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Synergistic impacts of physical activity and sleep on risk of dementia and all-cause mortality in chinese older stroke survivors 体力活动和睡眠对中国老年脑卒中幸存者痴呆风险和全因死亡率的协同影响
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108547
Jiawen Wei, Yan Shen

Background

Physical activity (PA) and sleep reduce the risk of dementia and mortality, but evidence among older stroke survivors in China is limited.

Objective

To investigate the impact of PA on dementia and all-cause mortality risks in this population and analyze its joint effect with sleep.

Methods

Utilizing data from the CLHLS, we analyzed the correlation of PA with dementia and mortality in elderly stroke survivors and explored the mediating role of dementia in the PA–mortality relationship. Joint variables of PA and sleep were constructed to assess their combined effects on dementia and mortality.

Results

Older stroke survivors engaging in regular PA had a 38% reduced risk of dementia (OR=0.62, 95% CI: 0.56-0.69, P<0.001) and a 44% lower risk of mortality (HR=0.56, 95% CI: 0.52-0.59, P<0.001). Additional protective factors against dementia included pet ownership, social activity, and reading, whereas television viewing and radio listening were linked to an increased risk of dementia. Raising domestic animals/pets, participating in outdoor activities, and performing housework were associated with a lower mortality risk (P<0.05). Dementia mediated 5.9% of PA–mortality risk relationship. The joint analysis highlighted that coupling regular PA with sleep exceeding 9 h was associated with a 42% decrease in dementia risk, whereas pairing it with 9 h or less of sleep yielded a 60% decrease in mortality risk.

Conclusion

For elderly stroke survivors, PA confers protective effects against both dementia and all-cause mortality. This association is partially mediated by the reduced risk of dementia. Furthermore, the beneficial impact of regular PA on these outcomes is moderated by sleep duration, underscoring the necessity of a joint consideration of both factors in prognostic assessments.
背景:体育活动(PA)和睡眠可以降低痴呆和死亡率的风险,但在中国老年中风幸存者中的证据有限。目的:探讨PA对老年痴呆及全因死亡风险的影响,并分析其与睡眠的联合作用。方法:利用CLHLS数据,分析老年脑卒中幸存者PA与痴呆和死亡率的相关性,探讨痴呆在PA-死亡率关系中的中介作用。构建了PA和睡眠的联合变量来评估它们对痴呆和死亡率的综合影响。结果:老年脑卒中幸存者定期接受PA治疗,痴呆风险降低38% (OR=0.62, 95% CI: 0.56-0.69)。结论:对于老年脑卒中幸存者,PA对痴呆和全因死亡率均有保护作用。这种关联部分是由痴呆风险降低介导的。此外,定期PA对这些结果的有益影响受到睡眠时间的影响,强调了在预后评估中联合考虑这两个因素的必要性。
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引用次数: 0
Metabolic syndrome severity and stroke risk: a longitudinal analysis in middle-aged and older chinese adults 代谢综合征严重程度与卒中风险:中国中老年成人的纵向分析。
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-03-01 Epub Date: 2026-01-09 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108553
Wang Rong MD , Zhanlan Zhu MD , Dongji Wang MD , Wenbin Shang MD

Background

Metabolic syndrome (MetS) contributes to cerebrovascular disease in older adults. Traditional binary diagnostic criteria may not fully capture metabolic dysfunction or its impact on stroke risk.

Objective

This study explores the relationship between MetS severity and stroke risk.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (2011–2018). MetS severity was quantified using a validated scoring algorithm, and a cumulative severity score was calculated as the average of MetS scores at waves 1 and 3, weighted by the interval between waves. Cox proportional hazards models evaluated the relationship between baseline MetS severity and stroke events, while logistic regression assessed cumulative score in relation to incident stroke occurring after wave 3. Restricted cubic spline (RCS) functions were applied to explore nonlinear associations. Subgroup and interaction analyses were performed, and sensitivity analyses excluded participants receiving metabolic-related medications or with stroke occurring within two years prior to follow-up.

Results

During a median follow-up of 7 years, 459 stroke cases were documented (7.04%). Each interquartile increase in baseline MetS score was associated with a 33.4% higher stroke risk (HR = 1.334; 95% CI 1.239–1.436). Stroke risk increased significantly across quartiles (P for trend < 0.0001), with the highest quartile exhibiting nearly a threefold greater risk compared with the lowest (HR = 2.923; 95% CI 2.208–3.871). Cumulative MetS score was also positively associated with stroke (OR = 1.034; 95% CI 1.025–1.043), with the highest quartile showing significantly elevated odds (OR = 1.069; 95% CI 1.049–1.092). RCS analyses demonstrated significant nonlinear associations between baseline and cumulative MetS scores and stroke risk in the overall population, whereas linear associations were observed in stratified analyses according to MetS status. Additional analyses assessing changes in MetS score between waves 1 and 3 showed no significant association with stroke risk.

Conclusion

Greater MetS severity is independently associated with increased stroke risk among middle-aged and older Chinese adults. These findings highlight the need for continuous surveillance of MetS severity and timely intervention to mitigate stroke burden in aging populations.
背景:代谢综合征(MetS)与老年人脑血管疾病有关。传统的二元诊断标准可能不能完全捕获代谢功能障碍或其对卒中风险的影响。目的:探讨MetS严重程度与卒中风险的关系。方法:数据来源于中国健康与退休纵向研究(2011-2018)。使用经过验证的评分算法对MetS的严重程度进行量化,并计算累积严重性评分为第1和第3波MetS评分的平均值,并按波之间的间隔加权。Cox比例风险模型评估基线MetS严重程度与卒中事件之间的关系,而逻辑回归评估累积评分与第3波后发生的卒中事件的关系。利用限制三次样条函数(RCS)来研究非线性关联。进行了亚组分析和相互作用分析,敏感性分析排除了接受代谢相关药物治疗或随访前两年内发生中风的参与者。结果:在中位随访7年期间,记录了459例卒中病例(7.04%)。基线met评分每增加四分位数,卒中风险增加33.4% (HR = 1.334;95% CI 1.239-1.436)。卒中风险在四分位数中显著增加(P < 0.0001),最高四分位数的风险比最低四分位数的风险高出近三倍(HR = 2.923;95% CI 2.208-3.871)。累积MetS评分也与卒中呈正相关(OR = 1.034;95% CI 1.025-1.043),最高的四分位数显示显著升高的几率(OR = 1.069;95% CI 1.049-1.092)。RCS分析显示,基线和累积MetS评分与总体人群卒中风险之间存在显著的非线性关联,而根据MetS状态进行分层分析则观察到线性关联。额外的分析评估了第1波和第3波之间MetS评分的变化,显示与卒中风险没有显著关联。结论:在中国中老年人群中,较大的MetS严重程度与卒中风险增加独立相关。这些发现强调了持续监测MetS严重程度和及时干预以减轻老年人群卒中负担的必要性。
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引用次数: 0
Spatial and spatiotemporal pattern of stroke relative risk in Ghana using Bayesian modelling approach 空间和时空模式的中风相对风险在加纳使用贝叶斯建模方法。
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-03-01 Epub Date: 2026-01-21 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108567
Abdul-Karim Iddrisu , Sampson Appiah Takyi , Joyseline Owusu Afriyie , Abubakar Siddick

Introduction

Stroke ranks as the second-leading cause of death and third in combined death and disability globally. In Ghana, there is a significant incidence of stroke, yet systematic reviews highlight a lack of comprehensive data on stroke in Sub-Saharan Africa, including Ghana. Additionally, information on the spatial and spatiotemporal distribution of stroke risk across Ghana's 16 regions remains limited. The objective of this study was to study the spatial and spatiotemporal distribution of stroke relative risk, identify regions with high-risk regions and associated predictors.

Material and Methods

Stroke risk for each region was estimated using Bayesian spatial and spatiotemporal models, and these risks were mapped to visualize areas with elevated stroke relative risk. The Random Forest and Gradient Boosting models, nonparametric ensemble machine learning algorithms, were used to investigate the effects of potential predictors on stroke risk. The study utilized annual stroke data from 2018 to 2022 obtained from the Ghana Health Service (GHS) via the District Health Information Management System version 2 (DHIMS2) and utilized parameter estimates within the Integrated Nested Laplace Approximation via R software version 4.3.2.

Results

Stroke relative risk decreases significantly over the study period. Some regions exhibited elevated risk, where the spatial model identified Volta, Central, Eastern, Bono, Upper East, Bono East, and Oti as high-risk regions, while the spatiotemporal model pinpointed Eastern, Ahafo, Bono East, Upper West, Savannah, Bono, and Western as high-risk regions. Clustering and variability in stroke risk were observed among regions. The study highlighted that gross national income significantly decreases the risk of stroke occurrence. While temperature and diabetes prevalence showed increased stroke risk, they were not statistically significant.

Conclusion

This study offers valuable insights that can inform resource allocation to regions experiencing elevated stroke risk. Identified high-risk regions can inform targeted screening strategies, referral pathway strengthening, and resource prioritization. Diagnostic capacity (including CT/MRI access), health-facility reporting quality, and surveillance system upgrades needed to reduce measurement bias and improve case ascertainment. Furthermore, we situate the findings within Ghana’s existing noncommunicable disease (NCD) policy frameworks and describe how routine updates of the model using new DHIMS2 data can support ongoing decision-making.
在全球范围内,中风是第二大死亡原因和第三大死亡和残疾原因。在加纳,中风发病率很高,但系统综述强调,包括加纳在内的撒哈拉以南非洲缺乏全面的中风数据。此外,关于加纳16个地区中风风险时空分布的信息仍然有限。本研究的目的是研究脑卒中相对风险的时空分布,确定高危区域和相关预测因素。材料和方法:使用贝叶斯空间和时空模型估计每个地区的卒中风险,并将这些风险绘制成可视化卒中相对风险升高的区域。使用随机森林和梯度增强模型(非参数集成机器学习算法)来研究潜在预测因素对中风风险的影响。该研究利用了通过地区卫生信息管理系统版本2 (DHIMS2)从加纳卫生服务(GHS)获得的2018年至2022年的年度中风数据,并通过R软件版本4.3.2利用集成嵌套拉普拉斯近似中的参数估计。结果:中风的相对风险在研究期间显著降低。空间模型将Volta、Central、Eastern、Bono、Upper East、Bono East和Oti确定为高风险地区,而时空模型将Eastern、Ahafo、Bono East、Upper West、Savannah、Bono和Western确定为高风险地区。在不同地区之间观察到卒中风险的聚类性和变异性。该研究强调,国民总收入显著降低中风发生的风险。虽然体温和糖尿病患病率显示中风风险增加,但它们在统计上并不显著。结论:这项研究提供了有价值的见解,可以为卒中高风险地区的资源分配提供信息。确定的高风险地区可以告知有针对性的筛查策略,转诊途径加强和资源优先排序。诊断能力(包括CT/MRI获取)、卫生机构报告质量和监测系统升级需要减少测量偏差和改善病例确定。此外,我们将研究结果置于加纳现有的非传染性疾病(NCD)政策框架中,并描述了使用新的DHIMS2数据对模型进行常规更新如何支持正在进行的决策。
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引用次数: 0
Outcomes of low-dose versus standard-dose alteplase in acute ischemic stroke patients aged over 80 years: A real-world propensity score-matched study from China 低剂量与标准剂量阿替普酶治疗80岁以上急性缺血性卒中患者的结果:一项来自中国的真实世界倾向评分匹配研究
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-03-01 Epub Date: 2026-01-04 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108548
Chang-sheng Li MD , Hong-Qiu Gu MD , Kai-xuan Yang MS , Zi-mo Chen MD , Xia Meng MD , Chun-juan Wang MD , Zi-xiao Li MD

Background

Optimal alteplase dosing for intravenous thrombolysis in stroke patients aged >80 years remains debated due to underrepresentation in pivotal trials. This study evaluates the relative effectiveness and safety of low-dose (0.6 mg/kg) versus standard-dose (0.9 mg/kg) alteplase in elderly patients treated within 4.5 hours of onset.

Methods

Utilizing the China Stroke Center Alliance registry database (2018-2022), we conducted a propensity score-matched analysis encompassing 6,522 patients over 80 years of age, ultimately generating 2,050 matched pairs. The primary outcome was functional dependence or death at discharge (mRS 2–6). Secondary measures included major disability (mRS 3–6), in-hospital mortality, and symptomatic intracranial hemorrhage (sICH).

Results

The primary outcome showed no statistical difference between low-dose (81.6 %) and standard-dose (81.8 %) groups (OR 0.99; 95 % CI 0.84-1.16; P=0.871). Rates of major disability (56.0 % vs. 57.7 %; OR 1.02; P=0.730), mortality (15.6 % vs. 14.4 %; OR 1.10; P=0.294), and sICH (4.4 % vs. 5.2 %; OR 0.85; P=0.274) were broadly alike. Low-dose alteplase showed a numerical decline in bleeding events. Subgroup analysis found no modifying factors.

Conclusions

In octogenarian stroke patients, low-dose alteplase offers parallel efficacy and safety to standard therapy, with a possible reduction in hemorrhagic complications. These results support low-dose regimens as a reasonable option for elderly patients, particularly when minimizing bleeding risk is a clinical priority.
背景:由于关键试验中代表性不足,80岁中风患者静脉溶栓的最佳阿替普酶剂量仍存在争议。本研究评估了低剂量(0.6 mg/kg)与标准剂量(0.9 mg/kg)阿替普酶在发病4.5小时内治疗的老年患者的相对有效性和安全性。方法:利用中国脑卒中中心联盟注册数据库(2018-2022),对6522例80岁以上患者进行倾向评分匹配分析,最终生成2050对匹配。主要结局是功能依赖或出院时死亡(mRS 2-6)。次要测量包括主要残疾(mRS 3-6)、住院死亡率和症状性颅内出血(siich)。结果:低剂量组(81.6%)与标准剂量组(81.8%)的主要结局无统计学差异(OR 0.99; 95% CI 0.84 ~ 1.16; P=0.871)。主要致残率(56.0% vs. 57.7%; OR 1.02; P=0.730)、死亡率(15.6% vs. 14.4%; OR 1.10; P=0.294)和脑出血(4.4% vs. 5.2%; OR 0.85; P=0.274)大致相似。低剂量阿替普酶显示出血事件的数量下降。亚组分析未发现影响因素。结论:在80多岁的脑卒中患者中,低剂量阿替普酶与标准治疗具有同等的疗效和安全性,并可能减少出血性并发症。这些结果支持低剂量方案作为老年患者的合理选择,特别是当最小化出血风险是临床优先考虑的时候。
{"title":"Outcomes of low-dose versus standard-dose alteplase in acute ischemic stroke patients aged over 80 years: A real-world propensity score-matched study from China","authors":"Chang-sheng Li MD ,&nbsp;Hong-Qiu Gu MD ,&nbsp;Kai-xuan Yang MS ,&nbsp;Zi-mo Chen MD ,&nbsp;Xia Meng MD ,&nbsp;Chun-juan Wang MD ,&nbsp;Zi-xiao Li MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108548","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108548","url":null,"abstract":"<div><h3>Background</h3><div>Optimal alteplase dosing for intravenous thrombolysis in stroke patients aged &gt;80 years remains debated due to underrepresentation in pivotal trials. This study evaluates the relative effectiveness and safety of low-dose (0.6 mg/kg) versus standard-dose (0.9 mg/kg) alteplase in elderly patients treated within 4.5 hours of onset.</div></div><div><h3>Methods</h3><div>Utilizing the China Stroke Center Alliance registry database (2018-2022), we conducted a propensity score-matched analysis encompassing 6,522 patients over 80 years of age, ultimately generating 2,050 matched pairs. The primary outcome was functional dependence or death at discharge (mRS 2–6). Secondary measures included major disability (mRS 3–6), in-hospital mortality, and symptomatic intracranial hemorrhage (sICH).</div></div><div><h3>Results</h3><div>The primary outcome showed no statistical difference between low-dose (81.6 %) and standard-dose (81.8 %) groups (OR 0.99; 95 % CI 0.84-1.16; P=0.871). Rates of major disability (56.0 % vs. 57.7 %; OR 1.02; P=0.730), mortality (15.6 % vs. 14.4 %; OR 1.10; P=0.294), and sICH (4.4 % vs. 5.2 %; OR 0.85; P=0.274) were broadly alike. Low-dose alteplase showed a numerical decline in bleeding events. Subgroup analysis found no modifying factors.</div></div><div><h3>Conclusions</h3><div>In octogenarian stroke patients, low-dose alteplase offers parallel efficacy and safety to standard therapy, with a possible reduction in hemorrhagic complications. These results support low-dose regimens as a reasonable option for elderly patients, particularly when minimizing bleeding risk is a clinical priority.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108548"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality of life after decompressive surgery for severe cerebral venous thrombosis 重度脑静脉血栓形成减压手术后的生活质量。
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108549
Mayte Sanchez van Kammen MD, PhD , Sanjit Aaron MD , Jorge M Ferreira MD , Patrícia Canhão MD, PhD , Adriana B. Conforto MD , Antonio Arauz , Marta Carvalho MD , Jaime Masjuan MD , Vijay K Sharma MD , Jukka Putaala MD, PhD , Maarten Uyttenboogaart MD , Rodrigo Bazan MD , Bert A Coert MD , Prabhu Kirubakaran MD , Pankaj Singh MD , Diana Aguiar de Sousa MD, PhD , Jonathan M Coutinho MD, PhD , José M Ferro MD, PhD , the DECOMPRESS 2 study group

Background

Decompressive surgery can be lifesaving in patients with severe cerebral venous thrombosis (CVT) and impending brain herniation. However, data on health-related quality of life (HRQoL) after surgery are limited.

Methods

DECOMPRESS-2 was a prospective cohort study including adult patients with CVT from 15 centers in 10 countries who underwent decompressive surgery (2011–2019). HRQoL was assessed using EQ5D-3 L utility scores, subdomains, and a visual analogue scale (VAS) at 6 and 12 months post-surgery. Complete case analysis, multiple imputation, best- and worst-case analyses were performed. Predictors of EQ5D-score (Tobit regression) and VAS (linear regression) at 12 months were analyzed.

Results

Of 118 patients, 112 were included (median age 38 years [IQR 27–46], 68% female). At 12-months, EQ5D-3 L and VAS were available for 89% and 90% of survivors, respectively. Median EQ5D-3L-score was 0.70 (IQR 0.52–0.85, mean 0.59 [SD 0.38]) and median VAS was 70 (IQR 56–80, mean 69 [SD 18]). Overall, 84% of patients reported problems in ≥1 subdomain of the EQ5D-3L: 68% with usual activities, 59% pain/discomfort, 58% anxiety/depression, 47% with self-care, 43% with mobility. Higher age and residence in a middle-income country (vs. high-income) predicted poorer EQ5D-3 L and VAS. Preoperative coma predicted worse EQ5D-3 L only.

Conclusions

Twelve months after decompressive surgery for CVT, over 4 out of 5 survivors reported problems in at least one subdomain of the EQ5D-3 L. Higher age, middle-income country status and preoperative coma were negative predictors of quality of life.
背景:减压手术可以挽救严重脑静脉血栓形成(CVT)和即将发生的脑疝患者的生命。然而,手术后与健康相关的生活质量(HRQoL)数据有限。方法:DECOMPRESS-2是一项前瞻性队列研究,包括来自10个国家15个中心接受减压手术的成年CVT患者(2011-2019)。HRQoL在术后6个月和12个月采用EQ5D-3L效用评分、子域和视觉模拟量表(VAS)进行评估。完整的案例分析,多重归算,最佳和最坏情况分析进行。分析12个月eq5d评分(Tobit回归)和VAS(线性回归)的预测因子。结果:118例患者中,纳入112例(中位年龄38岁[IQR 27-46], 68%为女性)。12个月时,89%和90%的幸存者分别获得EQ5D-3L和VAS。eq5d - 3l评分中位数为0.70 (IQR为0.52 ~ 0.85,平均0.59 [SD 0.38]), VAS中位数为70 (IQR为56 ~ 80,平均69 [SD 18])。总体而言,84%的患者报告了EQ5D-3L≥1个亚域的问题:68%的患者有正常活动,59%的患者有疼痛/不适,58%的患者有焦虑/抑郁,47%的患者有自我护理,43%的患者有活动能力。中等收入国家的年龄和居住地越高(与高收入国家相比),EQ5D-3L和VAS越差。术前昏迷仅预测EQ5D-3L加重。结论:CVT减压手术12个月后,超过4 / 5的幸存者报告了至少一个EQ5D-3L亚域的问题。较高的年龄、中等收入国家和术前昏迷是生活质量的负向预测因子。
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引用次数: 0
Deep learning architectures for modeling and forecasting stroke cases in Ghana 用于建模和预测加纳中风病例的深度学习架构
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-03-01 Epub Date: 2026-01-21 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108570
Abdul-Karim Iddrisu , Morongwa Gabanakgosi , Abubakar Hudu Siddick

Introduction

Stroke remains a leading cause of global morbidity and mortality, ranking second in deaths and third in disability-adjusted life years (DALYs). Its burden is particularly severe in low- and middle-income countries such as Ghana, where stroke is currently the leading cause of death. However, local data and predictive modeling remain limited, hindering effective health planning and intervention. This study aimed to model and forecast stroke incidence in Ghana using advanced deep learning techniques to support data-driven public health strategies.

Material and Methods

Monthly stroke case data from 2018 to 2023 were obtained from Ghana Health Service. Four deep learning models; Long Short-Term Memory (LSTM), Bayesian LSTM (BLSTM), Convolutional LSTM (ConvLSTM), and Bayesian ConvLSTM (BConvLSTM), were employed to capture spatiotemporal patterns in stroke incidence. Diabetes prevalence was included as a covariate. Model performance was evaluated using mean absolute error (MAE), mean square error (MSE), root mean square error (RMSE), and mean absolute percentage error (MAPE). Data analyses were carried out using python version 3.13.7 and R version software.

Results

LSTM and BLSTM models showed strong forecasting performance, with LSTM yielding the lowest errors. ConvLSTM and BConvLSTM models underperformed significantly. Forecasts from 2024 to 2028 reveal initial variability in 2024, with monthly cases between 1,694 and 2,007, followed by gradual stabilization through 2028, where values converge between 1,774 and 1,781.

Conclusion

The study highlights a persistently high but stabilizing stroke burden in Ghana. It underscores the urgent need for targeted interventions addressing modifiable risk factors, particularly diabetes, and supports LSTM as the most effective model for forecasting in this context.
中风仍然是全球发病率和死亡率的主要原因,在死亡人数中排名第二,在残疾调整生命年(DALYs)中排名第三。在加纳等低收入和中等收入国家,中风的负担尤其严重,在这些国家,中风目前是主要的死亡原因。然而,当地数据和预测模型仍然有限,阻碍了有效的卫生规划和干预。本研究旨在利用先进的深度学习技术模拟和预测加纳的中风发病率,以支持数据驱动的公共卫生战略。材料与方法从加纳卫生服务中心获取2018 - 2023年每月脑卒中病例数据。四种深度学习模型;采用长短期记忆(LSTM)、贝叶斯LSTM (BLSTM)、卷积LSTM (ConvLSTM)和贝叶斯ConvLSTM (BConvLSTM)来捕捉脑卒中发生的时空模式。糖尿病患病率作为协变量包括在内。使用平均绝对误差(MAE)、均方误差(MSE)、均方根误差(RMSE)和平均绝对百分比误差(MAPE)评估模型性能。采用python 3.13.7版和R版软件进行数据分析。结果slstm和BLSTM模型预测效果较好,其中LSTM模型误差最小。ConvLSTM和BConvLSTM模型表现不佳。从2024年到2028年的预测显示,2024年的初始变化,每月病例数在1694至2007之间,随后到2028年逐渐稳定,病例数在1774至1781之间收敛。结论:该研究强调了加纳卒中负担持续偏高但趋于稳定。报告强调,迫切需要针对可改变的风险因素,特别是糖尿病,采取有针对性的干预措施,并支持LSTM作为这方面最有效的预测模型。
{"title":"Deep learning architectures for modeling and forecasting stroke cases in Ghana","authors":"Abdul-Karim Iddrisu ,&nbsp;Morongwa Gabanakgosi ,&nbsp;Abubakar Hudu Siddick","doi":"10.1016/j.jstrokecerebrovasdis.2026.108570","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108570","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke remains a leading cause of global morbidity and mortality, ranking second in deaths and third in disability-adjusted life years (DALYs). Its burden is particularly severe in low- and middle-income countries such as Ghana, where stroke is currently the leading cause of death. However, local data and predictive modeling remain limited, hindering effective health planning and intervention. This study aimed to model and forecast stroke incidence in Ghana using advanced deep learning techniques to support data-driven public health strategies.</div></div><div><h3>Material and Methods</h3><div>Monthly stroke case data from 2018 to 2023 were obtained from Ghana Health Service. Four deep learning models; Long Short-Term Memory (LSTM), Bayesian LSTM (BLSTM), Convolutional LSTM (ConvLSTM), and Bayesian ConvLSTM (BConvLSTM), were employed to capture spatiotemporal patterns in stroke incidence. Diabetes prevalence was included as a covariate. Model performance was evaluated using mean absolute error (MAE), mean square error (MSE), root mean square error (RMSE), and mean absolute percentage error (MAPE). Data analyses were carried out using python version 3.13.7 and R version software.</div></div><div><h3>Results</h3><div>LSTM and BLSTM models showed strong forecasting performance, with LSTM yielding the lowest errors. ConvLSTM and BConvLSTM models underperformed significantly. Forecasts from 2024 to 2028 reveal initial variability in 2024, with monthly cases between 1,694 and 2,007, followed by gradual stabilization through 2028, where values converge between 1,774 and 1,781.</div></div><div><h3>Conclusion</h3><div>The study highlights a persistently high but stabilizing stroke burden in Ghana. It underscores the urgent need for targeted interventions addressing modifiable risk factors, particularly diabetes, and supports LSTM as the most effective model for forecasting in this context.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108570"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between monocyte to high-density lipoprotein cholesterol ratio and stroke prevalence in American adults: A cross-sectional NHANES Study 美国成人单核细胞与高密度脂蛋白胆固醇比值与卒中患病率之间的关系:一项横断面NHANES研究。
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108580
Jiahui Wang , Guojiang Zheng , Jianhua Xu

Background

The monocyte to high-density lipoprotein ratio (MHR) is a novel biomarker reflecting systemic inflammation and lipid metabolism disturbances, providing insights into the pathophysiological mechanisms of stroke development. While prior research has established a connection between MHR and cardiovascular outcomes, its association with stroke has yet to be conclusively validated in large-scale, population-based cohorts.

Methods

Data from the 1999-2018 National Health and Nutrition Examination Survey (NHANES) was used for the analysis. Subgroup analyses evaluated association robustness across demographic strata.The study assessed the link between MHR and stroke prevalence using restricted cubic spline regression (RCS) methods. Adjustments were made for demographic characteristics, lifestyle factors, and clinical confounding variables.Subgroup and sensitivity analyses evaluated the robustness of observed associations.

Results

Among the 28,238 participants included in the study, 805 individuals (2.08%) experienced a stroke. A comprehensive logistic regression analysis demonstrated that each standard deviation (SD) increase in MHR was associated with 20% higher odds of stroke (OR = 1.20, 95% CI: 1.08-1.33, P < 0.05). RCS analysis indicated a linear association between MHR and stroke(P > 0.05). Subgroup and sensitivity analyses consistently demonstrated a significant positive association between MHR and stroke. This national, cross-sectional study demonstrated a linear positive correlation between the MHR and stroke, highlighting its potential utility as an indicator. However, the cross-sectional design precludes causal inference, which requires verification by prospective studies.
背景:单核细胞与高密度脂蛋白比值(MHR)是反映全身性炎症和脂质代谢紊乱的一种新的生物标志物,为脑卒中发展的病理生理机制提供了新的见解。虽然先前的研究已经建立了MHR与心血管预后之间的联系,但其与中风的关联尚未在大规模、基于人群的队列中得到最终验证。方法:采用1999-2018年全国健康与营养调查(NHANES)数据进行分析。亚组分析评估了跨人口阶层的关联稳健性。该研究使用限制性三次样条回归(RCS)方法评估了MHR与卒中患病率之间的联系。对人口统计学特征、生活方式因素和临床混杂变量进行了调整。亚组分析和敏感性分析评估了观察到的关联的稳健性。结果:在纳入研究的28238名参与者中,805人(2.08%)经历过中风。综合logistic回归分析显示,MHR每增加一个标准差(SD),卒中几率增加20% (OR = 1.20,95% CI: 1.08-1.33, P < 0.05)。RCS分析显示MHR与脑卒中呈线性相关(P < 0.05)。亚组分析和敏感性分析一致表明MHR与卒中之间存在显著的正相关。这项全国性的横断面研究证明了MHR与中风之间的线性正相关,突出了其作为指标的潜在效用。然而,横断面设计排除了因果推理,这需要前瞻性研究的验证。
{"title":"Association between monocyte to high-density lipoprotein cholesterol ratio and stroke prevalence in American adults: A cross-sectional NHANES Study","authors":"Jiahui Wang ,&nbsp;Guojiang Zheng ,&nbsp;Jianhua Xu","doi":"10.1016/j.jstrokecerebrovasdis.2026.108580","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108580","url":null,"abstract":"<div><h3>Background</h3><div>The monocyte to high-density lipoprotein ratio (MHR) is a novel biomarker reflecting systemic inflammation and lipid metabolism disturbances, providing insights into the pathophysiological mechanisms of stroke development. While prior research has established a connection between MHR and cardiovascular outcomes, its association with stroke has yet to be conclusively validated in large-scale, population-based cohorts.</div></div><div><h3>Methods</h3><div>Data from the 1999-2018 National Health and Nutrition Examination Survey (NHANES) was used for the analysis. Subgroup analyses evaluated association robustness across demographic strata.The study assessed the link between MHR and stroke prevalence using restricted cubic spline regression (RCS) methods. Adjustments were made for demographic characteristics, lifestyle factors, and clinical confounding variables.Subgroup and sensitivity analyses evaluated the robustness of observed associations.</div></div><div><h3>Results</h3><div>Among the 28,238 participants included in the study, 805 individuals (2.08%) experienced a stroke. A comprehensive logistic regression analysis demonstrated that each standard deviation (SD) increase in MHR was associated with 20% higher odds of stroke (OR = 1.20, 95% CI: 1.08-1.33, <em>P</em> &lt; 0.05). RCS analysis indicated a linear association between MHR and stroke<em>(P</em> &gt; 0.05). Subgroup and sensitivity analyses consistently demonstrated a significant positive association between MHR and stroke. This national, cross-sectional study demonstrated a linear positive correlation between the MHR and stroke, highlighting its potential utility as an indicator. However, the cross-sectional design precludes causal inference, which requires verification by prospective studies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108580"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
RKIP regulates the ERK/MAPK signaling pathway to improve neuroinflammatory injury in male rats with ischemic stroke RKIP通过调控ERK/MAPK信号通路改善雄性缺血性脑卒中大鼠的神经炎症损伤。
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-03-01 Epub Date: 2026-01-14 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108560
Rui Mao, Xin Tan, Rong Li, Zhiyong Yang, Hua Liu

Background

To explore the mechanism by which RAF kinase inhibitory protein (RKIP) alleviates neuroinflammatory damage in male rats with ischemic stroke (IS).

Methods

Male rats were subjected to middle cerebral artery occlusion (MCAO) to establish an IS model. Two weeks before MCAO, a single tail-vein injection of lentivirus or an equivalent volume of normal saline was administered to rats. The neurological deficit scores, infarct volume fractions, and pathological changes of the ischemic penumbra were evaluated in the rats. Immunohistochemstry, double-labeled immunofluorescence, ELISA, and Western blot were performed to assess microglial polarization, neuroinflammation and ERK/MAPK-related protein expressions.

Results

IS rats exhibited elevated neurological deficit scores and enlarged infarct volume fractions, accompanied by aggravated histopathological damage in the ischemic penumbra. Microglial M1 polarization was enhanced, meanwhile, IL-6 and TNF-α were up-regulated, whereas the anti-inflammatory mediator IL-10 was down-regulated, indicating a pronounced neuroinflammatory response. In particular, Western blot results showed that the ischemic penumbra expression of RKIP in IS rats was markedly lower in IS group than that in Control group. After achieving RKIP overexpression via lentivirus mediation, the polarization direction of microglia in the ischemic penumbra of IS rats shifted toward the M2 phenotype. This was specifically manifested by a significant decrease in the proportion of iNOS⁺/Iba1⁺ double-positive microglia, while the proportion of Arg-1⁺/Iba1⁺ double-positive microglia was significantly increased, and the neuroinflammatory response was alleviated. Moreover, its overexpression significantly reduced the expressions of p-ERK1/2 and p-p38 MAPK in ischemic penumbra. Interestingly, rmEGF-activated ERK elevated the protein levels of p-ERK1/2 and p-p38 MAPK in ischemic penumbra without altering RKIP expression itself. Consequently, the proportion of iNOS⁺/Iba1⁺ double-positive microglia rebounded, while that of Arg-1⁺/Iba1⁺ double-positive microglia decreased . Finally, functional experiments demonstrated that ERK partially reversed the neuroinflammatory protection conferred by RKIP overexpression in IS rats.

Conclusion

Overexpression of RKIP may alleviate the neuroinflammatory damage in IS rats by inhibiting ERK/MAPK pathway, thereby improving neurological function.
背景:探讨RAF激酶抑制蛋白(RKIP)减轻雄性缺血性脑卒中大鼠神经炎症损伤的机制。方法:雄性大鼠大脑中动脉闭塞(MCAO)建立缺血性脑卒中(IS)模型。在MCAO前2周,给予大鼠尾静脉单次注射慢病毒或等量生理盐水。测定大鼠神经功能缺损评分、梗死体积分数及缺血半暗带病理改变。采用免疫组织化学、双标记免疫荧光、ELISA和Western blot检测小胶质细胞极化、神经炎症和ERK/ mapk相关蛋白的表达。结果:IS大鼠神经功能缺损评分升高,梗死体积分数增大,伴有缺血半暗带组织病理学损伤加重。小胶质细胞M1极化增强,同时IL-6和TNF-α上调,而抗炎介质IL-10下调,表明神经炎症反应明显。特别是Western blot结果显示,IS组大鼠缺血半暗区RKIP表达明显低于对照组。通过慢病毒介导实现RKIP过表达后,IS大鼠缺血半暗区小胶质细胞极化方向向M2表型转移。具体表现为iNOS + /Iba1 +双阳性小胶质细胞比例显著降低,而Arg-1 + /Iba1 +双阳性小胶质细胞比例显著升高,神经炎症反应得到缓解。过表达可显著降低缺血半暗区p-ERK1/2和p-p38 MAPK的表达。有趣的是,rmegf激活的ERK提高了缺血半暗区p-ERK1/2和p-p38 MAPK的蛋白水平,而不改变RKIP本身的表达。因此,iNOS + /Iba1 +双阳性小胶质细胞的比例出现反弹,而Arg-1 + /Iba1 +双阳性小胶质细胞的比例下降。最后,功能实验表明,ERK部分逆转了IS大鼠中RKIP过表达所赋予的神经炎症保护。结论:过表达RKIP可能通过抑制ERK/MAPK通路减轻IS大鼠神经炎症损伤,从而改善神经功能。
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引用次数: 0
Comment on “Association between biological aging and stroke and all-cause mortality: A population-based cross-sectional study and Mendelian randomization analysis” 对“生物衰老与中风和全因死亡率的关系:一项基于人群的横断面研究和孟德尔随机化分析”的评论。
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-02-01 Epub Date: 2025-12-20 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108534
Pankaj Bansal M.D , Prashant Ramdas Kokiwar M.D , A. Kavya M.D , Archana Dhyani M.D
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引用次数: 0
Comment on “synergistic impacts of physical activity and sleep on risk of dementia and all-cause mortality in Chinese older stroke survivors” 对“体力活动和睡眠对中国老年中风幸存者痴呆风险和全因死亡率的协同影响”的评论。
IF 1.8 4区 医学 Q3 NEUROSCIENCES Pub Date : 2026-02-01 Epub Date: 2025-12-16 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108526
Bhumesh Tyagi MD , Leelabati Toppo MD , Aishwarya Biradar MD
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引用次数: 0
期刊
Journal of Stroke & Cerebrovascular Diseases
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