Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

A description of functional needs of community-dwelling stroke survivors in Rwanda: a prospective observational cohort study

PURPOSE

Stroke survivors in low- and middle-income countries have different needs compared to those in high-income countries. Our aim was to describe the unmet functional needs of Rwandan stroke survivors at discharge and three months after stroke.

METHODS

A study using an adapted modified Needs Assessment Questionnaire (mNAQ) was conducted at six hospitals in Rwanda. Moderate or severe needs are described using descriptive statistics and logistic regression models.

RESULTS

A total of 337 participants, with a mean age of 61 years, were recruited. Most were female (59%), and 70% had an ischemic stroke, while 71% had hypertension. At discharge, 97% of participants had moderate to severe needs. Follow-up at three months was available for 78% of participants and 22% died. At three months, over 70% of participants continued to have moderate to severe needs.

CONCLUSIONS

Almost all Rwandan stroke survivors have moderate to severe needs and disability at the time of discharge, and for those that survive, over 70% continue to have moderate to severe needs at 3 months. This estimate is much higher than previously reported. Improving functioning in the community is essential for Rwandan stroke survivors.

Intestinal injury and changes of the gut microbiota after ischemic stroke

Stroke is the second leading cause of death and the third leading cause of disability worldwide, with ischemic stroke (IS) accounting for the vast majority of cases. This paper reviews the latest research on intestinal damage, changes in the gut microbiota, and related therapeutic strategies after IS. Following IS, the integrity of the intestinal mucosal barrier is compromised, leading to increased intestinal permeability. The gut microbiota can translocate to other organs, triggering systemic immune responses that inhibit recovery after IS. Moreover, the composition and proportion of the gut microbiota change after IS. The number of beneficial bacteria decreases, whereas the number of harmful bacteria increases. The production of beneficial metabolites, such as short-chain fatty acids (SCFAs), is reduced, and the levels of harmful metabolites, such as trimethylamine N-oxide (TMAO), increase. Antibiotics after IS not only help prevent infection but also have neuroprotective effects. Although poststroke reperfusion therapy can effectively restore cerebral blood flow, it may also cause intestinal mucosal damage and gastrointestinal dysfunction. Nutritional support after IS can alter the gut microbiota structure and promote neurological recovery. Therefore, individualized treatment for IS patients is crucial. In summary, IS affects not only the brain but the entire body system, especially the gut. Intestinal damage and dysbiosis are critical in IS occurrence, development, and prognosis. By protecting the intestinal mucosa and modulating the structure of the gut microbiota, intestinal damage and related infections can be reduced, improving patient prognosis. Future research is needed to explore therapeutic methods targeting the gut microbiota, providing more comprehensive and effective treatment strategies for IS patients.

Adjunctive intra-arterial thrombolysis following successful endovascular reperfusion in acute ischemic stroke: a systematic review and meta-analysis of seven randomized controlled trials

BACKGROUND

The benefits and risks of adjunctive intra-arterial thrombolysis (IAT) after successful endovascular thrombectomy (EVT) in acute ischemic stroke due to large vessel occlusion (AIS-LVO) remain uncertain. This study aimed to evaluate the efficacy and safety of IAT in this setting.

METHODS

We systematically searched PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov from inception to February 2025, and reviewed abstracts from the 2025 International Stroke Conference, to identify randomized controlled trials (RCTs) comparing IAT versus placebo or best medical management in AIS-LVO patients who achieved successful reperfusion after EVT. Outcome measures included 90-day excellent (modified Rankin Scale [mRS] 0-1) and good (mRS 0-2) functional outcomes, 90-day reduced disability (≥ 1-point mRS improvement), symptomatic intracranial hemorrhage (sICH), any ICH, and 90-day mortality. A random-effects model was employed for the meta-analysis.

RESULTS

Seven RCTs with 2131 patients (1083 assigned to IAT, and 1048 to control) were included. Compared to controls, IAT was associated with significantly higher likelihood of 90-day excellent functional outcomes (risk ratio 1.23, 95% confidence interval [CI] 1.11-1.36; I2 = 0%) and reduced disability (common odds ratio 1.20, 95% CI 1.03-1.40; I2 = 0%), but not with 90-day good functional outcomes. Risks of any ICH, sICH, and mortality were similar between groups. Subgroup analyses suggested numerically higher odds of excellent functional outcomes among patients with anterior circulation LVO or those receiving IA alteplase/tenecteplase.

CONCLUSION

Adjunctive IAT following successful EVT in AIS-LVO patients led to improved 90-day excellent functional outcomes and reduced disability without increasing sICH or mortality risks.

Cross-Species Multi-Omics Analysis Reveals Myeloid-Driven Endothelial Oxidative Stress in Ischemic Stroke

BACKGROUND

Ischemic stroke is a leading cause of mortality and disability worldwide, yet the interplay between peripheral and central immune responses is still only partially understood. Emerging evidence suggests that myeloid cells, when activated in the periphery, infiltrate the ischemic brain and contribute to the disruption of the blood-brain barrier (BBB) through both inflammatory and metabolic mechanisms.

METHODS

In this study, we integrated bulk RNA-sequencing (RNA-seq), single-cell RNA-seq (scRNA-seq), spatial transcriptomics, and flow cytometry data from human and mouse models of ischemic stroke. Mouse stroke models were induced by transient middle cerebral artery occlusion (tMCAO), and brain tissues were later collected at specified time points for analysis. We examined time-dependent transcriptional changes in the peripheral blood, delineated cell-type-specific responses by single-cell profiling, and validated myeloid infiltration into the ischemic brain. We also investigated endothelial metabolic reprogramming and oxidative stress by combining scMetabolism analyses (a computational R package for inferring metabolic pathway activity at the single-cell level) with in vitro oxygen-glucose deprivation/reperfusion (OGD/R) experiments.

RESULTS

Cross-species bulk RNA-seq revealed a modest early immune shift at 3 h post-stroke, escalating significantly by 24 h, with robust myeloid-centric gene signatures conserved in humans and mice. Single-cell analyses confirmed a pronounced expansion of neutrophils, monocytes, and megakaryocytes in peripheral blood, coupled with a decrease in T and B lymphocytes. Spatial transcriptomics and flow cytometry demonstrated substantial infiltration of CD11b+ myeloid cells into the infarct core, which showed extensive interaction with endothelial cells. Endothelial scRNA-seq data showed reductions in the oxidative phosphorylation, glutathione, and nicotinate metabolic pathways, together with elevated pentose phosphate pathway activity, suggestive of oxidative stress and compromised antioxidant capacity. Functional scoring further indicated diminished endothelial inflammation/repair potential, while in vitro OGD/R experiments revealed morphological disruption, CD31 downregulation, and increased 4-hydroxynonenal (4-HNE), underscoring the importance of endothelial oxidative damage in BBB breakdown.

CONCLUSIONS

These multi-omics findings highlight the existence of a coordinated peripheral-central immune axis in ischemic stroke, wherein myeloid cell recruitment and endothelial metabolic vulnerability jointly exacerbate inflammation and oxidative stress. The targeting of endothelial oxidative injury and myeloid-endothelial crosstalk may represent a promising strategy to mitigate secondary brain injury in ischemic stroke.

Association between atherogenic index of plasma and new-onset stroke in a population with cardiovascular-kidney-metabolic syndrome stages 0-3: insights from CHARLS

BACKGROUND

The associations between atherogenic index of plasma (AIP) and cardiovascular disease (CVD) have been widely reported; However, such association to the incidence of stroke in the population with Cardiovascular-Kidney-Metabolic (CKM) syndrome remains ambiguous.

METHODS

A total of 7754 participants with CKM syndrome stages 0-3 from the China Health and Retirement Longitudinal Study were enrolled in this study. The incidence of new-onset stroke events was the primary outcome of this study. We used Kaplan-Meier survival curves and Cox proportional hazards models to explore the association between baseline AIP levels and the risk of stroke in the population with CKM syndrome stages 0-3. Additionally, we utilized restricted cubic spline plots to analyze the form of this association.

RESULTS

During a median follow-up of 6.8 years, 455 participants (5.9%) with CKM syndrome experienced their first stroke events. AIP was positively associated with the risk of stroke in the population with CKM syndrome stages 0-3. Kaplan-Meier curves analysis demonstrated a significant difference in stroke incidence across the AIP groups among the entire cohort. In the fully adjusted Model 3, the results revealed a significantly elevated risk of stroke for participants in the Q2, Q3, and Q4 groups compared to those in the Q1 group, with respective HR (95% CI) value of 1.352 (1.009-1.811), 1.421 (1.064-1.897), and 1.414 (1.052-1.900). Restricted cubic spline plots revealed the association of AIP and stroke risk was nonlinear (P-overall < 0.05, P-non-linear < 0.05), with inflection points of 0.32.

CONCLUSION

This study provides evidence that baseline AIP levels were significantly positively associated with the risk of stroke in individuals with CKM syndrome stages 0-3, and AIP may serve as an effective risk marker for early identification of high-risk individuals prone to stroke within the CKM stages syndrome 0-3 population.

Baseline comorbidity of cardiovascular-kidney-metabolic syndrome increases the risk of adverse clinical outcomes in patients with chronic kidney disease

Introduction

Our study aims to analyze the relationship between different stage of Cardiovascular-Kidney-Metabolic (CKM) Syndrome in Chronic Kidney Disease (CKD) patients and the risk of progression to all-caused mortality or end-stage renal disease (ESRD).

Methods and results

A retrospective cohort study was performed by collecting baseline data of CKD patients. All participants were followed throughout the course of the study. Cox proportional hazards analysis and Fine-Gray subdistribution model was performed to analyze the prognostic value of different CKM stages on the risk of adverse clinical outcomes (all-caused mortality or progression to ESRD) of these patients. 1,358 patients finally completed the follow-up. Among them, 1,233 patients were alive, and 125 patients had died; and 163 patients progressed to ESRD. Baseline CKM stage 3 (OR=3.906, 95% CI=0.988-16.320, p=0.048) and stage 4 (OR=5.728, 95% CI=1.329-24.698, p=0.019) remain independent risk factors for all-cause mortality in CKD patients, while CKM stage 2b (OR=2.739, 95% CI=1.157-6.486, p=0.022) were identified as having an independent risk factor for progression to ESRD in CKD patients by adjusting confounding factors.

Conclusion

Our research demonstrated that a high-risk CKM stage can predict adverse clinical outcomes in CKD patients, including all-cause mortality and progression to ESRD.

Collateral Circulation and Rabep2 Polymorphisms in Large Artery Occlusion: Impacts on Short- and Long-Term Prognosis

BACKGROUND

Intracranial anterior circulation large artery occlusion (AC-LAO) is a predominant cause of ischemic stroke. Although collateral circulation plays a critical role in stroke outcomes, the genetic and environmental factors affecting collateral development are not fully understood. This study aimed to elucidate the associations between Rabep2 gene polymorphisms, collateral circulation, and both short- and long-term prognoses in patients with anterior circulation large artery occlusion.

METHODS AND RESULTS

We recruited 449 patients with anterior circulation large artery occlusion with cerebral infarction. Collateral circulation was assessed using single-phase computed tomography angiography, and stroke outcomes were evaluated at 1 month and 1 year using the modified Rankin Scale. A subset of 180 patients underwent genetic analysis for Rabep2 polymorphisms. Multivariable logistic regression was employed to identify predictors of short-term and long-term outcomes. Enhanced collateral circulation (P<0.001), lower high-density lipoprotein levels (P=0.019), and the absence of complications (P<0.001) were significantly correlated with favorable short-term outcomes. In the long term, age (P=0.039) and diabetes (P=0.006) were independent predictors of poor prognosis, whereas complications demonstrated a protective effect (P=0.016). The rs11645302 polymorphism of Rabep2 was linked to poorer collateral circulation among patients with the CC genotype (odds ratio [OR], 0.498 [95% CI, 0.270-0.918], P=0.025).

CONCLUSIONS

Collateral circulation, high-density lipoprotein levels, Rabep2 gene polymorphisms, age, and diabetes are significant predictors of outcomes in patients with anterior circulation large artery occlusion. These findings underscore the potential to integrate genetic and vascular factors into personalized risk stratification and therapeutic strategies for ischemic stroke.

REGISTRATION

URL: https://www.ClinicalTrials.gov; Unique Identifier: NCT04091412.

Decoding immune cell dynamics in ischemic stroke: insights from single-cell RNA sequencing analysis

Background

Ischemic stroke (IS) is a leading cause of adult disability worldwide. The inflammatory processes involved are complex, making it challenging to fully understand the pathological mechanisms of IS. Phagocytosis plays an important role in eliminating neurotoxic or damaged neurons resulting from inflammatory responses. This study employed bioinformatics methods to analyze single-cell RNA sequencing (scRNA-seq) data to investigate the cell types and molecular biological processes involved in IS.

Methods

scRNA-seq data for IS were obtained from the Gene Expression Omnibus (GEO). Following sample screening and reprocessing, 5,582 single cells were identified from healthy controls and patients with IS. Uniform manifold approximation and projection (UMAP) was utilized to further explore the cellular composition in IS. Functional enrichment analysis of differentially expressed genes was conducted to identify transcriptional regulators, whereas cell developmental trajectories were predicted to uncover potential cell fate decisions. iTALK was employed to identify potential ligand-receptor axes within the cell-type immune microenvironment of IS.

Results

Based on scRNA-seq data analysis, we identified four cell types and their associated subclusters, along with genes exhibiting significant differential expression within these subclusters. Phagocytosis was significantly enriched in cell types linked to IS, while the differentiation trajectories of subpopulations in IS was different. Additionally, multiple receptor-ligand axes were identified, indicating diverse interactions within the immune microenvironment of IS.

Conclusion

This study demonstrated that phagocytosis in IS cell types critically influences disease progression. It also predicted the trajectories of infarct cells. These findings provide valuable insights into the molecular and cellular mechanisms underlying IS and highlight potential pathways for therapeutic intervention.

The burden of common neurological disorders in Asia: insights from the Global Burden of Disease Study (1990-2021)

BACKGROUND

Neurological disorders represent a significant global health issue, leading to severe cognitive impairments and being a major cause of premature mortality and disability. This study aims to utilize data from the Global Burden of Disease (GBD) research website to assess the burden of neurological disorders in the Asian region and its individual countries and territory from 1990 to 2021, with the goal of providing reference for global efforts and decision-making in the prevention, treatment, and management of neurological disorders.

METHODS

Based on the Global Burden of Disease data, this study assessed the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of 13 neurological disorders in the Asian region from 1990 to 2021. The epidemiological characteristics of neurological disorders across these Asian regions were analyzed. Joinpoint regression analysis was employed to assess the temporal patterns of the burden of neurological disorders, and the average annual percent change (AAPC) was calculated to determine the overall trend throughout the study period.

RESULTS

In 2021, stroke, migraine, and Alzheimer's disease and other dementias emerged as the primary contributors to neurological burden in Asia, with stroke accounting for 112.87 million disability-adjusted life years (DALYs), followed by migraine (25.4 million) and Alzheimer's disease and other dementias (20.0 million). Stroke was also the leading cause of neurological mortality (5.03 million deaths), trailed by Alzheimer's disease and other dementias (1.0 million). Stroke, migraine, and tension-type headache had the highest prevalence rates among neurological disorders, with 57.3 million, 683.5 million, and 1130.2 million. Temporal trends from 1990 to 2021 revealed a significant decline in age-standardized DALY rates for stroke (estimated annual percentage change [EAPC]: - 1.65%), though absolute DALYs increased (EAPC: 0.06%). In contrast, Alzheimer's disease and other dementias exhibited rising age-standardized (EAPC: 0.14%) and absolute DALYs (EAPC: 2.8%), while infectious neurological diseases (e.g., meningitis, tetanus) demonstrated marked reductions in burden. Sex-specific disparities were evident, with males experiencing a higher total DALY burden (84.8 million vs. 77.05 million), driven by stroke and Parkinson's disease, whereas Alzheimer's disease and other dementias and migraine disproportionately affected females. Geographically, stroke dominated Southeast Asia (67.6% of regional DALYs), while migraine contributed most substantially to West Asia (16%). Nationally, stroke ranked as the leading cause of neurological DALYs in most Asian countries, contrasting with migraine in Israel, Kuwait, Qatar, and the United Arab Emirates. Longitudinal analyses highlighted accelerated declines in stroke DALYs post- 2004 but escalating burdens for Alzheimer's disease and other dementias after 2019, reflecting divergent epidemiological trajectories.

CONCLUSIONS

In 2021, the burden of neurological disorders in Asia remained substantial, with stroke, migraine, and Alzheimer's disease and other dementias being the top three contributors to DALYs. The study also revealed significant differences in the burden of neurological disorders across various subregions and countries in Asia, highlighting the need for enhanced international collaboration, sharing of best practices, provision of technical support, and optimization of healthcare resource allocation.

Effects of Mindfulness and Exercise on Growth Factors, Inflammation, and Stress Markers in Chronic Stroke: The MindFit Project Randomized Clinical Trial

Background/Objectives: Stroke often leads to persistent cognitive and emotional impairments, which rehabilitation may mitigate. However, the biological mechanisms underlying such improvements remain unclear. This study investigated whether supplementing computerized cognitive training (CCT) with mindfulness-based stress reduction (MBSR) or physical exercise (PE) modulated biomarkers of neuroplasticity, inflammation, and stress in patients with chronic stroke compared to CCT alone. We also explored whether biomarker changes mediated or correlated with behavioral improvements. Methods: In a three-arm, single-blind, randomized controlled trial (NCT04759950), 141 patients with chronic stroke were randomized (1:1:1) to MBSR+CCT, PE+CCT, or CCT-only for 12 weeks. Plasma levels of brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol were measured at baseline and post-intervention. Cognitive, mental health, mindfulness, and fitness outcomes were also assessed. Between- and within-group changes were analyzed using ANCOVA and paired t-tests. Per-protocol and complete-case analyses were conducted. Results: Among the 109 participants with ≥80% adherence, the only significant between-group difference was for VEGF: it remained stable in the MBSR+CCT group but declined in PE+CCT and CCT-only. Within-group analyses showed significant decreases in cortisol in MBSR+CCT and PE+CCT, while IGF-1 levels declined across all groups. In contrast, BDNF, IL-6, and CRP did not show significant changes, and biomarker changes were not significantly associated with behavioral improvements. Complete-case analysis (n = 126) yielded similar findings. Conclusions: Our findings suggest that combining MBSR or PE with CCT may modulate certain biological processes relevant to stroke recovery. MBSR may help maintain VEGF levels, which could support vascular health, while MBSR and PE may contribute to lowering cortisol levels. However, since no clear association with behavioral improvements was found, further research is needed to determine the clinical relevance of these biomarker changes in stroke recovery.

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.

Neuroprognostication in neonatal encephalopathy due to presumed hypoxic-ischemic encephalopathy

Over the last two decades, significant progress has been made in the management of neonatal encephalopathy due to presumed hypoxic-ischemic encephalopathy. One key area that requires improvement is timely and accurate neuroprognostication in this population to identify infants who may benefit from early interventions and harness the maximum neuroplastic capacity of the developing brain. Improved neuroprognostication also has the potential to foster more effective communication of findings to caregivers. In this review, we explore whether improved neuroprognostication is possible by assessing clinical, biochemical, electrographic, neurophysiological, and neuroimaging biomarkers and their role in neuroprognostication. IMPACT STATEMENT: Over the last two decades, significant progress has been made in the management of neonatal encephalopathy due to presumed hypoxic-ischemic encephalopathy. One key area that requires improvement is timely and accurate neuroprognostication in this population to identify infants who may benefit from early interventions and harness the maximum neuroplastic capacity of the developing brain. In this review article, we discuss general concepts and principles of neuroprognostication and the role of each prognostic marker.

Systematic analysis of the burden of ischemic stroke attributable to high LDL-C from 1990 to 2021

Background

Low-density lipoprotein cholesterol (LDL-C) is a public health concern linked to ischemic stroke. The study aimed to describe the epidemiological characteristics of ischemic stroke attributable to high LDL-C from 1990 to 2021.

Methods

In this study, we analyzed data from the Global Burden of Disease 2021 to present trends in ischemic stroke related to high LDL-C over the past 30 years. The relationship between disease burden and the Socio-Demographic Index (SDI) was examined. To assess international health disparities, we applied the Slope Index of Inequality (SII) and the Concentration Index (CI). Furthermore, we conducted a frontier analysis to identify areas for improvement and developmental gaps among nations, and employed the Bayesian Age-Period-Cohort (BAPC) model to forecast the disease burden for the next 15 years.

Results

In 2021, the incidence of ischemic stroke attributed to high LDL-C significantly increased compared to 1990, with a more pronounced growth rate in males. The burden mainly affects individuals aged 70 to 84. Analysis using the age-period-cohort model indicates that mortality rates and DALYs rise with age, while period and cohort effects exhibit a gradual decline. Across different SDI regions, trends generally follow a similar downward path, with a narrowing gap in disease burden among regions with varying SDI levels. However, the disease burden in high SDI countries remains significant, indicating potential for reduction. Predictions for the next 15 years suggest that while the global disease burden will decrease, there may be an increase among individuals under 55.

Conclusion

Compared to 1990, the overall age-standardized burden of ischemic stroke related to high LDL-C has been controlled. However, disparities persist across different SDI regions. We have observed an increasing burden among younger populations. Consequently, countries and regions must adopt new measures tailored to their SDI levels, with a specific emphasis on younger individuals. It is essential to develop prevention and treatment strategies aimed at high-risk groups.

Initial intraventricular involvement and early intracerebral hematoma retraction: The "ventricular washout"

INTRODUCTION

Intraventricular hematoma (IVH) occurs in approximately 40% of acute intracerebral hemorrhage (ICH) patients and is significantly associated with worse clinical outcomes. According to cerebrospinal fluid dynamics, some blood within the ventricles may circulate through the subarachnoid spaces, leading to its apparent "disappearance" on follow-up imaging. We aim to investigate the association between initial IVH involvement and significant early ICH retraction at follow-up imaging.

METHODS

Data are from the MCAHP (Multiphase CT Angiography Hematoma Prediction) Study, which included consecutive patients with acute ICH investigated with multimodal CT imaging. Patients who underwent surgery before follow-up imaging were excluded. IVH severity was assessed using the IVH score. The primary outcome was significant early ICH retraction, defined as volume decrease (⩾3 ml or ⩾15%) between the initial and follow-up scans. Secondary outcomes included early absolute and relative ICH decrease. Associations between outcomes and initial IVH involvement or IVH score were assessed with logistic regression adjusted for age, baseline NIHSS, initial ICH volume, and onset-to-CT time.

RESULTS

Overall, 177 ICH patients were included. The median age was 71 years (IQR = 59-80), 71 (40.1%) patients were female, and 64 (36.2%) presented with initial IVH involvement. Patients with initial IVH, compared to those without, had a larger initial ICH volume (28.5 ml [IQR = 12.7-52.5] vs. 18.9 ml [IQR = 8.1-30.6], p < 0.001) and different ICH location (deep = 54.7% vs 47.8%; lobar = 35.9% vs 46.0%; infratentorial = 7.3% vs 6.2%; p < 0.001). Early ICH retraction was observed in 33 (18.6%) patients: 21 (32.8%) with initial IVH and 10 (10.6%) without initial IVH. There was a significant association between early ICH retraction and initial IVH involvement (adjusted odds ratio [aOR] 4.02 [95% CI = 1.72-9.41]) and IVH score (aOR 1.14 [95% CI = 1.05-1.23] per 1-point increase). Similar results were observed for secondary outcomes.

CONCLUSION

Initial IVH involvement is associated with early ICH retraction - "intraventricular washout." This might result in an underestimation of hematoma expansion occurrence and severity in these patients, with potential implications when evaluating the predictive performance of hematoma expansion markers/scores and the radiological efficacy of hemostatic treatments.

Global Trends and Cross-Country Inequalities in Stroke and Subtypes Attributable to High Body Mass Index From 1990 to 2021

BACKGROUND

Stroke is a major global cause of death and disability, with high body mass index (HBMI) as a key modifiable risk factor. Understanding HBMI-attributable stroke burden is crucial for effective prevention.

METHODS AND RESULTS

Using Global Burden of Disease 2021 data, we analyzed disability-adjusted life years and mortality from stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) attributable to HBMI at global, regional, and national levels from 1990 to 2021. We conducted decomposition, frontier, inequality, and predictive analyses to assess epidemiological trends and future projections up to 2035. Despite country-specific variations in disability-adjusted life years and mortality, the global burden of stroke and its subtypes attributable to HBMI has increased from 1990 to 2021. Frontier analysis indicated that countries with higher sociodemographic index were expected to own lower age-standardized rates for stroke and its subtypes attributable to HBMI. Decomposition analysis revealed that population growth and aging were the primary contributors to the rise. Significant cross-country disparities remained, although inequality analysis showed a decline in SDI-related differences over time. The projected annual rise in disability-adjusted life years and mortality from 2021 to 2035 suggested ongoing significant challenges in stroke control and management in the coming decades.

CONCLUSION

The global health challenge posed by the increasing burden of stroke and its subtypes attributable to HBMI remains significant, especially in low- and middle-sociodemographic index regions. Targeted lifestyle modifications and policy interventions are crucial for reducing HBMI and mitigating stroke burden, warranting special attention from policymakers in high-burden regions.

Metagenomic next-generation sequencing of bronchoalveolar lavage fluid samples offers diagnostic utility in bacteriologically negative pulmonary tuberculosis

Rapid diagnosing Mycobacterium tuberculosis (M. tb) in patients with pulmonary tuberculosis (PTB) cases is critical, particularly in cases without bacteriologically confirmed disease, as it enables timely treatment initiation and can thus interrupt further disease transmission. In this study, the utility of metagenomic next-generation sequencing (mNGS) as a diagnostic tool was evaluated using samples of bronchoalveolar lavage fluid (BALF) samples from 300 bacteriologically negative PTB (BN-PTB) patients hospitalized from January 2020 through December 2023. The diagnostic performance of mNGS was compared to that of acid-fast staining (AFS), conventional Roche culture, and the Xpert method among these BN-PTB patients, using clinical diagnosis as the gold standard. The final analyses enrolled 112 PTB patients and 188 non-PTB cases. These analyses revealed that mNGS-based M. tb detection yields a sensitivity of 94.64 % (106/112), a specificity of 98.94 % (186/188), a positive predictive value (PPV) of 98.15 % (106/108), and a negative predictive value (NPV) of 96.88 % (186/192). This mNGS approach outperformed the AFS, Roche culture, and Xpert methods in terms of sensitivity, specificity, PPV, and NPV (p < 0.05). The superior diagnostic performance of this approach was further supported by its area under the curve and corresponding confidence intervals. Together, these data demonstrate that mNGS can improve the detection of M. tb in BALF samples from BN-PTB patients with high levels of speed, sensitivity, and specificity. This mNGS approach may thus be a valuable diagnostic tool for the rapid detection of M. tb in BN-PTB, providing a foundation for the precision diagnosis and treatment of PTB in the future.

Clinical evaluation of the BP2 upper arm blood pressure monitor according to the ISO 81060-2:2018+Amd 1:2020

OBJECTIVE

To evaluate the clinical measurement accuracy of the BP2 oscillometric upper arm blood pressure monitor in the general population according to the ISO 81060-2:2018+Amd 1:2020 standard.

METHODS

Participants were recruited and the same arm sequential method was used for blood pressure measurement according to the ISO 81060-2:2018+Amd 1:2020. The validation results were assessed following the protocol and the Bland-Altman scatterplot was used to show the difference between the test device and reference results.

RESULTS

A total of 85 participants were included in the final analysis. For the validation criterion 1, the mean ± SD of the differences between the test device and reference readings was -2.93 ± 7.65 and -2.40 ± 6.82 mmHg for systolic and diastolic blood pressure, respectively. For criterion 2, the ±SD of the averaged differences between the test device and reference readings per participant was ±6.16 and ±5.74 mmHg for systolic and diastolic blood pressure, respectively.

CONCLUSION

The BP2 upper arm blood pressure monitor passed all the requirements of the ISO 81060-2:2018+Amd 1:2020 standard and can be recommended for clinical use and self-measurement in the general population.

The links between soil and water pollution and cardiovascular disease

Soil and water pollution represent significant threats to global health, ecosystems, and biodiversity. Healthy soils underpin terrestrial ecosystems, supporting food production, biodiversity, water retention, and carbon sequestration. However, soil degradation jeopardizes the health of 3.2 billion people, while over 2 billion live in water-stressed regions. Pollution of soil, air, and water is a leading environmental cause of disease, contributing to over 9 million premature deaths annually. Soil contamination stems from heavy metals, synthetic chemicals, pesticides, and plastics, driven by industrial activity, agriculture, and waste mismanagement. These pollutants induce oxidative stress, inflammation, and hormonal disruption, significantly increasing risks for non-communicable diseases (NCDs) such as cardiovascular disease (CVD). Emerging contaminants like micro- and nanoplastics amplify health risks through cellular damage, oxidative stress, and cardiovascular dysfunction. Urbanization and climate change exacerbate soil degradation through deforestation, overfertilization, and pollution, further threatening ecosystem sustainability and human health. Mitigation efforts, such as reducing chemical exposure, adopting sustainable land-use practices, and advancing urban planning, have shown promise in lowering pollution-related health impacts. Public health initiatives, stricter pollution controls, and lifestyle interventions, including antioxidant-rich diets, can also mitigate risks. Pollution remains preventable, as demonstrated by high-income nations implementing cost-effective solutions. Policies like the European Commission's Zero-Pollution Vision aim to reduce pollution to safe levels by 2050, promoting sustainable ecosystems and public health. Addressing soil pollution is critical to combating the global burden of NCDs, particularly CVDs, and fostering a healthier environment for future generations.

Alzheimer's and dementia: Diagnosis, assessment, and disease monitoring global, regional, and national burden of Alzheimer's disease and other dementias (ADODs) and their risk factors, 1990-2021: A systematic analysis for the Global Burden of Disease study 2021

INTRODUCTION

Aging populations globally lead to growing challenges in Alzheimer's disease and other dementias (ADODs). Tracking ADODs aids health strategies. To describe global, regional, and national incidence, prevalence, death, and disability-adjusted life years (DALYs) of ADODs in 2021, and analyze changes from 1990 to 2021.

METHODS

We analyzed ADODs using the 2021 Global Burden of Disease database, calculating estimated annual percentage change (EAPC), applying Joinpoint regression, and assessing risk factors.

RESULTS

Between 1990 and 2021, ADOD incidence, prevalence, deaths, and DALYs increased significantly. DALYs grew 295.45% and fatalities grew 167.72%. Age-standardized rates (ASRs) rose for both genders, with women generally higher but men showing steeper increases. ASRs correlated positively with Sociodemographic Index. Risk factor contribution to DALYs and death rose by 4.1%. In 2021, metabolic factors and high fasting plasma glucose most influenced ADODs.

DISCUSSION

The global ADOD burden has risen since 1990. Early screening, especially for elderly women, is crucial. Policymakers must act to reverse this trend.

Highlights

Based on Global Burden of Disease data 1990-2021, the incidence, prevalence, mortality, and disability-adjusted life years due to Alzheimer's and dementia are depicted globally, regionally, and nationally.The effects of gender and age were explored.The contribution of different risk factors to the disease was studied.

Embracing a Penta helix hub framework for co-creating sustaining and potentially disruptive sterilization innovation that enables artificial intelligence and sustainability: A scoping review

The supply of safe pipeline medical devices is of paramount importance. Opportunities exist to transform reusable medical devices for improved processing that meets diverse patient needs. There is increased interest in multi-actor hub frameworks to meet innovation challenges globally. The purpose of this scoping paper was to identify critical decontamination and sterilization needs for the medtech and pharmaceutical sectors with a focus on understanding how to effectively use the Penta helix hub framework that combines academia, industry, healthcare, policy-makers/regulators and patients/society. A PRISMA scoping review of PubMed publications was conducted over the period 2010 to January 2025. Thirty of the 124 'helix hub' papers addressed innovation where only 3 of 16 healthcare-focused helices used or mentioned the need for key performance indicators (KPIs). Early-phase helix innovation ecosystems are mainly supported by qualitative or non-empirical data. This review explores multi-actor needs along with describing quantifiable KPIs at micro (end-user), meso (innovation hub) and macro (regional, national and international) levels. This integrated Penta hub approach will help to effectively plan, co-create, manage, analyse and utilize voluminous data, for example there are ca. 60,000 and 56,000 publications per year on artificial intelligence (AI) and medical devices respectively along, with some 35,000 adverse reports on devices submitted to the US FDA. This review addresses sustaining and potentially disruptive opportunities for decontamination and sterilization that includes the use of AI-enabled devices, bespoke training and sustainability.

Prevention of Stroke in Intracerebral Haemorrhage Survivors with Atrial Fibrillation: Rationale and Design for PRESTIGE-AF Trial

Adequate secondary prevention in survivors of intracerebral hemorrhage (ICH) who also have atrial fibrillation (AF) is a long-standing clinical dilemma because these patients are at increased risk of recurrent ICH as well as of ischemic stroke. The efficacy and safety of oral anticoagulation, the standard preventive medication for ischemic stroke patients with AF, in ICH patients with AF are uncertain. PRESTIGE-AF is an international, phase 3b, multi-center, randomized, open, blinded end-point assessment (PROBE) clinical trial that compared the efficacy and safety of direct oral anticoagulants (DOACs) with no DOAC (either no antithrombotic treatment or any antiplatelet drug). Randomization occurred in a 1:1 ratio and stratification was based on ICH location and sex. The two co-primary binary endpoints included ischemic stroke and recurrent ICH which will be analyzed hierarchically according to the intention-to-treat principle. Secondary efficacy endpoints encompassed all-stroke and systemic embolism, all-cause and cardiovascular mortality, major adverse cardiac events, and net clinical benefit. Secondary safety endpoints included any major hemorrhage and intracranial hemorrhage. All outcome events were adjudicated by an independent committee. Results of PRESTIGE-AF are expected to support risk-adjusted secondary prevention in ICH survivors with AF and to inform clinical guideline recommendations.

The impact of gut microbiota on the occurrence, treatment, and prognosis of ischemic stroke

Ischemic stroke (IS) is a cerebrovascular disease that predominantly affects middle-aged and elderly populations, exhibiting high mortality and disability rates. At present, the incidence of IS is increasing annually, with a notable trend towards younger affected individuals. Recent discoveries concerning the "gut-brain axis" have established a connection between the gut and the brain. Numerous studies have revealed that intestinal microbes play a crucial role in the onset, progression, and outcomes of IS. They are involved in the entire pathophysiological process of IS through mechanisms such as chronic inflammation, neural regulation, and metabolic processes. Although numerous studies have explored the relationship between IS and intestinal microbiota, comprehensive analyses of specific microbiota is relatively scarce. Therefore, this paper provides an overview of the typical changes in gut microbiota following IS and investigates the role of specific microorganisms in this context. Additionally, it presents a comprehensive analysis of post-stroke microbiological therapy and the relationship between IS and diet. The aim is to identify potential microbial targets for therapeutic intervention, as well as to highlight the benefits of microbiological therapies and the significance of dietary management. Overall, this paper seeks to provide key strategies for the treatment and management of IS, advocating for healthy diets and health programs for individuals. Meanwhile, it may offer a new perspective on the future interdisciplinary development of neurology, microbiology and nutrition.

Occult blood in feces is associated with a poor functional outcome of ischemic stroke patients receiving intravenous thrombolysis

Background

Although fecal occult hemoglobin is commonly valued as a screening tool for colorectal cancer, few studies have examined the clinical significance of fecal immunochemical testing (FIT) in other diseases. This study aimed to explore the association between occult blood in feces and functional outcomes of acute ischemic stroke (AIS) patients who received intravenous thrombolysis treatment.

Methods

Patients diagnosed with acute ischemic stroke and received thrombolytic therapy were recruited from the neurology department of the Affiliated Hospital of Hangzhou Normal University. FIT was conducted for patients during hospitalization. Functional outcome was assessed by the modified Rankin Scale (mRS). A favorable outcome was defined as mRS 0-2 and a poor outcome as mRS 3-6.

Results

A total of 214 patients were included for analysis. The proportion of FIT-positive patients was higher in the poor outcome group than in the favorable group (12.3% vs. 45.6%, p < 0.001). Logistic regression models showed that FIT-positive patients had an increased risk of a poor outcome (OR: 4.188, 95% CI: 1.424-11.51, p = 0.005) after adjusting for possible variables. Moreover, in addition to gastrointestinal bleeding, NIHSS score at baseline (OR: 1.092, 95% CI: 1.013-1.176, p = 0.021) and white blood cell level (OR: 1.215, 95% CI: 1.018-1.448, p = 0.031) were also the independent risk factors for positive FIT after thrombolytic therapy in AIS.

Conclusion

Positive FIT was related to the poor outcomes in AIS patients who received thrombolytic therapy. High NIHSS scores at baseline and high white blood cell levels were the risks of FIT.

The Lived Experience of Participating in Online Peer-To-Peer Groups After Acquired Brain Injury: Phenomenological Study

BACKGROUND

Stroke and other acquired brain injuries (ABIs) can present challenging experiences for individuals, both in recovery of functions affected by visible or invisible impairments and in learning to live with the new situation. Research has shown that sharing experiences face-to-face in peer groups can be beneficial during recovery. However, there is limited knowledge about the lived experiences of people with ABI who participate in online peer-to-peer groups.

OBJECTIVE

The aim of our study was to explore the lived experiences of participating in online peer-to-peer groups for people with ABI, where participants themselves set the agenda.

METHODS

Members of 2 Facebook groups (FBGs) for people with ABI were invited to participate in this study, and 20 individuals were included (14 women and 6 men; age range 24-74 years). One FBG focused on stroke and the other on fatigue caused by ABI. One group was private, and the other group was public. Data were collected through semistructured interviews, in which participants were encouraged to describe their experiences of engaging in FBGs in detail. The interviews were conducted over telephone or Zoom and digitally recorded. The audio recordings were then transcribed verbatim, resulting in 224 pages of text, and analyzed using the empirical phenomenological psychological method.

RESULTS

The analysis presented a common meaning structure with 1 main characteristic that is, "validating self," common for all 20 participants, and 3 subcharacteristics, that is, "learning-having one's own experiences confirmed," "adjusting self-building competence and self-compassion," and "supporting others-becoming a valued lived-experience expert/authority." Together, the subcharacteristics reflected a process of validating self from newcomer to lived-experience expert or authority. In this process, members of FBGs moved from being newcomers with pronounced needs for support and to learn and to have their experiences confirmed by others with similar experiences. Thus, participants were building competence and developing self-compassion. Gradually, they assumed the role of advisors, mentors, or coaches, acknowledging their experiences and competence as valuable to others, thereby validating themselves as compassionate lived-experience experts or authorities in supporting others.

CONCLUSIONS

Participation in online peer-to-peer groups can offer unique opportunities for individuals with ABI to validate self through processes that involve learning, developing self-compassion and compassion for others, and offering support to others with similar experiences. Given that rehabilitation after an ABI is often of limited duration and that positive experiences can be achieved over time through involvement in digital peer-to-peer support, health care professionals should assist patients by providing information and directing them to digital networks for people with ABI. However, when recommending the use of online peer-to-peer support, impairments and insufficient digital competence that may complicate or prevent the use of social media should be assessed and support provided when relevant.

Cross-sectional study on smoking types and stroke risk: development of a predictive model for identifying stroke risk

Background

Stroke, a major global health concern, is responsible for high mortality and long-term disabilities. With the aging population and increasing prevalence of risk factors, its incidence is on the rise. Existing risk assessment tools have limitations, and there is a pressing need for more accurate and personalized stroke risk prediction models. Smoking, a significant modifiable risk factor, has not been comprehensively examined in current models regarding different smoking types.

Methods

Data were sourced from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) and the 2020-2021 Behavioral Risk Factor Surveillance System (BRFSS). Tobacco use (including combustible cigarettes and e-cigarettes) and stroke history were obtained through questionnaires. Participants were divided into four subgroups: non-smokers, exclusive combustible cigarette users, exclusive e-cigarette users, and dual users. Covariates such as age, sex, race, education, and health conditions were also collected. Multivariate logistic regression was used to analyze the relationship between smoking and stroke. Four machine-learning models (XGBoost, logistic regression, Random Forest, and Gaussian Naive Bayes) were evaluated using the area under the receiver-operating characteristic curve (AUC), and Shapley's additive interpretation method was applied for feature importance ranking and model interpretation.

Results

A total of 273,028 individuals were included in the study. Exclusive combustible cigarette users had an elevated stroke risk (β: 1.36, 95% CI: 1.26-1.47, P < 0.0001). Among the four machine-learning models, the XGBoost model showed the best discriminative ability with an AUC of 0.794 (95% CI = 0.787-0.802).

Conclusion

This study reveals a significant association between smoking types and stroke risk. An XGBoost-based stroke prediction model was established, which has the potential to improve the accuracy of stroke risk assessment and contribute to personalized interventions for stroke prevention, thus alleviating the healthcare burden related to stroke.

Effects of poststroke heart rate variability on the neurological impairment severity and the prognosis among patients with ischaemic stroke: a scoping review

OBJECTIVES

Changes in poststroke heart rate variability (HRV) might be helpful for early identification of patients with neurological impairment and poor prognosis, which could allow for early intervention to reduce adverse outcomes. The aim of this study is to perform a scoping review to identify the influence of poststroke HRV on the neurological impairment severity and the prognosis among patients with ischaemic stroke (IS).

DESIGN

The study design allows us to examine existing research, identify the research gaps and target the important areas for future research. In the search and report process, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and checklist were used.

DATA SOURCES

Three databases (PubMed, Web of Science and Ovid MEDLINE (Ovid)) were searched before December 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The literature related to the topic of this study was mainly included, and the articles were excluded if they only focused on cerebral haemorrhage or were reviews, guidelines, books, etc. DATA EXTRACTION AND SYNTHESIS: Descriptive analysis was used to display the distribution of the included studies and then the summary method was adopted for further analysing.

RESULTS

3251 articles that may be related to the scoping review topic were screened. After title and abstract screening and full-text reading, 21 records were finally included. Whether at discharge (n=6) or after follow-up (n=11), it was found that when the SD of all normal-to-normal intervals (SDNN) or the SD of the averages of normal-to-normal intervals decreased, the neurological impairment severity would be increased, including dysarthria, aphasia and hemiplegia. The root mean square of successive differences, the ratio of low frequency to high frequency and the high frequency were valuable predictors for the occurrence of adverse cardiocerebrovascular events. And the poor prognosis among patients with IS might be influenced by SDNN.

CONCLUSION

This scoping review confirmed that post-IS HRV indicators can predict neurological impairment and prognosis of patients with stroke, highlighting a potential direction for early intervention. Large independent cohorts should be used to evaluate the predictive performance, reliability and potential limitations of these indicators in the future, and it will be important to explore interventions that make HRV change.

Distinguishing stroke from transient ischemic attack using plaque characteristics and arterial transit artifacts

Purpose

We aimed to investigate the differences in plaque characteristics and hemodynamics in patients with ischemic stroke and transient ischemic attack (TIA), comparing the diagnostic abilities of high-resolution magnetic resonance imaging (HRMRI) and arterial spin labeling (ASL) for ischemic stroke.

Methods

This retrospective analysis included patients who underwent HRMRI and ASL between October 2020 and December 2023. We compared clinical risk factors, vascular plaque characteristics, and the presence of arterial transit artifacts (ATAs) at post-labeling delays (PLDs) of 1.5-s and 2.5-s between stroke and TIA groups. Multivariate logistic regression analysis was used to evaluate the diagnostic performance of different prediction models combining clinical factors, differential plaque characteristics, and the presence of ^PLD ATAs.

Results

A total of 147 patients (mean age, 57.12 ± 13.08 years; 102 men) were initially included in this study, divided into stroke (79) and TIA (68) groups. Significant differences in vascular positive remodeling, intraplaque hemorrhage, enhancement ratio, and the presence of 1.5-s and 2.5-s ATAs (p < 0.05) were observed between groups. Combined HRMRI and ASL performed best in distinguishing ischemic stroke and TIA (area under the curve [AUC], 0.926; 95% confidence interval [CI], 0.885-0.967), with no significant difference in ischemic stroke diagnostic performance between HRMRI and ASL (95% CI, -0.039 to 0.087, Z = 0.742, p = 0.458).

Conclusion

A model combined with plaque characteristics and ATAs showed good diagnostic performance in distinguishing between TIA and stroke in patients with intracranial atherosclerotic stenosis. ASL provides a simpler imaging evaluation method than HRMRI, and ATA evaluation may become a more widely used imaging marker in clinical practice.

Trends in pulmonary arterial hypertension: insights from Global Burden of Disease 1990-2021

OBJECTIVE

This study aimed to assess the global, regional and national burden of pulmonary arterial hypertension (PAH) from 1990 to 2021 using data from the Global Burden of Disease Study 2021. The focus was on evaluating trends in incidence, prevalence, mortality and disability-adjusted life-years (DALYs) associated with PAH and examining these trends by age, gender and sociodemographic index (SDI).

DESIGN

This is a systematic analysis leveraging data from the Global Burden of Disease Study 2021. The analysis focused on both crude and age-standardised rates to track temporal trends in PAH burden, with data stratified by region and SDI.

SETTING

The study used global, regiona, and national data from 204 countries and regions, spanning from 1990 to 2021.

PARTICIPANTS

The participants in this study include individuals diagnosed with PAH, with data representing populations globally, categorised by age, gender and SDI.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures included global, regional and national incidence, prevalence, mortality and DALYs related to PAH. Secondary outcomes consisted of age-standardised rates (age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR)) and trends over the study period. A key strength of this study is the detailed stratification by SDI, revealing how PAH burden varies across different socio-economic settings. This extended temporal analysis offers new insights into long-term trends, highlighting the rising burden in lower-SDI regions and significant regional disparities in disease management and outcomes.

RESULTS

From 1990 to 2021, global PAH cases showed substantial increases in both incidence (85.62%) and prevalence (81.46%), while age-standardised rates remained stable. Across SDI levels, high-SDI regions maintained stable ASIRs (0.37 per 100 000) with a slight decline (estimated average percentage change (EAPC) -0.06%), while low-SDI regions demonstrated the most significant reduction (EAPC -0.30%). Deaths increased by 48.36% globally, though the ASMR decreased from 0.35 to 0.27 per 100 000. The disease burden measured by DALYs decreased by 6.59%, with high-SDI regions showing better improvements in age-standardised DALY rates (-1.39% EAPC) compared with other SDI levels. Gender analysis revealed persistent female predominance (female-to-male ratio 1.62:1), particularly pronounced in populations over 50 years across all SDI quintiles.

CONCLUSIONS

While global age-standardised rates have declined, PAH remains a significant global health burden, particularly in low-SDI regions. These findings underscore the need for targeted prevention and intervention strategies, especially for high-risk populations, such as females and the elderly, to reduce the global health impact of PAH.

Description of the Risk Factors for Ischemic Stroke in the Lebanese Population: Their Association with Age at First Stroke Incidence and the Predictors of Recurrence

Background: Stroke is the third most common cause of death in Lebanon. With many preventive strategies identified, stroke remains a national burden, especially in developing countries, where risk factors and epidemiological states are understudied. This study aims to investigate the association of sociodemographic factors and health-related risk factors with age at first ischemic stroke and its recurrence in the Lebanese population. Methods: A retrospective study including 214 ischemic stroke cases was carried out. Sociodemographic characteristics and health-related risk factors were assessed, in addition to disability levels (modified Rankin score (mRS)), age at first ischemic stroke incidence, and number of ischemic strokes. Data were analyzed using SPSS software version 25, including descriptive, bivariate, and multivariate analyses. Results: This study showed that stressful factors were significantly associated with a younger age at first ischemic stroke, such as having no partner (p < 0.001), having employment (p < 0.001), and having migraines (p < 0.001). However, metabolic risk factors were associated with an older age of ischemic stroke, such as hypertension (p < 0.001) and hyperlipidemia (p < 0.001). Moreover, having a partner (OR: 2.136), having a family history of stroke (OR: 2.873), having hyperlipidemia (OR: 3.71), and having atrial fibrillation (OR: 2.521) were associated with ischemic stroke recurrence. Conclusions: Many modifiable factors are associated with age at first ischemic stroke and its recurrence. This study sheds light on the necessity of increasing knowledge and awareness of well-known risk factors in the Lebanese population. These results suggest implementing targeted preventive strategies and highlight the importance of complying with early detection and follow-up measures.

Bioinformatics identification and validation of pyroptosis-related gene for ischemic stroke

BACKGROUND

Ischemic stroke (IS) is one of the common and frequent diseases with extremely high lethality and disability in the world, and there is no effective treatment at present. This study aimed to screen hub genes involved in cerebral ischemia/reperfusion injury (CIRI) and pyroptosis, and explore promising intervention targets.

METHODS

CIRI-related genes (GSE202659 and GSE131193) and pyroptosis-related genes (PRGs) in mice were obtained from the Gene Expression Omnibus (GEO) and GeneCards database. We screened for LASSO regression to construct a prognostic model of GSE131193 and PRGs and examined by GSE137482. The functional enrichment analysis of Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Set Enrichment Analysis (GSEA) and Gene Set Variation Analysis (GSVA) were performed on pyroptosis-related differentially expressed genes (PRDEGs) of GSE202659.The key modules for CIRI and pyroptosis were identified by Weight Gene Co-expression Network Analysis (WGCNA). Subsequently, Protein-protein Interaction (PPI) network and the Cytoscape was constructed to screen out hub genes. Used the starBase to predict miRNA interacting with hub genes and constructed mRNA-miRNA-lncRNA interaction networks. CIRI-related Molecular Subtypes were constructed for hub genes. The relationship between immune cells and hub genes was verified via CIBERSORT. Finally, we selected C57BL/6 mice to construct models to confirm hub genes by enzyme linked immunosorbent assay (ELISA), reverse transcription-polymerase chain reaction (RT-PCR), western blot, and Immunofluorescence.

RESULTS

A total of 272 PRGs and 35 PRDEGs were screened. An eight-gene risk prediction models were established (AUC = 0.868). GO, KEGG, GSEA and GSVA analyses revealed that PRDEGs were mainly involved in positive regulation of cytokine production, and NOD-like receptor signaling pathway. And then, seven hub genes (Irf1, Icam1, Tlr2, Tnf, Cebpb, Il1rn, and Casp8) were identified by PPI. Icam1, Tnf, Cebpb, Il1rn, and Casp8 had high expression profiles in Cluster2 by hierarchical clustering. The immune infiltration analysis results showed that among the hub genes, Cebpb, Il1rn, and Casp8, showed a significant positive correlation with the degree of NK.Actived, and Icam1 showed a significant negative correlation with B.Cells.Memory. The results of animal experiments significantly demonstrated an upregulation of Irf1, Icam1, Tlr2, Cebpb, and Il1rn.

CONCLUSION

Our finding indicated that Irf1, Icam1, Tlr2, Cebpb, and Il1rn are hub genes associated with pyroptosis, and these genes are all associated with different immune cells, so as to provide new targets for the prevention and treatment of IS from the perspective of pyroptosis.

Temporal trends of ischemic stroke attributable to diet high in sodium in China from the global burden of disease study 2021

Background

Ischemic stroke is a significant global health burden, with high sodium intake recognized as a key risk factor. This study aimed to assess the disease burden of ischemic stroke attributable to diet high in sodium in China from 1990 to 2021. Additionally, we analyzed the influence of age, period, and cohort effects on the trends in ischemic stroke burden and projected the disease burden from 2022 to 2036.

Methods

Data from the Global Burden of Disease Study 2021 (GBD 2021) were used to analyze the ischemic stroke burden among high-risk populations in China. Annual average percent change (AAPC) was calculated using Joinpoint regression models to evaluate trends in ischemic stroke burden from 1990 to 2021. Age-period-cohort models were employed to estimate the independent effects of age, period, and cohort on the ischemic stroke burden, and to project the burden from 2022 to 2036 using Bayesian age-period-cohort models.

Results

From 1990 to 2021, ischemic stroke mortality attributable to diet high in sodium in China showed a continuous increase, while the age-standardized mortality and disability-adjusted life years (DALYs) significantly declined. In the age-period-cohort analysis, the age effect on ischemic stroke burden increased steadily over the study period. Period effects revealed an initial decline in the relative risk (RR) of ischemic stroke mortality and DALY rates, followed by an increase in cohorts born before 2004-2009, and a gradual decline in cohorts born after that period. Cohort effects demonstrated a continuous decline in the relative risk of ischemic stroke mortality and DALY rates from 1990 to 2021.

Conclusion

This study found that ischemic stroke attributable to a diet high in sodium in China fluctuated from 1990 to 2021, with a declining trend observed in recent years. Projections indicate that this downward trend will continue. Age and birth period are key factors influencing the disease burden, with older adults and men being particularly affected. Future policy efforts should focus on enhancing health management in high-risk populations to further reduce the burden of ischemic stroke linked to high sodium intake.

Association between the hemoglobin-to-red cell distribution width ratio and three-month unfavorable outcome in older acute ischemic stroke patients: a prospective study

Objective

Acute ischemic stroke (AIS) is a prevalent acute condition among older individuals. This study is the first investigation of the link between the HRR and unfavorable three-month outcome in older AIS patients.

Methods

This secondary research used data from a sample of 1,470 older AIS patients collected from a South Korean hospital between January 2010 and December 2016. Multiple imputation was applied to account for absent values. Binary logistic regression analysis was used to examine the relationship between the baseline HRR and adverse outcome at three-month. Restricted cubic spline analysis was employed to evaluate the correlation between HRR levels and adverse outcome. Interaction tests were performed to discern variations among subgroups.

Results

At 3 months, the overall incidence of adverse events was 31.43%, with a median HRR of 9.49. Compared to those with a lower HRR (Q1), the adjusted odds ratios (ORs) for the HRR in Q2, Q3, and Q4 were 0.61 (95% CI: 0.41-0.92, p = 0.017), 0.49 (95% CI: 0.31-0.78, p = 0.003), and 0.54 (95% CI: 0.31-0.92, p = 0.025), respectively. The correlation between the HRR and adverse outcome was non-linear (p < 0.05). An inflection point threshold of 10.70 was established via RCS analysis. Each 1-unit increase in HRR on the left side of the infection point was associated with a 24.0% decrease in the likelihood of adverse outcomes (OR = 0.76, 95% CI: 0.66-0.86, p < 0.001). ROC analysis revealed that HRR had the highest AUC (0.64, 95% CI: 0.61-0.67), followed by hs-CRP (0.60, 95% CI: 0.57-0.63), FPG/HbA1c (0.59, 95% CI: 0.55-0.63), and WBC (0.55, 95% CI: 0.51-0.58).

Conclusion

A lower HRR was correlated with a higher risk for adverse outcome in older AIS patients.

Clinical staff's perceptions of transitional care from hospital to home for stroke patients: a qualitative study

BACKGROUND

The transition from hospital to home is a critical period for stroke survivors and their caregivers. This study explores the clinical staff's attitudes and perspectives on transitional care (from hospital to home) for stroke patients in the neurology department.

METHODS

This qualitative descriptive phenomenological study involved semi-structured interviews with 15 clinical staff members in the neurology department of a tertiary hospital, conducted either face-to-face or via telephone. Colaizzi's method was used to analyze the data.

RESULTS

Five major themes emerged: (1) Clinical staff recognize the importance of transitional care for patients' recovery post-stroke and the value of building strong relationships with stroke patients; (2) There are diverse understandings of the definition of transitional care, doctors generally have a more accurate understanding, while nurses' understanding of transitional care needs improvement; (3) Staff perceive challenges in implementing transitional care, including a lack of self-directed learning, time constraints, and limited opportunities for continuous learning; (4) There is a consistent need for education, both doctors and nurses expressed a desire for training, but nurses require fair opportunities for ongoing learning; (5) The establishment of advanced (nursing) specialists is recommended, including specific work positions or specialized professionals.

CONCLUSIONS

Clinical staff in the neurology department could recognize the significance of transitional care for stroke patients. However, heavy workloads, inadequate competence, and limited learning opportunities reported by nurses hinder their participation in transitional care. To ensure quality transitional care, nurses, in particular, need equitable access to training in areas such as stroke pathophysiology, rehabilitation, symptom monitoring and evaluation, communication, and educational skills. Guidance from clinical specialists is strongly recommended to enhance the implementation and quality of transitional care.

Joinpoint regression and age period cohort analysis of global and Chinese HIV incidence trends from 1990 to 2021

In China and globally, to analyze the temporal trends of HIV incidence and age, period and cohort effects from 1990 to 2021. A Joinpoint regression model was applied to analyze the time-varying trends of standardized HIV incidence rates worldwide and in China from 1990 to 2021, using data from the Global Burden of Disease Study 2021. The study also explored the effects of age, period, and cohort on HIV incidence trends. From 1990 to 2021, the global standardized incidence of AIDS increased initially and then declined, with females experiencing a higher disease burden than males. In China, the burden was greater in males than females. The age-period-cohort model revealed that the global risk of AIDS incidence peaked between ages 60 and 69, while in China, it was highest between ages 75 and 79. From 1990 to 2021, the global and Chinese standardized incidence rates of AIDS generally followed an increasing trend before declining, with notable gender differences and the highest incidence rates observed in older populations. It is important to address the issues related to AIDS among the elderly and develop targeted health policies to reduce societal burdens and improve public health.

Acute Stroke Units Nested within Broader Neurology: Care Bundles for Nursing to Enhance Competence and Interdisciplinary Coordination

PURPOSE OF REVIEW

The benefits of acute stroke unit care, with nurses as central figures, are well-documented. As care bundles gain traction to enhance evidence-based nursing care, this review explores their development and adaptation in a setting where stroke care is integrated into general neurology. It also highlights key elements for reinforcing competence and interdisciplinary support.

RECENT FINDINGS

Most evidenced based acute stroke unit recommendations focus on hyperacute medical management. In comparison, the literature on decision-making for selecting and evaluating key components of nursing surveillance to support specialized stroke care in geographically smaller settings is sparse although the benefits of nursing care bundles is emerging. Well-structured care bundles, grounded in robust evidence and supported by thorough documentation and effective implementation strategies, provide a clear framework for nursing care, facilitate continuous monitoring, and are useful for enhancing practices especially in smaller stroke units that lack the resources of more comprehensive state-of-the-art units. Tailoring stroke nursing care bundles to local contexts requires an adaptable approach.

Blood pressure management in reperfused ischemic stroke

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of intensive systolic blood pressure management (target less than 160 mmHg) versus conventional management (target less than 180 mmHg) in people undergoing ischemic stroke reperfusion via systemic thrombolysis or endovascular thrombectomy.

Burden and risk factors of stroke in Vietnam from 1990 to 2021 - a systematic analysis from global burden disease 2021

BACKGROUND

Stroke is a leading cause of death in Vietnam. However, a comprehensive analysis of stroke burden remains limited. This study aims to investigate the burden of stroke and various risk factors in Vietnam from 1990 to 2021.

STUDY DESIGN AND METHODS

We utilized data from the Global Burden of Disease 2021 estimates. For the burden of stroke, we included the following variables as age-standardized rates (ASR) per 100,000 people per year: incidence, prevalence, disability-adjusted life years (DALYs), and mortality. Stroke-related mortality and DALYs associated with 23 risk factors were also analyzed. Trends were analyzed using joinpoint regression analysis.

RESULTS

In 2021, stroke was responsible for 166,954 deaths (Males:96,764; Females:70,190). The ASR for stroke incidence was 203·36 (95%CI: 190·51-271·81) per 100,000 people, exceeding 187·98 in Southeast Asia and 141·55 globally. From 1990 to 2021, stroke incidence, death, and DALYs decreased steadily, with average annual percentage changes (AAPCs) of -0·34%, -0·49%, and -0·61%. The prevalence of stroke decreased among women (AAPC:-0·19%) and increased among men (AAPC:0·26%). Metabolic risks were the largest contributors to stroke-related mortality (144·89 per 100,000) and DALYs (2,872·37 per 100,000). The analysis revealed that behavioral risks were more prevalent in males, and metabolic risks in females.

CONCLUSION

Stroke is the leading cause of death and disability in Vietnam. Although its overall burden has declined, the persistent and significant burden among males, coupled with specific risk factors, remains a major concern. Further researches are warranted to develop targeted interventions addressing the distinct risk factors.

Impact of thrombus composition on virtual thrombectomy procedures using human clot analogues mechanical data

Endovascular thrombectomy (EVT) aims at restoring blood flow in case of acute ischemic stroke by removing the thrombus occluding a large cerebral artery. During the procedure with stent-retriever, the thrombus is captured within the device, which is then retrieved, subjecting the thrombus to several forces, potentially leading to its fragmentation. In silico studies, along with mechanical characterisation of thrombi, can enhance our understanding of the EVT, helping the development of new devices and interventional strategies. Our group previously validated a numerical approach to study EVT able to account for thrombus fragmentation. In this study, the same methodology was employed to explore the applicability of the chosen failure criterion to EVT simulations and the impact of thrombus composition on the outcome of the in silico procedure. For the first time, human clot analogues experimental data were applied to this methodology. Clot analogues of three different compositions were tested, and a material model incorporating failure was calibrated, followed by a verification analysis. Finally, the calibrated material model was used to perform EVT simulations, combining the three tested thrombus compositions with three different stent retriever models. The experimental tests confirmed a compression-tension asymmetry in the stress-strain curves, showing decreasing stiffness with increasing the red blood cell (RBC) content. Applying the resulting material models to EVT simulations demonstrated: (i) the dependency of the failure criterion on the thrombus mesh size, (ii) a greater tendency for RBC-rich thrombi to fragment, and (iii) increased difficulty in retrieving RBC-poor thrombi compared to RBC-rich thrombi.

Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021

Background

Despite substantial declines in burden over time, stroke remains a public health threat in the Americas. This study aimed to assess the current magnitude, trends, and disparities in the estimates of stroke burden by sex and age in the Americas from 1990 to 2021.

Methods

Estimates from the Global Burden of Disease, Injuries and Risk Factors Study 2021 were used to analyze incidence, prevalence, mortality, years of life lost due to premature death, years lived with disabilities, and disability-adjusted life years (DALYs) caused by stroke and its major subtypes stratified by age, and sex in the Americas from 1990 to 2021. We used Joinpoint regression analysis to estimate the average annual percent change (AAPC) of stroke mortality and disease burden outcomes and assessed trends.

Findings

In 2021, there were 1.1 million (95% uncertainty interval: 1.0-1.2) new cases, 12.9 million (12.3-13.7) prevalent cases, 0.5 million (0.5-0.6) deaths, and 11.4 million (10.6-12.1) DALYs due to stroke in the Americas. The absolute number of stroke burden outcomes increased from 1990 to 2021, but their corresponding age-standardized rates significantly declined. A deceleration in reduction rates of burden outcomes for all strokes and most stroke subtypes occurred over the last decade, with pronounced difference between sexes mainly in incidence among younger groups. From 2015 to 2021, trends in incidence rates from all stroke and stroke subtypes reversed to increase in most age groups, and strikingly, trends in mortality and DALY rates from ischemic stroke among younger populations reversed to upward with AAPC over 1.4%. A substantial number of countries contributed to these increasing trends.

Interpretation

Regionally, the annual number of stroke cases and deaths significantly increased from 1990 to 2021, despite reductions in age-standardized rates. The declining pace in age-standardized stroke rates has decelerated in recent years, while trends in incidence, and ischemic stroke mortality and DALY among middle-aged adults and adults, reversed towards upward in the period 2015-2021. Further studies are needed to understand the determinants of this recent pattern and identify the most cost-effective interventions to stem this alarming trend.

Funding

There was no funding source for this study.

Targeting intracellular autophagic process for the treatment of post-stroke ischemia/reperfusion injury

Cerebral ischemia/reperfusion (I/R) injury is an important pathophysiological condition of ischemic stroke that involves a variety of physiological and pathological cell death pathways, including autophagy, apoptosis, necroptosis, and phagoptosis, among which autophagy is the most studied. We have reviewed studies published in the past 5 years regarding the association between autophagy and cerebral I/R injury. To the best of our knowledge, this is the first review article summarizing potential candidates targeting autophagic pathways in the treatment of I/R injury post ischemic stroke. The findings of this review may help to better understand the pathogenesis and mechanisms of I/R events and bridge the gap between basic and translational research that may lead to the development of novel therapeutic approaches for I/R injury.

Ambient air pollution exposure in relation to cerebral small vessel disease in Chinese population: A cranial magnetic resonance imaging-based study

Cerebral small vessel disease (CSVD), a chronic and progressive vascular disorder closely associated with stroke and dementia, is primarily identified and diagnosed in cranial magnetic resonance imaging (MRI). Given the limited evidence on the relationship between air pollution and CSVD, this study aimed to investigate the links between multiple air pollutants exposure and CSVD risk. Eligible subjects and their cranial MRI data were obtained from the Multi-modality Medical Imaging Study Based on Kailuan Study, totaling 1216 participants. Ordinal and binary logistic regression models were utilized to evaluate the associations between air pollution exposure and the neuroimaging markers of CSVD. For each interquartile range increase in air pollutant exposure during the examination year, the odds ratios and 95% confidence intervals of the increased white matter hyperintensity burden were 1.45 (1.15, 1.84) for PM2.5, 1.72 (1.27, 2.34) for PM10, 1.26 (1.05, 1.51) for SO2, 1.52 (1.16, 2.00) for NO2, and 1.63 (1.26, 2.13) for CO. The results remained consistent even when the model was fitted using air pollution from different exposure windows. Furthermore, the estimated effect sizes for the total burden of CSVD were 1.20 (1.01, 1.43) for PM2.5, 1.39 (1.12, 1.74) for PM10, 1.26 (1.03, 1.53) for NO2, and 1.30 (1.08, 1.58) for CO. These findings suggest that a positive link between air pollutants exposure and neuroimaging markers of CSVD in the Chinese population, revealing the importance of controlling environmental pollutants to protect the population against cerebral small vessel damage.

Trends in stroke incidence, death, and disability outcomes in a multi-ethnic population: Auckland regional community stroke studies (1981-2022)

Background

Reliable data on trends of stroke incidence and outcomes over time are necessary for assessing the effectiveness of public health and clinical strategies, and for allocating healthcare resources. We assessed the levels and trends in incidence, mortality, early case fatality and disability for stroke in a defined, ethnically mixed population over 40 years.

Methods

To analyse data from five population-based stroke incidence studies in adult residents (age ≥15 years) of the Greater Auckland Region of New Zealand (NZ) (1.35 million) over 12-month calendar periods for 1981-1982, 1991-1992, 2002-2003, 2011-2012, and 2021-2022. Fatal and non-fatal, hospitalised and non-hospitalised stroke events (first-ever and recurrent) were identified through multiple overlapping sources using clinical World Health Organization (WHO) diagnostic criteria and neuroimaging to define three major pathological types of stroke: ischaemic stroke (IS), primary intracerebral haemorrhage (PICH), subarachnoid haemorrhage (SAH), and stroke of undetermined type (SUT). Crude and age-standardised annual incidence, mortality, 28-day case fatality and disability level, and 40-year trends were calculated by age, sex, and ethnicity assuming a Poisson distribution. For comparison of our findings, we carried out a pooled analysis of methodologically comparable population-based stroke epidemiology estimates in high-income countries over the last two decades.

Findings

Overall, there were 7462 first-ever strokes (9917 events) over the 40-year period (4,682,012 person-years). From 1981-1982 to 2021-2022, age-standardised stroke incidence rates decreased from 156/100,000 (95% confidence interval [CI] 143; 170) to 124/100,000 (119; 130) and mortality rates from 98/100,000 (88; 110) to 28/100,000 (26; 31) in nearly all age, sex, and ethnic groups. Moreover, from 2002-2003 to 2021-2022, there was an increase in stroke incidence of 1.28% per year (95% CI 0.38-2.17) in people aged 15-54 years, with the mean age of people with stroke decreasing from 73.0 (SD ± 13.8) in 2002-2003 to 71.6 (SD ± 14.9) in 2011-2012 and 70.7 (SD ± 15.2) years in 2021-2022 (p for trend <0.0001). The risk of stroke in Māori and Pacific people in 2021-2022 was almost 1.5 and 2.0 times greater than that in NZ Europeans. Ethnic disparities in the risk of stroke and age of stroke onset remained stable over the study period. From 1981-1982 to 2021-2022, 28-day stroke case fatality declined from 33.1% to 12.1% (p < 0.0001). There was a trend towards reducing 28-day case-fatality (from 31.6% [95% CI 27.6; 35.7] in 1981-1982 to 11.4% [10.0; 12.7] in 2021-2022) and an increasing proportion of stroke survivors with good functional outcome at discharge/28-days post-stroke (increased from 45.7% (95% CI 41.3; 50.0) in 1981-1982 to 60.2% (58.1; 62.3) in 2021-2022).

Interpretation

Stroke incidence, 1-year mortality and 28-day case-fatality and disability have decreased in Auckland, NZ over the last 4 decades. However, over the last decade (2011-2022) there was a stagnation in the decline in the age-standardised stroke incidence rates. The absolute numbers of people with strokes, and those who have died or remained disabled from stroke, have significantly increased from 1981 to 2022. Ethnic disparities in the risk and burden of stroke persist. Effective prevention strategies for stroke must remain a high priority.

Funding

Health Research Council of New Zealand.

Global, regional and national trends in the burden of intracranial hemorrhage, 1990-2021: Results from the Global Burden of Disease study

Intracerebral hemorrhage (ICH) is a significant global public health issue that is characterized by a rapid start, severe symptoms, and a poor prognosis. It is the most common type of hemorrhagic stroke. We analyzed global intracranial hemorrhage incidence, mortality, disability-adjusted life years (DALYs), and corresponding age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) by using GBD 2021 data. The data were further stratified by age, sex, and region to assess the global burden of ICH from 1990 to 2021, providing the most up-to-date epidemiologic reference data for public health prevention and treatment strategies. In 2021, there were 3,444,300 (95 % UI, 305.30 to 381.20) new cases, 3,308,400 (302.11-359.47) deaths and 79,457,400 (7230.45-8548.02) DALYs. The burden of intracranial hemorrhage was higher in Oceania and Southeast Asia (Age-standardized DALY rates of 2582.46 per 100,000 and 1976.78 per 100,000), but lower in Australasia (126.59), high-income North America (221.19), and Western Europe (161.23). Of the 204 countries and territories globally, the burden of intracranial hemorrhage is higher in countries such as Nauru, Solomon Islands and Marshall Islands. From 1990 to 2021, global age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) declined, corresponding to EAPCs of -1.52, -1.63 and -1.75, with females declining more than males. In 2021, the most significant risk factor for ICH was high systolic blood pressure, accounting for 56.4 % of total DALYs for intracranial hemorrhage. Other major risk factors include: ambient particulate matter pollution, smoking, solid fuel pollution of household air, high sodium diet, and renal dysfunction. We need to target interventions at relevant risk factors, such as hypertension management, environmental particulate management, smoking cessation campaigns, focusing on high-risk groups and high-burden areas, and continue to deepen the implementation of the universal primary prevention strategy.

Adherence to rehabilitation exercise and influencing factors among people with acute stroke: a cross-sectional study

Background

Post-stroke rehabilitation exercise is recognized as the most effective and preferred intervention to reduce disability rates in patients. However, adherence to exercise is low among stroke patients. Previous research has mainly focused on the negative psychological factors influencing adherence, while the positive psychological aspects remain underexplored. Therefore, this study aims to investigate the factors influencing adherence to rehabilitation exercises in acute stroke patients, especially the positive psychological factors, in order to reduce the disability rate of stroke.

Methods

From October 2023 to March 2024, a total of 227 patients with acute stroke were selected from a Grade-A hospital in Chongqing, China, using total sampling method. The patients' general demographic data, Stroke Functional Exercise Adherence Questionnaire Scale (EAQ), Hospital Anxiety and Depression Scale (HAD), and Index of Subjective Well-Being Scale (IWB) were assessed. ANOVA, t-test analysis, correlation analysis, and multiple linear regression models were used to explore the influencing factors in people with acute stroke.

Results

The total score for rehabilitation exercise adherence in acute stroke patients was 38.41 ± 11.13, corresponding to a mean adherence rate of 68.6%. Factors influencing adherence to rehabilitation exercise in acute stroke patients were identified, including age (p < 0.0001), presence of ICU stay (p = 0.03), National Institutes of Health Stroke Scale (NIHSS) score (p < 0.0001), and subjective well-being (p < 0.01).

Conclusion

Adherence to rehabilitation exercises in acute stroke patients was found to be medium. Our findings highlight that age, presence of ICU stay, and NIHSS score were found to have negative correlations with adherence. While a positive correlation was observed with subjective well-being.

Self-rehabilitation strategy for rural community-dwelling stroke survivors in a lower-middle income country: a modified Delphi study

BACKGROUND

More than half of stroke survivors in lower-middle income countries lack access to stroke rehabilitation services. The promotion of self-rehabilitation could be promising for addressing stroke rehabilitation inadequacies in lower-middle income countries. Self-rehabilitation interventions are more readily acceptable to community-dwelling stroke survivors, and therefore, have the potential to boost the successful realization of the Sustainable Development Goals and other WHO rehabilitation goals. We report a consensus-building process that sought to identify which task trainings are relevant to include in a task-specific self-rehabilitation strategy for rural community-dwelling stroke survivors.

METHODS

An iterative two-stage mixed-method consensus-building approach was used: (1) focus group discussions (n =  5) with rural community-dwelling chronic stroke survivors were conducted to explore personal life experiences in performing daily activities, and the results were used to develop a list of candidate task trainings that could be included in a task-specific self-rehabilitation intervention model for improving functional ability of survivors; (2) a three-round Delphi exercise with a panel of stroke rehabilitation experts to establish consensus on the importance/relevance of the developed task trainings. Consensus was pre-defined to be the point where the proportion of items given a rating of 3 (quite relevant) or 4 (highly relevant) by expert panellists is ≥  0.8. Kendall's coefficient of concordance (W) was used to assess the level of agreement among the expert panellists.

RESULTS

A list of 74 task trainings was generated from the results of the focus group discussions involving 29 chronic stroke survivors. The tasks were classified as follows: training for the upper extremity (37); lower extremity training (21); trunk training (7); and balance training (9). A panel of 13 stroke rehabilitation experts reviewed these task trainings using the Delphi method and consensus was reached on keeping 28 task trainings in the first round (Kendall's W =  0.252, p <  0.001) and an additional 7 in the second round (Kendall's W =  0.409, p <  0.001). In the study team's analysis of open text responses, several areas of debate were identified and some task trainings were modified. The exercise yielded 49 task trainings (66% of 74) on which there was consensus (the mean proportion of items given a rating of 3 or 4 by panellists was 0.93; Kendall's W =  0.291, p <  0.001) to keep 3 task training groups relating to: upper extremity (27), lower extremity/balance (8), trunk strength (4) as well as warm up exercises (10).

CONCLUSION

The study provides a consensus-based view of the features of a task-specific self-rehabilitation training strategy to improve outcomes following a stroke. This self-rehabilitation training strategy can be used as an intervention approach to augment and promote stroke rehabilitation among rural community-dwelling stroke survivors, especially in sub-Saharan Africa.

The burden of ischemic stroke in Eastern Europe from 1990 to 2021

BACKGROUND AND PURPOSE

Ischemic stroke is a significant public health concern, particularly in Eastern Europe, where the burden remains high. This study aims to evaluate the trends and burden of ischemic stroke in Eastern Europe from 1990 to 2021, providing insights into epidemiological changes and informing public health strategies.

METHODS

We used data from the Global Burden of Disease 2021 database to comprehensively assess regional and national ischemic stroke indicators in Eastern Europe. These indicators included the number of cases, incidence, number of deaths, mortality, disability-adjusted life years (DALYs), DALY rates, and estimated annual percentage change (EAPC). Joinpoint analysis was employed to examine sex-specific time trends in the burden of ischemic stroke across Eastern European countries. These estimates incorporated the Socio-Demographic Index (SDI).

RESULTS

In 2021, Eastern Europe reported 490,197 cases of ischemic stroke, with an age-standardized incidence rate (ASIR) of 142.57 (95% UI: 122.12 to 164.67), exceeding the global level. The region recorded 329,291 deaths, with an age-standardized mortality rate (ASMR) of 90.99 (95% UI: 82.79 to 98.48), significantly higher than the global rate. Disability-adjusted life years (DALYs) totaled 5,713,718, with an age-standardized DALYs rate (ASDR) of 1601.20 (95% UI: 1483.51 to 1723.12). Our joinpoint regression analysis indicates that the disease burden remains notably high in Eastern Europe, despite an overall declining trend from 1990 to 2021 in ASIR and ASMR across most countries, with estimated annual percentage changes (EAPC) of -1.13 (95% CI: -1.24 to -1.02) and - 2.78 (95% CI: -3.24 to -2.32), respectively. Lithuania reported the highest incidence rate, while the Russian Federation had the highest mortality and DALY rate. Conversely, Estonia showed significant improvements in stroke indicators. Key risk factors included low temperature and smoking, contributing notably to environmental and behavioral risks.

CONCLUSION

Ischemic stroke continues to be a significant global health issue. Our temporal trends study results indicate that the disease burden remains notably high in Eastern Europe, particularly in Lithuania and the Russian Federation.

Cinnamaldehyde and its combination with deferoxamine ameliorate inflammation, ferroptosis and hematoma expansion after intracerebral hemorrhage in mice

Intracerebral hemorrhage (ICH) is a most serious type of hemorrhagic stroke with a continuously rising incidence globally, without effective cure available. The underlying mechanisms driving brain injury are complex and include inflammation, oxidative stress, glutamate excitotoxicity, membrane damage, lipid peroxidation, ferroptosis and other cellular death modes. Hematoma clearance is the key to limit brain damage and foster the recovery process. The quest for effective ICH remedies is continuing and strategically evolving with the expansion of knowledge and understanding of target mechanisms and novel lead compounds. In this study, we have investigated the effects of cinnamaldehyde after ICH as an individual treatment as well as in combination with deferoxamine. The autologous blood injection model was employed using C57BL/6 mice. Following 2 h of ICH induction, animals received IP injection once per day for three days; normal saline in ICH model group, cinnamaldehyde, deferoxamine, and combined cinnamaldehyde and deferoxamine in respective groups. Measurement of neurobehavioral scoring, markers of inflammation NFкB, TNFα, IL-1, IL6, iNOS; oxidative stress and ferroptosis GSH, TBARS, glutamate, choline containing phospholipids, GPX4, SLC7A11, SLC40A1, ACSL4; and hematoma clearance hemoglobin, haptoglobin, hemopexin, zonulin, CD163, LRP1, HO1, CD36, CD206, were investigated using ELISA, PCR, and western blot. Immunofluorescence for NeuN/SLC40A1, GFAP/GPX4, NeuN/HO1, Iba1/HO1 was also performed. We have found that cinnamaldehyde possess anti-inflammatory, antioxidant, anti-ferroptotic and hematoma limiting properties that were comparable to those obtained with deferoxamine. However, combination of cinnamaldehyde and deferoxamine demonstrated remarkable effectiveness in restoration of these parameters indicating their synergistic effect in ICH model.

Spatial-temporal variations of stroke mortality worldwide from 2000 to 2021

BACKGROUND

Stroke is a leading cause of premature death worldwide. Spatial-temporal characteristics are important for evidence-based stroke care planning and resource allocation. However, long-term global variations of stroke are still lacking.

OBJECTIVE

To identify the characteristics of the global spatial distribution of age-standardized mortality rate (ASMR) due to stroke during 2000-2021, thereby informing the efficient allocation of global health care resources.

METHODS

Based on age-standardized mortality rate (ASMR) due to stroke from the Global Health Estimates database, we analyzed stroke variation from 2000 to 2021 in 183 countries worldwide using Moran's I, Getis-Ord Gi*, and Standard Deviation Ellipse. We stratified the 183 countries into different income groups according to World Bank classification to identify the socioeconomic influence on stroke mortality.

RESULTS

The result showed that ① From 2000 to 2021, the number of stroke deaths increased worldwide, but the AMSR due to stroke showed a downward trend; ② The spatial distribution of the global AMSR due to stroke varies across geographic regions. with the highest in Asia and southern Africa, and the lowest in Europe and North America; ③ The spatial pattern of hot and cold spots of AMSR due to stroke remained relatively stable from 2000 to 2021, with the greatest changes in Africa and Asia; ④ Generally, countries belong to higher economic groups have lower stroke mortality rate, and this pattern persisted throughout the study period.

CONCLUSIONS

Our findings provide evidence on spatial variations of stroke mortality worldwide over 20 years, and are informative on evidence-based allocation of medical resources globally.

CLINICAL TRIAL NUMBER

Not applicable.

Interaction of Triglyceride-Glucose Index and Metabolic Syndrome with Risk of Incident Stroke Among Middle-Aged and Older Chinese Adults

Objective

The triglyceride-glucose (TyG) index, a reliable surrogate marker of insulin resistance, has been shown as an independent risk factor for stroke. Still, the interaction between metabolic syndrome (MetS) and the TyG index in determining stroke risk remains to be clarified, which may help optimize stroke prevention strategies. This study aims to explore whether metabolic syndrome (MetS) influences the association between the TyG index and the risk of stroke.

Methods

A total of 7770 middle-aged and older participants free of stroke at baseline were enrolled from the China Health and Retirement Longitudinal Study. The TyG index was calculated as ln (triglyceride [mg/dL] × fasting glucose [mg/dL]/2). MetS was defined following the modified International Diabetes Federation criteria. The outcome was self-reported, physician-diagnosed, incident stroke during follow-up. Cox proportional hazard models were used to examine whether MetS influences the associations between the TyG index and the risk of incident stroke.

Results

A total of 568 (7.3%) incident stroke cases occurred after a median observation time of 7.0 years. After adjusting for potential confounders, a higher TyG level was associated with an increased risk of incident stroke (hazard ratio (HR) 1.19, 95% CI 1.05-1.33, P = 0.016). The association was significant in participants without MetS (HR 1.69, 95% CI 1.40-1.97, P < 0.001), but not in those with MetS (HR 1.05, 95% CI 0.88-1.21, P = 0.599). The interaction between the TyG index and MetS on the risk of incident stroke was significant (P = 0.004).

Conclusion

MetS influenced the association of the TyG index with the risk of incident stroke among middle-aged and older Chinese adults. The TyG index may be more effective for stroke risk stratification in populations without MetS compared to those with MetS.