Journal of Stroke & Cerebrovascular Diseases最新文献_第4页

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

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-11 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108521

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 Chinese Longitudinal Healthy Longevity Survey (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 [Odds Ratio (OR) =0.62, 95 % Confidence Interval (CI): 0.56-0.69, P < 0.001] and a 44 % lower risk of mortality [Hazard Ratio (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. This study underscores the importance of adopting an integrative perspective to assess exercise, daily activities, and sleep in stroke survivor prognosis. Our findings provide critical evidence for developing individualized, non-pharmacological, comprehensive management strategies and indicate future directions for interventional research.

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：利用中国纵向健康寿命调查（CLHLS）的数据，分析老年脑卒中幸存者PA与痴呆和死亡率的相关性，并探讨痴呆在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治疗可使痴呆风险降低38%[优势比(OR) =0.62, 95%可信区间（CI）： 0.56-0.69， p]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。这项研究强调了采用综合视角来评估运动、日常活动和睡眠对中风幸存者预后的重要性。我们的研究结果为制定个性化、非药物、综合的治疗策略提供了重要证据，并为今后的介入研究指明了方向。

{"title":"Synergistic impacts of physical activity and sleep on risk of dementia and all-cause mortality in Chinese older stroke survivors","authors":"Jiawen Wei, Yan Shen","doi":"10.1016/j.jstrokecerebrovasdis.2025.108521","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108521","url":null,"abstract":"<div><h3>Background</h3><div>Physical activity (PA) and sleep reduce the risk of dementia and mortality, but evidence among older stroke survivors in China is limited.</div></div><div><h3>Objective</h3><div>To investigate the impact of PA on dementia and all-cause mortality risks in this population and analyze its joint effect with sleep.</div></div><div><h3>Methods</h3><div>Utilizing data from the Chinese Longitudinal Healthy Longevity Survey (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.</div></div><div><h3>Results</h3><div>Older stroke survivors engaging in regular PA had a 38 % reduced risk of dementia [Odds Ratio (OR) =0.62, 95 % Confidence Interval (CI): 0.56-0.69, <em>P</em> < 0.001] and a 44 % lower risk of mortality [Hazard Ratio (HR) =0.56, 95 % CI: 0.52-0.59, <em>P</em> < 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 (<em>P</em> < 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.</div></div><div><h3>Conclusion</h3><div>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. This study underscores the importance of adopting an integrative perspective to assess exercise, daily activities, and sleep in stroke survivor prognosis. Our findings provide critical evidence for developing individualized, non-pharmacological, comprehensive management strategies and indicate future directions for interventional research.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108521"},"PeriodicalIF":1.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746501","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

Cerebral small vessel disease characteristics associate with domain-specific impairments during Intracerebral Hemorrhage: A retrospective cohort study 脑出血期间脑小血管疾病特征与脑区域特异性损伤相关：一项回顾性队列研究

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-10 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108522

Karim Borei MD , Abdulaziz T. Bako PhD MPH MBBS , Alan P. Pan MS , Osman Khan BS , Gavin W. Britz MD MPH MBA , Farhaan S. Vahidy PhD MBBS MPH , Thomas B.H. Potter PhD

Introduction

Cerebral Small Vessel Disease (CSVD) is associated with cognitive disruptions after intracerebral hemorrhage (ICH), however evidence connecting CSVD to admission National Institutes of Health Stroke Scale (NIHSS) scores is limited.

Methods

Electronic medical record data were retrieved for adult patients (>18 years) with admission for primary ICH and available NIHSS and CSVD assessment. CSVD burden was graded from 0 to 4 based on magnetic resonance imaging, with 1 point assessed for: 1) deep Fazekas score of 2-3 or periventricular (PV) Fazekas score of 3; 2) cerebral microbleed presence; 3) lacune presence; 4) > 20 basal ganglia perivascular spaces. Severe CSVD was defined as a summary score ≥ 3, and individual marker severity was assessed using the same criteria. The primary outcome was moderate-severe stroke (total NIHSS score ≥5). Secondary outcomes were severe motor deficit (motor score >12), complete aphasia (language score = 3), and cortical deficit (any impairment in language, extinction, and gaze). Associations between CSVD and NIHSS were determined using multivariable logistic regression, adjusting for major clinical and demographic factors. Adjusted odds ratios (aOR) and 95 % confidence interval (CI) are reported.

Results

The cohort included 1024 patients (median age [interquartile range]: 71 [61-79], 53 % male). Patients were 43 % White, 23 % Black, 21 % Hispanic, 8 % Asian, 5 % other; 477 (47 %) showed moderate-severe NIHSS scores and 262 (26 %) showed severe CSVD. Periventricular white matter hyperintensity (WMH) burden was independently associated with moderate-severe NIHSS score (aOR, 95 % CI: 1.54, [1.02-2.33]). Deep WMH burden was independently associated with aphasia (2.02, [1.03-3.91]), and motor deficit (3.64, [1.15-12.19]).

Conclusion

Severe WMH burdens independently increase odds of neurological deficit among patients with primary ICH.

脑血管病（CSVD）与脑出血（ICH）后的认知中断相关，然而，将CSVD与入院美国国立卫生研究院卒中量表（NIHSS）评分联系起来的证据有限。方法：检索因原发性脑出血入院的成人患者（bb0 ~ 18岁）的电子病历数据，并进行NIHSS和CSVD评估。根据磁共振成像从0-4分对CSVD负担进行分级，1分评估：1)深部Fazekas评分为2-3或心室周围（PV） Fazekas评分为3；2)存在脑微出血；3)空白存在；4) bbb20基底神经节血管周围间隙。重度CSVD定义为总评分≥3分，使用相同的标准评估个体标志物的严重程度。主要结局为中重度脑卒中（NIHSS总评分≥5）。次要结果是严重的运动缺陷（运动评分>12），完全失语（语言评分 = 3）和皮质缺陷（语言、消失和凝视的任何损伤）。采用多变量logistic回归确定CSVD和NIHSS之间的关联，调整主要临床和人口因素。报告了校正优势比（aOR）和95%置信区间（CI）。结果：该队列纳入1024例患者（中位年龄[四分位数间距]:71岁[61-79岁]，53%为男性）。白人43%，黑人23%，西班牙裔21%，亚洲8%，其他5%；477例（47%）为中重度NIHSS评分，262例（26%）为重度CSVD。脑室周围白质高强度（WMH）负担与中重度NIHSS评分独立相关（aOR, 95% CI: 1.54,[1.02-2.33]）。重度WMH负担与失语症（2.02,[1.03-3.91]）和运动缺陷（3.64,[1.15-12.19]）独立相关。结论：严重的WMH负担单独增加了原发性脑出血患者神经功能障碍的几率。

{"title":"Cerebral small vessel disease characteristics associate with domain-specific impairments during Intracerebral Hemorrhage: A retrospective cohort study","authors":"Karim Borei MD , Abdulaziz T. Bako PhD MPH MBBS , Alan P. Pan MS , Osman Khan BS , Gavin W. Britz MD MPH MBA , Farhaan S. Vahidy PhD MBBS MPH , Thomas B.H. Potter PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108522","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108522","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebral Small Vessel Disease (CSVD) is associated with cognitive disruptions after intracerebral hemorrhage (ICH), however evidence connecting CSVD to admission National Institutes of Health Stroke Scale (NIHSS) scores is limited.</div></div><div><h3>Methods</h3><div>Electronic medical record data were retrieved for adult patients (>18 years) with admission for primary ICH and available NIHSS and CSVD assessment. CSVD burden was graded from 0 to 4 based on magnetic resonance imaging, with 1 point assessed for: 1) deep Fazekas score of 2-3 or periventricular (PV) Fazekas score of 3; 2) cerebral microbleed presence; 3) lacune presence; 4) > 20 basal ganglia perivascular spaces. Severe CSVD was defined as a summary score ≥ 3, and individual marker severity was assessed using the same criteria. The primary outcome was moderate-severe stroke (total NIHSS score ≥5). Secondary outcomes were severe motor deficit (motor score >12), complete aphasia (language score = 3), and cortical deficit (any impairment in language, extinction, and gaze). Associations between CSVD and NIHSS were determined using multivariable logistic regression, adjusting for major clinical and demographic factors. Adjusted odds ratios (aOR) and 95 % confidence interval (CI) are reported.</div></div><div><h3>Results</h3><div>The cohort included 1024 patients (median age [interquartile range]: 71 [61-79], 53 % male). Patients were 43 % White, 23 % Black, 21 % Hispanic, 8 % Asian, 5 % other; 477 (47 %) showed moderate-severe NIHSS scores and 262 (26 %) showed severe CSVD. Periventricular white matter hyperintensity (WMH) burden was independently associated with moderate-severe NIHSS score (aOR, 95 % CI: 1.54, [1.02-2.33]). Deep WMH burden was independently associated with aphasia (2.02, [1.03-3.91]), and motor deficit (3.64, [1.15-12.19]).</div></div><div><h3>Conclusion</h3><div>Severe WMH burdens independently increase odds of neurological deficit among patients with primary ICH.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108522"},"PeriodicalIF":1.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746575","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

Letter to the editor: Acupuncture combined with repetitive transcranial magnetic stimulation for enhancing cortical excitability in the lesional hemisphere after ischemic stroke: A systematic review and meta-analysis 给编辑的信：针灸联合重复经颅磁刺激增强缺血性卒中后病变半球皮层兴奋性：系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-10 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108520

Wei Li, Lei Shi

引用次数: 0

Association between blood pressure and outcome in patients with acute ischemic stroke treated with alteplase 阿替普酶治疗急性缺血性卒中患者血压与预后的关系

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-06 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108518

Ole Morten Rønning MD, PhD , Linn Nordby MD , Nicola Logallo MD, PhD , Christopher E Kvistad MD, PhD , Espen Saxhaug Kristoffersen MD, PhD , Håkon Ihle-Hansen MD, PhD , Hege Ihle-Hansen MD, PhD , Vojtech Novotny MD PhD , Ulrike Waje-Andreassen MD, PhD , Halvor Næss MD, PhD , Lars Thomassen MD, PhD , Bente Thommessen MD, PhD

Background

The role of blood pressure (BP) in acute stroke remains unclear. We investigated the impact of BP trajectories during the first 24 hours (h) after hospital admission on outcomes in acute ischemic stroke patients treated with intravenous alteplase.

Methods

In 424 ischemic stroke patients from the NOR-TEST I trial treated with alteplase, we assessed systolic BP (sBP) at baseline, change in sBP between 0 h and 24 h, and increase in sBP over the same period. Outcomes included modified Rankin Scale (mRS) at 3 months, NIHSS at 24 h, and symptomatic intracerebral haemorrhage (sICH) within 48 h.

Logistic and linear regression analyses were used to explore the association of blood pressure trajectories and outcome adjusted for age, sex, time from onset of symptoms to intravenous thrombolysis (IVT) and NIHSS at admittance (NIHSSadm).

Results

Mean sBP at baseline (admittance), 2 h and 24 h were 155, 147 and 142 mmHg, respectively. An increase in sBP from baseline to 24 h was seen in 115 patients (27 %), while 409 showed an overall change. In unadjusted analyses, sBP increase (but not baseline sBP or change in sBP) was associated with worse mRS at 3 months. This remained significant after adjustment (OR 0.933, 95 %CI 0.876 – 0.993). Higher baseline sBP and sBP increase predicted worse NIHSS at 24 h. sBP increase and baseline sBP were also associated with sICH within 48 h, but only baseline sBP remained significant after adjustment (OR 1.022, 95 % CI 1.003–1.042).

Conclusions

An increase in sBP within the first 24 h was associated with worse neurological and functional outcomes at 3 months, while higher baseline sBP was linked to worse neurological outcomes and sICH in acute ischemic stroke patients treated with alteplase.

Clinical trial registration

NCT01949948.

背景：血压（BP）在急性脑卒中中的作用尚不清楚。我们研究了入院后24小时内血压变化轨迹对静脉注射阿替普酶治疗的急性缺血性卒中患者预后的影响。方法：在接受阿替普酶治疗的424例缺血性脑卒中患者中，我们评估了基线时的收缩压（sBP）， 0 - 24小时的收缩压变化，以及同期的收缩压升高。结果包括3个月时的改良Rankin量表（mRS）， 24小时时的NIHSS， 48小时内的症状性脑出血（siich）。采用Logistic和线性回归分析来探讨血压轨迹与年龄、性别、症状出现到静脉溶栓（IVT）和入院时NIHSS （NIHSSadm）调整后的结果之间的关系。结果：基线（入院）、2h和24h时的平均收缩压分别为155、147和142 mmHg。115例（27%）患者的收缩压从基线升高到24小时，而409例患者的收缩压出现总体变化。在未经调整的分析中，收缩压升高（但不包括基线收缩压或收缩压变化）与3个月时较差的mRS相关。调整后，这仍然是显著的（OR 0.933, 95%CI 0.876 - 0.993）。较高的基线收缩压和收缩压升高预测24 h时NIHSS恶化，48h内收缩压升高和基线收缩压也与sICH相关，但调整后只有基线收缩压仍然显著（OR 1.022, 95% CI 1.003-1.042）。结论：在接受阿替普酶治疗的急性缺血性卒中患者中，最初24小时内收缩压升高与3个月时较差的神经和功能预后相关，而较高的基线收缩压与较差的神经预后和sICH相关。

{"title":"Association between blood pressure and outcome in patients with acute ischemic stroke treated with alteplase","authors":"Ole Morten Rønning MD, PhD , Linn Nordby MD , Nicola Logallo MD, PhD , Christopher E Kvistad MD, PhD , Espen Saxhaug Kristoffersen MD, PhD , Håkon Ihle-Hansen MD, PhD , Hege Ihle-Hansen MD, PhD , Vojtech Novotny MD PhD , Ulrike Waje-Andreassen MD, PhD , Halvor Næss MD, PhD , Lars Thomassen MD, PhD , Bente Thommessen MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108518","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108518","url":null,"abstract":"<div><h3>Background</h3><div>The role of blood pressure (BP) in acute stroke remains unclear. We investigated the impact of BP trajectories during the first 24 hours (h) after hospital admission on outcomes in acute ischemic stroke patients treated with intravenous alteplase.</div></div><div><h3>Methods</h3><div>In 424 ischemic stroke patients from the NOR-TEST I trial treated with alteplase, we assessed systolic BP (sBP) at baseline, change in sBP between 0 h and 24 h, and increase in sBP over the same period. Outcomes included modified Rankin Scale (mRS) at 3 months, NIHSS at 24 h, and symptomatic intracerebral haemorrhage (sICH) within 48 h.</div><div>Logistic and linear regression analyses were used to explore the association of blood pressure trajectories and outcome adjusted for age, sex, time from onset of symptoms to intravenous thrombolysis (IVT) and NIHSS at admittance (NIHSSadm).</div></div><div><h3>Results</h3><div>Mean sBP at baseline (admittance), 2 h and 24 h were 155, 147 and 142 mmHg, respectively. An increase in sBP from baseline to 24 h was seen in 115 patients (27 %), while 409 showed an overall change. In unadjusted analyses, sBP increase (but not baseline sBP or change in sBP) was associated with worse mRS at 3 months. This remained significant after adjustment (OR 0.933, 95 %CI 0.876 – 0.993). Higher baseline sBP and sBP increase predicted worse NIHSS at 24 h. sBP increase and baseline sBP were also associated with sICH within 48 h, but only baseline sBP remained significant after adjustment (OR 1.022, 95 % CI 1.003–1.042).</div></div><div><h3>Conclusions</h3><div>An increase in sBP within the first 24 h was associated with worse neurological and functional outcomes at 3 months, while higher baseline sBP was linked to worse neurological outcomes and sICH in acute ischemic stroke patients treated with alteplase.</div></div><div><h3>Clinical trial registration</h3><div>NCT01949948.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108518"},"PeriodicalIF":1.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710658","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

Based on the PINK1/Parkin signaling pathway, the protective effect of salidroside on cerebral ischemia-reperfusion injury in male rats was investigated 基于PINK1/Parkin信号通路，研究红景天苷对雄性大鼠脑缺血再灌注损伤的保护作用。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-06 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108519

Ting Dong , Haoyu Wang , Yanwei Li , Jun Tan

Objective

Based on the male Sprague-Dawley rats middle cerebral artery occlusion model and SH-SY5Y hypoxia-reoxygenation model, this study systematically evaluated the neuroprotective effect of salidroside (SAL) on cerebral ischemia/reperfusion injury in rats, and explored its possible protective mechanism through PINK1/Parkin signaling axis regulating mitochondrial autophagy.

Materials and methods

Using the middle cerebral artery occlusion (MCAO) model in male Sprague-Dawley rats and the SH-SY5Y cell hypoxia-reoxygenation model, we assessed neurological damage severity through the modified neurological severity scores (NSS). Brain histopathological changes were evaluated using hematoxylin-eosin staining, while the infarct volume in the ischemic brain was assessed with 2,3,5-triphenyltetrazolium chloride (TTC) staining. Transmission electron microscopy was employed to observe mitochondrial ultrastructural alterations in the ischemic brain tissue. Western blotting was used for quantitative analysis of key autophagy-related molecules (PINK1, Parkin), and ROS, MDA, and ferrous ion kit were utilized to evaluate ferroptosis biomarker.

Results

The findings indicate that SAL effectively reduces infarction rates and ameliorates histopathological changes. SAL decreases the formation of reactive oxygen species, malondialdehyde, and ferrous ions by upregulating the expression of PINK1 and Parkin proteins, thereby mitigating apoptosis. Furthermore, SAL significantly inhibits ferroptosis in SH-SY5Y neuroblastoma cells subjected to OGD/R and reduces oxidative stress. The application of the mitochondrial autophagy inhibitor Mdivi-1 enhances the protective effect of SAL against ferroptosis in both MCAO and OGD/R models. Therefore, we draw the following conclusions: In the rat cerebral ischemia-reperfusion injury model and the SH-SY5Y cell oxygen-glucose deprivation/reoxygenation (OGD/R) model, iron death was found to be increased. Pre-treatment with salidroside was able to reduce the occurrence of iron death in both the cerebral ischemia-reperfusion injury model and the cellular OGD/R model.

Conclusions

Salidroside may inhibit iron death by activating the PINK 1 / Parkin signaling pathway and thereby reduce cerebral ischemia-reperfusion injury. Targeted regulation of this pathway may become an important strategy to interfere with CIRI.

目的：基于雄性Sprague-Dawley大鼠大脑中动脉闭塞模型和SH-SY5Y缺氧复氧模型，系统评价红红草苷（SAL）对大鼠脑缺血再灌注损伤的神经保护作用，并通过PINK1/Parkin信号轴调节线粒体自噬，探讨其可能的保护机制。材料与方法：采用sd - dawley雄性大鼠大脑中动脉闭塞（MCAO）模型和SH-SY5Y细胞缺氧复氧模型，采用改良神经损伤严重程度评分法（NSS）评估神经损伤严重程度。采用苏木精-伊红染色评估脑组织病理学改变，2,3,5-三苯四唑氯（TTC）染色评估缺血脑梗死体积。透射电镜观察缺血脑组织线粒体超微结构变化。采用Western blotting定量分析自噬相关关键分子（PINK1、Parkin），采用ROS、MDA、亚铁离子试剂盒评价铁凋亡生物标志物。结果：SAL能有效降低梗死发生率，改善组织病理改变。SAL通过上调PINK1和Parkin蛋白的表达，减少活性氧、丙二醛和亚铁离子的形成，从而减轻细胞凋亡。此外，SAL显著抑制OGD/R下SH-SY5Y神经母细胞瘤细胞的铁下垂，并降低氧化应激。在MCAO和OGD/R模型中，线粒体自噬抑制剂Mdivi-1的应用增强了SAL对铁凋亡的保护作用。因此，我们得出以下结论：在大鼠脑缺血再灌注损伤模型和SH-SY5Y细胞氧-葡萄糖剥夺/再氧合（OGD/R）模型中，发现铁死亡增加。红景天苷预处理可以减少脑缺血再灌注损伤模型和细胞OGD/R模型中铁死亡的发生。结论：红景天苷可能通过激活PINK 1 / Parkin信号通路抑制铁死亡，从而减轻脑缺血再灌注损伤。靶向调控这一通路可能成为干扰CIRI的重要策略。

{"title":"Based on the PINK1/Parkin signaling pathway, the protective effect of salidroside on cerebral ischemia-reperfusion injury in male rats was investigated","authors":"Ting Dong , Haoyu Wang , Yanwei Li , Jun Tan","doi":"10.1016/j.jstrokecerebrovasdis.2025.108519","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108519","url":null,"abstract":"<div><h3>Objective</h3><div>Based on the male Sprague-Dawley rats middle cerebral artery occlusion model and SH-SY5Y hypoxia-reoxygenation model, this study systematically evaluated the neuroprotective effect of salidroside (SAL) on cerebral ischemia/reperfusion injury in rats, and explored its possible protective mechanism through PINK1/Parkin signaling axis regulating mitochondrial autophagy.</div></div><div><h3>Materials and methods</h3><div>Using the middle cerebral artery occlusion (MCAO) model in male Sprague-Dawley rats and the SH-SY5Y cell hypoxia-reoxygenation model, we assessed neurological damage severity through the modified neurological severity scores (NSS). Brain histopathological changes were evaluated using hematoxylin-eosin staining, while the infarct volume in the ischemic brain was assessed with 2,3,5-triphenyltetrazolium chloride (TTC) staining. Transmission electron microscopy was employed to observe mitochondrial ultrastructural alterations in the ischemic brain tissue. Western blotting was used for quantitative analysis of key autophagy-related molecules (PINK1, Parkin), and ROS, MDA, and ferrous ion kit were utilized to evaluate ferroptosis biomarker.</div></div><div><h3>Results</h3><div>The findings indicate that SAL effectively reduces infarction rates and ameliorates histopathological changes. SAL decreases the formation of reactive oxygen species, malondialdehyde, and ferrous ions by upregulating the expression of PINK1 and Parkin proteins, thereby mitigating apoptosis. Furthermore, SAL significantly inhibits ferroptosis in SH-SY5Y neuroblastoma cells subjected to OGD/R and reduces oxidative stress. The application of the mitochondrial autophagy inhibitor Mdivi-1 enhances the protective effect of SAL against ferroptosis in both MCAO and OGD/R models. Therefore, we draw the following conclusions: In the rat cerebral ischemia-reperfusion injury model and the SH-SY5Y cell oxygen-glucose deprivation/reoxygenation (OGD/R) model, iron death was found to be increased. Pre-treatment with salidroside was able to reduce the occurrence of iron death in both the cerebral ischemia-reperfusion injury model and the cellular OGD/R model.</div></div><div><h3>Conclusions</h3><div>Salidroside may inhibit iron death by activating the PINK 1 / Parkin signaling pathway and thereby reduce cerebral ischemia-reperfusion injury. Targeted regulation of this pathway may become an important strategy to interfere with CIRI.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108519"},"PeriodicalIF":1.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710645","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

A comparative analysis of SCALE-CTP and RAPID in determining the affected brain volumes of patients with ischemic stroke SCALE-CTP与RAPID测定缺血性脑卒中患者脑容量的比较分析。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-05 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108517

Jundong Hwang , Hyeon Sik Yang , Gi-Youn Kim , Regina EY Kim , Minho Lee , Donghyeon Kim , Jin Wook Choi , Woo Sang Jung , Kijeong Lee

Background

Computed tomography perfusion (CTP) is widely used to treat acute strokes. The affected brain volume, measured based on the threshold value in the calculated CTP map, has helped guide treatment decisions. We proposed a new software program developed for CTP analysis, SCALE-CTP, and compared the affected brain volumes estimated using RAPID and SCALE-CTP.

Methods

We recruited 362 individuals from the local hospital to evaluate the concordance between SCALE-CTP and RAPID in predicting affected brain volumes, including relative cerebral blood flow (rCBF) <30 % and time-to-maximum concentration (Tmax) > 6 s, and the mismatch volumes. Concordance correlation coefficients (CCC) and Bland–Altman plots were used to assess agreement. Subgroup analyses and comparisons with DWI-derived infarction areas were also performed, along with an evaluation of differences in clinical decision-making.

Results

The calculated volumes from two different software showed excellent concordance (rCBF < 30 % volume: 0.91, Tmax > 6s: 0.88 volume, mismatch volume: 0.82). The concordance between the two software programs remains excellent in the subgroup analysis. In the subset of 38 cases, the differences between DWI-derived infarction area and rCBF < 30 % volume from both software were similar, while SCALE-CTP showed more variability. Their differences in clinical decision making were slightly different.

Conclusion

SCALE-CTP demonstrated strong agreement with RAPID in predicting affected brain volumes and shows potential as a reliable tool for guiding hyperacute ischemic stroke treatment. Further validation is needed to confirm its clinical utility.

背景：计算机断层扫描灌注（CTP）被广泛应用于急性脑卒中的治疗。根据计算的CTP图中的阈值来测量受影响的脑容量，有助于指导治疗决策。我们提出了一种新的CTP分析软件，SCALE-CTP，并比较了使用RAPID和SCALE-CTP估计的受影响的脑容量。方法：我们从当地医院招募了362名患者，评估SCALE-CTP和RAPID在预测影响脑容量（包括相对脑血流量（rCBF） 6s和不匹配容量）方面的一致性。一致性相关系数（CCC）和Bland-Altman图用于评估一致性。还进行了亚组分析和与dwi衍生梗死区域的比较，并评估了临床决策的差异。结果：两种不同软件计算的体积具有良好的一致性（rCBF < 30%体积：0.91，Tmax bbb6s体积：0.88，错配体积：0.82）。在亚群分析中，两个软件程序之间的一致性仍然很好。在38例的子集中，两种软件得出的dwi衍生的梗死面积和rCBF < 30%体积之间的差异相似，而SCALE-CTP显示出更多的可变性。他们在临床决策方面的差异略有不同。结论：SCALE-CTP与RAPID在预测受影响脑容量方面表现出强烈的一致性，并显示出作为指导超急性缺血性脑卒中治疗的可靠工具的潜力。需要进一步验证以确认其临床应用。

{"title":"A comparative analysis of SCALE-CTP and RAPID in determining the affected brain volumes of patients with ischemic stroke","authors":"Jundong Hwang , Hyeon Sik Yang , Gi-Youn Kim , Regina EY Kim , Minho Lee , Donghyeon Kim , Jin Wook Choi , Woo Sang Jung , Kijeong Lee","doi":"10.1016/j.jstrokecerebrovasdis.2025.108517","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108517","url":null,"abstract":"<div><h3>Background</h3><div>Computed tomography perfusion (CTP) is widely used to treat acute strokes. The affected brain volume, measured based on the threshold value in the calculated CTP map, has helped guide treatment decisions. We proposed a new software program developed for CTP analysis, SCALE-CTP, and compared the affected brain volumes estimated using RAPID and SCALE-CTP.</div></div><div><h3>Methods</h3><div>We recruited 362 individuals from the local hospital to evaluate the concordance between SCALE-CTP and RAPID in predicting affected brain volumes, including relative cerebral blood flow (rCBF) <30 % and time-to-maximum concentration (Tmax) > 6 s, and the mismatch volumes. Concordance correlation coefficients (CCC) and Bland–Altman plots were used to assess agreement. Subgroup analyses and comparisons with DWI-derived infarction areas were also performed, along with an evaluation of differences in clinical decision-making.</div></div><div><h3>Results</h3><div>The calculated volumes from two different software showed excellent concordance (rCBF < 30 % volume: 0.91, Tmax > 6s: 0.88 volume, mismatch volume: 0.82). The concordance between the two software programs remains excellent in the subgroup analysis. In the subset of 38 cases, the differences between DWI-derived infarction area and rCBF < 30 % volume from both software were similar, while SCALE-CTP showed more variability. Their differences in clinical decision making were slightly different.</div></div><div><h3>Conclusion</h3><div>SCALE-CTP demonstrated strong agreement with RAPID in predicting affected brain volumes and shows potential as a reliable tool for guiding hyperacute ischemic stroke treatment. Further validation is needed to confirm its clinical utility.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108517"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703757","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

Integrated TyG index and eGDR measure enhances stroke risk stratification in early cardiovascular-kidney-metabolic syndrome: A prospective national cohort analysis 综合TyG指数和eGDR测量增强早期心血管-肾-代谢综合征卒中风险分层：一项前瞻性国家队列分析

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-05 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108516

Xiaolei Wang, Hongfeng Sun, Taojing Zhang, Hui Zhou

Background

The triglyceride-glucose (TyG) index and estimated glucose disposal rate (eGDR) are established markers of insulin resistance (IR), yet their combined role in predicting stroke among individuals with early-stage cardiovascular-kidney-metabolic (CKM) syndrome remains unclear.

Methods

We included 4,414 participants from the China Health and Retirement Longitudinal Study (CHARLS) with baseline (2011) and follow-up (2015) data. TyG-eGDR was calculated at both timepoints, and cumulative exposure was derived. K-means clustering categorized participants into three dynamic trajectory groups. Cox proportional hazards models evaluated stroke risk, restricted cubic splines (RCS) tested nonlinearity, and receiver operating characteristic (ROC) curves assessed predictive performance.

Results

Over the follow-up period, 219 stroke events occurred. Compared to the low TyG-eGDR trajectory group, the high-trajectory group had a 2.84-fold increased stroke risk (HR = 2.84, 95 % CI: 1.67–4.81). Participants with the highest cumulative TyG-eGDR exposure exhibited a 4.28-fold increased stroke risk (HR = 4.28, 95 % CI: 2.66–6.89), while those with high baseline levels had a 3.46-fold elevated risk (HR = 3.46, 95 % CI: 1.82–6.58). RCS analyses revealed significant nonlinear relationships between TyG-eGDR indices and stroke (P < 0.05).

Conclusions

Sustained high TyG-eGDR levels predict stroke risk in early CKM syndrome, supporting its integration into routine metabolic cerebrovascular risk assessment.

背景：甘油三酯-葡萄糖（TyG）指数和估计葡萄糖处置率（eGDR）是胰岛素抵抗（IR）的既定指标，但它们在预测早期心血管-肾脏代谢（CKM）综合征患者中风中的联合作用尚不清楚。方法：我们纳入了来自中国健康与退休纵向研究（CHARLS）的4,414名参与者，包括基线（2011年）和随访（2015年）数据。在两个时间点计算TyG-eGDR，并得出累积暴露量。K-means聚类将参与者分为三个动态轨迹组。Cox比例风险模型评估卒中风险，限制性三次样条（RCS）测试非线性，受试者工作特征（ROC）曲线评估预测效果。结果：随访期间共发生219例脑卒中事件。与低TyG-eGDR轨迹组相比，高轨迹组卒中风险增加2.84倍（HR = 2.84,95% CI: 1.67-4.81）。累积TyG-eGDR暴露最高的参与者卒中风险增加4.28倍（HR = 4.28,95% CI: 2.66-6.89），而基线水平高的参与者卒中风险增加3.46倍（HR = 3.46,95% CI: 1.82-6.58）。RCS分析显示TyG-eGDR指数与卒中之间存在显著的非线性关系（P < 0.05）。结论：TyG-eGDR持续高水平预测早期CKM综合征卒中风险，支持将其纳入常规代谢性脑血管风险评估。

{"title":"Integrated TyG index and eGDR measure enhances stroke risk stratification in early cardiovascular-kidney-metabolic syndrome: A prospective national cohort analysis","authors":"Xiaolei Wang, Hongfeng Sun, Taojing Zhang, Hui Zhou","doi":"10.1016/j.jstrokecerebrovasdis.2025.108516","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108516","url":null,"abstract":"<div><h3>Background</h3><div>The triglyceride-glucose (TyG) index and estimated glucose disposal rate (eGDR) are established markers of insulin resistance (IR), yet their combined role in predicting stroke among individuals with early-stage cardiovascular-kidney-metabolic (CKM) syndrome remains unclear.</div></div><div><h3>Methods</h3><div>We included 4,414 participants from the China Health and Retirement Longitudinal Study (CHARLS) with baseline (2011) and follow-up (2015) data. TyG-eGDR was calculated at both timepoints, and cumulative exposure was derived. K-means clustering categorized participants into three dynamic trajectory groups. Cox proportional hazards models evaluated stroke risk, restricted cubic splines (RCS) tested nonlinearity, and receiver operating characteristic (ROC) curves assessed predictive performance.</div></div><div><h3>Results</h3><div>Over the follow-up period, 219 stroke events occurred. Compared to the low TyG-eGDR trajectory group, the high-trajectory group had a 2.84-fold increased stroke risk (HR = 2.84, 95 % CI: 1.67–4.81). Participants with the highest cumulative TyG-eGDR exposure exhibited a 4.28-fold increased stroke risk (HR = 4.28, 95 % CI: 2.66–6.89), while those with high baseline levels had a 3.46-fold elevated risk (HR = 3.46, 95 % CI: 1.82–6.58). RCS analyses revealed significant nonlinear relationships between TyG-eGDR indices and stroke (<em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Sustained high TyG-eGDR levels predict stroke risk in early CKM syndrome, supporting its integration into routine metabolic cerebrovascular risk assessment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108516"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703744","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

Cerebroprotection in acute ischemic stroke: Perspectives on combining cerebrolysin with recanalization therapy 急性缺血性脑卒中的脑保护：溶脑素联合再通治疗的观点。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-03 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108515

Marc Ribó , Jacek Staszewski , Steven R. Zeiler , Sławomir Michalak , Ahmed El Bassiouny , Fernando Gongora-Rivera , Zdravka Poljakovic , Dina R Khasanova , Mikhail N Kalinin , Aurauma Chutinet , Roni Eichel , Klaudyna Kojder , Marissa Ong , Marina Roje Bedeković , Chien-Hung Chang , Minwoo Lee , Peter Quitasol , Alexander Tsiskaridse , Natan M Bornstein

This article provides perspectives on the use of Cerebrolysin as an adjunct treatment to reperfusion therapy in acute ischemic stroke (AIS). In the evolving landscape of AIS reperfusion therapy, we hypothesize that adjunctive cerebroprotective therapy, such as Cerebrolysin, is likely to further improve patient outcomes. Beyond its established neurorecovery benefits, recent data indicate that Cerebrolysin also offers protection to the neurovascular unit and the blood-brain barrier. This paper introduces the CErebrolysin in RECanalization And Perfusion (CERECAP) program, a collaborative initiative of independent academic investigations exploring the favorable trends of Cerebrolysin in reperfusion. The CERECAP program has generated compelling data demonstrating Cerebrolysin’s alignment with current AIS reperfusion therapy concepts, particularly its role in early intervention targeting multiple pathways. We review these studies and discuss the critical need to clearly define the patient population that benefit most from adjunctive Cerebrolysin therapy in AIS.

本文就脑溶血素作为急性缺血性脑卒中再灌注治疗的辅助治疗提供了一些观点。在AIS再灌注治疗不断发展的前景中，我们假设辅助脑保护治疗，如脑溶血素，可能会进一步改善患者的预后。除了其既定的神经恢复的好处，最近的数据表明，脑溶素也提供保护神经血管单位和血脑屏障。本文介绍了脑溶血素再通灌注（CERECAP）计划，这是一项独立学术研究的合作倡议，旨在探索脑溶血素在再灌注中的有利趋势。CERECAP项目产生了令人信服的数据，证明了脑溶血素与当前AIS再灌注治疗概念的一致性，特别是其在针对多途径的早期干预中的作用。我们回顾了这些研究，并讨论了在AIS中明确定义从辅助脑溶素治疗中获益最多的患者群体的迫切需要。

{"title":"Cerebroprotection in acute ischemic stroke: Perspectives on combining cerebrolysin with recanalization therapy","authors":"Marc Ribó , Jacek Staszewski , Steven R. Zeiler , Sławomir Michalak , Ahmed El Bassiouny , Fernando Gongora-Rivera , Zdravka Poljakovic , Dina R Khasanova , Mikhail N Kalinin , Aurauma Chutinet , Roni Eichel , Klaudyna Kojder , Marissa Ong , Marina Roje Bedeković , Chien-Hung Chang , Minwoo Lee , Peter Quitasol , Alexander Tsiskaridse , Natan M Bornstein","doi":"10.1016/j.jstrokecerebrovasdis.2025.108515","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108515","url":null,"abstract":"<div><div>This article provides perspectives on the use of Cerebrolysin as an adjunct treatment to reperfusion therapy in acute ischemic stroke (AIS). In the evolving landscape of AIS reperfusion therapy, we hypothesize that adjunctive cerebroprotective therapy, such as Cerebrolysin, is likely to further improve patient outcomes. Beyond its established neurorecovery benefits, recent data indicate that Cerebrolysin also offers protection to the neurovascular unit and the blood-brain barrier. This paper introduces the CErebrolysin in RECanalization And Perfusion (CERECAP) program, a collaborative initiative of independent academic investigations exploring the favorable trends of Cerebrolysin in reperfusion. The CERECAP program has generated compelling data demonstrating Cerebrolysin’s alignment with current AIS reperfusion therapy concepts, particularly its role in early intervention targeting multiple pathways. We review these studies and discuss the critical need to clearly define the patient population that benefit most from adjunctive Cerebrolysin therapy in AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108515"},"PeriodicalIF":1.8,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688917","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

Improved outcome prediction in large vessel occlusion stroke: A comparison of Tmax-based hypoperfusion ratios HIR10/4 and HIR10/6 改进的大血管闭塞卒中预后预测：基于tmax的低灌注比HIR10/4和HIR10/6的比较

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-01 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108504

Jeewon Chon MA , Ashley Treanor BS , Andrew C. Pickles BS , William Y. Shin BA , Ronak H. Jani MD , John T. Tsiang MD , Amy Wozniak MS , Anthony W. Kam MD, PhD , David P. Pasquale MD , Joseph C. Serrone MD , Brandon J. Bond MD

Background

The hypoperfusion intensity ratio (HIR), derived from CT perfusion (CTP), reflects collateral flow quality, but its optimal formulation remains unsettled.

Objective

To compare the prognostic utility of conventional HIR_10/6 (time-to-maximum [T_max] >10s / >6 s) with an alternative HIR_10/4 (T_max >10s / >4 s) in patients undergoing endovascular thrombectomy (EVT).

Methods

We retrospectively analyzed consecutive large-vessel occlusion (LVO) strokes treated with EVT at our quaternary academic medical center (2015–2024). CTP was processed using RAPID software. Primary outcomes were modified Rankin Scale (mRS) at discharge and at 90 days. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS) at discharge and hemorrhagic transformation on follow-up imaging. Ordinal and linear regression models were adjusted for age, sex, vascular risk factors, intravenous thrombolysis, presentation window, and transfer status. Receiver operating characteristic (ROC) curves assessed discriminative performance.

Results

Among 280 patients (mean age 70 ±15 years; 49 % male), mean HIR_10/6 was 0.418 and HIR_10/4 was 0.241. Each 0.1-unit increase in HIR_10/4 translated to 31 % higher odds of worse mRS at discharge (adjusted odds ratio [aOR] 1.31, 95 % CI 1.12–1.54; p=0.001), 24 % higher odds of worse mRS at 90 days (aOR 1.24, 95 % CI 1.04–1.48; p=0.016), and higher discharge NIHSS (β=0.88, 95 % CI 0.05–1.71; p=0.039). HIR_10/6 showed weaker associations and was not significant for discharge NIHSS. Neither HIR metric demonstrated meaningful discrimination for hemorrhagic transformation or dichotomized outcomes (area under the curve [AUC] 0.50–0.52).

Conclusions

Incorporating mildly delayed tissue (T_max >4 s) may enhance the physiologic sensitivity of HIR. HIR_10/4 may be a potential prognostic biomarker; however, prospective validation is needed, and its standalone ability to discriminate binary outcomes remains limited.

背景：由CT灌注（CTP）得出的低灌注强度比（HIR）反映了侧支血流质量，但其最佳公式仍未确定。目的：比较常规HIR10/6（时间至最大[Tmax] >0秒 / >6s）与替代HIR10/4 （Tmax >0秒 / >4s）在血管内取栓（EVT）患者中的预后价值。方法：回顾性分析2015-2024年在我院第四医学中心接受EVT治疗的连续大血管闭塞（LVO）脑卒中患者。采用RAPID软件对CTP进行处理。主要结果是出院时和90天时的修正Rankin量表（mRS）。次要结果包括出院时的美国国立卫生研究院卒中量表（NIHSS）和随访成像时的出血转化。排序和线性回归模型根据年龄、性别、血管危险因素、静脉溶栓、呈现窗口和转移状态进行调整。受试者工作特征（ROC）曲线评估鉴别表现。结果：280例患者（平均年龄70 ±15岁，男性49%），平均HIR10/6为0.418，HIR10/4为0.241。HIR10/4每增加0.1个单位，出院时mRS恶化的几率增加31%（校正比值比[aOR] 1.31, 95% CI 1.12-1.54; p=0.001）， 90天mRS恶化的几率增加24% (aOR 1.24, 95% CI 1.04-1.48; p=0.016)，出院时NIHSS升高（β=0.88, 95% CI 0.05-1.71; p=0.039）。HIR10/6与出院NIHSS的相关性较弱，且不显著。两项HIR指标均未显示出出血转化或二分类结果的显著区别（曲线下面积[AUC] 0.50-0.52）。结论：纳入轻度延迟组织（Tmax b>s）可提高HIR的生理敏感性。HIR10/4可能是一个潜在的预后生物标志物；然而，需要前瞻性验证，并且其单独区分二元结果的能力仍然有限。

{"title":"Improved outcome prediction in large vessel occlusion stroke: A comparison of Tmax-based hypoperfusion ratios HIR10/4 and HIR10/6","authors":"Jeewon Chon MA , Ashley Treanor BS , Andrew C. Pickles BS , William Y. Shin BA , Ronak H. Jani MD , John T. Tsiang MD , Amy Wozniak MS , Anthony W. Kam MD, PhD , David P. Pasquale MD , Joseph C. Serrone MD , Brandon J. Bond MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108504","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108504","url":null,"abstract":"<div><h3>Background</h3><div>The hypoperfusion intensity ratio (HIR), derived from CT perfusion (CTP), reflects collateral flow quality, but its optimal formulation remains unsettled.</div></div><div><h3>Objective</h3><div>To compare the prognostic utility of conventional HIR<sub>10/6</sub> (time-to-maximum [T<sub>max</sub>] >10s / >6 s) with an alternative HIR<sub>10/4</sub> (T<sub>max</sub> >10s / >4 s) in patients undergoing endovascular thrombectomy (EVT).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed consecutive large-vessel occlusion (LVO) strokes treated with EVT at our quaternary academic medical center (2015–2024). CTP was processed using RAPID software. Primary outcomes were modified Rankin Scale (mRS) at discharge and at 90 days. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS) at discharge and hemorrhagic transformation on follow-up imaging. Ordinal and linear regression models were adjusted for age, sex, vascular risk factors, intravenous thrombolysis, presentation window, and transfer status. Receiver operating characteristic (ROC) curves assessed discriminative performance.</div></div><div><h3>Results</h3><div>Among 280 patients (mean age 70 ±15 years; 49 % male), mean HIR<sub>10/6</sub> was 0.418 and HIR<sub>10/4</sub> was 0.241. Each 0.1-unit increase in HIR<sub>10/4</sub> translated to 31 % higher odds of worse mRS at discharge (adjusted odds ratio [aOR] 1.31, 95 % CI 1.12–1.54; <em>p</em>=0.001), 24 % higher odds of worse mRS at 90 days (aOR 1.24, 95 % CI 1.04–1.48; <em>p</em>=0.016), and higher discharge NIHSS (β=0.88, 95 % CI 0.05–1.71; <em>p</em>=0.039). HIR<sub>10/6</sub> showed weaker associations and was not significant for discharge NIHSS. Neither HIR metric demonstrated meaningful discrimination for hemorrhagic transformation or dichotomized outcomes (area under the curve [AUC] 0.50–0.52).</div></div><div><h3>Conclusions</h3><div>Incorporating mildly delayed tissue (T<sub>max</sub> >4 s) may enhance the physiologic sensitivity of HIR. HIR<sub>10/4</sub> may be a potential prognostic biomarker; however, prospective validation is needed, and its standalone ability to discriminate binary outcomes remains limited.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108504"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644516","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

Age at natural menopause and stroke: A U-shaped association in the health and retirement study 自然绝经年龄与中风：健康与退休研究中的u型关联。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-12-01 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108497

QinFeng Zeng , Wenjia Zhang, Yingzhi Liu, Weijun Yang, XiaoLing Wu, Jieding Li

Background

The association between age at natural menopause and cerebrovascular risk is unclear. This study investigates non-linear relationships, effect modification, mediation, and long-term stroke-free survival in postmenopausal women.

Methods

We analyzed 9,159 postmenopausal women from the Health and Retirement Study. Menopause age was categorized (<40, 40–44, 45–49, 50–55, >55) and modeled continuously. Stroke outcomes were derived from self-reports and linked Medicare claims. We used multivariable logistic regression with restricted cubic splines, interaction terms among hypertension, diabetes, and hypercholesterolemia, structural equation modeling for mediation, and Kaplan-Meier/Cox models for survival analysis.

Results

Each additional year of later menopause was linked to lower stroke odds (OR 0.935, 95 % CI 0.922–0.948). Compared to the 50–55 age group, those with menopause <45 years (OR 2.76, 95 % CI 2.09–3.47) and 45–49 years (OR 2.08, 95 % CI 1.72–2.62) had higher risks. Spline analysis indicated a U-shaped curve, with the lowest risk at ages 50–52. Stroke-free survival differed significantly across groups (log-rank p = 0.0017), particularly worse with premature menopause.

Conclusions

Age at natural menopause exhibits a U-shaped association with stroke risk, emphasizing the importance of timing in individualized prevention strategies.

背景：自然绝经年龄与脑血管风险之间的关系尚不清楚。本研究探讨了绝经后妇女的非线性关系、效应修正、调解和长期无卒中生存。方法：我们分析了9159名来自健康与退休研究的绝经后妇女。绝经年龄分类（55岁）并连续建模。中风的结果来源于自我报告和相关的医疗保险索赔。我们使用限制三次样条的多变量逻辑回归，高血压、糖尿病和高胆固醇血症之间的相互作用项，结构方程模型作为中介，Kaplan-Meier/Cox模型用于生存分析。结果：绝经时间每晚一年与卒中风险降低相关（OR 0.935, 95% CI 0.922-0.948）。结论：自然绝经年龄与卒中风险呈u型相关，强调了个体化预防策略中时机的重要性。

{"title":"Age at natural menopause and stroke: A U-shaped association in the health and retirement study","authors":"QinFeng Zeng , Wenjia Zhang, Yingzhi Liu, Weijun Yang, XiaoLing Wu, Jieding Li","doi":"10.1016/j.jstrokecerebrovasdis.2025.108497","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108497","url":null,"abstract":"<div><h3>Background</h3><div>The association between age at natural menopause and cerebrovascular risk is unclear. This study investigates non-linear relationships, effect modification, mediation, and long-term stroke-free survival in postmenopausal women.</div></div><div><h3>Methods</h3><div>We analyzed 9,159 postmenopausal women from the Health and Retirement Study. Menopause age was categorized (<40, 40–44, 45–49, 50–55, >55) and modeled continuously. Stroke outcomes were derived from self-reports and linked Medicare claims. We used multivariable logistic regression with restricted cubic splines, interaction terms among hypertension, diabetes, and hypercholesterolemia, structural equation modeling for mediation, and Kaplan-Meier/Cox models for survival analysis.</div></div><div><h3>Results</h3><div>Each additional year of later menopause was linked to lower stroke odds (OR 0.935, 95 % CI 0.922–0.948). Compared to the 50–55 age group, those with menopause <45 years (OR 2.76, 95 % CI 2.09–3.47) and 45–49 years (OR 2.08, 95 % CI 1.72–2.62) had higher risks. Spline analysis indicated a U-shaped curve, with the lowest risk at ages 50–52. Stroke-free survival differed significantly across groups (log-rank <em>p</em> = 0.0017), particularly worse with premature menopause.</div></div><div><h3>Conclusions</h3><div>Age at natural menopause exhibits a U-shaped association with stroke risk, emphasizing the importance of timing in individualized prevention strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108497"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575177","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