Global stroke statistics 2022

Early neuropsychological screening and long-term functional outcome in a sample of patients affected by mild stroke: The ReSCog Project

Stroke causes severe long-term disabilities with a significant reduction in quality of life. This study aims to explore the predictive value of cognitive screening in the acute phase of mild stroke on patients' functional outcome after discharge. A total of 110 patients with mild stroke were recruited. Patients were included in the study if they were discharged directly home from the acute units. The cognitive profile of patients was assessed with the Oxford Cognitive Screen (OCS). The OCS was administered 3-10 days after stroke, providing a five domain-specific cognitive profile. Long-term functional outcomes were evaluated by the Stroke Impact Scale 3.0 (SIS 3.0), a self-reported questionnaire that includes physical, cognitive, emotional and social participation dimensions. All patients completed the survey online on average 10 months after stroke. Our results show that OCS is positively associated with physical and cognitive dimensions, after adjusting for age and stroke severity measured by NIHSS at admission. In conclusion, OCS in acute mild stroke seems to be an independent predictor of long-term functional outcomes and could help clinicians in the long-term management of patients.

Genetically predicted plasma levels of amino acids and stroke risk: a Mendelian randomization study

Stroke, including ischemic stroke (IS) and small vessel stroke (SVS), is a major cause of morbidity and mortality globally. The role of amino acids remains underexplored in the risk and outcomes of stroke. In the present study, the causal effects of genetically determined amino acid levels on stroke and its functional outcomes were investigated using Mendelian randomization (MR). Data was analyzed by single nucleotide polymorphisms (SNPs), Inverse-variance weighted (IVW), etc. The results of False Discovery Rate (FDR) correction show that higher genetically determined levels of CSF glycine, glutamate, glutamine, and phenylalanine are associated with increased risks of SVS (odds ratios [OR]: 1.34, 1.48, 1.58, and 1.58, respectively; 95 % confidence intervals [CI]: 1.14-1.56, 1.17-1.87, 1.29-1.94, and 1.32-1.89; P-values: 2.46 × 10-4, 9.50 × 10-4, 1.30 × 10-5, and 7.37 × 10-7). Higher phenylalanine levels were associated with poor functional outcomes after ischemic stroke, defined as a modified Rankin Scale score ≥ 3 (OR per SD increase: 1.79; 95 % CI: 1.26-2.55; P = 1.15 × 10-3). These findings suggest that amino acids can serve as potential biomarkers and therapeutic targets for stroke.

Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate the disease burden of ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and overall stroke among young adults (aged 15-49 years) in 204 countries and territories from 1990 to 2021, along with the associated risk factors.

METHODS

GBD (Global Burden of Disease Study) 2021 data were used to assess the burden and trends via age-standardized rates and their estimated annual percentage changes.

RESULTS

Although age-standardized rates generally declined from 1990 to 2021, the number of incident and prevalent stroke cases among young adults increased by 36% (95% uncertainty interval, 31%-41%) and 41% (95% uncertainty interval, 38%-43%), respectively. Notably, from 2015 to 2021, the age-standardized incidence of ischemic stroke and subarachnoid hemorrhage among young adults increased, with estimated annual percentage changes of 0.65 (95% CI, 0.39-0.92) and 0.58 (95% CI, 0.47-0.69), respectively. High systolic blood pressure was the primary risk factor for stroke-related disability-adjusted life-years among young adults. However, other risk factors varied by region, with higher proportions of smoking, high low-density lipoprotein cholesterol, and high body mass index in high sociodemographic index regions, and higher proportions of household air pollution from solid fuels and diet low in vegetable in low sociodemographic index regions. From 1990 to 2021, the total number of stroke-related disability-adjusted life-years among young adults due to risk factors increased by 12% (95% uncertainty interval, 2%-22%), driven principally by high systolic blood pressure, ambient particulate matter pollution, high body mass index, high low-density lipoprotein cholesterol, and high fasting blood glucose.

CONCLUSIONS

Since 2015, there has been a concerning rebound in the age-standardized incidence rates of ischemic stroke and subarachnoid hemorrhage among young adults globally. Given regional and sociodemographic index variations in risk factors, targeted and cost-effective policies and interventions are urgently needed to reduce stroke burden in this demographic.

Advancing Comprehensive Stroke Care-From Acute Recovery to Long-Term Wellbeing

Stroke is one of the most complex diseases of our time; it impacts individuals across many facets of functioning, depending on the areas of the brain that have been damaged [...].

The Czech Fugl-Meyer assessment for post-stroke sensorimotor function: translation and cross-cultural adaptation and validation

OBJECTIVE

To ensure wider use of the internationally recommended Fugl-Meyer Assessment (FMA) of sensorimotor function for people with stroke, official translations of the scale are needed. This study aimed to perform a translation and cross-cultural adaptation/validation of the FMA into the Czech language.

DESIGN

Translation and cross-cultural adaptation/validation.

SUBJECTS/PATIENTS

Five clinical experts and 1 external expert participated as reviewers; 11 individuals with stroke in the early subacute phase were included in the pilot testing.

METHODS

A standardized process using forward-backward translations, expert panel reviews, and pilot testing between and within the raters (inter- and intra-rater reliability) were employed to ensure conceptual, semantic, and operational validity of the new Czech FMA. Agreement between raters was assessed in 11 individuals with stroke on 2 consecutive days at University Hospital Olomouc by using Svensson's rank-based statistics.

RESULTS

Percentage of agreement between and within raters ranged between 70-100% and 55-100%, respectively. Systematic disagreements, found in 7 out of 96 FMA items, were discussed and revised in the final version.

CONCLUSION

The Czech FMA offers a more unified and standardized assessment of sensorimotor impairment in clinical and research settings. This will improve stroke rehabilitation care and allow for wider international collaboration.

The Association Between Serum Pentraxin-3 Level at Admission and the Functional Outcome of Patients After Acute Ischemic Stroke: A Meta-Analysis

Background

Acute ischemic stroke (AIS) remains a leading cause of disability worldwide, placing a significant burden on patients' quality of life and healthcare systems. Pentraxin-3 (PTX-3), an inflammatory biomarker, may be associated with AIS prognosis; however, existing evidence is inconclusive.

Aims

To examine whether serum PTX-3 levels at admission are linked to the likelihood of poor functional outcomes in AIS patients.

Study Design

Systematic review and meta-analysis.

Methods

A comprehensive search of PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases was conducted to identify studies evaluating PTX-3 levels in AIS patients. Eligible studies included those that measured PTX-3 within 48 h of admission and evaluated outcomes using the modified Rankin Scale, with scores > 2 defined as poor outcomes. A random-effects model was used to calculate pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs).

Results

Ten cohort studies involving1202 AIS patients were included. Higher PTX-3 levels at admission were significantly associated with an increased risk of poor functional outcomes (OR, 2.06; 95% CI, 1.72-2.47; p < 0.001), with no significant heterogeneity (I² = 0%). Meta-regression showed that using higher PTX-3 cutoff values reported stronger associations (p < 0.05). Subgroup analyses confirmed consistent associations across study designs, patient characteristics, and timing of outcome assessment. The association was more pronounced in studies using a PTX-3 cutoff ≥ 3.3 ng/mL compared to those with a cutoff < 3.3 ng/mL.

Conclusion

Elevated serum PTX-3 levels at admission may serve as a prognostic biomarker for poor functional outcomes in AIS. Differences in PTX-3 cutoff values and potential residual confounding should also be considered. Further multicenter studies involving diverse populations are necessary to confirm these results and establish PTX-3 as a reliable prognostic indicator in clinical practice.

Self-reported physical activity more than 1 year after stroke and its determinants in relation to the WHO recommendations

BACKGROUND

Physical activity (PA) after stroke has significant health benefits if it is conducted regularly, with sufficient intensity and duration. Because of the health benefits, it is important to identify those below the World Health Organization (WHO) recommended level of PA. However, few studies have assessed the level of PA after stroke in relation to the WHO recommendations and which sociodemographic factors and stroke characteristics are associated with those below the WHO recommendations.

OBJECTIVE

To assess survivors of stroke at least 1 year after onset and (1) describe their self-reported level of PA; (2) explore the association between PA, sociodemographics, and stroke characteristics, and (3) determine the characteristics of those below the WHO recommended level of PA.

DESIGN

Cross-sectional descriptive survey.

SETTING

Community settings.

PARTICIPANTS

Data were collected from 160 survivors of stroke (mean age 73 years, 46% women, mean time since stroke onset 35 months).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Swedish National Board of Health and Welfare Physical Activity Questionnaire and the following sociodemographics and stroke characteristics: gender, age, marital status, vocational situation, need for home help, use of mobility devices, time since stroke onset, first-time stroke, type of stroke, location of stroke, and stroke treatment.

RESULTS

Two thirds (66.3%) of the participants were below the WHO recommendations. The hierarchical regression analysis explained 13% of the variance in PA with need for home help as a single significant contributor. Those who did not meet the WHO recommendations were significantly older, more likely to live alone, and in need of home help and mobility devices.

CONCLUSIONS

A majority of survivors of stroke do not meet the WHO recommended level of PA. Future studies should assess how other factors characterize those who are physically inactive. This knowledge could help rehabilitation professionals to target interventions and self-management programs to promote PA among survivors of stroke.

Altered Gut Microbiota and Plasma Metabolome Profiles Characterize Depression Individuals with Ischemic Stroke: A Comparative Analysis

Purpose

Depression has been recognized as a significant risk factor for ischemic stroke (IS). This study aimed to describe gut microbiota differences between depression people with and without IS, thereby establishing the link between gut microbiota and an elevated risk of IS development in people with depression.

People and Methods

This study included 30 hospitalized patients with comorbid depression and IS, and 30 age-/sex-matched patients with depression alone. We used two approaches: (1) genetic analysis techniques (16S rRNA gene sequencing) to map gut microbial ecosystems, and (2) broad-spectrum chemical (nontargeted metabolomics) analysis to detect blood metabolites.

Results

Alpha (α)-diversity and beta (β)-diversity of people with depression, with or without IS, did not show significant differences between the two groups. The IS group showed increased levels of gut bacteria carrying pro-inflammatory molecules, specifically Gram-negative Enterobacteriaceae containing lipopolysaccharide (LPS) components, the Linear discriminant analysis (LDA) value =4.177, P=0.014. Alongside, the IS group reduced populations of beneficial microbes that produce butyric acid important for gut health, such as Acidaminococcaceae (LDA value =4.045, P=0.014), Roseburia (LDA value =3.894, P=0.007), and Fusicatenibacter (LDA value =3.345, P=0.012), compared to the non-IS group. 38 plasma metabolites with significant differences between people with IS and non-IS groups. The abundance of Alloprevotella and Bacteroides massiliensis was correlated with 9 and 4 metabolites, respectively.

Conclusion

This study highlighted that people with depression and IS exhibited distinct alterations in both their gut microbiome and metabolite profiles, in contrast to people with depression without IS. These findings may guide future interventions targeting gut microbiota to identify IS in depression people.

A Study on the Healthcare Workforce and Care for Acute Stroke: Results From the Survey of Hospitals Included in the National Acute Stroke Quality Assessment Program

BACKGROUND

With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey.

METHODS

For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke.

RESULTS

In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high.

CONCLUSION

Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Association Between Naples Prognostic Score and All-Cause and Cardiovascular Mortality in Stroke Patients

OBJECTIVES

Stroke is a primary public health challenge worldwide, with its prognosis profoundly related to inflammation and nutritional status. Naples prognostic score (NPS) is an integrated indicator of combined inflammation and nutrition. The study aimed to elucidate the link between NPS and all-cause and cardiovascular (CVD) deaths in stroke patients.

METHODS

NHANES (2001 to 2018) data set was used. Multivariate corrected Cox models, Kaplan-Meier, and restricted cubic spline analysis were adopted to explore the link between NPS, all-cause, and CVD mortality in stroke patients. Subgroup analyses based on age, sex, BMI, education, alcohol consumption, smoking, hypertension, and diabetes were performed to further explore associations.

RESULTS

Totally, 1247 stroke patients were enrolled. High NPS levels were notably linked with a heightened risk of all-cause mortality (HR: 1.320, 95% CI: 1.180-1.470, P<0.001) and CVD death (HR: 1.390, 95% CI: 1.120-1.730, P=0.003) in stroke patients after adjusting for relevant factors. Compared with group 0 (NPS=0), group 2 (NPS=3-4) had a high hazard ratio for all-cause mortality (HR: 2.920, 95% CI: 1.820-4.670, P<0.001) and CVD mortality (HR: 2.610, 95% CI: 1.140-5.970, P=0.023). The RCS suggested a linear link between NPS and both all-cause (P for nonlinear=0.2202) and CVD deaths (P for nonlinear=0.9841) in stroke patients. These links were mostly consistent in subgroups. There was no pronounced interaction between status and NPS scores for each subgroup (all P<0.05).

CONCLUSIONS

High NPS scores are connected with an augmented risk of all-cause mortality and CVD death in stroke patients. NPS is possibly connected with prognosis in stroke patients.

Prioritizing gaps in stroke care: A two-round Delphi process

BACKGROUND

Despite international recognition of stroke as a significant health priority, discrepancies persist between the target values for stroke quality measures and the actual values that are achieved in clinical practice, referred to as gaps. This study aimed to reach consensus among international experts on prioritizing gaps in stroke care.

METHODS

A two-round Delphi process was conducted, surveying an international expert panel in the field of stroke care and cerebrovascular medicine, including patient representatives, healthcare professionals, researchers, policymakers, and medical directors. Experts scored the importance and required effort to close 13 gaps throughout the stroke care continuum and proposed potential solutions. Data were analyzed using descriptive statistics and qualitative analysis methods.

RESULTS

In the first and second Delphi rounds, 35 and 30 experts participated, respectively. Expert consensus was reached on the high importance of closing 11 out of 13 gaps. Two out of 13 gaps were considered moderately important to close, with expert consensus for one of these two gaps. Expert consensus indicated that only one gap, related to the prevention of complications after stroke, requires moderate effort to close, whereas the others were considered to require high effort to close. Key focus areas for potential solutions included: "Care infrastructure," "Geographic disparities," "Interdisciplinary collaboration," and "Advocacy and funding."

CONCLUSIONS

While closing gaps in stroke care primarily requires high effort and substantial resources, targeted interventions in the identified key focus areas may provide feasible and clinically meaningful improvements.

Feasibility Study of Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage with Large Hematoma: a Comparison with Craniotomy Using Propensity Score Matching Analysis

BACKGROUND

Spontaneous intracerebral hemorrhage (ICH) with large hematomas is commonly treated with craniotomy combined with decompressive craniectomy, procedures that involve huge trauma and require subsequent cranioplasty. Recently, endoscopic surgery has shown significant promise in treating ICH, but its feasibility for large hematomas remains uncertain. Therefore, this study aims to compare endoscopic surgery with craniotomy and to evaluate the efficacy and safety of endoscopic surgery in treating large hematomas ICH.

METHODS

A retrospective analysis was conducted on the clinical data from patients with spontaneous supratentorial ICH and hematoma volumes exceeding 50 mL who underwent either endoscopic surgery or craniotomy. Propensity score matching analysis was employed to reduce selection bias. The efficacy and safety of endoscopic surgery were evaluated by analyzing blood loss, postoperative edema, mortality rate, complications, and the Glasgow Outcome Scale (GOS) at 6-month follow-up.

RESULTS

A total of 113 cases that met the criteria were collected, with 65 in the endoscopic surgery group and 48 in the craniotomy group. After propensity score matching, each group contained 34 cases. The mean hematoma volume was 64.84 ± 11.02 mL in the endoscopy group and 66.57 ± 12.77 mL in the craniotomy group (p = 0.554). Hematoma evacuation rates were 93.27% in the endoscopy group and 89.34% in the craniotomy group (p = 0.141). The endoscopy group exhibited lower blood loss, shorter surgical time, and reduced postoperative edema volume at 24 h compared to the craniotomy group. The rate of pulmonary infection was slightly lower in the endoscopy group compared to the craniotomy group (70.59% vs. 91.18%, p = 0.031), but there were no statistically significant differences in overall complications and mortality rate between the two groups. GOS scores were similar in both groups at the 6-month follow-up.

CONCLUSIONS

Endoscopic surgery is safe and feasible for treating spontaneous supratentorial ICH with large hematomas, demonstrating efficacy similar to that of craniotomy with decompressive craniectomy.

Salt Substitution and Recurrent Stroke and Death: A Randomized Clinical Trial

Importance

The direct effect of consumption of salt substitutes on recurrent stroke and mortality among patients with stroke remains unclear.

Objective

To evaluate the effects of salt substitutes vs regular salt on the incidence of recurrent stroke and mortality among patients with stroke.

Design, Setting, and Participants

The Salt Substitute and Stroke Study (SSaSS), an open-label, cluster randomized clinical trial, was conducted in 600 northern Chinese villages (clusters). Patients who self-reported a hospital diagnosis of stroke were included in this prespecified subgroup analysis. Data were analyzed from November 2023 to August 2024.

Interventions

Participants were assigned to use either a salt substitute, consisting of 75% sodium chloride and 25% potassium chloride by mass, or regular salt.

Main Outcomes and Measures

The primary outcome was recurrent stroke.

Results

After excluding 5746 persons without a baseline history of stroke, 15 249 patients with stroke (mean [SD] age, 64.1 [8.8] years; 6999 [45.9%] female; 8250 male [54.1%]) were included. Over a median (IQR) follow-up of 61.2 (60.9-61.6) months, the mean difference in systolic blood pressure was -2.05 mm Hg (95% CI, -3.03 to -1.08 mm Hg). A total of 2735 recurrent stroke events (691 fatal and 2044 nonfatal) and 3242 deaths were recorded. Recurrent stroke was significantly lower in the salt substitute vs regular salt group (rate ratio [RR], 0.86; 95% CI, 0.77-0.95; P = .005), with larger effects on hemorrhagic stroke (relative reduction, 30%; P = .002). Death rates were also significantly lower (RR, 0.88; 95% CI, 0.82-0.96; P = .003), with larger effects on stroke-related deaths (relative reduction 21%; P = .01). No significant difference was observed for hyperkalemia (RR, 1.01; 95% CI, 0.74-1.38; P = .96).

Conclusions and Relevance

Results of this cluster trial demonstrate that salt substitution was safe, along with reduced risks of stroke recurrence and death, which underscores large health gains from scaling up this low-cost intervention among patients with stroke.

Trial Registration

ClinicalTrials.gov Identifier: NCT02092090.

Ferroptosis: a potential therapeutic target in cardio-cerebrovascular diseases

Cardio-cerebrovascular diseases (CCVDs) are the leading cause of global mortality, yet effective treatment options remain limited. Ferroptosis, a novel form of regulated cell death, has emerged as a critical player in various CCVDs, including atherosclerosis, myocardial infarction, ischemia-reperfusion injury, cardiomyopathy, and ischemic/hemorrhagic strokes. This review highlights the core mechanisms of ferroptosis, its pathological implications in CCVDs, and the therapeutic potential of targeting this process. Additionally, it explores the role of Chinese herbal medicines (CHMs) in mitigating ferroptosis, offering novel therapeutic strategies for CCVDs management. Ferroptosis is regulated by several key pathways. The GPX4-GSH-System Xc- axis is central to ferroptosis execution, involving GPX4 using GSH to neutralize lipid peroxides, with system Xc- being crucial for GSH synthesis. The NAD(P)H/FSP1/CoQ10 axis involves FSP1 regenerating CoQ10 via NAD(P)H, inhibiting lipid peroxidation independently of GPX4. Lipid peroxidation, driven by PUFAs and enzymes like ACSL4 and LPCAT3, and iron metabolism, regulated by proteins like TfR1 and ferritin, are also crucial for ferroptosis. Inhibiting ferroptosis shows promise in managing CCVDs. In atherosclerosis, ferroptosis inhibitors reduce iron accumulation and lipid peroxidation. In myocardial infarction, inhibitors protect cardiomyocytes by preserving GPX4 and SLC7A11 levels. In ischemia-reperfusion injury, targeting ferroptosis reduces myocardial and cerebral damage. In diabetic cardiomyopathy, Nrf2 activators alleviate oxidative stress and iron metabolism irregularities. CHMs offer natural compounds that mitigate ferroptosis. They possess antioxidant properties, chelate iron, and modulate signaling pathways like Nrf2 and AMPK. For example, Salvia miltiorrhiza and Astragalus membranaceus reduce oxidative stress, while some CHMs chelate iron, reducing its availability for ferroptosis. In conclusion, ferroptosis plays a pivotal role in CCVDs, and targeting it offers novel therapeutic avenues. CHMs show promise in reducing ferroptosis and improving patient outcomes. Future research should explore combination therapies and further elucidate the molecular interactions in ferroptosis.

Immersive Virtual Reality in Stroke Rehabilitation: A Systematic Review and Meta-Analysis of Its Efficacy in Upper Limb Recovery

Background: Immersive virtual reality (imVR) has shown promise for upper limb stroke rehabilitation (ULSR). However, optimal implementation and treatment modalities remain unclear. This systematic review and meta-analysis aimed to evaluate imVR's efficacy in ULSR and determine optimal treatment parameters. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs), comparing imVR to conventional rehabilitation (CR) in adult stroke patients, was conducted. Databases including, the Web of Science, Scopus, and PubMed, were searched. Meta-regression further explored the relationship between intervention duration, frequency, and outcomes. Results: Twenty-three studies were included in the systematic review, representing 395 patients, with thirteen incorporated into the meta-analysis. imVR showed statistically significant improvements in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) Scale (mean difference (MD) = 3.04, 95% CI [1.46; 4.62], p < 0.001) and the Box and Block Test (BBT) (MD = 2.85, 95% CI [0.70; 4.99], p = 0.009) compared to CR, but not in the Action Research Arm Test (ARAT) (MD = 3.47, 95% CI [-0.22; 7.15], p = 0.06). However, these improvements did not reach clinically significant thresholds (7 points for FMA-UE and 6 points for BBT). Clinical subgroup analysis showed significant improvements for both subacute (standardized mean difference (SMD) = 0.92, 95% CI [0.48; 1.36], p = 0.002) and chronic (SMD = 0.69, 95% CI [0.03; 1.35], p = 0.03) stroke stages. Meta-regression indicated that there was a significant positive relationship between the intervention duration and upper limb improvement. Conclusions: imVR demonstrates potential for improving upper limb motor function following stroke, particularly with longer intervention durations and individual session lengths for chronic stroke. However, the improvements observed were not clinically significant, highlighting the need for further research with larger sample sizes and standardized outcome measures to determine optimal treatment protocols.

Global, regional, and national burden and trends of stroke among youths and young adults aged 15-39 years from 1990 to 2021: findings from the Global Burden of Disease study 2021

Background

Stroke is a leading cause of disability and mortality worldwide, with rising incidence rates among youths and young adults aged 15-39 years. However, comprehensive assessments of stroke burden in this age group at global, regional, and national levels are limited. This study examines trends in stroke incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 using data from the Global Burden of Disease (GBD) study.

Methods

Data from the GBD study (1990-2021) were analyzed to assess the age-standardized incidence, mortality, and DALYs related to stroke in individuals aged 15-39 years. The relationship between stroke burden and the Socio-Demographic Index (SDI) was explored across 204 countries and 21 regions. Trends were analyzed using the estimated annual percentage change (EAPC) and average annual percentage change (AAPC).

Results

This study reveals global, regional, and national trends in stroke burden among youths and young adults (15-39 years) from 1990 to 2021. In 2021, the global age-standardized stroke incidence was 757,234.61 cases, with 8.72 million DALYs and 122,742 stroke-related deaths. Although global incidence increased by 19.09%, age-standardized rates (ASRs) declined by 0.67% annually. DALYs and mortality rates also decreased globally. Notably, stroke burden increased in low and low-middle SDI regions. South Asia had the highest number of cases, while Oceania reported the highest mortality rate. These findings underscore regional disparities in stroke trends. Globally, metabolic risks (46.2%) and high systolic blood pressure (37.87%) are major contributors to stroke-related mortality.

The Ethanolic Extract of Polygala paniculata L. Blocks Panx1 Channels and Reduces Ischemic Brain Infarct in a Dose- and Sex-Dependent Way

Polygala paniculata L. is a native plant from tropical America. The therapeutic potential of the hydroalcoholic extract of P. paniculata (HEPp) has been scientifically explored due to folk medicine reports on its action against several afflictions. HEPp contains several bioactive molecules with neuroprotective activities, making it a promising candidate for stroke treatment. This study used electrophysiological, biochemical, and in vivo experiments to evaluate the molecular mechanisms underlying HEPp as a neuroprotective therapy for stroke targeting Pannexin-1 (Panx1). Panx1 is a non-selective channel that opens during ischemia and contributes to neuronal death. HEPp was not toxic to cortical neurons and pre-treatment with the extract reduced neuronal death promoted by oxygen and glucose deprivation in a dose-dependent manner. Additionally, HEPp blocked Panx1 currents in a dose-dependent manner and the effect, which was shown to be partially due to rutin. Animals submitted to photothrombosis and post-treated with HEPp had reduced infarct volume, and the effective dose was lower in males (1 mg/kg) than in females (10 mg/kg). On the other hand, in Panx1 KD mice (50% Panx1 levels), the acute treatment reduced the infarct volume only in males. Upon chronic treatment with HEPp, a reduction in Panx1 protein levels was observed. The current study provides reliable evidence of the neuroprotective properties of HEPp in both in vitro and in vivo models of stroke. The underlying mechanism involves, at least in part, the inhibition of Panx1 channel function and possibly downregulation of protein levels, suppressing the secondary events that lead to apoptosis and inflammation.

Predictors of recovery from dysphagia after stroke: A systematic review and meta-analysis

Objective

This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years, thereby providing an evidence-based basis for nurses to identify high-risk patients and develop individualized rehabilitation plans to improve patient prognosis.

Methods

Databases including the China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), China Science and Technology Journal (VIP), WanFang, PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and Scopus were retrieved to search for literature on the predictors of recovery from dysphagia after stroke. The retrieval period was from January 2013 to December 2023. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) and the Prediction model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed using Revman5.3 and Stata15.1 software. The review protocol has been registered with PROSPERO (CRD42024605570).

Results

A total of 1,216 results were obtained, including 599 in English and 617 in Chinese. A total of 34 studies were included, involving 156,309 patients with post-stroke dysphagia, and the rate of dysphagia recovery increased from 13.53% at 1 week to 95% at 6 months after stroke. Meta-analysis results showed that older age [OR = 1.06, 95%CI (1.04, 1.08), P < 0.001], lower BMI [OR = 1.28, 95%CI (1.17, 1.40), P < 0.001], bilateral stroke [OR = 3.10, 95%CI (2.04, 4.72), P < 0.001], higher National Institutes of Health Stroke Scale (NIHSS) score [OR = 1.19, 95%CI (1.01, 1.39), P = 0.030], tracheal intubation [OR = 5.08, 95%CI (1.57, 16.39), P = 0.007] and aspiration [OR = 4.70, 95%CI (3.06, 7.20), P < 0.001] were unfavorable factors for the recovery of swallowing function in patients with post-stroke dysphagia.

Conclusions

The lack of standardized criteria for rehabilitation assessment of post-stroke dysphagia has resulted in reported recovery rates of swallowing function exhibiting wide variability. Nurses should take targeted preventive measures for patients aged ≥70 years, low BMI, bilateral stroke, high NIHSS score, tracheal intubation, and aspiration to promote the recovery of swallowing function in patients with post-stroke dysphagia.

The impacts of a healthy lifestyle on the physical and mental health status of female stroke survivors in Australia

INTRODUCTION

This longitudinal study aimed to explore the impacts of adopting a healthy lifestyle on self-reported physical and mental health outcomes among Australian females who are living with stroke.

METHODS

The study utilized data retrieved from the Australian Longitudinal Study on Women's Health's 1946-51 cohort (from survey 5 conducted in 2007 to survey 9 conducted in 2019), focusing on 531 female stroke survivors. The dependent variables for this study were self-reported physical and mental health status, whereas the independent variables were lifestyle behaviors, including physical activity, smoking, alcohol consumption, and supplement use. Generalized Estimating Equation models were employed to assess the longitudinal associations between a dependent variable and the independent and confounding variables.

RESULTS

The average age of the participants was 58.1 (SD = 1.4) years in survey 5 and 70.5 years in survey 9. The longitudinal analyses revealed that stroke survivors who engaged in moderate/high levels of physical activity had significantly better physical and mental health status than their inactive or sedentary counterparts. Besides, current smokers had significantly poorer physical and mental health status than nonsmokers. In addition, risky/high-risk alcohol consumers had significantly poorer mental health status compared to no/low-risk alcohol consumers.

CONCLUSIONS

Our findings suggest that post-stroke individuals can improve their physical and mental health by maintaining a healthy lifestyle. Specifically, targeted and appropriate programs and strategies are needed to promote physical activity and reduce smoking and alcohol consumption in female stroke survivors in order to optimize their overall health and quality of life.

Effects of butylphthalide on cerebral vascular circulation, coagulation function, and neurological function in patients with acute severe ischemic stroke following intravenous thrombolysis: a preliminary study

OBJECTIVE

To analyze the effects of Butylphthalide on cerebral vascular circulation, coagulation function, and neurological function in patients with acute severe ischemic stroke following intravenous thrombolysis.

METHODS

Clinical efficacy, cerebral vascular circulation indicators [anterior cerebral artery (ACA), middle cerebral artery (MCA), vertebral artery (VA) blood flow velocity], coagulation function indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB)], neurological function indicators [Activities of Daily Living (ADL) score.

RESULTS

The total effective rate of treatment in the control group was 76.47%, while in the observation group, it was 96.08%, with the observation group showing a significantly higher total effective rate than the control group (p < 0.05). Before treatment, there was no significant difference in ACA, MCA, and VA blood flow velocity between the two groups (p > 0.05). However, after treatment, the ACA, MCA, and VA blood flow velocity in the observation group were significantly higher than those in the control group (p < 0.05). Before treatment, there was no significant difference in PT, APTT, TT, and FIB levels between the two groups (p > 0.05).

CONCLUSION

In patients with acute severe ischemic stroke undergoing intravenous thrombolysis, the addition of Butylphthalide to the treatment regimen yields favorable clinical outcomes. Compared to Alteplase alone, the addition of Butylphthalide further improves cerebral vascular circulation and coagulation function, promoting the recovery and reconstruction of neurological function in patients. Importantly, the addition of Butylphthalide does not increase the risk of adverse reactions, making it a safe and ideal option for clinical application.

E-health literacy in stroke patients: Latent profile analysis and influencing factors

AIMS

This study sought to explore latent categories of electronic health (e-health) literacy among stroke patients and analyse its influencing factors.

DESIGN

A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied.

METHODS

Between July and October 2020, 558 stroke participants from three tertiary care hospitals in Henan Province, China, were recruited using a convenience sampling method. A general information questionnaire and the Electronic Health Literacy Scale were used to collect their socio-demographic information and e-health literacy. Latent profile analysis was used to analyse latent categories of e-health literacy in stroke patients. Multiple logistic regression was used to analyse factors influencing latent categories of e-health literacy in stroke patients.

RESULTS

Three latent categories of e-health literacy existed, including the low e-health literacy group, the low application-high decision-making group and the high literacy-low decision-making group. Multiple logistic regression showed that education level, presence of comorbidities, willingness to interact with people with mental illness, health information sources, frequency of Internet access, frequency of health information inquiry and willingness to receive remote care were predictors of the participants' latent categories of e-health literacy.

CONCLUSION

Three latent categories of e-health literacy in stroke patients exist, and each latent category's characteristics should be considered while developing health education programmes. It is imperative that healthcare providers understand the requirement of creating tailored and efficient health education programmes for various categories of stroke patients to enhance their e-health literacy.

IMPACT

It is imperative to improve Chinese stroke patients' overall e-health literacy. We categorized stroke patients' e-health literacy using advanced LPA. These findings hold implications for healthcare approaches, contributing to the enhancement of stroke patients' e-health literacy, enabling them to apply the acquired e-health information to manage and solve their own health issues.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring Discharge Preparedness of Patients With Stroke: A Qualitative Descriptive Study

Aim: This study aimed to explore the experiences and perceptions of patients in a rehabilitation center who had experienced a stroke, regarding their concerns about discharge and life after stroke. Methods: A qualitative descriptive design was used and unstructured interviews were conducted with 100 patients with stroke. Reflexive thematic analysis was employed to identify recurring patterns and themes in the data, ensuring an in-depth understanding of the participants' experiences. Results: Three themes were generated from the analysis: (a) general post-hospitalization concerns, (b) concerns regarding the ability to handle activities of daily living, and (c) post-discharge aspirations and goals. Conclusions: This study sheds light on the diverse perspectives of patients with stroke regarding discharge from rehabilitation centers. A person-centered approach for patients with stroke is an important step for coordinating discharge planning. Developing a personalized care plan for meeting patients' needs is critical to address fundamental care issues.

Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis

BACKGROUND

Cerebral venous sinus thrombosis is a rare stroke with several clinical manifestations. Several studies have identified prognostic risk factors associated with poor functional outcomes and established predictive models. This systematic review and meta-analysis assessed the overall effect size of all prognostic risk factors.

METHODS

A systematic review was conducted to explore all prognostic risk factors in studies published from the initial to June 2024 among 5 Databases included PubMed / Medline, Scopus, EBSCOhost, Web of Science, and Cochran Library. The quality of the methodology was analyzed using the Newcastle-Ottawa Scale. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 29.

RESULTS

Sixty-four studies involving 18,958 participants with a mean age of 38.46 years and females 63.03% were included in the quantitative meta-analysis. Functional outcomes were primarily measured using the Modified Rankin Scale (mRS), with scores ≥ 2 or ≥ 3 indicating poor outcomes in 35.00% and 60.00% of studies, respectively. For general information, age (InOR = 0.98, 95% CI 0.53-1.43), intracranial hemorrhage (OR = 3.79, 95% CI 2.77-5.20), and ischemic infarction (OR = 3.18, 95% CI 2.40-4.23) were associated with poor functional outcomes. For general and neurological symptoms, headache (OR = 0.22, 95% CI 0.17-0.29), seizure (OR = 2.74, 95% CI 1.76-4.27), focal deficit (OR = 4.72, 95% CI 3.86-5.78), coma (OR = 11.60, 95% CI 6.12-21.98), and consciousness alteration (OR = 7.07, 95% CI 4.15-12.04) were outstanding factors. The blood biomarkers of NLR (log OR = 1.72, 95% CI 0.96-2.47), lymphocytes (Cohen's d = -0.63, 95 CI -0.78--0.47), and D-dimer (lnOR = 1.34, 95% CI 0.87-1.80) were the three most frequently reported factors. Parenchymal lesion (OR = 4.71, 95% CI 1.12-19.84) and deep cerebral venous thrombosis (OR = 6.30, 95% CI 2.92-13.63) in radiological images were two frequently reported factors. CVST patients with cancer (OR = 3.87, 95% CI 2.95-5.07) or high blood glucose levels (OR = 3.52, 95% CI 1.61-7.68) were associated with poor functional outcomes. In the meta-regression analysis, ischemic infarction (P = 0.032), consciousness alteration (P < 0.001), and NLR (P = 0.015) were associated with mRS prediction.

CONCLUSIONS

Pooled effect sizes revealed that ischemic infarction, headache, neurological focal deficit, lymphopenia, and cancer were significantly associated with poor functional outcomes, with low to moderate heterogeneity. Consciousness alterations/deterioration and deep cerebral venous thrombosis were also significant prognostic factors, albeit with substantial heterogeneity. The meta-regression analysis showed that the effect sizes of consciousness alterations/deterioration and NLR increased with worsening mRS scores. Other notable risk factors included age, intracranial hemorrhage, seizures, coma, D-dimer, parenchymal lesions, and hyperglycemia. This systematic review provides a comprehensive overview of the prognostic risk factors for poor functional outcomes in patients undergoing CVST, which can guide clinical decision-making and future research.

TRIAL REGISTRATION

This systematic review and meta-analysis has been registered with INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols), and the registration number is INPLASY202480072. The registration period is 14 August 2024.

Danhong injection modulates microglial polarization and neuroinflammation via the JUNB/NF-κB pathway in ischemic stroke

ETHNOPHARMACOLOGICAL RELEVANCE

Ischemic stroke (IS) is a leading cause of death and disability in China. Danhong Injection (DHI) is a traditional Chinese medicine preparation made from Salvia miltiorrhiza var. miltiorrhiza and Carthamus tinctoriusL. It is used for treating stroke in China with proven safety and efficacy. Microglia M1/M2 polarization is a key factor in IS inflammatory response. However, the key transcription factors that regulate microglia polarization are unknown. It is also not clear how DHI exerts its mechanism in the treatment of IS.

AIM OF THE STUDY

This research aimed to investigate the effect of DHI on microglial polarization and neuroinflammation associated with IS and to elucidate the underlying mechanisms, with an emphasis on the JUNB/NF-κB signaling pathway.

MATERIALS AND METHODS

An oxygen-glucose deprivation (OGD) damage cell model and a permanent middle cerebral artery occlusion (pMCAO) model in C57BL/6 mice were employed. Neurological deficits, cerebral infarct volume, and microglial activation were assessed. Non-targeted metabolomics analysis with UHPLC-QE-MS and molecular biology methods, including RT-qPCR and Western blot, were applied to investigate the mechanisms.

RESULTS

In vivo, DHI decreased inflammation, reduced brain damage, and enhanced neurological function. DHI also ameliorated microglial activation and OGD-induced apoptosis in vitro. Metabolomics analysis identified significant metabolic changes, particularly in amino acid metabolism. Additionally, DHI treatment decreased the upregulated mRNA levels of ASS1 and ASL after OGD, indicating an influence on the arginine biosynthesis pathway, which is crucial for microglial function. DHI modulated the M1 to M2 phenotypes of microglial polarization and regulated microglial polarization through the JUNB/NF-κB signaling pathway. This was confirmed by JUNB silencing experiments.

CONCLUSIONS

DHI exhibits neuroprotective effects via suppressing ASS1 through the JUNB/NF-κB pathway, promoting the M2 state of microglia, and lowering the expression of inflammatory cytokines. This research unveils the potential therapeutic target of JUNB for IS treatment and sheds light on the novel intervention mechanism of DHI in microglial cells.

Association between communication patterns, benefit finding, and relationship satisfaction in stroke couples: an actor-partner interdependence mediation model

AIMS

To explore the mediating role of relationship satisfaction between communication patterns and benefit findings in stroke couples using the actor-partner interdependence mediation model.

METHODS AND RESULTS

A cross-sectional study was conducted from October 2022 to April 2023 in China. Based on the actor-partner interdependence mediation model, we used structural equation modelling to explore the mediating role of relationship satisfaction of stroke patients and their spouses in communication patterns and benefit findings. A total of 381 stroke couples (patients, 61.4% male, mean age 54.06; caregivers, mean age 53.58) were included in the data analysis. Actor effects showed that stroke couples' relationship satisfaction mediated each of their own three communication patterns (constructive communication, demand/withdraw communication, and mutual avoidance) and benefit findings. In addition, patients' relationship satisfaction mediated patient demand-spouse withdraw and spouses' benefit findings. Partner effect showed that patients' relationship satisfaction mediated the association between their own three communication patterns and spouses' benefit findings. Patients' relationship satisfaction mediated the association between patient demand-spouse withdraw and patients' benefit findings. Moreover, spouses' relationship satisfaction mediated the association between the two communication avoidance patterns exhibited by patients (spouse demand-patient withdraw and mutual avoidance) and the spouses' benefit findings.

CONCLUSION

The results have demonstrated a reciprocal influence on benefit findings between stroke patients and their spouses. The communication patterns within these couples have impacted not only their own benefit findings but also those of their spouses, with relationship satisfaction playing a mediating role.

A comprehensive analysis of stroke risk factors and development of a predictive model using machine learning approaches

Stroke is a leading cause of death and disability globally, particularly in China. Identifying risk factors for stroke at an early stage is critical to improving patient outcomes and reducing the overall disease burden. However, the complexity of stroke risk factors requires advanced approaches for accurate prediction. The objective of this study is to identify key risk factors for stroke and develop a predictive model using machine learning techniques to enhance early detection and improve clinical decision-making. Data from the China Health and Retirement Longitudinal Study (2011-2020) were analyzed, classifying participants based on baseline characteristics. We evaluated correlations among 12 chronic diseases and applied machine learning algorithms to identify stroke-associated parameters. A dose-response relationship between these parameters and stroke was assessed using restricted cubic splines with Cox proportional hazards models. A refined predictive model, incorporating age, sex, and key risk factors, was developed. Stroke patients were significantly older (average age 69.03 years) and had a higher proportion of women (53%) compared to non-stroke individuals. Additionally, stroke patients were more likely to reside in rural areas, be unmarried, smoke, and suffer from various diseases. While the 12 chronic diseases were correlated (p < 0.05), the correlation coefficients were generally weak (r < 0.5). Machine learning identified nine parameters significantly associated with stroke risk: TyG-WC, WHtR, TyG-BMI, TyG, TMO, CysC, CREA, SBP, and HDL-C. Of these, TyG-WC, WHtR, TyG-BMI, TyG, CysC, CREA, and SBP exhibited a positive dose-response relationship with stroke risk. In contrast, TMO and HDL-C were associated with reduced stroke risk. In the fully adjusted model, elevated CysC (HR = 2.606, 95% CI 1.869-3.635), CREA (HR = 1.819, 95% CI 1.240-2.668), and SBP (HR = 1.008, 95% CI 1.003-1.012) were significantly associated with increased stroke risk, while higher HDL-C (HR = 0.989, 95% CI 0.984-0.995) and TMO (HR = 0.99995, 95% CI 0.99994-0.99997) were protective. A nomogram model incorporating age, sex, and the identified parameters demonstrated superior predictive accuracy, with a significantly higher Harrell's C-index compared to individual predictors. This study identifies several significant stroke risk factors and presents a predictive model that can enhance early detection of high-risk individuals. Among them, CREA, CysC, SBP, TyG-BMI, TyG, TyG-WC, and WHtR were positively associated with stroke risk, whereas TMO and HDL-C were opposite. This serves as a valuable decision-support resource for clinicians, facilitating more effective prevention and treatment strategies, ultimately improving patient outcomes.

A systematic review of current national hospital-based stroke registries monitoring access to evidence-based care and patient outcomes

BACKGROUND

National stroke clinical quality registries/audits support improvements in stroke care. In a 2016 systematic review, 28 registries were identified. Since 2016 there have been important advances in stroke care, including the development of thrombectomy services. Therefore, we sought to understand whether registries have evolved with these advances in care. The aim of this systematic review was to identify current, hospital-based national stroke registries/audits and describe variables (processes, outcome), methods, funding and governance).

METHODS

We searched four databases (21st May 2015 to 1st February 2024), grey literature and stroke organisations' websites. Initially two reviewers screened each citation; when agreement was satisfactory, one of four reviewers screened each citation. The same process was applied to full texts. If there were no new publications from registries identified in the original 2016 review, we contacted the registry leads. We extracted data using predefined categories on country (including income level), clinical/process variables, methods, funding and governance.

RESULTS

We found 37 registries from 31 countries (28 high income, four upper-middle income, five lower-middle income) of which 16 had been identified in 2016 and 21 were new. Twenty-two of the same variables were collected by >50% of registries/audits (mostly acute care, including thrombectomy, and secondary prevention), compared with only four variables in 2016. Descriptions of funding, management, methods of consent and data privacy, follow-up, feedback to hospitals, linkage to other datasets and alignment of variables with guidelines were variably reported. Reasons for apparent termination of some registries was unclear.

CONCLUSIONS

The total number of stroke registries has increased since 2016, and the number of variables collected has increased, reflecting advances in stroke care. However, some registries appeared to have ceased; the reasons are unclear.

Zhongfeng decoction attenuates cerebral ischemia-reperfusion injury by inhibiting autophagy via regulating the AGE-RAGE signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Tackling phlegm and improving blood circulation is vital in the treatment of ischemic stroke (IS), culminating in the development of Zhongfeng Decoction (ZFD), a method grounded in this approach and serving as an effective therapy for IS. Nonetheless, the defensive mechanism of the ZFD in preventing cerebral ischemia-reperfusion damage remains ambiguous.

AIM OF THE STUDY

Determine the active ingredients in ZFD that have neuroprotective effects, and identify its mechanism of action against IS.

MATERIALS AND METHODS

A cerebral ischemia model in rats was developed, utilizing TTC, Nissl staining, and an oxidative stress kit to evaluate the neuroprotective impact of ZFD on this rat model. Following this, an amalgamation of LC-MS and network pharmacology techniques was employed to pinpoint potential active components, primary targets, and crucial action mechanisms of ZFD in treating IS. Finally, key targets and signaling pathways were detected using qRT-PCR, ELISA, Western blotting, electron microscopy, and other methods.

RESULTS

Through LC-MS and network analysis, 15 active ingredients and 6 hub targets were identified from ZFD. Analysis of pathway enrichment revealed that ZFD predominantly engages in the AGE-RAGE signaling route. Kaempferol, quercetin, luteolin, baicalein, and nobiletin in ZFD are the main active ingredients for treating IS. In vivo validation showed that ZFD can improve nerve damage in cerebral ischemic rats, reduce the mRNA expression of IL6, SERPINE1, CCL2, and TGFB1 related to inflammation. Furthermore, we also confirmed that ZFD can inhibit the protein expression of AGEs, RAGE, p-IKBα/IKBα, p-NF-κB p65/NF-κB p65, reduce autophagy levels, and thus decrease neuronal apoptosis.

CONCLUSIONS

The mechanism of action of ZFD in treating IS primarily includes inflammation suppression, oxidative stress response alleviation, post-stroke cell autophagy and apoptosis regulation, and potential mediation of the AGE-RAGE signaling pathway. This study elucidates how ZFD functions in treating IS, establishing a theoretical basis for its clinical application.

Overexpression of Growth Differentiation Factor 15 Reduces Neuronal Cell Damage Induced by Oxygen-Glucose Deprivation/Reoxygenation via Inhibiting Endoplasmic Reticulum Stress-Mediated Ferroptosis

Growth differentiation factor 15 (GDF15) can be induced under various stress conditions. This study aimed to explore the role of GDF15 in oxygen-glucose deprivation/reoxygenation (OGD/R)-induced HT22 cells. OGD/R was employed to induce the HT22 cell model, and GDF15 expression was upregulated via transfection. Subsequently, the effects on inflammatory factors, oxidative stress markers, apoptosis-related proteins, and ferroptosis markers were detected. Relevant indicators were evaluated using techniques such as ELISA, probes, flow cytometry, and western blotting. Furthermore, changes in these phenotypes under the influence of the endoplasmic reticulum (ER) stress agonist tunicamycin (TM) were evaluated. The result showed that GDF15 was significantly up-regulated in OGD/R-treated HT22 cells. Overexpression of GDF15 significantly reduced the levels of inflammatory factors tumor necrosis factor-α, IL (interleukin)-1β, and IL-6, inhibited the production of reactive oxygen species and MDA, and improved activity of superoxide dismutase and GSH-Px. Flow cytometry and western blotting results showed that GDF15 overexpression significantly reduced cell apoptosis, reduced caspase3 activity, and regulated the expression of Bcl2 and Bax. In addition, overexpression of GDF15 reduces the levels of ferroptosis markers by inhibiting ER stress. ER stress inducer TM can reverse the protective effects of GDF15 overexpression and promote inflammation, oxidative stress, and apoptosis. This study shows that overexpression of GDF15 reduces OGD/R-induced HT22 cell damage, and ER stress-mediated ferroptosis is included in the regulatory mechanisms. This provides a theoretical basis for GDF15 as a new target for the treatment of cerebral ischemia-reperfusion injury.

Stroke clinical coding education program in Australia and New Zealand

BACKGROUND

Accurate coded diagnostic data are important for epidemiological research of stroke.

OBJECTIVE

To develop, implement and evaluate an online education program for improving clinical coding of stroke.

METHOD

The Australia and New Zealand Stroke Coding Working Group co-developed an education program comprising eight modules: rationale for coding of stroke; understanding stroke; management of stroke; national coding standards; coding trees; good clinical documentation; coding practices; and scenarios. Clinical coders and health information managers participated in the 90-minute education program. Pre- and post-education surveys were administered to assess knowledge of stroke and coding, and to obtain feedback. Descriptive analyses were used for quantitative data, inductive thematic analysis for open-text responses, with all results triangulated.

RESULTS

Of 615 participants, 404 (66%) completed both pre- and post-education assessments. Respondents had improved knowledge for 9/12 questions (p < 0.05), including knowledge of applicable coding standards, coding of intracerebral haemorrhage and the actions to take when coding stroke (all p < 0.001). Majority of respondents agreed that information was pitched at an appropriate level; education materials were well organised; presenters had adequate knowledge; and that they would recommend the session to colleagues. In qualitative evaluations, the education program was beneficial for newly trained clinical coders, or as a knowledge refresher, and respondents valued clinical information from a stroke neurologist.

CONCLUSION

Our education program was associated with increased knowledge for clinical coding of stroke. To continue to address the quality of coded stroke data through improved stroke documentation, the next stage will be to adapt the educational program for clinicians.

Predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage

BACKGROUND AND PURPOSE

Affective disturbances and cognitive impairment are common sequelae of intracerebral hemorrhage (ICH), yet predictive models for these outcomes remain limited, especially for spontaneous supratentorial ICH with small hematomas (<30 mL). The aim of this study was to investigate predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage.

METHODS

We retrospectively analyzed 1692 patients with spontaneous supratentorial ICH between January 2018 and December 2020 at the First Affiliated Hospital of Harbin Medical University. Of these, 1563 patients completed a median follow-up of 3.5 years. Cognitive function was evaluated using the modified Telephone Interview for Cognitive Status, and affective disturbances using the Hamilton Depression Scale and the Hamilton Anxiety Scale. Restricted cubic spline analyses were employed to examine the relationships between predictors and outcomes.

RESULTS

In this cohort, 58.5% had cognitive impairment, 52.8% reported depressive symptoms, and 39.4% exhibited anxiety symptoms. Logistic regression models using Boruta's algorithm demonstrated strong predictive capacity, with areas under the curve of 0.82 for cognitive impairment, 0.78 for depressive symptoms, and 0.73 for anxiety symptoms. Hematoma volume was significantly linked to depressive symptoms (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.38-1.76) and inversely to cognitive impairment (OR 0.67, 95% CI 0.59-0.77). Uric acid levels displayed a nonlinear relationship with cognitive impairment (OR 0.70, 95% CI 0.61-0.81). Hospitalization days significantly raised the risk of both depressive (OR 1.16, 95% CI 1.03-1.30) and anxiety symptoms (OR 1.17, 95% CI 1.04-1.31).

CONCLUSIONS

The logistic regression model, enhanced by Boruta's algorithm, provides a valuable tool for predicting affective disturbances and cognitive impairment after ICH. It facilitates early identification and improves risk assessment for these neuropsychiatric outcomes in patients with small hematomas.

Factors related to sedentary behavior in older adult stroke patients in China: a study based on decision tree and logistic regression model

Objective

This study investigates the factors influencing sedentary behavior in older adult Chinese stroke patients using decision trees and logistic regression models.

Methods

Convenience sampling method was employed to enroll 346 respondents aged ≥60 years with stroke from the Department of Neurology of three tertiary-level A hospitals in Heilongjiang province, based on the inclusion criteria. The Sedentary Behavior Questionnaire for Older Adults, the International Physical Activity Questionnaire Short Form (IPAQ-S), the Pittsburgh Sleep Quality Index (PSQI), the Self-Rating Depression Scale (SDS), and the Social Support Scale (SSRS) were used to assess sedentary behavior, physical activity level, sleep quality, depressive symptoms, and social support, respectively. Decision tree and logistic regression models were employed to analyze the factors related to sedentary behavior in older adult stroke patients.

Results

Of the 346 respondents, 233 (67.3%) had sedentary behavior. The logistic regression model showed that education level (OR = 2.843, 95%CI: 1.219-6.626), BMI (OR = 3.686, 95%CI: 1.838-7.393), longest consecutive sitting time (OR = 3.853, 95%CI: 1.867-7.953), and sleep quality (OR = 3.832, 95%CI: 1.716-8.557) were identified as risk factors for sedentary behavior in older adult stroke patients, while drink alcohol (OR = 0.386, 95%CI: 0.184-0.809) and physical activity level (OR = 0.064, 95%CI: 0.030-0.140) were identified as protective factors for sedentary behavior. Besides, the decision tree model showed that physical activity level, longest consecutive sitting time, sleep quality, BMI, depressive symptoms, and age were associated with sedentary behavior. The sensitivity and specificity of the logistic regression model were 69.9 and 93.1%, respectively, and the area under the receiver operating characteristic (ROC) curve was 0.900 (95% CI: 0.863-0.938). The sensitivity and specificity of the decision tree model were 66.4, and 93.1% respectively, and the area under the ROC curve was 0.860 (95% CI: 0.816-0.904).

Conclusion

Our findings indicated that physical activity level, longest consecutive sitting time, sleep quality, and BMI were key factors associated with sedentary behavior. To achieve the purpose of improving rehabilitation effect and quality of life, this study combining decision trees with logistic regression models was of high value in studying factors influencing sedentary behavior in older adult stroke patients.

Management of people after stroke in 383 Victorian general practices, 2014-2018: analysis of linked stroke registry and general practice data

OBJECTIVE

To evaluate the management in Victorian general practice of people who have been hospitalised with stroke or transient ischaemic attacks (TIA).

STUDY DESIGN

Retrospective observational study; analysis of linked Australian Stroke Clinical Registry (AuSCR) and general practice data.

SETTING

383 general practices in the Eastern Melbourne, South Eastern Melbourne, and Gippsland primary health networks (Victoria), 1 January 2014 - 31 December 2018.

PARTICIPANTS

Adults who had been hospitalised with acute stroke or TIA and had at least two encounters with the same general practice during the observation period (7-18 months after the acute event).

MAIN OUTCOME MEASURES

Assessment of cardiometabolic risk factors (blood pressure, serum lipids, blood glucose, urinary protein); prescribing of guideline-recommended prevention medications (blood pressure-, lipid-, or glucose-lowering, antithrombotic agents); attainment of guideline targets for cardiometabolic risk factors at final assessment during observation period.

RESULTS

During 2014-2018, 3376 eligible AuSCR registrants (1465 women, 43.4%) had at least two encounters with one of the 383 general practices during the observation period; median age at stroke onset was 73.9 (interquartile range, 64.4-81.9) years, 737 events were TIAs (21.8%). Blood pressure was assessed in 2718 patients (80.5%), serum lipids in 1830 (54.2%), blood glucose in 1708 (50.6%). Prevention medications were prescribed for 2949 patients (87.4%), including lipid-lowering (2427, 71.9%) and blood pressure-lowering agents (2363, 70.0%). Blood glucose targets had been achieved by 1346 of 1708 patients assessed for this risk factor (78.8%), blood pressure targets by 1935 of 2717 (71.2%), and serum lipid targets by 765 of 1830 (41.8%). The incidence of having risk factors assessed was lower among patients aged 60 years or younger (incidence rate ratio [IRR], 0.97; 95% confidence interval [CI], 0.92-1.03) and those over 80 years of age (IRR, 0.92; 95% CI 0.88-0.97) than for those aged 61-80 years, and for women (IRR, 0.91; 95% CI, 0.87-0.95) and people with dementia (IRR, 0.89; 95% CI, 0.81-0.98). The likelihood of having classes of prevention medication prescribed was lower for patients aged 60 years or younger (IRR, 0.92; 95% CI, 0.88-0.97) and those over 80 years of age (IRR, 0.96; 95% CI, 0.92-0.997) than for patients aged 61-80 years, and for women (IRR, 0.95; 95% CI, 0.91-0.98) and people with dementia (IRR, 0.88; 95% CI, 0.78-0.98).

CONCLUSIONS

The general practice management of people who have been hospitalised with stroke or TIA could be improved. Effective monitoring of cardiometabolic risk factors will enable general practitioners to optimise care for people who need careful attention to prevent adverse secondary events.

"The association between HALP score and infection in acute ischemic stroke patients"

BACKGROUND AND PURPOSE

Stroke-associated infection (SAI) is related to increased mortality in acute ischemic stroke (AIS) cases. The HALP index is used to evaluate nutrition and inflammation. Our research aimed to assess the relation between HALP scores and infection risk in AIS cases.

MATERIALS AND METHODS

132 cases of acute ischemic stroke were registered. 77 cases were male and 55 cases were female. The median age of the attending cases was 66 (35-104) years. Laboratory variables were assessed within 24 h after hospitalization in the neurology care unit. The HALP score is evaluated utilizing the formula "Hemoglobin (g/dL) × Albumin (g/dL) × Lymphocyte (/10^3/uL) / Platelet (/10^3/uL)".

RESULTS

Cases were separated into two groups according to their corresponding HALP score. Group-1 cases have a low HALP score (HALP score ≤ 18227,93). Group-2 cases have a high HALP score (HALP score > 18227,93). 26 (19.6 %) cases were diagnosed with various infections after hospitalization in the neurology care unit. Urinary tract infections were frequent infection causes in AIS cases (13 cases, 50 %). Pneumonia was observed in 8 cases, making up 30 % of the total cases. Another infection was seen in 5 (20 %) of the cases. The frequently encountered bacteria were Escherichia coli ESBL + (n = 7, 27 %) and Staphylococcus aureus (n = 6, 23 %). The mortality ratio was higher in Group-1 cases than in Group-2 cases (34 % vs 7 %).

CONCLUSIONS

This investigation has suggested a relationship between infection and HALP score in AIS patients.

Maximising the Quality of Stroke Care: Reporting of Data Collection Methods and Resourcing in National Stroke Registries: A Systematic Review

Stroke registries are tools for improving care and advancing research. We aim to describe the methodology and resourcing of existing national stroke registries. We conducted a systematic search of the published, peer-reviewed literature and grey literature examining descriptions of data collection methods and resourcing of national stroke registries published from 2012 to 2023. The systematic review was registered in PROSPERO (CRD42023393841). 101 records relating to 21 registries in 19 countries were identified. They universally employed web-based platforms for data collection. The principal profession of data collectors was nursing. All included the acute phase of care, 28% (6) registered the pre-hospital (ambulance) phase and 14% (3) included rehabilitation. 80% (17) collected outcome data. The registries varied in their approach to outcome data collection; in 9 registries it was collected by hospitals, in 2 it was collected by the registry, and 7 had linkage to national administrative databases allowing follow-up of a limited number of end points. Coverage of the total number of strokes varies from 6 to 95%. Despite widespread use of Electronic Health Records (EHRs) the ability to automatically populate variables remained limited. Governance and management structures are diverse, making it challenging to compare their resourcing. Data collection for clinical registries requires time and necessary skills and imposes a significant administrative burden on the professionals entering data. We highlight the role of clinical registries as powerful instruments for quality improvement. Future work should involve creating a central repository of stroke registries to enable the development of new registries and facilitate international collaboration.

Association between tea consumption and stroke in the American adult females: analyses of NHANES 2011-2018 data

Background

Epidemiological surveys show that there is a significant gender difference in the incidence of stroke, with females having a noticeably higher rate than males. Accordingly, it is crucial to seek preventive measures for stroke specifically targeted at females. Although previous studies have shown that tea has been proven to be negatively correlated with stroke, the relationship between tea and stroke in American adult females is still unclear. Therefore, we aimed to investigate the relationship between tea consumption and the occurrence of stroke in American adult females.

Methods

The data analyzed is derived from the NHANES database between 2011 and 2018. The quantity of tea consumed was gathered from a 24-h dietary review. Stroke was identified by using questionnaire. The association between tea consumption and stroke was investigated using a weighted regression model. Then we used interaction testing and subgroup analysis to conduct a thorough analysis. Simultaneously, the association between the sugar content in tea and stroke was examined.

Results

This study included 5731 adult females aged between 20 and 60 years. Compared to those who did not consume tea, the likelihood of stroke decreased by 9% for each additional 100 g of tea ingested by participants (OR = 0.91, 95%CI: 0.83-1.00). In the unadjusted model, those who drank 307.5-480 g of tea per day had a substantially decreased risk of stroke than those who did not drink tea (OR = 0.23, 95%CI: 0.08-0.64). After adjustment, this relationship also persisted (Model II: OR = 0.23, 95% CI: 0.08-0.64; Model III: OR = 0.23, 95% CI: 0.08-0.66). In both Model II and Model III, there was a statistically significant relationship between consuming 480-744 g of tea per day and the risk of stroke (Model II: OR = 0.39, 95%CI: 0.16-0.94; Model III: OR = 0.42, 95% CI: 0.18-0.98). Subgroup analysis revealed an interaction only with level of education (P = 0.031). Ultimately, we also demonstrated that people who drink sugar free tea have a lower risk of stroke, and even after adjusting for mixed factors.

Conclusion

This study suggested that proper tea consumption was associated with a lower risk of stroke in adult females, which recommended drinking sugar free tea.

Quality of life and quality-adjusted life years after stroke in Sierra Leone

BACKGROUND

Stroke is a leading cause of mortality and negatively affects health-related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at 1 year post-stroke and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population.

METHODS

A prospective stroke register was established at the two-principal adult tertiary government hospitals in Freetown, Sierra Leone. Participants were followed up at 7, 90 days, and 1 year post-stroke to capture all-cause mortality and EQ-5D-3L data. QALYs were calculated at the patient level using EQ-5D-3L utility values and survival data from the register, following the area under the curve method. Utilities were based on the UK and Zimbabwe (as a sensitivity analysis) EQ-5D value sets, as there is no Sierra Leonean or West African value set. Explanatory models were developed based on previous literature to assess variables associated with HRQoL and QALYs at 1 year after stroke. To address missing values, Multiple Imputation by Chained Equations (MICE), with linear and logistic regression models for continuous and binary variables, respectively, were used.

RESULTS

EQ-5D-3L data were available for 373/460 (81.1%), 360/367 (98.1%), and 299/308 (97.1%) participants at 7, 90 days, and 1 year after stroke. For stroke survivors, median EQ-5D-3L utility increased from 0.20 (95% CI: -0.16 to 0.59) at 7 days post-stroke to 0.76 (0.47 to 1.0) at 90 days and remained stable at 1 year 0.76 (0.49 to 1.0). Mean QALYs at 1 year after stroke were 0.28 (SD: 0.35) and closely associated with stroke severity. Older age, lower educational attainment, patients with subarachnoid hemorrhage and undetermined stroke types all had lower QALYs and lower HRQoL, while being the primary breadwinner was associated with higher HRQoL. Sensitivity analysis with the Zimbabwe value set did not significantly change regression results but did influence the absolute values with Zimbabwe utility values being higher, with fewer utility values less than 0.

CONCLUSION

We generated QALYs after stroke for the first time in an African country. QALYs were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods.

DATA AVAILABILITY

The Stroke in Sierra Leone anonymized dataset is available on request to researchers, see data access section.

Cross-prevalence of multiple sclerosis and stroke evaluated on cohorts of four independent specialty medical centers

BACKGROUND

Numerous sources reported the increased risk of cerebrovascular accidents (CVA) in individuals with multiple sclerosis (MS), without a single study thus far challenging the conclusion. Before addressing hypothesis on potential cause-effect relationships, a question whether there are indeed frequent comorbidities between MS and CVA needed to be answered.

METHODS

Authors designed a study to evaluate substantial populations of four independent neurology centers with the purpose to assess the prevalence of CVA diagnosis in patients with MS, and vice versa. Data of subjects meeting enrollment criteria were entered into a single database. Authors compared obtained data with the MS and CVA prevalences in the populations of specific countries.

RESULTS

Of the 1881 subjects' records, the main diagnosis was MS for 51.5% and CVA for 48.5%. The CVA prevalence as a secondary diagnosis among MS subjects was 1.47% in USA cohort and 1.65% in combined USA+ Russian Federation (RF) cohorts, which is lower than known prevalence of stroke in adult population of these regions. The prevalence of MS as a secondary diagnosis among subjects with stroke in USA cohort was 0.4% and in combined USA+RF cohorts was 0.33%, which is higher, but not statistically different from calculated MS prevalence in both USA and RF populations combined.

CONCLUSION

Thus, authors found that prevalence of CVA in cohorts with MS of 2 independent centers was at least not higher, than that in general population, which differs from previously published data.

The supportive care needs of stroke patients: A scoping review

The aims of the current review were to identify the current supportive care needs of stroke patients, categorize those needs according to the supportive care needs framework (SCNF), and to form a SCNF of stroke patients. Preferred Reporting Items for Systematic Reviews and Meta-Extension for Scoping Reviews (PRISMA-ScR) and Guidance for conducting systematic scoping reviews were followed. Ten databases were searched, including six English databases: PubMed, Embase, Web of Science, Cumulative Index to Nursing Allied Health Literature, Cochrane Library, and PsycINFO, and four Chinese databases: China National Knowledge Infrastructure, Wan Fang, China Biology Medicine Database and Chongqing VIP. The search period covers from the establishment of the database to December 31, 2022. Three thousand twenty-nine hits were screened resulting in the inclusion of 34 articles in the final literature review. The greatest need identified by stroke patients was information, followed by psychological, social, rehabilitation, practical, physical, emotional, and spiritual needs. The supportive care needs of stroke patients were identified. A preliminary SCNF of stroke patients was developed according to Fitch's SCNF. The multitude of existing needs of stroke patients need to be addressed. This review may represent the first time that SCNF for stroke patients has been developed. This work may lay the foundation for future research on the supportive care needs of stroke patients and provide a framework for the implementation of supportive care in clinical stroke units.

Dissecting causal relationships between gut microbiome, immune cells, and brain injury: A Mendelian randomization study

Increasing literature has affirmed that changes in the gut microbiome (GM) composition were linked to distinct brain injury (BI) through the gut-brain axis, but it is uncertain if such links reflect causality. Further, the immune cell changes mediating the impact of GM on BI are not completely understood. We made use of the summary statistics of 211 GM (MiBioGen consortium), 731 immune cells, and 2 different BIs (FinnGen consortium), namely traumatic BI (TBI) and focal BI (FBI), from the extensive genome-wide association studies to date. We executed bidirectional Mendelian randomization (MR) analyses to ascertain the causal relationships between the GM and BI, and 2-step MR to validate possible mediating immune cells. Additionally, thorough sensitivity analyses verified the heterogeneity, robustness, as well as horizontal pleiotropy of the results. Based on the results of inverse-variance weighted (IVW) and sensitivity analyses, in MR analyses, 5 specific GM taxa and 6 specific GM taxa were causally associated with FBI and TBI, respectively; 27 immunophenotypes and 39 immunophenotypes were causally associated with FBI and TBI, respectively. Remarkably, Anaerofilum, LachnospiraceaeNC2004group, RuminococcaceaeUCG004, CCR2 on myeloid dendritic cell (DC), CD123 on CD62L+ plasmacytoid DC, and CD123 on plasmacytoid DC were causally associated with TBI and FBI (all P < .040). However, our reverse MR did not indicate any influence of TBI and FBI on the specific GM. In mediation analysis, we found that the associations between Escherichia.Shigella and FBI were mediated by CD123 on CD62L + plasmacytoid DC in addition to CD123 on plasmacytoid DC, each accounting for 4.21% and 4.21%; the association between FamilyXIIIAD3011group and TBI was mediated by CCR2 on myeloid DC, with mediated proportions of 5.07%. No remarkable horizontal pleiotropy or heterogeneity of instrumental variables was detected. Our comprehensive MR analysis first provides insight into potential causal links between several specific GM taxa with FBI/TBI. Additionally, CD123 on plasmacytoid DC in conjunction with CCR2 on myeloid DC may function in gut microbiota-host crosstalk in FBI and TBI, correspondingly. Further studies are critical to unravel the underlying mechanisms of the links between GM and BI.

Dietary total antioxidant capacity and risk of stroke: a systematic review and dose-response meta-analysis of observational studies

Background

Previous studies have reported the association between dietary total antioxidant capacity (TAC) and risk of stroke, but these findings have been inconsistent. We therefore performed this systematic review and dose–response meta-analysis of observational studies to evaluate the association between dietary TAC and risk of stroke.

Methods

A systematic literature search was carried out through PubMed, ISI Web of Science, EBSCO, Scopus and China National Knowledge Infrastructure (CNKI) databases, to find the relevant articles published up to 31 May, 2024. Random-effects or fixed-effects models were used to pool the relative risks (RRs) and their 95% confidence intervals (CIs) where appropriate. Heterogeneity across studies were determined using the Cochran’s Q test and I-square (I2) statistics.

Results

Eight observational studies (six cohort and two case–control studies) were included in the final analysis. The pooled results showed that higher intake of dietary TAC was associated with a lower risk of stroke (RR = 0.88; 95%CI: 0.81–0.95, p = 0.002). Additionally, dose–response analysis of cohort studies demonstrated a linear association between dietary TAC intake and risk of stroke (RR = 0.994; 95%CI: 0.990–0.999, Pnon-linearity = 0.329, Pdose–response = 0.014). Subgroup analyses showed the inverse association between dietary TAC intake and risk of stroke in the studies with mean age &lt; 50 (RR = 0.82, 95%CI: 0.67–0.99, p = 0.044), and there was no evidence of heterogeneity (p = 0.360; I2 = 0.0%).

Conclusion

Our findings indicated that higher intake of dietary TAC was inversely associated with the risk of stroke. Future studies in particular of longitudinal design are needed to confirm this inverse relationship.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024547706.

Tongxinluo and Functional Outcomes Among Patients With Acute Ischemic Stroke: A Randomized Clinical Trial

Importance

Previous studies revealed limited effectiveness of neuroprotective agents in treating acute ischemic stroke (AIS). Tongxinluo, developed from traditional Chinese medicines, has been recognized as a novel neuroprotective agent with anti-inflammatory properties that stabilize vulnerable plaques in animal models and patients with myocardial infarction.

Objective

To assess the efficacy and safety of Tongxinluo in patients with acute ischemic stroke (AIS).

Design, Setting, and Participants

This multicenter, open-label, double-blind, randomized clinical trial included 2007 patients with AIS and a National Institutes of Health Stroke Scale score between 4 and 22 at admission. The trial was conducted at 50 hospitals in China from March 1, 2014, to October 31, 2016. Data were analyzed from November 14, 2016, to November 16, 2017.

Interventions

Eligible patients were randomized within 72 hours of symptom onset to the Tongxinluo group or the control group. Participants received 4 oral capsules of Tongxinluo or placebo, 3 times a day for 90 days. Other treatment was administrated according to guidelines.

Main Outcomes and Measure

The primary outcome was a favorable functional outcome at day 90 after randomization, defined as a modified Rankin Scale (mRS) score of 0 to 1 (on a scale of 0 [no neurologic deficit, no symptoms, or completely recovered] to 6 [death]). All statistical analyses were performed in a modified intention-to-treat population, defined as all patients who underwent randomization, were given any treatment, and underwent any posttreatment assessment.

Results

Among 2007 patients with AIS who were randomized, 1946 (96.5%) were included in the modified intention-to-treat analysis (973 in the Tongxinluo group and 973 in the control group, with mean [SD] age of 60.5 [9.2] years and 1342 [69.0%] male). Patients in the Tongxinluo group had a significantly higher proportion of favorable functional outcomes at day 90 compared with those in the control group (mRS score of 0-1, 640 [65.8%] vs 575 [59.1%]; odds ratio, 1.33 [95% CI, 1.11-1.60]; P = .002). The prespecified subgroup analyses indicated that, among all subgroups, additional Tongxinluo treatment had similar outcomes.

Conclusions and Relevance

Among patients with ischemic stroke within 72 hours after symptom onset, those additionally receiving Tongxinluo were more likely to have a favorable functional outcome, compared with a placebo group. Further research in patients with thrombolysis and endovascular treatment are needed to explore these outcomes.

Trial registration

ClinicalTrials.gov Identifier: NCT01919671.

Contemporary Statistics of Acute Ischemic Stroke and Transient Ischemic Attack in 2021: Insights From the CRCS-K-NIH Registry

This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively. Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques. There has been a decrease in intravenous thrombolysis rates, from 12% in 2017-2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for non-cardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.

Global, regional, and national burden of ischemic stroke, 1990-2021: an analysis of data from the global burden of disease study 2021

Background

Ischemic stroke remains a major contributor to global mortality and morbidity. This study aims to provide an updated assessment of rates in ischemic stroke prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021, specifically focusing on including prevalence investigation alongside other measures. The analysis is stratified by sex, age, and socio-demographic index (SDI) at global, regional, and national levels.

Methods

Data for this study was obtained from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). To quantify temporal patterns and assess trends in age-standardized rates of ischemic stroke prevalence (ASPR), incidence (ASIR), mortality (ASDR), and DALYs, estimated annual percentage changes (EAPCs) were computed over the study period. The analyses were disaggregated by gender, 20 age categories, 21 GBD regions, 204 nations/territories, and 5 SDI quintiles. R statistical package V 4.4.2 was performed for statistical analyses and plot illustrations.

Findings

In 2021, the global burden of ischemic stroke remained substantial, with a total of 69,944,884.8 cases with an ASPR of 819.5 cases per 100,000 individuals (95% UI: 760.3-878.7). The ASIR was 92.4 per 100,000 people (95% UI: 79.8-105.8), while the ASDR was 44.2 per 100,000 persons (95% UI: 39.3-47.8). Additionally, the age-standardized DALY rate was 837.4 per 100,000 individuals (95% UI: 763.7-905). Regionally, areas with high-middle SDI exhibited the greatest ASPR, ASIR, ASDR, and age-standardized DALY rates, whereas high SDI regions had the lowest rates. Geospatially, Southern Sub-Saharan Africa had the highest ASPR, while Eastern Europe showed the highest ASIR. The greatest ASDR and age-standardized DALY rates were observed in Eastern Europe, Central Asia, as well as North Africa, and the Middle East. Among countries, Ghana had the highest ASPR, and North Macedonia had both the highest ASIR and ASDR. Furthermore, North Macedonia also exhibited the highest age-standardized DALY rate.

Interpretation

Regions with high-middle and middle SDI continued to experience elevated ASPR, ASIR, ASDR and age-standardized DALY rates. The highest ischemic stroke burden was observed in Southern Sub-Saharan Africa, Central Asia, Eastern Europe, and the Middle East.

Funding

None.

Translational potential of mesenchymal stem cells in regenerative therapies for human diseases: challenges and opportunities

Advances in stem cell technology offer new possibilities for patients with untreated diseases and disorders. Stem cell-based therapy, which includes multipotent mesenchymal stem cells (MSCs), has recently become important in regenerative therapies. MSCs are multipotent progenitor cells that possess the ability to undergo in vitro self-renewal and differentiate into various mesenchymal lineages. MSCs have demonstrated promise in several areas, such as tissue regeneration, immunological modulation, anti-inflammatory qualities, and wound healing. Additionally, the development of specific guidelines and quality control methods that ultimately result in the therapeutic application of MSCs has been made easier by recent advancements in the study of MSC biology. This review discusses the latest clinical uses of MSCs obtained from the umbilical cord (UC), bone marrow (BM), or adipose tissue (AT) in treating various human diseases such as pulmonary dysfunctions, neurological disorders, endocrine/metabolic diseases, skin burns, cardiovascular conditions, and reproductive disorders. Additionally, this review offers comprehensive information regarding the clinical application of targeted therapies utilizing MSCs. It also presents and examines the concept of MSC tissue origin and its potential impact on the function of MSCs in downstream applications. The ultimate aim of this research is to facilitate translational research into clinical applications in regenerative therapies.

Effect of infarct location and volume on cognitive dysfunction in elderly patients with acute insular cerebral infarction

BACKGROUND

The aging of the population has become increasingly obvious in recent years, and the incidence of cerebral infarction has shown an increasing trend annually, with high death and disability rates.

AIM

To analyze the effects of infarct location and volume on cognitive dysfunction in elderly patients with acute insular cerebral infarction.

METHODS

Between January 2020 and December 2023, we treated 98 cases of elderly acute insula, patients with cerebral infarction in the cerebral infarction acute phase (3-4 weeks) and for the course of 6 months in Montreal Cognitive Assessment Scale (MoCA) for screening of cognition. Notably, 58 and 40 patients were placed in the cognitive impairment group and without-cognitive impairment group, respectively. In patients with cerebral infarction, magnetic resonance imaging was used to screen and clearly analyze the MoCA scores of two groups of patients with different infarctions, the relationship between the parts of the infarction volume, and analysis of acute insula cognitive disorder in elderly patients with cerebral infarction and the relationship between the two.

RESULTS

The number of patients with cognitive impairment in the basal ganglia and thalamus was significantly higher than that without cognitive impairment (P < 0.05). The total infarct volume in the cognitive impairment group was higher than that in the non-cognitive impairment group, and the difference was statistically significant (P < 0.05). The infarct volumes at different sites in the cognitive impairment group was higher than in the non-cognitive impairment group (P < 0.05). In the cognitive impairment group, the infarct volumes in the basal ganglia, thalamus, and mixed lesions were negatively correlated with the total MoCA score, with correlation coefficients of -0.67, -0.73, and -0.77, respectively.

CONCLUSION

In elderly patients with acute insular infarction, infarction in the basal ganglia, thalamus, and mixed lesions were more likely to lead to cognitive dysfunction than in other areas, and patients with large infarct volumes were more likely to develop cognitive dysfunction. The infarct volume in the basal ganglia, thalamus, and mixed lesions was significantly negatively correlated with the MoCA score.

Association between stress hyperglycemia ratio and functional outcomes in patients with acute ischemic stroke

OBJECTIVE

This study aimed to evaluate the association between stress hyperglycemia ratio (SHR) and poor functional outcomes at 90 days in patients with acute ischemic stroke (AIS).

METHODS

This study retrospectively collected 1988 AIS patients admitted to two hospitals in the Shenzhen area between January 2022 and March 2023. A total of 1255 patients with Fasting Blood-glucose (FBG) and hemoglobin A1c (HbA1C) values at admission were included in this analysis. SHR, measured by FBG/HbA1C, was evaluated as both a tri-categorical variable (Tertile 1: ≤ 0.83; Tertile 2: 0.84 -0.95; Tertile 3: ≥ 0.96). The outcome was poor functional outcomes (modified Rankin Scale [mRS] score 2-6) at 90 days. We performed univariate analysis, multiple equation regression analysis, stratified analysis, and interactive analysis.

RESULTS

Compared with patients in the lowest tertile of SHR, the highest tertile group had significantly lower odds of achieving poor functional outcomes (adjusted odds ratio, OR = 2.84, 95% CI: 2.02-3.99, P < 0.0001) at 90 days after adjusting for potential covariates. Similar results were observed after further adjustment for white blood cell count, neutrophil count, lymphocyte count, fasting blood glucose, stroke type, intravenous thrombolytic therapy, baseline Glasgow score, and baseline NIHSS score.

CONCLUSION

SHR, as measured by the FBG/HbA1C, was associated with an increased odds of achieving poor functional outcomes in patients with AIS at 90 days.

Impact of Interprofessional Collaborative Practice on Functional Improvements Among Post-Acute Stroke Survivors: A Retrospective Cross-Sectional Study

Background

Stroke survivors in post-acute care frequently experience physiological dysfunction and reduced quality of life. This study aims to assess the impact of the Post-Acute Care Interprofessional Collaborative Practice (PAC-IPCP) program across different care settings, and to identify sensitive tools for assessing physiological functions among post-acute stroke survivors.

Methods

This retrospective study involved 210 stroke survivors in Taiwan. Participants who self-selection for their preferred between hospital care setting and home care setting under PAC-IPCP. Multiple assessment tools were utilized, including the Barthel Index (BI), Functional Oral Intake Scale (FOIS), Mini Nutritional Assessment (MNA), EQ-5D-3L, and Instrumental Activities of Daily Living (IADL). The logistic regression was used to estimate the odds ratios of various functional assessment tools between hospital and home care settings. Additionally, the area under the ROC curves was used to determine which functional assessment tools had higher accuracy in measuring the association between care settings.

Results

Of the study population, 138 stroke survivors (65.71%) selection hospital care setting and 72 stroke survivors (34.29%) selection home care setting. The PAC-IPCP program was equally effective in both care settings for physical function status and quality of life improvements. Specifically, the BI emerged as the most sensitive tool for assessing care settings, with an adjusted OR of 1.04 (95% CI:1.02-1.07, p < 0.0001; AUC = 0.7557). IPCP-based hospital and home care models are equally effective in facilitating improved functional outcomes in post-acute stroke survivors.

Conclusion

The PAC-IPCP program is versatile and effective across care settings. The BI stands out as a robust assessment tool for physiological functions, endorsing its broader clinical application. Future studies should also consider swallowing and nutritional status for a more holistic approach to rehabilitation.

Effectiveness of Virtual Reality in Occupational Therapy for Post-Stroke Adults: A Systematic Review

Background: In recent years, there has been a growing use of technological advancements to enhance the rehabilitation of individuals who have suffered from cerebrovascular accidents. Virtual reality rehabilitation programs enable patients to engage in a customized therapy program while interacting with a computer-generated environment. Therefore, our goal was to investigate the effectiveness of virtual reality in occupational therapy for people's rehabilitation after a cerebrovascular accident. Methods: We systematically searched databases (Pubmed/Medline, Scopus, Web of Science, and Science Direct) for randomized controlled trials published within the last 10 years. Studies involving adult stroke survivors undergoing virtual reality-based interventions aimed at improving upper-extremity motor function were included. The quality assessment followed PRISMA guidelines, with the risk of bias assessed using the Cochrane tool (version 6.4) and methodological quality evaluated using GRADEpro. Results: We selected sixteen studies that met the main criteria for the implementation of virtual reality technology. The interventions described in the articles focused mainly on the upper extremities and their fine motor skills. Conclusions: When used in conventional treatments to improve people's motor and cognitive functions after a cerebrovascular accident, virtual reality emerges as a beneficial tool. Additionally, virtual reality encourages adherence to the interventional process of rehabilitation through occupational therapy.

The Prognostic Role of the Neutrophil-to-Lymphocytes Ratio in the Most Frequent Cardiovascular Diseases: An Update

Given the continuous changes in the world, with an increasing trend of unhealthy lifestyles, metabolic comorbidities, and increased susceptibility to cardiovascular diseases (CVDs), researchers change their attention to improve not only the therapeutic platform but also current CVD predictive and prognostic tools to improve disease outcomes. As CVD is characterized by an inflammatory paradigm involving, to some degree, the innate and adaptative immune systems, the neutrophil-to-lymphocyte ratio (NLR) emerged as a potential low-cost, rapidly available, and reliable inflammatory marker, with substantial recent evidence showing its potential utility in clinical practice. Thus, in this literature review, we will present an up-to-date discussion of the prognostic role of NLR in the most frequent CVDs, such as acute and chronic coronary disease, atherosclerotic disease, heart failure, cardiac valvopathies, and cardiac arrhythmias with predilection to atrial fibrillation.