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

Biliverdin alleviates cerebral ischemia-reperfusion injury by regulating the P4hb/MAPK/mTOR pathway to inhibit autophagy

BACKGROUND

Biliverdin (BV) exhibits anti-inflammatory and antioxidative effects. Autophagy activation is crucial in the pathogenesis of cerebral ischemia-reperfusion injury (CIRI). This study aimed to investigate whether BV could ameliorate CIRI by regulating autophagy.

METHODS

A middle cerebral artery occlusion-reperfusion (MCAO/R) model in Sprague-Dawley (SD) rats and an oxygen-glucose deprivation/reoxygenation (OGD/R) model in PC12 cells were employed to explore the neuroprotective effects of BV and its underlying mechanisms. In these rats, once BV was administered post-MCAO/R, its treatment efficacy and underlying mechanisms were evaluated through behavioral, morphological, and molecular analyses. Alternatively, for PC12 cells, following successful OGD/R modeling, BV, autophagy activator rapamycin, prolyl 4-hydroxylase beta (P4hb) knockdown or overexpression, and the specific inhibitors of three classic autophagy pathways were applied. Cell viability (using CCK8 assay), Calcein/PI staining, autophagosome staining (using MDC assay), reverse transcription quantitative polymerase chain reaction, and western blot were subsequently carried out to investigate the mechanisms by which BV ameliorates CIRI.

RESULTS

BV alleviated CIRI by inhibiting autophagy. Further investigation suggested that BV downregulated P4hb expression. In vitro experiments showed that P4hb knockdown reduced autophagy in post-CIRI cells, while its overexpression reversed the effects of BV. Rescue experiments indicated that MAPK pathway inhibitors counteracted the effects of P4hb overexpression on autophagy post-CIRI.

CONCLUSION

BV improves CIRI by regulating the P4hb/MAPK/mTOR signaling pathway to inhibit autophagy, offering a novel therapeutic strategy for ischemic stroke.

Impact of sodium butyrate on stroke-related intestinal injury in diabetic mice: Interference with Caspase-1/GSDMD pyroptosis pathway and preservation of intestinal barrier

Diabetic stroke-associated acute intestinal injury is characterized by high mortality, disability, and poor prognosis due to the lack of effective therapies. Our prior research demonstrated that administration of 300 mg/kg sodium butyrate (NaB) can improve neurological outcomes post-diabetic stroke. Nonetheless, whether the effect of NaB is related to intestinal regulation, along with its underlying mechanisms, remains uncertain. This study aims to investigate the effects and mechanistic pathways of NaB on diabetic stroke-associated acute intestinal injury. A middle cerebral artery occlusion/reperfusion model was established in mice with streptozotocin-induced diabetes. The results demonstrated that NaB alleviated colonic injury 24 h after reperfusion in diabetic stroke. Pyroptosis-related protein levels in colonic tissues were significantly elevated following diabetic stroke but were markedly reduced with NaB treatment. NaB also improved gut barrier integrity and reduced inflammation, promoting epithelial barrier self-repair. In the NaB combined with lipopolysaccharide group, lipopolysaccharide administration induced a significant inflammatory response in the colonic tissue. Conversely, treatment with NaB and VX-765 (an inhibitor for Caspase-1) led to a notable alleviation in intestinal inflammation. These findings suggest that NaB mitigates colonic injury and enhances barrier function following diabetic stroke, potentially through the Caspase-1/Gasdermin D pyroptosis pathway. This study may provide a novel strategy and direction for intestinal rehabilitation in diabetic stroke patients.

Effects of hyperbaric oxygen combined with Danhong injection on 90-day functional independence and the 1-year recurrence rate in patients with ischemic stroke: A matched cohort study

BACKGROUND

Both hyperbaric oxygen therapy and Danshen (Salvia miltiorrhiza) injection have shown potential therapeutic effects on ischemic stroke, but the impact of their combination on long-term functional outcomes and recurrence risk has not been systematically evaluated. This study aimed to assess the effects of hyperbaric oxygen combined with Danhong injection on 90-day functional independence and the 1-year recurrence rate in patients with ischaemic stroke.

METHODS

This study employed a retrospective matched cohort design and collected data from patients with ischemic stroke treated at our hospital between January 2018 and December 2022. After 1:1 propensity score matching, 80 patients were included in each group. The intervention group received hyperbaric oxygen therapy (2.0-2.5 ATA, once daily for 10 sessions) combined with Danhong injection (20 ml/day for 14 consecutive days) in addition to standard treatment; the control group received standard treatment only. The primary outcome was 90-day functional independence (mRS ≤2); secondary outcomes included the 1-year stroke recurrence rate, NIHSS score improvement, and others.

RESULTS

The percentage of 90-day functional independence in the intervention group (72.5 %) was significantly greater than that in the control group (53.8 %) (P = 0.014), with a relative risk ratio of 1.35 (95 % CI: 1.06-1.71). Multivariate analysis revealed that combined therapy was independently associated with 90-day functional independence (adjusted OR = 2.28, 95 % CI: 1.19-4.37; P = 0.013). The 1-year stroke recurrence rate in the intervention group (7.6 %) was significantly lower than that in the control group (16.5 %) (P = 0.042), with an adjusted hazard ratio of 0.46 (95 % CI: 0.22-0.94, P = 0.033). Subgroup analysis revealed that patients aged <65 years, those with NIHSS scores ranging from 4-15, those with small-artery occlusion or large-artery atherosclerosis stroke, and those who began treatment within 24 hours benefited more significantly. The combined therapy was well tolerated, with no serious adverse events.

CONCLUSION

Hyperbaric oxygen combined with Danhong injection significantly improved 90-day functional independence and reduced the 1-year recurrence risk in patients with ischaemic stroke, particularly in specific patient subgroups. This combined treatment strategy provides a new therapeutic option for comprehensive stroke management.

Tongfu Xingshen capsule alleviates stroke-associated pneumonia-induced multiple organ injuries by modulating the gut microbiota and sphingolipid metabolism

BACKGROUND

Stroke-associated pneumonia (SAP) represents a major complication and cause of death in patients suffering from intracerebral haemorrhage (ICH). It's urgent to develop more effective therapeutic strategies. Tongfu Xingshen capsule (TFXS) is a traditional Chinese medicine that has been utilised in clinical studies for the treatment of ICH and SAP, but the underlying mechanisms remain to be fully elucidated.

PURPOSE

This study aims to explore the therapeutic effects and mechanisms of TFXS on SAP using an aspiration-induced Klebsiella pneumoniae infection-complicating ICH rat model and an intratracheal injection of lipopolysaccharide (LPS)-induced acute lung injury-complicating ICH rat model.

METHODS

The chemical components of TFXS are characterised using ULPLC-Q Exactive-Orbitrap-MS. The therapeutic effects of TFXS are evaluated through neurological scoring, histopathology analysis, magnetic resonance imaging, immunofluorescence, Alcian blue-nuclear fast red staining, myeloperoxidase activity assessment, leukocyte counting, and ELISA. To investigate the underlying mechanisms, faecal microbiota transplantation, 16S rRNA sequencing, untargeted metabolomics, and Spearman correlation analyses are performed.

RESULTS

A total of 60 compounds are identified in TFXS. Pharmacological analysis reveals that TFXS significantly mitigates neurological deficits, enhances haematoma absorption, attenuates brain damage and neuroinflammation, and improves pneumonia and pulmonary injury by reducing the infiltration of leukocytes and lymphocytes, as well as suppressing the infiltration and overactivation of neutrophils. TFXS also alleviates intestinal lesions and barrier damage by increasing acidic mucins and the expression of the tight junction protein zonula occludens-1 (ZO-1). Mechanistically, TFXS ameliorates pneumonia and pulmonary injury in a gut microbiota-dependent manner. It reverses sphingolipid metabolism disorders and ceramide accumulation by modulating SAP-induced gut microbiota dysbiosis and enhancing the abundance of probiotics, including Lactobacillus, Allobaculum and Enterococcus.

CONCLUSION

TFXS exerts anti-inflammatory and protective effects on the brain, lung, and gut by alleviating gut microbiota dysbiosis and sphingolipid metabolism disorders. These findings highlight TFXS as a promising therapeutic candidate for the treatment of SAP.

Silibinin protects the ischemic brain in mice by exerting anti-apoptotic effects via the EGFR/ERK pathway

Apoptosis is a significant occurrence of cell death in the cerebral ischemia process, potentially revealing specific treatment points. Silibinin (SIL) has been proven to regulate a range of biological effects on inflammation, oxidative stress and apoptosis. Meanwhile, the epidermal growth factor receptor (EGFR) has been reported to impact cell apoptosis owing to its proliferative activity, which is in the opposite direction of apoptosis. This brings up the question of whether silibinin modulates apoptosis after cerebral ischemic injury and whether EGFR is involved in mediating this effect. We therefore examined the potential protective role of silibinin in ischemic brain and the underlying mechanisms. We assigned CD1 mice into groups and assessed neurological function via behavioral tests, infarct volume staining, and edema measurement. Neuronal vitality in the infarcted hemisphere was assessed using Nissl staining, while the level of apoptosis was evaluated by detecting cleaved Caspase-3, Bcl-2, and Bax. Penumbra vascular conditions were examined by immunofluorescence and two-photon imaging. Western Blot and immunohistochemistry detected EGFR/ERK level changes. An EGFR inhibitor was used to confirm the involvement of the EGFR/ERK pathway in the disease process. Our findings indicated that silibinin substantially diminished infarct volume and brain edema, reduced neuronal apoptosis following stroke, enhancing neurological function. These effects were accompanied by up-regulation of p-EGFR/EGFR, p-ERK/ERK, and Bcl-2, as well as down-regulation of Bax and cleaved-Caspase3 in ischemic brain tissue post-stroke, while inhibiting EGFR activation attenuated or reversed the anti-apoptotic effects of silibinin. We concluded that silibinin protected the brain after cerebral ischemia by exerting anti-apoptotic effects via the activation of EGFR/ERK signaling pathway.

Prediction of NIHSS Scores and Acute Ischemic Stroke Severity Using a Cross-attention Vision Transformer Model with Multimodal MRI

RATIONALE AND OBJECTIVES

This study aimed to develop and evaluate models for classifying the severity of neurological impairment in acute ischemic stroke (AIS) patients using multimodal MRI data.

METHODS

A retrospective cohort of 1227 AIS patients was collected and categorized into mild (NIHSS<5) and moderate-to-severe (NIHSS≥5) stroke groups based on NIHSS scores. Eight baseline models were constructed for performance comparison, including a clinical model, radiomics models using DWI or multiple MRI sequences, and deep learning (DL) models with varying fusion strategies (early fusion, later fusion, full cross-fusion, and DWI-centered cross-fusion). All DL models were based on the Vision Transformer (ViT) framework. Model performance was evaluated using metrics such as AUC and ACC, and robustness was assessed through subgroup analyses and visualization using Grad-CAM.

RESULTS

Among the eight models, the DL model using DWI as the primary sequence with cross-fusion of other MRI sequences (Model 8) achieved the best performance. In the test cohort, Model 8 demonstrated an AUC of 0.914, ACC of 0.830, and high specificity (0.818) and sensitivity (0.853). Subgroup analysis shows that model 8 is robust in most subgroups with no significant prediction difference (p > 0.05), and the AUC value consistently exceeds 0.900. A significant predictive difference was observed in the BMI group (p < 0.001). The results of external validation showed that the AUC values of the model 8 in center 2 and center 3 reached 0.910 and 0.912, respectively. Visualization using Grad-CAM emphasized the infarct core as the most critical region contributing to predictions, with consistent feature attention across DWI, T1WI, T2WI, and FLAIR sequences, further validating the interpretability of the model.

CONCLUSION

A ViT-based DL model with cross-modal fusion strategies provides a non-invasive and efficient tool for classifying AIS severity. Its robust performance across subgroups and interpretability make it a promising tool for personalized management and decision-making in clinical practice.

Design, synthesis and biological evaluation of 2-arylbenzo[b]furan-4-vinylcarbonyl derivatives based on Salvianolic acid C as antioxidant neuroprotective agents for the treatment of ischemic stroke

Ischemic stroke is a globally recognized disease characterized by high mortality and disability rates, with limited clinical treatment options available. The development of neuroprotective agents with antioxidant properties continues to be a focal point of current research. In this study, we designed and synthesized 42 derivatives using α, β-unsaturated carbonyl and 2-arylbenzo[b]furan in Salvianolic acid C as the core skeleton, and evaluated their biological activities. Among these, compound 6p demonstrated notable antioxidant neuroprotective activity and low cytotoxicity. Furthermore, it exhibited the most potent cell protective activity and ROS scavenging capacity in t-BHP-induced PC12 cells. In a rat model of ischemia-reperfusion injury, 6p was found to reduce ROS levels and neuronal apoptosis in brain tissue, enhance neurological function, and decrease the size of cerebral infarction in rats. Additionally, 6p promotes the nuclear translocation of NRF2 and elevates the expression of the antioxidant protein HO-1. Molecular docking results indicated that 6p can bind to key sites within KEAP1 complex. In conclusion, these findings suggest that compound 6p serves as a potential neuroprotective agent for the treatment of ischemic stroke.

Survey methods contributing to the difference of dentin hypersensitivity prevalence among publications between 1998 and 2022: a research-on-research study

BACKGROUND

The prevalence of dentin hypersensitivity (DH) differed significantly among previous reports, which may confuse clinicians and public health practitioners. This study aimed to identify which survey methods contributed to the difference in reported DH prevalence.

METHODS

A systematic search was performed in Medline, Embase, ProQuest, CNKI, and ClinicalTrial.gov databases up to November 2022. Two authors extracted the basic characteristics and survey methods independently. A random-effect meta-analysis was performed to estimate the effects of survey methods on estimated DH prevalence. The Newcastle-Ottawa Scale (NOS) was employed to appraise the methodological quality of the studies included in the analysis.

RESULTS

Thirty-nine studies were included. The average estimate of DH prevalence was 32% (95% CIs: 27 - 37%). The statistical heterogeneity was very high among studies (I2 = 99.7%, P < 0.001), especially in the field of survey methods. Variables were observed in sampling approaches, study settings, and inclusion criteria. Besides, clinical examination protocols and reporting of inter-examiner reliability remained inconsistent. Meta-regression analysis showed that the DH prevalence might be underestimated when the clinical examinations were conducted only for participants with positive subjective symptoms (P = 0.001). The included studies scored 5.74 ± 1.7 on the NOS, indicating relatively low methodological quality. The lower study quality was primarily attributed to insufficient elaboration on representativeness of the exposed cohort, comparability of cohorts on the basis of the design or analysis controlled for confounders, and follow-up procedures.

CONCLUSION

The included studies demonstrated substantial heterogeneity in survey methods. Conducting clinical examinations for all participants enhanced detection rates. The reliability of our pooled prevalence estimates was substantially compromised due to the studies' low methodological quality and high heterogeneity. It is recommended to propose the instructive detailed guideline to standardize the design and improve the quality of studies.

Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis

In this systematic review of randomized controlled trials, we examined the optimal blood pressure (BP) target for patients with prior stroke, comparing intensive BP control (systolic BP [SBP] <130 mmHg) with standard BP control (SBP < 140 mmHg). Literature searches of PubMed/MEDLINE, the Cochrane Database, and Ichu-shi identified seven randomized controlled trials for quantitative analysis. Meta-analyses were performed using random-effects models, with most included trials assessed as having low risks of bias. The meta-analysis showed significant reductions in recurrent stroke (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65-0.96) and major cardiovascular events (RR, 0.86; 95% CI, 0.76-0.97) in the intensive BP control arm. Intensive BP control was more effective in reducing recurrent hemorrhagic stroke (RR, 0.33; 95% CI, 0.15-0.74) than ischemic stroke (RR, 0.87; 95% CI, 0.71-1.08). However, adverse events such as syncope or dizziness were significantly more frequent in the intensive BP control arm (RR, 1.30; 95% CI, 1.00-1.68). Absolute risk reductions (per 1,000 persons) for recurrent stroke (-14; 95% CI, -24 to -4) and major cardiovascular events (-17; 95% CI, -28 to -6) outweighed the absolute increase in syncope or dizziness (4; 95% CI, 0-9). We recommend a lower SBP target of <130 mmHg, with careful monitoring for hypotension-related symptoms, to prevent recurrent stroke and major cardiovascular events in patients with prior stroke.

The impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels: A comprehensive analysis for the Global Burden of Disease Study 2021

BACKGROUND

We aim to estimate impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels METHODS: Utilizing standardized GBD methodologies, we conducted a comprehensive analysis of the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with stroke across 204 countries and regions spanning the periods from 1990 to 2019, 2019 to 2021, and 1990 to 2021. Our study provides detailed estimates accompanied by corresponding 95% uncertainty intervals (UIs), stratified by age and sex. To elucidate the temporal trends in stroke burden, we calculated the Estimated Annual Percentage Change (EAPC). Additionally, we explored the relationship between stroke burden and sociodemographic index (SDI) levels. The DALYs attributable to various risk factors for stroke were also analyzed. The burden of stroke in the next 20 years was also predicted.

RESULTS

From 2019 to 2021, the age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and DALYs rates for stroke remained stable, diverging from the declining trends observed from 1990 to 2019 and from 1990 to 2021 at global, regional, and national levels, as indicated by both percent change analysis and EAPC analysis. This pattern was similarly reflected in the global burden of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). The changes in the burden of stroke, ICH, and IS from 2019 to 2021 were consistent between males and females. Importantly, the impact of COVID-19 on stroke burden remains substantial, irrespective of variations in the SDI. The IS burden increased in the next 20 years, and more attention should be paid on the stroke burden in young people.

CONCLUSIONS

Throughout the COVID-19 pandemic, the burden of stroke exhibited a stable trajectory, in contrast to the declining trend observed from 1990 to 2019 and from 1990 to 2021. The increased burden was observed in IS and young people in the next 20 years. These observations highlight the disparities in stroke burden that exist across different levels of socioeconomic development. The longitudinal epidemiological data presented in this study provide valuable insights into the significant shifts brought about by the COVID-19 pandemic, offering crucial information for researchers, policymakers, healthcare professionals, and other stakeholders.

Activation of GPER1 alleviates white matter injury by promoting microglia M2 polarization through EGFR/Stat3 pathway in intracerebral hemorrhage mice

BACKGROUND

White matter injury (WMI) is a major pathophysiological process after intracerebral hemorrhage (ICH). G protein-coupled estrogen receptor 1 (GPER1) has been validated to exert a crucial role in regulating neuroinflammation and microglia polarization. Our previous report reveals activation of GPER1 improves the neurological deficits after ICH via inhibition of A1 astrocytes. However, the role of GPER1 on the protection of WMI and modulation of microglia polarization after ICH remains unclear.

METHODS

In present study, ICH mice model was induced by autologous whole blood injection and in vitro ICH model was established via treatment BV2 cells with FeSO4. Mice were treated with GPER1 agonist G1, antagonist G15 and BV2 cells were treated with G1, G15 or EGFR inhibitor AG1478. Besides, BV2 conditional medium was used to intervene MO3.13 oligodendrocytes. Immunostaining, immunoblots, transmission electron microscope and PI staining were used to determine the WMI, microglia polarization and potential molecular mechanism after ICH, respectively.

RESULTS

Our data showed treatment with G1 ameliorated the WMI on the day 3 after ICH. Besides, activation of GPER1 reduced the release of IL-1β, TNF-α and increased the produce of IL-4, IL-10 as well as shifting microglia from proinflammatory M1 to anti-inflammatory M2 phenotype in vivo and in vitro. Meanwhile, MO3.13 cells treated with BV2 conditional medium validated GPER1 alleviated oligodendrocytes death via mitigating neuroinflammation and modulating microglia polarization. Mechanistic study demonstrated EGFR/Stat3 signaling pathway was involved in the protection of WMI and modulation microglia polarization after ICH.

CONCLUSION

Collectively, our findings demonstrated activation of GPER1 alleviated WMI via modulating microglia M2 polarization after ICH through EGFR/Stat3 signaling pathway.

Validation of the Pangao PG-800B18 upper-arm blood pressure monitor according to the ISO 81060-2:2018+Amd 1:2020 protocol in the general population

OBJECTIVE

The study aimed to validate the Pangao PG-800B18 oscillometric upper-arm blood pressure monitor in the general population in accordance with the International Organization for Standardization (ISO) 81060-2:2018 and amendment (Amd) 1:2020 protocol.

METHODS

Participants were recruited, and the same left-arm sequential method was used for blood pressure measurement in accordance with the protocol. Data validation and analysis were performed according to the protocol, and the Bland-Altman scatter plot was used to show the difference between the test device and reference results.

RESULTS

A total of 86 participants were included in the validation analysis. For the validation criterion 1 of the protocol, the mean ± SD of the differences between the test device and reference readings was -1.21 ± 6.71 mmHg and -0.73 ± 5.83 mmHg for systolic (SBP) and diastolic blood pressure (DBP), respectively. Furthermore, the SD of the differences between the test device and reference readings per participant was 5.81 and 5.02 mmHg for SBP and DBP, fulfilling the criterion 2 with SD values of ≤6.95 for SBP and ≤5.89 for DBP.

CONCLUSION

The Pangao PG-800B18 upper-arm blood pressure monitor fulfilled the requirements of the ISO validation standard and can be recommended for clinical use and self-measurement in the general population.

Spot Sign in Intracerebral Hemorrhage: Critical Reappraisal and Future Clinical Implications

Hematoma expansion (HE) is a common occurrence affecting around 10% to 30% of patients with acute intracerebral hemorrhage within the initial hours from symptom onset and is the only modifiable factor associated with poor clinical outcomes. The detection of contrast extravasation on computed tomography (CT) angiography, known as the spot sign, was initially embraced as a promising radiological marker for predicting HE that could aid patient selection for acute interventions aimed at minimizing HE. However, the initial enthusiasm waned as clinical studies failed to show clear clinical benefits of hemostatic treatments when patients were selected based on the presence of this imaging marker. In this narrative review, we provide a comprehensive summary of the pathophysiology, definitions, imaging protocols, and predictive performance of the spot sign, along with the clinical studies that have selected and treated patients based on its presence. Finally, we delve into some nuances of the spot sign that can enhance its predictive performance and help stratify HE risk with greater precision. These features include static findings observed on single-phase CT angiography (ie, number, volume, CT density, and colocalization with hypodensities), as well as dynamic findings identified on multiphase/dynamic CT angiography (ie, timing of appearance, volume increase, volume decrease for tissue dispersion, and CT density changes). In this reappraisal of the spot sign, we aim to reinvigorate research on advanced neuroimaging in intracerebral hemorrhage that could lead to a more accurate HE prediction. This could facilitate better selection for therapies aimed at preventing HE or surgical approaches to address the bleeding source.

Tenecteplase versus alteplase in patients with acute ischemic stroke: An updated meta-analysis of randomized controlled trials

INTRODUCTION

Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. While alteplase has been widely used for acute management, recent clinical trials suggest that tenecteplase (TNK) may offer improved clinical outcomes. This study aims to compare the efficacy and safety of TNK compared with alteplase.

METHODS

A comprehensive literature search was conducted using PubMed, Embase and Cochrane Library from inception to October 2024 to identify randomized controlled trials that compared TNK at 0.25 mg/kg dosage with alteplase. Data about clinical outcomes was extracted from both groups and assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs).

RESULTS

A total of 11 RCTs with 7,546 patients were included in the analysis. TNK showed statistically significant improvement in excellent functional outcome (mRS 0-1) compared with alteplase (OR= 1.14, 95 % CI= 1.03-1.25). No statistically significant difference was observed for good functional outcome (mRS 0-2) (OR= 1.11, 95 % CI= 0.9-1.25), early neurological improvement (OR=1.08, 95 % CI= 0.93-1.26), all-cause death (OR=0.99, 95 % CI= 0.81-1.19), symptomatic intracranial hemorrhage (OR=1.11, 95 % CI=0.81-1.52) and poor functional outcome (mRS=4-6) (OR=0.95, 95 % CI=0.79-1.14).

CONCLUSION

In patients with acute ischemic stroke, TNK demonstrated a significant advantage over alteplase in achieving excellent functional outcomes. The incidence of early neurological improvement, symptomatic intracranial hemorrhage, all-cause death, and poor functional outcome remained comparable across the two groups.

Global trends, disparities, and future projections of ischemic stroke burden attributed to low-fiber diets: An analysis based on GBD 2021

OBJECTIVE

This study aims to analyze the disease burden attributed to ischemic stroke related to low-fiber diets (IFD-IS) from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) database to identify trends and influencing factors of the disease burden.

METHODS

We conducted a comprehensive analysis of the number of deaths, Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLLs), and Years Lost due to Disability (YLDs) associated with IFD-IS, covering various regions and populations. Statistical methods, including breakpoint regression, decomposition analysis, health inequality analysis, and forecasting analysis, were employed to assess trends and their correlation with the Sociodemographic Index (SDI).

RESULTS

The findings indicate that deaths, DALYs, YLLs, and YLDs related to IFD-IS have gradually increased globally, with a significantly higher burden in males compared to females. Notable regional disparities were observed, particularly with heavier burdens in China and sub-Saharan Africa. Higher SDI regions demonstrated better control over disease burdens, while aging and population growth were the primary factors contributing to the increase. Additionally, the trend of health inequality related to IFD-IS has slightly diminished, although it is projected that the disease burden will continue to rise by 2040.

CONCLUSION

This study underscores the necessity of implementing targeted public health interventions for IFD-IS, particularly in low SDI regions. Enhancing dietary education and resource allocation can significantly mitigate the rising trend of IFD-IS. Ongoing monitoring and research are crucial for formulating effective health policies to address this public health challenge.

Joint effect of modifiable risk factors and genetic susceptibility on ischaemic stroke

PURPOSE

To investigate the effects of modifiable risk factors and genetic susceptibility on ischaemic stroke (IS).

METHODS

A total of 490365 participants from the UK Biobank, with a 17-year follow-up, were included in this study. Data on 115 modifiable exposures were collected from five domains: early life, environment, lifestyle, socioeconomic status, and physical measures. Additionaly, genetic data were collected. An exposure-wide association analysis was conducted to identify potential risk factors. Risk scores for each domain and genes were calculated. The effect of each domain score on IS and the joint effects among the five domains were analyzed using multi-variate Cox models. The population attributable fraction was estimated to quantize the impact of eliminating unfavorable factors.

RESULTS

Sixty-four of the 115 modifiable exposures were found to be significantly associated with the risk of IS (P < 4.35 × 10-4 for Bonferroni correction). Newly identified factors included maternal smoking and being either overweight or underweight at age 10, which could significantly increase the risk of IS by 4.78 % to 14.74 %, 11.01 % to 23.75 %, and 3.29 % to 12.80 %, respectively. Additionally, exposure to hard water was associated with a decreased risk of IS by 6.96 % to 11.48 % compared to exposure to soft water. The associations varied across domains, with socioeconomic factors accounting for 5.2 % of IS cases, lifestyle accounting for 2.8 %, and physical measures accounting for 2.5 %, representing the top three contributing factors. Overall, it was estimated that 10.6 % to 11.3 % of IS cases could be prevented by eliminating the identified risks.

CONCLUSIONS

Interactions between risk factors and genetic susceptibility elevated the risk of IS. Risk factors from different domains contributed variably to IS, with socioeconomic factors accounting for the largest proportion.

Burden of smoking-related stroke in Saudi Arabia: trends from 1990 to 2021

BACKGROUND

Stroke ranks among the top causes of death and disability globally, with smoking being a significant risk factor for its development. This study aims to assess the impact of smoking-related strokes in Saudi Arabia from 1990 to 2021.

METHODS

The data was extracted from the Global Burden of Disease (GBD) 2021 database. We assessed the burden of smoking-related stroke by estimating the age-standardized rate (ASR) of years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs) and deaths related to this disease.

RESULTS

From 1990 to 2021, there was a respective 22.37% and 24.15% absolute decrease in the ASR of DALYs and ASR of YLLs, with average annual percentage changes (AAPCs) of -0.85 (-0.88, -0.83) and -0.92 (-0.94, -0.89) attributable to smoking-related stroke in Saudi Arabia. The ASR of death fell absolutely by 28.48%, with AAPC of -1.08 (-1.11, -1.05) between 1990 and 2021. In contrast, the ASR of YLDs absolutely increased by 5.17% during the same period, with an APCC of 0.15 (0.14, 0.17). Further, the decline in AAPCs of ASR of DALYs (-1.99), ASR of YLLs (-1.79), and ASR of deaths (-1.90) was primarily influenced by the reduction in the female population, p < 0.001, except ASR of YLDs, where the increase in the AAPC was attributed to a rise in the male population, p < 0.001. In 2021, YLLs contributed 93% (157.81/179.02) of total DALYs from smoking-related strokes in Saudi Arabia. Death rates rose in all age groups in 2021, with the most significant increases seen in the younger and middle-aged groups (30-59 years).

CONCLUSION

While the rates of deaths, DALYs, and YLLs attributable to smoking-related stroke decreased in Saudi Arabia between 1990 and 2021, YLDs significantly increased, mainly in males during the same period. This emphasizes the need for targeted intervention focused mainly on the younger and middle-aged males.

The relationship between CALLY index and stroke in hypertensive patients: insights from NHANES

Background

At present, stroke ranks as the third leading cause of mortality, and hypertension is a major risk factor for stroke. Complementary assessment of inflammation level, immunity, and nutritional status is now possible using the newly developed C-reactive protein-albumin-lymphocyte (CALLY) index biomarker. One key concern in this study is that its correlation with the risk of stroke in individuals with hypertensiveness.

Methods

In this study, we used cross-sectional analyses from the National Health and Nutrition Examination Survey (NHANES) database through 2003 to 2010. The CALLY index was calculated by albumin and lymphocytes divided by C-reactive protein (CRP). In order to further analysis, the CALLY index was log-transformed to increase data normality and lessen the impact of extreme values on the analytical findings. We investigated the odds ratios and confidence intervals of the ln CALLY index and its components in connection to stroke in people with hypertension. A weighted multivariable logistic regression model was carried out. Additionally, we used weighted restricted cubic splines (RCS) and subgroup analyses to further examine the association between the CALLY index and stroke prevalence in hypertensive individuals.

Results

This study included 8,146 hypertensive participants, of whom 616 hypertensive participants had a stroke. In unadjusted modeling, we found a 39% reduction in the incidence of stroke in the hypertensive population in the highest ln CALLY quartile group (OR 0.61, 95% CI 0.46-0.82), and the negative association remained significant after adjustment for confounders. While ALB showed a robust protective impact in hypertensive people, with greater ALB levels linked to a decreased risk of stroke (OR 0.50, 95% CI 0.37-0.68), we also discovered a positive correlation between CRP and stroke risk (OR 1.13, 95% CI 1.04-1.22). A substantial correlation between the ln CALLY index and stroke risk in hypertensive individuals was also validated by subgroup analysis. The ln CALLY index and stroke risk in this sample also showed a strong linear negative connection, according to weighted restricted cubic spline (RCS) analysis.

Conclusion

There is a significant negative association between the CALLY index and stroke risk in hypertensive patients in the U.S. adults. The CALLY index may be a potential indicator for early identification of individuals at higher risk of stroke in hypertensive patients and provide potential for clinical intervention.

Residual Risk of Recurrent Stroke Despite Anticoagulation in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

Importance

Atrial fibrillation (AF) is a leading cause of stroke, and oral anticoagulants (OAC) reduce this risk. However, there are limited data on the residual risk of recurrent stroke in patients with AF.

Objective

To determine the recurrent stroke risk in patients with AF by performing a systematic review and meta-analysis.

Data Sources

Eligible studies were identified by searching Ovid MEDLINE and Embase from inception (Ovid: January 1946; Embase: January 1970) until January 2025.

Study Selection

Eligible studies enrolled patients with prior ischemic stroke and AF, reported information on incidence of recurrent stroke, and had follow-up data for 1 or more years. Three reviewers independently screened abstracts and performed full-text reviews.

Data Extraction and Synthesis

Data extraction was performed by 2 reviewers and independently verified by a third. Incidence rates were pooled using random-effects meta-analysis. Analysis was repeated in patients whose qualifying event occurred despite OAC. Study quality was assessed using the Quality In Prognosis Studies tool.

Main Outcomes and Measures

The primary outcome was recurrent ischemic stroke. The secondary outcomes were any recurrent stroke (ischemic stroke or intra-cerebral hemorrhage [ICH]) and ICH during follow-up.

Results

A total of 23 studies were identified, which included 78 733 patients and 140 307 years of follow-up. The median proportion of OAC use across studies was 92%. The pooled incidence of recurrent ischemic stroke was 3.75% per year (95% CI, 3.17%-4.33%). The risk was higher in noninterventional observational cohorts (4.20% per year; 95% CI, 3.41%-4.99%) compared with randomized clinical trials (2.26% per year; 95% CI, 1.96%-2.57%) (P value for interaction <.001). The risk of any recurrent stroke was 4.88% per year (95% CI, 3.87%-5.90%), and the risk of ICH was 0.58% per year (95% CI, 0.43%-0.73%). In patients with stroke despite OAC, the risk was 7.20% per year (95% CI, 5.05%-9.34%) for ischemic stroke, 8.96% per year (95% CI, 8.25%-9.67%) for any stroke, and 1.40% per year (95% CI, 0.40%-2.40%) for ICH.

Conclusions and Relevance

In this systematic review and meta-analysis, even with modern prevention therapy, the residual recurrence risk after AF-related stroke is high, with an estimated 1 in 6 patients experiencing a recurrent ischemic stroke at 5 years. These data demonstrate an urgent need to improve our understanding of the biological processes responsible for recurrence, improve risk stratification, and develop new secondary prevention strategies after AF-related stroke.

Genetic Risk Scores in Stroke Research and Care

Stroke remains a leading cause of death and disability worldwide. While well-established risk factors play a major role, genetic predisposition is a crucial determinant of stroke susceptibility, with heritability estimates up to 39% for ischemic stroke and 29% for intracerebral hemorrhage. Advances in next-generation sequencing and genome-wide association studies have identified numerous genetic loci associated with stroke risk, paving the way for the development of genetic risk scores. These scores aggregate information from multiple genetic variants to estimate an individual's stroke risk, offering a promising tool for personalized risk stratification that complements traditional clinical models. While GRSs have demonstrated strong predictive potential for primary stroke events in population-based settings, their integration into clinical practice remains limited. Emerging evidence suggests that GRSs could add value in clinical decision-making, for instance, for stratifying ischemic stroke risk in patients with atrial fibrillation, assessing intracerebral hemorrhage risk in anticoagulant users, and predicting vascular risk factor control in stroke survivors. The incorporation of GRSs with multiomics data and machine learning may further refine risk assessment, driving personalized prevention strategies for both primary and secondary stroke preventions. A major challenge is the limited applicability of GRS across diverse populations, as most genome-wide association studies have been conducted in individuals of European ancestry. Addressing this limitation is critical for ensuring equitable and effective implementation of GRSs in clinical settings. As methodologies continue to evolve, integrating GRS into stroke research could significantly enhance risk assessment and support precision medicine approaches tailored to individual patients.

Global, regional, and national burden of female infertility and trends from 1990 to 2021 with projections to 2050 based on the GBD 2021 analysis

Female infertility represents a significant reproductive health issue that critically affects global fertility rates. In this study, we utilized the most recent data from the Global Burden of Disease (GBD) study 2021. Initially, we assessed the global burden by the number of female infertility prevalence and disability-adjusted life years (DALYs), along with the age-standardized rate (ASR) per 100,000 individuals, stratified by age, sociodemographic index (SDI), nationality, and region. Furthermore, linear regression models were employed to examine the temporal trends of disease burden from 1990 to 2021. Cluster analysis facilitated the evaluation of disease burden change patterns across different GBD regions. Lastly, the autoregressive composite moving average model was applied to forecast future disease burdens. In 2021, the global prevalence of female infertility was estimated at 110,089,459, contributing to 6,210,145 DALYs, there was an observed increase of 84.44% in prevalence and 84.43% in DALYs since 1990. The highest burden occurred among individuals aged 35-39, with the most rapid increase observed in the 30-34 age group. The burden of female infertility displayed considerable variability across GBD regions and countries, with areas of high-medium SDI facing elevated risks. Projections indicate a continuing rise in the ASR of prevalence and DALYs for female infertility over the next 2 decades. The global burden of female infertility has intensified from 1990 to 2021, with notable disparities across different SDI regions and countries. Women aged 35-39 face the highest risk, and there is a trend toward earlier onset of infertility.

Prevalence and patterns of comorbidities in individuals with epilepsy: A nationwide analysis using colombian healthcare registry data

INTRODUCTION

Epilepsy is a multifaceted neurological disorder that extends beyond seizure episodes, with substantial comorbidities impacting patients' quality of life. This study quantifies the burden and association patterns of epilepsy-related comorbidities in the Colombian population.

METHODS

This descriptive, cross-sectional study analyzed data from the nationwide Colombian healthcare registry (RIPS) from 2019 to 2023. We estimated the prevalence of epilepsy and selected comorbidities including neurological conditions (migraine, multiple sclerosis, stroke, Alzheimer's disease in individuals 65+), psychiatric disorders (depression, major depression, anxiety, schizophrenia), trauma (general and head trauma), and infectious diseases (HIV, neurocysticercosis). Prevalence ratios (PRs) were calculated comparing individuals with epilepsy to those without, with stratification by sex and age groups. Chi-squared tests were conducted to assess statistical significance of differences in prevalence, with p < 0.05 considered significant.

RESULTS

Among 53,785,138 individuals in the Colombian healthcare system, 461,118 were diagnosed with epilepsy (prevalence 8.57 per 1000), with the highest prevalence in older adults (11.37 per 1000 in ages 65+). Neurological comorbidities were common, with migraine present in 6.86 % of epilepsy patients versus 3.89 % in the general population (p < 0.001), multiple sclerosis in 0.152 % versus 0.021 % (p < 0.001), and stroke in 6.04 % versus 0.75 % (p < 0.001). Among psychiatric conditions, depression affected 5.84 % of epilepsy patients compared to 1.87 % in the general population (p < 0.001), while schizophrenia was diagnosed in 4.13 % of epilepsy patients versus 0.41 % in the general population (p < 0.001). Trauma was present in 25.0 % of epilepsy patients compared to 16.4 % generally (p < 0.001), with head trauma specifically in 7.1 % versus 2.5 % (p < 0.001). Neurocysticercosis, though rare overall (0.0064 % in general population), was notably more prevalent in epilepsy patients (0.289 %, p < 0.001). Significant sex differences were observed, with females showing higher prevalence of migraine (9.82 % vs 3.89 % in males) and depression (7.33 % vs 4.34 %) within the epilepsy population, while males had higher rates of schizophrenia (4.81 % vs 3.46 %) and head trauma (8.93 % vs 5.32 %).

CONCLUSION

This study provides critical insights into the burden of epilepsy-related comorbidities in Colombia, highlighting the importance of targeted interventions. The substantial comorbidity burden demonstrated across neurological, psychiatric, traumatic, and infectious domains underscores the importance of interdisciplinary, patient-centered care approaches that extend beyond seizure control. By addressing these comorbidities through integrated care models, clinicians can significantly improve both health outcomes and quality of life for people living with epilepsy.

Associations between dietary index for gut microbiota and stroke, and the mediating role of inflammation: a prospective cohort study

Background: There has been a growing focus on the link between diet, gut microbiota, and stroke. The dietary index for gut microbiota (DI-GM), a novel indicator reflecting the effect of diet on gut microbiota diversity, has not been extensively studied in relation to stroke. This study aimed to examine the association between DI-GM and stroke, and to explore the potential mediating role of inflammatory biomarkers. Methods: We included 124 943 participants from the UK Biobank without stroke at baseline. The DI-GM was calculated using 24-hour dietary assessments. Cox proportional hazard models were employed to analyze the longitudinal associations of DI-GM with stroke and its subtypes. Restricted cubic spline (RCS) and subgroup analyses were also performed. Additionally, mediation analyses were conducted to explore the potential mediating role of inflammatory biomarkers between DI-GM and stroke risk. Results: During a median follow-up of 11.08 years, 3741 participants experienced a stroke, including 1626 ischemic strokes and 536 hemorrhagic strokes. After adjusting for covariates in the main model, higher DI-GM was significantly associated with reduced risks of stroke (HR = 0.97, 95% CI, 0.95-0.99, P < 0.001) and ischemic stroke (HR = 0.96, 95% CI, 0.94-0.99, P = 0.008), but not hemorrhagic stroke. No significant non-linear association was observed in the RCS analysis. Mediation analyses indicated that inflammatory biomarkers, including C-reactive protein, neutrophils, monocytes, leukocytes, neutrophil-to-lymphocyte ratio, and INFLA-score, partially mediated the association, accounting for 2.82% to 10.40% of the total effect. Conclusions: Higher DI-GM was associated with a reduced risk of stroke, particularly ischemic stroke. This protective association may be partially mediated by reductions in serum inflammatory biomarkers.

Global burden of motor neuron disease: unraveling socioeconomic disparities, aging dynamics, and divergent future trajectories (1990-2040)

BACKGROUND AND OBJECTIVES

Motor neuron disease (MND) is a progressive neurodegenerative disorder associated with high morbidity and mortality. With global aging, the burden of MND is expected to increase, particularly in regions with rapidly aging populations. This study utilizes Global Burden of Disease (GBD) 2021 data to assess the global and regional MND burden from 1990 to 2021, examining trends by age, sex, and socio-demographic index (SDI), and projecting future trends to 2040.

METHODS

Data from the GBD 2021 database for the years 1990-2021 were analyzed to evaluate age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and disability-adjusted life years (DALYs) for MND across SDI regions, age groups, and sexes. Temporal trends were explored using joinpoint regression analysis, while future projections were generated using the Bayesian age-period-cohort (BAPC) model for 2021-2040.

RESULTS

From 1990 to 2021, global MND prevalence increased by 68.43%, reaching 272,732 cases, while the age-standardized prevalence rate (ASPR) slightly declined, reflecting the influence of population aging. Although global incidence increased by 74.54%, the age-standardized incidence rate (ASIR) showed a modest decline, suggesting improvements in diagnostic practices. Mortality and DALY rates continued to rise globally, with high-SDI regions bearing the highest burden. Projections indicate that by 2040, global MND prevalence will decline slightly, while incidence, mortality, and DALYs will continue to rise in low- and middle-SDI regions due to aging populations.

DISCUSSION

The global MND burden is heavily influenced by aging, particularly in high-SDI regions. Although incidence rates have slightly decreased, mortality and disability burdens are increasing, highlighting ongoing challenges in disease management and treatment. The findings stress the importance of age-targeted interventions, improving healthcare access, and addressing socio-economic disparities to mitigate the future impact of MND, particularly in low- and middle-SDI regions.

Prevalence of Stroke in Spain and Its Impact on Quality of Life: Socioeconomic Inequalities and Access to Rehabilitation

Stroke is a cerebrovascular syndrome due to a sudden interruption of blood flow to the brain that causes transient or permanent damage. Despite advances in the field of medical science, stroke is still common and continues to have a significant effect on quality of life.

OBJECTIVE

The objective of the study was to analyze the prevalence of strokes in Spain, considering differences in sociodemographic factors, functional limitations, and access to rehabilitation, with special attention to sex-related disparities.

METHODOLOGY

A cross-sectional study was conducted using data from the latest European Health Survey in Spain carried out between 2019 and 2020 on a total of 22,072 people. Individuals over 16 years of age with a medical diagnosis of stroke were selected for this study. Sociodemographic variables, self-perception of health, limitations in daily activities, level of physical activity, and access to rehabilitation treatment were analyzed. Descriptive measures and inferential tests were applied for statistical analysis.

RESULTS

The prevalence of strokes occurring in Spain was estimated at 2.02%, which is lower than European figures. Men tend to have strokes at younger ages (50% between 36 and 73 years), while women report a poorer quality of life after the incident. Most patients had not received rehabilitation services in the last year.

CONCLUSIONS

Given the aging population, it is essential to reinforce prevention, early detection and rehabilitation therapies to improve quality of life and reduce the burden of care.

Global burden of ischemic stroke in adults aged 60 years and older from 1990 to 2021: Population-based study

BACKGROUND

Ischemic stroke is an important public health problem. However, comprehensive data on its burden in aging populations is limited. The aim of this study is to provide an up-to-date assessment of the prevalence, incidence, mortality, disability-adjusted life years, and risk factors for ischemic stroke globally in adults aged 60 years and older from 1990 to 2021 based on population changes.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 served as the data source for this study. Average annual percentage changes were estimated over the study period to quantify temporal patterns and assess trends in age-standardized rates of the prevalence, incidence, mortality, and disability-adjusted life-years of ischemic stroke.

RESULTS

The significant increase in the prevalence and incidence of ischemic stroke is mainly related to population ageing and the significant increase in the number of people over 60 years of age, with the significant increase in the population over 60 years of age being the main driving force, while epidemiological changes have had the opposite effect. Critically, using the entire age population for calculations will prompt us to underestimate the burden of ischemic stroke. The burden of ischemic stroke disease is highest in older men than in older women, and the age-standardized prevalence rates, incidence rates, mortality rates, and disability-adjusted life-years rates are 26-35% higher in men than in women. High-middle sociodemographic index and Sub-Saharan Africa regions suffer the heaviest burden. Ischemic stroke health inequities widen, with less developed regions bearing a heavier ischemic stroke burden and the disparity in that burden becoming more pronounced over time.

CONCLUSION

Population aging is the primary driver of the growing burden of ischemic stroke. Our findings indicate that prevention and control of this disease remain critical public health challenges. Targeted interventions addressing modifiable risk factors could significantly reduce the global burden of ischemic stroke.

Switch to tenecteplase for intravenous thrombolysis in stroke patients: experience from a German high-volume stroke center

BACKGROUND

Tenecteplase (TNK) offers promising efficacy and safety data for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) and pharmacological advantages over alteplase (rt-PA), justifying its gradual adoption as primary thrombolytic agent. At our tertiary care center, we transitioned from rt-PA to TNK, providing valuable real-world insights into this process, including its use beyond the 4.5-hour time window.

METHODS

We retrospectively analyzed our stroke registry to compare clinical and procedural data from AIS patients treated with rt-PA (up to 6 months before transition) and those treated with TNK (up to 6 months after transition, starting June 2024). Primary endpoints included treatment metrics, such as door-to-needle (DTN), door-to-imaging (DTI), imaging-to-needle (ITN), door-to-groin and door-to-recanalization times. Safety outcomes comprised rate of any intracranial hemorrhage (ICH), symptomatic ICH (sICH), parenchymatous hematoma type 2 (PH 2) and post-thrombolysis angioedema. A semiquantitative questionnaire evaluated satisfaction with TNK and changes in lysis behavior among nurses and physicians 3 months post-implementation.

RESULTS

During the twelve-month period (December 1, 2023 - November 30, 2024), 276 patients underwent IVT. Median DTN times were significantly shorter with TNK (n = 138) compared to rt-PA (n = 138) (TNK 27 min [IQR 19-39] vs. rt-PA 34 min [IQR 25-62]; p = 0.011). No significant differences were observed in safety outcomes, including any ICH (TNK 9% vs. rt-PA 6%; p = 0.30), sICH (2% vs. 1%; p = 0.31), PH 2 rates (1% in both groups), or angioedema (3% vs. 1%; p = 0.18). Staff satisfaction with TNK was high, citing advantages in preparation, administration, and time efficiency. Importantly, no changes in lysis behavior were reported following the transition.

CONCLUSIONS

Transitioning to TNK in routine practice at a tertiary care center seems feasible with reduced ITN and consequently DTN times. Functional outcomes at discharge were comparable without significant difference in the rate of (s)ICH. Overall, the transition to TNK was well-received by medical staff, highlighting TNK's practical advantages in acute stroke care.

TRIAL REGISTRATION

N.A.

Profiling 92 circulating neurobiological proteins identifies novel candidate biomarkers of long-term cognitive outcome after ischemic stroke

The biological underpinnings of post-stroke cognitive function are largely unknown, and protein investigations can point towards important pathways for further study. We profiled plasma levels of 91 neurology-related proteins (Olink Neurology panel) and serum Neurofilament light chain (NfL) levels in 205 cases in the Sahlgrenska Academy Study on Ischemic Stroke. Blood was sampled in the acute and convalescent (3 months post-stroke) phase. Cognitive outcome was evaluated by the Barrow Neurological Institute Screen for Higher Cerebral Functions 7 years post-stroke. In linear regression models, 6 and 5 proteins in the acute and convalescent phase, respectively, were univariably associated with cognitive outcome at False Discovery Rate (FDR) < 0.05, and 9 and 8 at p < 0.05 after adjustment for age, sex, education and sampling day (model 1) and/or additional adjustment for stroke severity (model 2). Of these, 15 proteins contributed with information in multi-protein models on at least one time-point. These included brain-expressed proteoglycans (NCAN, BCAN, GPC5, SPOCK1); contactin-5 (CNTN5); metabolic enzymes (HAGH, NMNAT1); cluster of differentiation (CD)-proteins (SIGLEC1, CLEC10A, CD200R1); GDNF family receptor alpha-1 (GFR-alpha-1); brorin (VWC2); beta-nerve growth factor (beta-NGF); myostatin (GDF-8); and NfL. We identified novel candidate protein biomarkers of post-stroke cognitive outcome that likely reflect different biological processes, warranting further exploration.

Trends, levels, and projections of Head and Neck Cancer in China between 2000 and 2021: Findings from the Global Burden of Disease 2021

Head and neck cancer (HNC), a condition that is both disfiguring and potentially fatal, has become a critical public health challenge. This study seeks to evaluate the trends in HNC burden and predict its future trajectory in China. Utilizing data from the 2021 Global Burden of Disease database, we focused on the incidence, mortality, and disability-adjusted life years related to lip and oral cavity, nasopharyngeal, and laryngeal cancers within the country. We analyzed changes in incidence and mortality rates using the estimated annual percentage change, age-period-cohort (APC) analysis, and decomposition analysis. Additionally, an Autoregressive Integrated Moving Average model was employed to forecast the future burden of HNC. In 2021, China's incidence rates for lip and oral cavity, nasopharyngeal, and laryngeal cancers were higher than those in 40.98%, 98.05%, and 50.73% of countries worldwide, respectively. The burden of HNC increases significantly with age, particularly among men. The APC analysis indicates a rising incidence of HNC among younger adults. Decomposition analysis comparing 2021-2019 highlighted that ASIR and aging were the primary factors influencing the number of cases and deaths. Projections indicate that the burden of HNC in China is expected to continue rising. To combat this growing issue, it is imperative to enhance public health strategies that focus on prevention, early detection, and efficient resource allocation.

Nomogram Prediction of Prognosis After Surgical Operation for Cerebral Hemorrhage

OBJECTIVE

This study aimed to investigate the risk factors for intensive care unit (ICU) mortality in patients with intracerebral hemorrhage after surgery and to construct a clinical nomogram.

METHODS

The data in this retrospetive analysis were acquired from the Medical Information Mart for Intensive Care IV database, and the study controls were randomly divided into training and validation subsets in a ratio of 7:3. The primary clinical endpoint was all-cause ICU mortality. The prediction model was developed and a nomogram was generated based on findings of the logistic regression and least absolute shrinkage and selection operator regression analyses. Receiver operating characteristic curve was employed to assess model performance, and decision curve analysis was used to assess the clinical utility of the nomogram.

RESULTS

This retrospective study comprised 859 participants, of whom 757 were survivors and 102 were nonsurvivors. The results showed that red cell distribution width (P = 0.014), Glucose (P < 0.001), mechanical ventilation ≥48 hours (P < 0.001), acute respiratory failure (P = 0.019), and Sequential Organ Failure Assessment (P = 0.017) were independent risk factors for death after intracerebral hemorrhage surgery. The results of the nomogram showed that blood glucose and red cell distribution width had the greatest impact on prognosis. The nomogram demonstrated strong discriminating for all-cause mortality in the ICU and showed a positive net benefit across a broad spectrum of threshold probabilities.

CONCLUSIONS

For patients with severe cerebral hemorrhage after craniotomy, we developed a distinctive nomogram model to forecast all-cause mortality in the critical care unit. It can simply and intuitively display the risk of poor prognosis for patients, providing clinicians with an important treatment tool for individualized treatment and outcome forecasting.

Post-stroke cognitive impairment and dementia research in Southeast Asia: A scoping review

INTRODUCTION

The incidence of stroke remains high in Southeast Asia (SEA), according to the 2021 Global Burden of Disease study. Stroke can lead to cognitive impairments and dementia, highlighting the need for evidence-based management.

AIM

To chart the research on post-stroke cognitive impairment and dementia (PSCID) in SEA.

METHODS

The review was conducted and reported using the PRISMA-ScR. A comprehensive search was performed across six databases: CINAHL, Scopus, Embase, PubMed, Web of Science, and APA PsycINFO. The last search date was September 15, 2024.

RESULTS

9118 references were identified, and 103 articles (from 78 studies) published between 1992 and 2024 were included. Singapore contributed 42 articles, followed by Indonesia with 28, Malaysia with 17 and Thailand with 15. 35 articles each were from cohort and cross-sectional studies, and 13 were case-control design articles. In Indonesia, the prevalence of post-stroke cognitive impairment (PSCI) ranged from 27.6 % to 81.2 %. In Malaysia, it was between 21.6 % and 76 %; in Singapore, it varied from 12 % to 57.2 %; and in Thailand, between 50.3 % and 55 %. The prevalence of post-troke dementia varied between 2.8 % and 48.4 % in the sources. The most risk factors associated with PSCID included increasing age and low levels of education. Mixed findings on the effectiveness of the limited management strategies for PSCI were reported. The region lacks research from low- and lower-middle-income countries (LLMICs). Moreover, thorough research on how PSCID affects survivors' quality of life (QoL) is deficient.

CONCLUSION

PSCID is common in SEA, requiring urgent interventions for improved QoL for survivors. More research focusing on low- and middle-income countries is needed.

Stroke incidence, trends, and geographic disparities in Ghana: An analysis of nationwide health facility records

OBJECTIVES

Despite the increasing burden of stroke and its effects in sub-Saharan Africa, there is a paucity of empirical studies on the burden of stroke and its risk factors to help guide targeted interventions in the region. This study examines the incidence, trends and some factors associated with stroke cases in Ghana.

STUDY DESIGN

Retrospective analysis of observational routinely collected data.

METHODS

Empirical data of confirmed stroke cases from all government-affiliated healthcare facilities were extracted from the District Health Information Management Systems of the Ghana Health Service spanning 2016-2021. Variables include stroke case counts by sex, age group and location. Cartographic geospatial mapping of stroke case density and negative binomial regressions were employed to assess trends and factors associated with stroke.

RESULTS

Stroke cases increased by more than two-fold in just six years (from 10,732 to 23,009). The rates for people 35-59years (IRR = 5.06, 95% CI: 4.04-6.63) and those above 60 years (IRR = 6.29, 95% CI: 5.01-7.88) were 5 and 6 times higher compared with 0-35year old. The rate of stroke in the year 2021 was 61 % higher than in 2016 (IRR = 1.61, 95% CI: 1.18-2.21). People in the northern savannah ecological zone had 77 % lower rate of stroke compared with those in the coastal zone of Ghana (IRR = 0.23, 95% CI: 0.18-0.30).

CONCLUSIONS

The incidence of stroke in Ghana is rising across all age groups, sexes and locations with a trajectory of early onset within the life course. There is an urgent need for the implementation of public health interventions for early detection, prevention and management of stroke cases in the country.

Enhancing readmission prediction model in older stroke patients by integrating insight from readiness for hospital discharge: Prospective cohort study

BACKGROUND

The 30-day hospital readmission rate is a key indicator of healthcare quality and system efficiency. This study aimed to develop machine-learning (ML) models to predict unplanned 30-day readmissions in older patients with ischemic stroke (IS) using a prospective cohort design.

METHODS

Patients were divided into two datasets: dataset I (January 2020-December 2021) for model development and dataset II (January 2022-December 2023) for validation. A diffusion model was applied to address data imbalance. Eleven machine-learning methods, including Random Forest (RF), Logistic Regression, CatBoost, eXtreme Gradient Boosting Light Gradient Boosting Machine, K-Nearest Neighbors Support Vector Machine, Multi-Layer Perceptron, and Gaussian Naive Bayes, and 2 ensemble learning models, were constructed to predict readmissions. Bayesian optimization was used to fine-tune the hyperparameters of these models. Model performance was primarily evaluated using the area under the receiver operating characteristic curve (AUC). Shapley Additive Explanations (SHAP) were utilized to identify and interpret the significance of predictive variables.

RESULTS

Dataset I included 489 patients, while dataset II comprised 418 patients, with readmission rates of 15.3 % and 16.0 %, respectively. The RF model achieved the highest predictive performance (AUC = 0.9116, sensitivity = 0.8806, specificity = 0.7806). SHAP analysis identified readiness for hospital discharge as the most significant predictor of readmission.

CONCLUSION

The RF model shows promise for predicting unplanned 30-day readmissions in older patients with IS. Multi-center studies with larger sample sizes are needed to validate these findings.

Chewing habits and masticatory performance are associated with obesity in 9- to 10-year-old children: A cross-sectional study from the Osaka MELON Study

OBJECTIVES

This study aimed to examine the relationships of masticatory performance and chewing habits with obesity in Japanese elementary school children.

METHODS

The participants were 1,403 children aged 9-10 years in Osaka City. Chewing habits were assessed via questionnaires, and masticatory performance was measured using a color-changeable chewing gum. Obesity was determined by the percentage of overweight based on height and weight. Multivariate logistic regression analyses were conducted to calculate odds ratios for obesity, using chewing habits and masticatory performance as explanatory variables, adjusted for sex, DMFT index, and Hellman dental developmental stage.

RESULTS

Logistic regression analysis showed significant associations between obesity and sex, eating fast, and lower masticatory performance in all participants (OR=1.54, 1.73, 1.50; 95 %CI=1.08-2.17, 1.23-2.44, 1.05-2.15, respectively). In boys, eating fast, eating with mouth full, and lower masticatory performance were significantly associated with obesity (OR=1.84, 1.59, 1.63; 95 %CI=1.16-2.92, 1.03-2.46, 1.02-2.59, respectively). No variable was significantly associated in girls. When eating fast and lower masticatory performance were combined, it was significantly associated with obesity, with the strongest odds ratio observed in boys exhibiting both behaviors (OR=3.00, 95 %CI=1.49-6.07).

CONCLUSIONS

In 9- to 10-year-old children, eating fast, eating with mouth full, and lower masticatory performance were linked to obesity, particularly in boys. Furthermore, the association with obesity was higher when eating fast and lower masticatory performance were combined.

CLINICAL SIGNIFICANCE

To prevent obesity in schoolchildren, approaching the problem not only from the habitual aspect of eating fast, but also from the functional aspect of lower masticatory performance is necessary.

Are Assistive Technologies Effective in the Management of Contractures in People with Stroke? - A Cochrane Review Summary with Commentary

BackgroundPatients who have had a stroke are at risk of contractures, a shortening of muscles and other soft tissues. Muscle stretching, manually or delivered by other means, is a common strategy to manage contractures following stroke. A Cochrane Review by Mohammed Meeran et al. has investigated the effectiveness of assistive technology defined as a mechanical, electrical, or electromechanical device used to stretch or lengthen a muscle statically, dynamically, or cyclically for preventing or reducing contractures.ObjectiveTo summarize the Cochrane Review by Mohammed Meeran et al. and comment on it from a rehabilitation perspective.MethodsThe Cochrane Review authors identified randomised controlled studies (RCTs) which investigated the use of electrical, mechanical, or electromechanical devices to manage contractures in adults with stroke. RCTs had to compare these assistive technologies with no treatment, routine therapy, or another assistive technology. Passive range of motion (PROM) was the primary outcome.ResultsSeven studies (294 participants) were included. Data from five studies (252 participants) comparing assistive technologies with routine care were meta-analyzed. The evidence was very uncertain about the effect of assistive technology on PROM, adverse events and other outcomes.ConclusionsThere is insufficient evidence to support clinical decisions about the effectiveness of assistive technology in the management of contractures in people with stroke. Rehabilitation professionals should select strategies for management of contractures in patients with stroke based on an expert assessment of a patient's individual needs and preferences, and ensure regular re-assessment. High quality research is necessary in this field.

Neurophysiology of Micturition: a Narrative Review on Preventing Mismanagement

INTRODUCTION

The insidious interrelation between three key factors underscores the critical need to understand the neural control of the lower urinary tract (LUT): the complexity of its functioning, the epidemiology of conditions that can disrupt it, and the nonspecific presentation of related symptoms. This paper examines the importance of understanding neurophysiology of micturition to prevent mismanagement and reduce unnecessary procedures.

MATERIAL AND METHODS

This review focuses on the neurophysiology of the micturition cycle, the epidemiology of major health conditions that affect it, and the nonspecific nature of lower urinary tract symptoms (LUTS) concerning underlying pathologies. The review was conducted in accordance with the guidelines of the Scale for Assessment of Narrative Review Articles (SANRA). Only articles in English were included, while case reports, editorials, and expert opinion pieces were excluded.

RESULTS

The ability of the LUT to store and release urine requires precise coordination and is mediated by a complex network involving the brain, spinal cord, peripheral ganglia, and nerves. Epidemiological data reveal a growing global burden of diseases that impact LUT functioning (LUTF). Moreover, the nonspecific nature of LUTS often leads to diagnostic challenges, and inappropriate treatment strategies.

CONCLUSION

The interplay between the complexity of LUTF, the widespread prevalence of conditions that can disrupt it, and the nonspecific nature of related symptoms frequently complicate urological decision-making. Overlooking associated neurological factors can result in suboptimal outcomes, diminished quality of life, and serious adverse consequences. A systematic approach is crucial to minimizing the risk of misdiagnosis and mismanagement, especially when considering invasive interventions.

Eligibility for Lecanemab Treatment in the Republic of Korea: Real-World Data From Memory Clinics

BACKGROUND AND PURPOSE

We aimed to determine the proportion of Korean patients with early Alzheimer's disease (AD) who are eligible to receive lecanemab based on the United States Appropriate Use Recommendations (US AUR), and also identify the barriers to this treatment.

METHODS

We retrospectively enrolled 6,132 patients with amnestic mild cognitive impairment or mild amnestic dementia at 13 hospitals from June 2023 to May 2024. Among them, 2,058 patients underwent amyloid positron emission tomography (PET) and 1,199 (58.3%) of these patients were amyloid-positive on PET. We excluded 732 patients who did not undergo brain magnetic resonance imaging between June 2023 and May 2024. Finally, 467 patients were included in the present study.

RESULTS

When applying the criteria of the US AUR, approximately 50% of patients with early AD were eligible to receive lecanemab treatment. Among the 467 included patients, 36.8% did not meet the inclusion criterion of a Mini-Mental State Examination (MMSE) score of ≥22.

CONCLUSIONS

Eligibility for lecanemab treatment was not restricted to Korean patients with early AD except for those with an MMSE score of ≥22. The MMSE criteria should therefore be reconsidered in areas with a higher proportion of older people, who tend to have lower levels of education.

Prehospital application of remote ischaemic perconditioning in acute ischaemic stroke patients in Catalonia: the REMOTE-CAT clinical trial

Background

Acute ischaemic stroke (IS) remains one of the leading causes of morbidity and mortality worldwide. Remote ischaemic perconditioning (RIperC) is a neuroprotective treatment with promising preclinical results, acting through humoral and neural mechanisms. This trial aimed to evaluate the clinical benefits of prehospital-initiated RIperC in acute IS patients.

Methods

REMOTE-CAT was a multicentre, randomised, double-blind, sham-controlled trial across four Catalonian stroke centres. Patients over 18 years with stroke symptoms under 8 h, a pre-stroke modified Rankin Scale (mRS) score <3, and motor deficits (RACE motor score ≥1) were randomised 1:1 to active RIperC or sham. RIperC was applied via an automated cuff on the unaffected arm in five 5-min inflation-deflation cycles. Investigators and participants were blinded to treatment. The primary outcome was the proportion of patients with a favourable outcome (mRS <3) at 90 days. The intention-to-treat analysis included all patients receiving at least one inflation-deflation cycle and had a final diagnosis of ischaemic stroke or transient ischaemic attack (ClinicalTrials.gov: NCT03375762).

Findings

Between August 2019 and December 2023, 350 patients were screened, with 200 randomised. After 78 exclusions (29 haemorrhagic strokes, 41 stroke mimics, and 8 patients with mRS >3), 122 patients were included in the primary analysis (RIperC group, n = 57; sham group, n = 65). The RIperC group had a higher proportion of mRS <3 at 90 days (64.9%) than the sham group (47.3%), though not statistically significant in the unadjusted analysis (OR 2.03 [95% CI 0.98-4.21], p = 0.057 However, statistical significance was achieved in the post-hoc analysis adjusted for age, baseline status (determined by pre-stroke mRS score), and initial stroke severity (measured by baseline RACE score by paramedics) (OR 2.94 [95% CI 1.21-7.16], p = 0.017). No serious adverse events were observed.

Interpretation

Despite the small sample size, our findings suggest that prehospital application of RIPerC is safe and may confer clinical benefit, as indicated in the post hoc adjusted analysis. However, larger, adequately powered trials are required to validate these results, and to determine potential differential effects across underrepresented patient subgroups.

Funding

Institute of Health Carlos III (ISCIII) of the Spanish Ministry of Health and Government of Catalonia-Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR).

The Role of Oxidative Stress in Ischaemic Stroke and the Influence of Gut Microbiota

Ischaemic stroke is the most prevalent stroke subtype, accounting for 80-90% of all cases worldwide, and remains a leading cause of morbidity and mortality. Its pathophysiology involves complex molecular cascades, with oxidative stress playing a central role. During cerebral ischaemia, reduced blood flow deprives neurons of essential oxygen and nutrients, triggering excitotoxicity, mitochondrial dysfunction, and excessive production of reactive oxygen and nitrogen species (RONS). Not only do these species damage cellular components, but they also activate inflammatory pathways, particularly those mediated by the transcription factor nuclear factor kappa-B (NF-κB). The pro-inflammatory milieu intensifies neuronal damage, compromises blood-brain barrier integrity, and exacerbates reperfusion-induced damage. Recent findings highlight the importance of the gut microbiota in modulating stroke outcomes, primarily through metabolic and immunological interactions along the gut-brain axis. Dysbiosis, characterised by reduced microbial diversity and an imbalance between beneficial and harmful strains, has been linked to increased systemic inflammation, oxidative stress, and worse prognoses. Specific gut-derived metabolites, including short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO), appear to either mitigate or intensify neuronal injury. SCFAs may strengthen the blood-brain barrier and temper inflammatory responses, whereas elevated TMAO levels may increase thrombotic risk. This narrative review consolidates both experimental and clinical data demonstrating the central role of oxidative stress in ischaemic stroke pathophysiology and explores the gut microbiota's ability to modulate these damaging processes. Therapeutic strategies targeting oxidative pathways or rebalancing gut microbial composition, such as antioxidant supplementation, dietary modulation, probiotics, and faecal microbiota transplantation, present promising paradigms for stroke intervention. However, their widespread clinical implementation is hindered by a lack of large-scale, randomised trials. Future efforts should employ a multidisciplinary approach to elucidate the intricate mechanisms linking oxidative stress and gut dysbiosis to ischaemic stroke, thereby paving the way for novel, mechanism-based therapies for improved patient outcomes.

Industrial-grade collaborative robots for motor rehabilitation after stroke and spinal cord injury: a systematic narrative review

BACKGROUND

There is a growing interest in exploring industrial-grade collaborative robots (cobots) for rehabilitation. This review explores their application for motor rehabilitation of the upper and lower extremities after a stroke and spinal cord injury (SCI). The article highlights the inherent safety features of cobots, emphasizing their design advantages over custom-built or traditional rehabilitation robots in terms of potential safety and time efficiency.

METHODS

Database searches and reference list screening were conducted to identify studies relating to the use of cobots for upper and lower extremity rehabilitation among individuals with stroke and SCI. These articles were then reviewed and summarized.

RESULTS

Thirty-three studies were included in this review. The findings suggest that the use of cobots in motor rehabilitation is still in the early stages. Some of the cobots used were equipped with sensors to detect and respond to the movement of the extremities and minimize the risk of injury. This safety aspect is crucial for patients with motor impairments. Most training protocols implemented with the cobots engaged users in repetitive task-based exercises with an overall positive user experience. Thus far, these devices have been primarily evaluated in individuals with stroke and SCI that affect the lower extremities, with no study addressing upper extremity impairments. This initial focus serves as a preliminary step toward assessing their applicability for individuals with stroke and SCI.

CONCLUSIONS

Cobots may have the capacity to transform therapy and support healthcare professionals in delivering more personalized and effective rehabilitation. However, there is limited evidence on their use to support upper and lower extremity rehabilitation among individuals with stroke and SCI. Further research and development are needed to refine these technologies and broaden their applications in rehabilitation settings to enhance functional recovery and overall quality of life for individuals with stroke and SCI.

Repurposing Antidiabetic Drugs for Cerebrovascular Diseases: Causal Evidence from Drug Target Mendelian Randomization and Colocalization

Cerebrovascular diseases have caused substantial social and economic burdens, and new treatment methods are urgently needed. Evaluating the feasibility of the use of antidiabetic drugs for treating cerebrovascular diseases is meaningful in this field. We designed a comprehensive study process that includes two-sample Mendelian randomization (MR), which uses genetic proxies for antidiabetic drug targets, summary-based MR (SMR) for mRNAs, and colocalization for drug target genes to assess their causal relationships with 10 cerebrovascular disease phenotypes. Seven of the eight main types of clinical antidiabetic drugs were identified, yielding eleven potential drug targets. Our study observed that sulfonylureas (KCNJ11) and metformin (GPD1) reduce the risk of stroke and that TZDs (PPARG) reduce the risk of hippocampal perivascular spaces. In addition, sulfonylureas can reduce the risk of certain cerebral small vessel disease. These results show that antidiabetic drugs have hypoglycemic properties and affect cerebrovascular health. Our study supports repurposing antidiabetic drugs as disease-modifying therapies to improve cerebrovascular health. Future research should focus on studying the role of drugs in different phenotypes of cerebrovascular diseases and explore the potential molecular mechanisms to analyze further the potential effects of antidiabetic drugs on cerebrovascular diseases.

Predictive value of circulating inflammatory biomarkers for early-onset post-stroke cognitive impairment: a prospective cohort study

Introduction

Stroke ranks as the second leading cause of mortality and the third leading cause of disability globally. Post-stroke cognitive impairment (PSCI) is a prevalent complication following acute ischemic stroke, imposing substantial burdens on patients, families, and society. This study aimed to explore the potential of circulating immune-inflammatory markers as predictors of PSCI.

Methods

Conducted as a prospective observational cohort study from June 2023 to August 2024 at the Affiliated Drum Tower Hospital, Medical School of Nanjing University, it included patients experiencing their first acute ischemic stroke within 72 h of symptom onset. Cognitive assessments were conducted 7 to 10 days post-stroke using the Montreal Cognitive Assessment (MoCA), with scores below 23 indicating PSCI.

Results

A total of 146 patients meeting the inclusion criteria were recruited, with 71 patients exhibiting PSCI during the acute phase of stroke. Compared to patients in the post-stroke no cognitive impairment (PSNCI) group, those with PSCI demonstrated significantly elevated peripheral blood neutrophil-to-lymphocyte ratio (NLR), globulin-to-lymphocyte ratio (GLR), and C-reactive protein-to-lymphocyte ratio (CLR), while the lymphocyte-to-monocyte ratio (LMR) was notably reduced (all p < 0.05). Both univariate and multivariate logistic regression analyses identified GLR as independently associated with PSCI. After adjusting for common clinical variables, the odds ratio (OR) for the highest tertile of GLR compared to the lowest was 6.20 (95% CI, 2.10-18.33; p = 0.001). The optimal GLR cutoff was 18.22, with a sensitivity of 62.0%, specificity of 78.7%, and an area under curve (AUC) of 0.726.

Conclusion

This study indicates that elevated circulating GLR levels during the acute phase post-stroke onset are an independent risk factor for early-onset PSCI, even after adjusting for clinically relevant variables.

Associations between naples prognostic score and stroke and mortality among older adults

BACKGROUND

Inflammation and malnutrition in the body are closely related to the incidence of stroke. Older adults often suffer from malnutrition and inflammation. Naples Prognostic Score (NPS), a novel inflammation-malnutrition score, can effectively assess the inflammation and nutritional status of the body. The aim of this study is to explore the connection between NPS and stroke among older adults, as well as the association between NPS and mortality in older adults.

METHODS

Participants eligible for the study were collected from National Health and Nutrition Examination Survey(NHANES) data from 1999 to 2018. Logistic regression models were employed to investigate the link between NPS and stroke. Additionally, restricted cubic spline was utilized to explore the correlations. Subgroup analysis was adopted in order to ensure the credibility of the results. Kaplan-Meier Survival curve and cox regression models and were utilized to evaluate the link between NPS and mortality among older adults.

RESULTS

16,940 older adults qualified for analysis. The participants with stroke had higher levels of NPS. In the logistic regression model, NPS was positively related to stroke (high NPS vs. low NPS, OR = 1.70 (95% CI 1.24-2.35), P < 0.001). Restricted cubic spline revealed a positive non-linear relationship (P for overall < 0.001, P for non-linear < 0.001). Subgroup analysis showed that the association between NPS and the incidence of stroke is more significant in the non-diabetes population (P < 0.001). The Kaplan-Meier curve shows that patients with high NPS have a significantly higher risk of all-cause mortality and cardiovascular mortality (P < 0.001). In the Cox regression model, a positive correlation was observed between NPS and mortality among older adults (all-cause mortality: HR = 1.36 (95% CI 1.30-1.42); cardiovascular mortality:HR = 1.59 (95% CI 1.45-1.75)).

CONCLUSIONS

A positive link was observed between NPS and stroke and mortality. Routine NPS screening may enhance risk stratification in geriatric clinics.

Evaluation of pre- and in-hospital workflows and time intervals with acute ischemic stroke patients

OBJECTIVE

Stroke is one of the leading causes of death and disability globally. Rapid recanalization therapy for acute ischemic stroke (AIS) patients is critical for improving outcome. While in-hospital time intervals have decreased and treatment methods have improved over the past decade, pre-hospital time intervals have remained unchanged. This study aims to develop a comprehensive understanding of the prognosis of AIS patients based on pre-hospital and in-hospital data.

METHODS

A retrospective study was conducted in Southwest Finland covering the period of 01/01/2022-31/12/2022. The study included a total of 174 AIS patients who were conveyed by the emergency medical services (EMS) to Turku University Hospital (TUH) and given intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). Pre- and in-hospital care records of AIS patients were analyzed to evaluate workflows, time intervals, and the impacts of these time intervals on patient outcome. Binary logistic regression analysis was utilized to identify predictors of on-scene time (OST) and favorable outcome.

RESULTS

The median OST for EMS was 19 minutes. Analysis indicated that the scene of the stroke event being an apartment building, barriers to care such as a locked door, vertigo as a symptom, and EMS taking measurements on-scene were predictive of longer OST. Longer OST was observed to negatively impact patient outcome, along with symptom severity and gender. Using the stroke code as the dispatch code and positive FAST signs were associated with shorter OST. In-hospital median door to needle time (DNT) was 14 minutes in the IVT group and 11 minutes in the IVT+EVT group. EMS prenotification was associated with shorter in-hospital time intervals.

CONCLUSIONS

The presence of vertigo as a symptom poses challenges to identification by EMS. Pre-hospital OST meets national targets, but EMS workflows could be optimized to reduce OST and thereby positively influence patient outcome. These findings underscore the need for targeted interventions in EMS protocols to improve stroke care outcomes.

VSIG4 Alleviates Intracranial Hemorrhage Injury by Regulating Oxidative Stress and Neuroinflammation in Macrophages via the NRF2/HO-1 Signaling Pathway

BACKGROUND

Oxidative stress and neuroinflammation are important secondary injury mechanisms in intracranial hemorrhage (ICH). V-set and immunoglobulin domain-containing 4 (VSIG4) has an inhibitory effect on oxidative stress and the inflammatory response. This study aimed to explore the possible role of VSIG4 in ICH-related neuropathology.

METHODS

In this study, VSIG4 levels were investigated in an ICH mouse model and lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Moreover, we examined oxidative stress levels, pro-inflammatory cytokine production, neuronal damage, inflammatory cell activation, brain water content, and neurological function. We performed these assays in ICH mice and macrophages with different VSIG4 levels. Additionally, the critical role of the nuclear factor erythroid 2 related factor 2/heme oxygenase-1 (NRF2/HO-1) signaling pathway in VSIG4 function was verified.

RESULTS

VSIG4 ameliorated neurological deficits in ICH mice (p < 0.01), alleviated cerebral edema (p < 0.05), and increased glutathione (p < 0.05) and decreased superoxide dismutase (SOD) levels (p < 0.01) in the perihematomal area and LPS-stimulated RAW264.7 cells. It also reduced Malondialdehyde (MDA) accumulation (p < 0.01), alleviated oxidative stress, and decreased interleukin-1β (IL-1β) (p < 0.01) and tumor necrosis factor-alpha (TNF-α) levels (p < 0.01), thereby attenuating the inflammatory response. Additionally, treatment of LPS-stimulated RAW264.7 cells with VSIG4 resulted in less damage to HT22 cells (p < 0.05). To further validate the involvement of the NRF2/HO-1 pathway in VSIG4-mediated neuroprotection, brusatol (an NRF2 inhibitor) was administered.

CONCLUSION

Our study demonstrates the neuroprotective effect and mechanism of action of VSIG4 in ICH.

Dilemmas in Secondary Stroke Prevention

Secondary stroke prevention encompasses many approaches, including antithrombotic therapy, risk factor management, and a healthy lifestyle. Recommendations are typically based on the results of randomized clinical trials that provide evidence of benefit. However, in some situations, clinicians extrapolate the results of clinical trials into everyday practice, or trials have not provided sufficient information to make treatment decisions. This review will discuss 4 scenarios: dual-antiplatelet therapy, the perils of combining antiplatelet and anticoagulation, indications for statin therapy, and therapeutic considerations for patients with paroxysmal atrial fibrillation.

Advances in Cerebrovascular Imaging and Interventions

Since the 1990s, the global burden of cerebrovascular disease - particularly stroke - has significantly increased [...].