the validation dataset. Calibration plots demonstrated close agreement between predicted and observed probabilities, and decision curves indicated a wide range of net benefit threshold probabilities.

Conclusions

This nomogram, incorporating baseline NIHSS, Fg, and a history of hypertension, accurately predicts poor three-month outcomes in AIS patients treated with intravenous rt-PA. Its ease of use may facilitate early risk stratification and assist clinicians in formulating more targeted management strategies and follow-up protocols for patients likely to experience unfavorable outcomes.

Association between serum A/G ratio and stroke: data from NHANES 2009-2020

Background

The serum albumin-to-globulin ratio (A/G) has been widely used as a biomarker to assess inflammation, immunity, and nutritional status. However, relatively few studies have been conducted on the predictive value of serum A/G in stroke. Therefore, this study aimed to evaluate the correlation between serum A/G levels and stroke prognosis, to provide a new reference for risk assessment and management of stroke patients.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) for 2009-2020. The study utilized questionnaire responses and 24-h dietary recall interviews. Participants were stratified by serum albumin/globulin (A/G) ratios into tertiles. Multivariable logistic regression, curve fitting, subgroup analyses, and interaction tests were conducted to assess the associations with serum A/G ratios.

Results

Of the 82,298 participants initially considered, 52,119 had complete data and no history of stroke, albumin, or globulin deficiency, which were included in the analysis. We observed a decrease in stroke incidence with increasing A/G ratios. Higher A/G ratios were also associated with lower incidences of moderate exercise, diabetes, and coronary heart disease. The relationship between A/G ratios and stroke was moderated by covariates such as gender, hypertension, diabetes, smoking, and body mass index.

Conclusion

In the US population, serum A/G ratios positively correlate with stroke incidence. Serum A/G could be a simple and economical marker for identifying stroke risk in the population, though further prospective studies are required to validate these findings.

Urban and rural disparities in stroke prediction using machine learning among Chinese older adults

Stroke is a significant health concern in China. Differences in stroke risk between rural and urban areas have been highlighted in prior research. However, there is a scarcity of studies on urban-rural differences in predicting stroke. This study aimed to develop stroke prediction models, and urban-rural subgroup analyses were conducted to explore disparities in determinants among middle-aged and older adults. We employed nine machine learning algorithms, namely logistic regression (LR), adaptive boosting classifier, support vector machines, extreme gradient boosting, random forest, Gaussian naive Bayes (GNB), gradient boosting machine, light gradient boosting decision machine, and K Nearest Neighbours, using data derived from 9,413 individuals aged 45 years and above obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 to build stroke prediction models and analyze urban-rural subgroups. In the total population, GNB (AUC = 0.76) was the best model for predicting strokes, and the ten most important variables were the time taken for repeated chair stands, the chair height from floor to seat, knee height, creatinine, complete repeated chair stands, mean corpuscular volume, platelet, uric acid, body mass index, and white blood cell. In the rural subgroup, LR and GNB (AUC = 0.76) were the best, and the ten most important variables were the time taken for repeated chair stands, creatinine, platelet, the chair height from floor to seat, knee height, complete repeated chair stands, pulse, white blood cell, maintaining semi - tandem balance statically, and uric acid. In the urban subgroup, LR (AUC = 0.67) was the best, and the ten most important variables were the time taken for repeated chair stands, mean corpuscular volume, maintaining semi - tandem balance statically, uric acid, right-hand grip strength, age, blood urea nitrogen, use of trunk, arms, legs for semi - tandem balance, number of marriages, and night sleep duration. The time taken for repeated chair stands was more critical in the stroke risk model for rural individuals. Uric acid and maintaining semi - tandem balance statically were more critical in the stroke risk model for urban individuals. Our results revealed the importance of knee height and physical function predictors for stroke and highlighted the differences in determinants between urban and rural individuals, proposing targeted stroke prevention and control strategies in different populations in terms of physical function.

Personalised screening tool for early detection of sarcopenia in stroke patients: a machine learning-based comparative study

BACKGROUND

Sarcopenia is a common complication in patients with stroke, adversely affecting recovery and increasing mortality risk. However, no standardised tool exists for its screening in this population. This study aims to identify factors influencing sarcopenia in patients with stroke, develop a risk prediction model and evaluate its predictive performance.

METHODS

Data from 794 patients with stroke were analysed to assess demographic and clinical characteristics. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate regression analysis. Logistic regression (LR), random forest (RF) and XGBoost algorithms were used to construct prediction models, with the optimal model subjected to external validation. Internal validation was conducted via bootstrap resampling, and external validation involved an additional cohort of 159 patients with stroke. Model performance was assessed using the area under the curve (AUC), calibration curves and decision curve analysis (DCA).

RESULTS

Seven variables were identified through LASSO and multivariate regression analysis. The LR model achieved the highest AUC (0.805), outperforming the RF (0.796) and XGBoost (0.780) models. Additionally, the LR model exhibited superior accuracy, precision, recall, specificity and F1-score. External validation confirmed the LR model's robustness, with an AUC of 0.816. Calibration and DCA curves demonstrated their accuracy and clinical applicability.

CONCLUSIONS

A predictive model, presented as a nomogram and an online risk calculator, was developed to assess sarcopenia risk in patients with stroke. Early screening using this model may facilitate timely interventions and improve patient outcomes.

Dietary index for gut microbiota is associated with stroke among US adults

Aims: Emerging evidence underscores the diet-microbiota-gut-brain axis as vital to brain health. The dietary index for gut microbiota (DI-GM), quantifying diet quality linked to gut microbiota diversity, reflects healthier gut microbiota with higher scores. Therefore, this study was designed to explore the unclear association between DI-GM and stroke. Methods: A cross-sectional analysis was conducted using data from 48 677 participants aged ≥20 years in the National Health and Nutrition Examination Survey (NHANES). Demographic and dietary data were collected, and multivariable weighted logistic regression analysis was performed to evaluate the association between the DI-GM and stroke. Additionally, restricted cubic spline (RCS), subgroup analyses, and receiver operating characteristic (ROC) curve were conducted. Results: In participants aged ≥20 years, the odds ratio (OR) was 0.96 (95% CI: 0.92-1.00, P = 0.075) in the crude model, but after adjustment, the OR was 0.93 (95% CI: 0.89-0.98, P = 0.003), while higher beneficial to gut microbiota scores were consistently associated with lower stroke prevalence with ORs of 0.87 (95% CI: 0.83-0.90, P < 0.001) in the crude model and 0.88 (95% CI: 0.83-0.93, P < 0.001) after adjustment. Among participants aged 20-29 years, no significant association was observed. For those aged ≥30 years, higher DI-GM and beneficial to gut microbiota scores were associated with lower stroke prevalence, with DI-GM showing ORs of 0.93 (95% CI: 0.89-0.97, P < 0.001) in the crude model and 0.93 (95% CI: 0.89-0.98, P = 0.003) after adjustment, and beneficial to gut microbiota scores showing ORs of 0.82 (95% CI: 0.79-0.86, P < 0.001) in the crude model and 0.88 (95% CI: 0.83-0.93, P < 0.001) after adjustment. RCS indicated a linear relationship between DI-GM and stroke. Conclusion: The DI-GM was inversely and linearly associated with stroke prevalence, particularly in adults aged 30 years and above.

GPNMB attenuates neuroinflammation and improves ischemic stroke via modulation of PI3K/Akt and p38 MAPK signaling pathways

BACKGROUND

Ischemic stroke is a leading cause of disability and mortality worldwide, with limited effective treatments. Neuroinflammation plays a crucial role in the progression of ischemic brain injury. Glycoprotein nonmetastatic melanoma protein B (GPNMB) has emerged as a potential regulator of inflammation, but its role and underlying mechanisms in ischemic stroke remain largely unknown.

METHODS

We investigated the expression profile, functional significance, and molecular pathways of GPNMB in ischemic stroke using a mouse model of middle cerebral artery occlusion (MCAO), transcriptome sequencing, and human serum samples. The effects of GPNMB knockdown on stroke outcomes, neuroinflammation, and neuronal damage were assessed in vivo. Bioinformatic analyses and experimental validation were performed to identify the downstream signaling pathways of GPNMB.

RESULTS

GPNMB was highly upregulated in the ischemic brain, with its expression peaking at 3-7 days post-MCAO. Serum GPNMB levels were elevated in ischemic stroke patients and correlated with stroke severity. GPNMB knockdown exacerbated stroke outcomes, neuroinflammation, and neuronal damage. Mechanistically, GPNMB positively modulated the PI3K/Akt/GSK3β pathway while negatively regulating p38 MAPK, JNK, and ERK activation. GPNMB knockdown enhanced the expression of NF-κB, a master transcriptional regulator of inflammation.

CONCLUSION

GPNMB is highly upregulated in the ischemic brain and confers neuroprotection against ischemic injury by modulating neuroinflammation via the PI3K/Akt and p38 MAPK signaling pathways.

Bioinformatics analysis of genes associated with disulfidptosis in spinal cord injury

Research findings indicate that programmed cell death (PCD) plays a pivotal role in the pathophysiology of spinal cord injury (SCI), and a recently discovered form of cell death, disulfidptosis, has emerged as a novel phenomenon. However, the characterization of disulfidptosis-related genes in SCI remains insufficiently explored. We retrieved SCI-related data from the Gene Expression Omnibus (GEO) database and identified three key genes associated with disulfidptosis in human SCI (CAPZB, SLC3A2, and TLN1), whose mediated signaling pathways are closely intertwined with SCI. Subsequent functional enrichment analysis suggested that these genes may regulate multiple pathways and exert corresponding roles in SCI pathology. Moreover, we predicted potential targeted drugs for the key genes along with their transcription factors and constructed an intricate regulatory network. CIBERSORT analysis revealed that CAPZB, SLC3A2, and TLN1 might be implicated in modulating changes within the immune microenvironment of individuals with SCI. Our study provides compelling evidence confirming the significant involvement of disulfidptosis following SCI while offering valuable insights into its underlying pathological mechanisms.

Eucommia ulmoides Oliv. Bark Extracts Alleviate MCAO/Reperfusion-Induced Neurological Dysfunction by Suppressing Microglial Inflammation in the Gray Matter

Ischemic stroke ranks as the second leading cause of global mortality. The limited time for effective thrombolytic treatment has prompted the exploration of alternative prevention approaches. Eucommia ulmoides (E. ulmoides) Oliv. bark has shown multiple pharmacological effects, including neuroprotection, anti-inflammation and autophagy modulation. This study aims to elucidate the neuroprotective effects of water extract of E. ulmoides (WEU) supplementation in a middle cerebral artery occlusion (MCAO) mouse model and to further explore the underlying molecular mechanisms. Seven bioactive compounds in WEU-aucubin, chlorogenic acid, geniposidic acid, quercetin, protocatechuic acid, betulin and pinoresinol diglucoside-were identified using HPLC-MS. Our results showed that WEU supplementation significantly decreased infarct volume and ameliorated neurological dysfunction in mice following MCAO/reperfusion (MCAO/R) injury. Furthermore, the administration of WEU significantly attenuated microglia activation induced by cortical ischemia in mice and inhibited the production of pro-inflammatory mediators, including interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Importantly, in contrast with the vehicle group, the protein expression levels of Toll-like receptor 4 (TLR4), phospho-p38 (p-p38) and nuclear factor kappa B (NF-κB) were reduced in the WEU group. Therefore, this present study provides evidence that E. ulmoides improves neurological behaviors by suppressing neuroinflammation and inhibiting the activation of the TLR4/ p38 MAPK and NF-κB pathways in mice after ischemia, which indicates that E.ulmoides is a promising candidate for alleviating gray matter ischemic change.

Cell-Free Nucleic Acids for Early Diagnosis of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Rapid identification of acute ischemic stroke (AIS) is challenging in both pre-hospital and hospital settings. We aimed to identify the most promising cell-free nucleic acids (cfNAs) as diagnostic biomarkers for IS within 72 h from symptom onset. We searched PubMed, Web of Science, EMBASE, and Cochrane Library for published articles that evaluated blood cfNAs in the early diagnosis of AIS until 10 May 2023. The diagnostic performances of individual cfNAs were pooled by random-effects meta-analysis based on the fold change of biomarkers' level between AIS and non-AIS patients. Of 2955 records, 66 articles reporting 143 different cfNAs met the inclusion criteria. The median sample size was 110, and 21.4% of the studies performed validation. Among selected high-quality studies, miR-106b-5p, miR-124, miR-155, lncRNA H19, and cfDNA showed good diagnostic performance. Data from four studies on cfDNA involving 355 AIS patients and 97 controls were pooled in the meta-analysis, which showed a significant fold change between AIS and controls (pooled ratio 1.48, 95% confidence interval 1.23-1.79, p < 0.001). This review highlights that cfDNA, miR-106b-5p, miR-124, miR-155, and lncRNA H19 are the most promising biomarkers for AIS diagnosis, and further research is needed for verification.

Quantitative evaluation method of stroke association based on multidimensional gait parameters by using machine learning

Objective

NIHSS for stroke is widely used in clinical, but it is complex and subjective. The purpose of the study is to present a quantitative evaluation method of stroke association based on multi-dimensional gait parameters by using machine learning.

Methods

39 ischemic stroke patients with hemiplegia were selected as the stroke group and 187 healthy adults from the community as the control group. Gaitboter system was used for gait analysis. Through the labeling of stroke patients by clinicians with NIHSS score, all gait parameters obtained were used to select appropriate gait parameters. By using machine learning algorithm, a discriminant model and a hierarchical model were trained.

Results

The discriminant model was used to distinguish between healthy people and stroke patients. The overall detection accuracy of the model based on KNN, SVM and Randomforest algorithms is 92.86, 92.86 and 90.00%, respectively. The hierarchical model was used to judge the severity of stroke in stroke patients. The model based on Randomforest, SVM and AdaBoost algorithm had an overall detection accuracy of 71.43, 85.71 and 85.71%, respectively.

Conclusion

The proposed stroke association quantitative evaluation method based on multi-dimensional gait parameters has the characteristics of high accuracy, objectivity, and quantification.

Covert Vascular Brain Injury and Cognitive Dysfunction Among Chinese Adults Living in Canada and China: The CAHHM and PURE-MIND Studies

BACKGROUND AND OBJECTIVE

It is unclear whether variation in covert cerebrovascular disease prevalence is attributable to ethnic differences or to other factors. We aimed to examine the associations of country of residence with covert vascular brain injury (VBI) and cognitive dysfunction among Chinese adults residing in Canada and China.

METHODS

This was a multisite cross-sectional study of Chinese adults aged 40-80 years in the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM; January 1, 2014, to December 31, 2018) and Prospective Urban Rural Epidemiological-Mind (PURE-MIND; November 1, 2010, to July 31, 2015) cohorts living in Canada and China. The exposure was country of residence. The co-primary outcomes were covert VBI (defined as MRI findings of high white matter hyperintensities or covert brain infarct) and cognitive dysfunction (defined as a Montreal Cognitive Assessment [MoCA] score <26). We used generalized linear models to describe the association between country of residence and each outcome, adjusting for selected covariates.

RESULTS

We included 884 adults living in Canada (mean age 57.3 years, 55.4% female) and 473 living in China (mean age 56.8 years, 60.3% female). Participants in Canada had a lower prevalence of covert VBI (age 65-79 years: male, 11.5%; female, 12.2%) than those living in China (age 65-79 years: male, 62.9%; female, 52.1%). Prevalence of MoCA score <26 was lower among men and women in Canada (age 65-79 years: 40.2% and 30.0%, respectively) than among men and women in China (age 65-79 years: 74.3% and 79.2%). Living in China was associated with a 6-fold increase in the odds of covert VBI (5.85, 4.06-8.45), which remained significant after covariate adjustment. Living in China was associated with a 7-fold increase in the odds of MoCA score <26 (6.98, 5.38-9.04), which was no longer significant after covariate adjustment.

DISCUSSION

Despite sharing a similar ethnicity, the prevalence of covert VBI and cognitive dysfunction varied substantially by country of residence. Disparities in cognitive dysfunction were completely explained by differences in education and traditional cerebrovascular risk factors, whereas disparities in covert VBI prevalence were only partially explained by differences in such factors, suggesting a role for other environmental factors.