Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108507
Xiaozhu Yu Master of Nursing (Lecturer) , Xichao Xia Doctor of Medicine (Professor) , Yanfang Guo Master of Nursing (Senior Nurse) , Yuhong Wu Master of Nursing (Chief Nurse)
Objective
To systematically analyze the application effect of holistic nursing intervention based on Harmonious Nursing Theory in patients during stroke recovery period, and provide evidence-based basis for optimizing clinical nursing programs.
Methods
Patients in the stroke recovery period were divided into observation group and control group with 83 cases each by random number table method. The control group received routine nursing intervention, while the observation group received holistic nursing intervention based on Harmonious Nursing Theory. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Herth Hope Index (HHI), SF-36 Short-Form Health Survey, and nursing satisfaction questionnaire were used to compare the differences in negative emotions, hope level, quality of life, and satisfaction between the two groups of patients before and after intervention.
Results
After the intervention, the self-reported anxiety score of the observation group was (42.87±17.32) and the self-reported depression score was (45.28±16.67), both significantly lower than those of the control group [(51.59±15.19) and (50.51±15.52), respectively; all P<0.05]. The total score of hope level in the observation group was (40.87±6.03), which was higher than that in the control group [(34.78±5.93); P<0.05]. The scores of all 8 dimensions of health status in the observation group were higher than those in the control group (all P<0.05). The nursing satisfaction rate of the observation group was 92.77%, which was higher than 78.31% of the control group (P<0.05).
Conclusion
Implementing holistic nursing intervention based on Harmonious Nursing Theory for patients in stroke recovery period can effectively alleviate negative emotions, improve hope level and quality of life, as well as enhance nursing satisfaction, which has high clinical promotion value.
{"title":"Effect of holistic nursing intervention based on harmonious nursing theory on patients in stroke recovery period","authors":"Xiaozhu Yu Master of Nursing (Lecturer) , Xichao Xia Doctor of Medicine (Professor) , Yanfang Guo Master of Nursing (Senior Nurse) , Yuhong Wu Master of Nursing (Chief Nurse)","doi":"10.1016/j.jstrokecerebrovasdis.2025.108507","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108507","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically analyze the application effect of holistic nursing intervention based on Harmonious Nursing Theory in patients during stroke recovery period, and provide evidence-based basis for optimizing clinical nursing programs.</div></div><div><h3>Methods</h3><div>Patients in the stroke recovery period were divided into observation group and control group with 83 cases each by random number table method. The control group received routine nursing intervention, while the observation group received holistic nursing intervention based on Harmonious Nursing Theory. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Herth Hope Index (HHI), SF-36 Short-Form Health Survey, and nursing satisfaction questionnaire were used to compare the differences in negative emotions, hope level, quality of life, and satisfaction between the two groups of patients before and after intervention.</div></div><div><h3>Results</h3><div>After the intervention, the self-reported anxiety score of the observation group was (42.87±17.32) and the self-reported depression score was (45.28±16.67), both significantly lower than those of the control group [(51.59±15.19) and (50.51±15.52), respectively; all <em>P</em><0.05]. The total score of hope level in the observation group was (40.87±6.03), which was higher than that in the control group [(34.78±5.93); <em>P</em><0.05]. The scores of all 8 dimensions of health status in the observation group were higher than those in the control group (all <em>P</em><0.05). The nursing satisfaction rate of the observation group was 92.77%, which was higher than 78.31% of the control group (<em>P</em><0.05).</div></div><div><h3>Conclusion</h3><div>Implementing holistic nursing intervention based on Harmonious Nursing Theory for patients in stroke recovery period can effectively alleviate negative emotions, improve hope level and quality of life, as well as enhance nursing satisfaction, which has high clinical promotion value.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108507"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623650","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}
Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108500
Prasen R Marella , Jacob A Sambursky , Kriti Bhayana , Asha P Jacob , Varsha Muddasani , Murli Mishra , Alexandra L Czap , James C Grotta
Background
For stroke patients with history of possible Direct Acting Oral Anticoagulant use, clinicians must make treatment decisions without knowledge of whether the patient is therapeutically anticoagulated. A urine-based point-of-care test might help guide these emergency decisions.
Methods
We prospectively enrolled patients with suspected recent factor-Xa-inhibitor (Xai) use being evaluated for acute stroke therapy in an urban teaching hospital. We obtained the urine test and plasma anti-Xa level in parallel with usual clinical management; the treating clinician did not use test results for decision-making but recorded treatment they would have given had they known the urine test was accurate. The primary outcome was feasibility. Secondary outcomes were accuracy of the urine test at plasma anti-Xa level >30 ng/mL and consequent change in clinical management.
Results
Twenty-one patients were enrolled over 1 year. The urine test was successfully carried out in all patients, median 59 minutes after Emergency Department arrival. Sensitivity and specificity for the urine test to detect threshold anti-Xa activity were 100 % and 87.5 %. Of 20 patients with ischemic stroke, none of whom were treated with thrombolytics, 6 had a negative test which would have resulted in treatment of 4 (66 %).
Conclusion
A urine point-of-care test for Xai activity is feasible, accurate, and would likely result in treatment of stroke patients currently excluded from thrombolysis.
{"title":"A urine-based point-of-care test for Factor Xa inhibitors in acute stroke management","authors":"Prasen R Marella , Jacob A Sambursky , Kriti Bhayana , Asha P Jacob , Varsha Muddasani , Murli Mishra , Alexandra L Czap , James C Grotta","doi":"10.1016/j.jstrokecerebrovasdis.2025.108500","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108500","url":null,"abstract":"<div><h3>Background</h3><div>For stroke patients with history of possible Direct Acting Oral Anticoagulant use, clinicians must make treatment decisions without knowledge of whether the patient is therapeutically anticoagulated. A urine-based point-of-care test might help guide these emergency decisions.</div></div><div><h3>Methods</h3><div>We prospectively enrolled patients with suspected recent factor-Xa-inhibitor (Xai) use being evaluated for acute stroke therapy in an urban teaching hospital. We obtained the urine test and plasma anti-Xa level in parallel with usual clinical management; the treating clinician did not use test results for decision-making but recorded treatment they would have given had they known the urine test was accurate. The primary outcome was feasibility. Secondary outcomes were accuracy of the urine test at plasma anti-Xa level >30 ng/mL and consequent change in clinical management.</div></div><div><h3>Results</h3><div>Twenty-one patients were enrolled over 1 year. The urine test was successfully carried out in all patients, median 59 minutes after Emergency Department arrival. Sensitivity and specificity for the urine test to detect threshold anti-Xa activity were 100 % and 87.5 %. Of 20 patients with ischemic stroke, none of whom were treated with thrombolytics, 6 had a negative test which would have resulted in treatment of 4 (66 %).</div></div><div><h3>Conclusion</h3><div>A urine point-of-care test for Xai activity is feasible, accurate, and would likely result in treatment of stroke patients currently excluded from thrombolysis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108500"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582808","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}
Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108501
Mc Lernon S , Appiah B , Moorley C , Thomas N , Mussa R , Gonzales S , Werring D , Olawade D․B , Flood C
Purpose
Stroke remains a significant health concern in high-income countries (HICs) and is increasing among younger adults. Although largely preventable, public awareness of stroke risk factors in HICs is not well established. We assessed awareness levels in World Bank-classified HICs and identified associated factors.
Methods
Systematic searches used Ovid MEDLINE, PsycINFO, Academic Search Complete, CINAHL, Cochrane Review Library, Emcare, and ASSIA. Two authors independently screened studies and extracted data. Risk of bias was assessed using Critical Appraisal Skills Programme checklists. Due to heterogeneity, narrative synthesis was conducted. Exploratory analyses including visual mapping and descriptive cross-country comparisons were performed despite methodological heterogeneity. Protocol registered on PROSPERO (CRD42025621931).
Findings
Of 2146 papers screened, 23 met inclusion criteria. Most studies reported low stroke risk factor awareness. Hypertension was most frequently identified, followed by smoking, dyslipidaemia, and diabetes. Sedentary lifestyle, alcohol consumption, ethnicity, and atrial fibrillation were least recognised. Risk of bias assessment revealed sampling and generalisability concerns in most studies. Most reported associations were unadjusted for potential confounders. Higher education was linked to greater awareness. Marked geographical clustering occurred, with 65 % of studies from Middle Eastern countries, predominantly Saudi Arabia.
Discussion
This review uniquely identifies critical evidence gaps including under-representation of diverse populations, lack of standardised awareness metrics, and predominance of unadjusted analyses in HIC stroke risk factor awareness research.
Conclusion
Stroke risk factor awareness gaps are prevalent and may limit prevention efforts. Large-scale, methodologically robust studies across diverse geographical, socioeconomic, and ethnic populations within HICs are urgently needed, as awareness characteristics may vary dramatically even within high-income settings. Targeted education is necessary for primary prevention strategies.
{"title":"Public awareness of stroke risk factors in high-income countries: A systematic review","authors":"Mc Lernon S , Appiah B , Moorley C , Thomas N , Mussa R , Gonzales S , Werring D , Olawade D․B , Flood C","doi":"10.1016/j.jstrokecerebrovasdis.2025.108501","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108501","url":null,"abstract":"<div><h3>Purpose</h3><div>Stroke remains a significant health concern in high-income countries (HICs) and is increasing among younger adults. Although largely preventable, public awareness of stroke risk factors in HICs is not well established. We assessed awareness levels in World Bank-classified HICs and identified associated factors.</div></div><div><h3>Methods</h3><div>Systematic searches used Ovid MEDLINE, PsycINFO, Academic Search Complete, CINAHL, Cochrane Review Library, Emcare, and ASSIA. Two authors independently screened studies and extracted data. Risk of bias was assessed using Critical Appraisal Skills Programme checklists. Due to heterogeneity, narrative synthesis was conducted. <strong>Exploratory analyses including visual mapping and descriptive cross-country comparisons were performed despite methodological heterogeneity.</strong> Protocol registered on PROSPERO (CRD42025621931).</div></div><div><h3>Findings</h3><div>Of 2146 papers screened, 23 met inclusion criteria. Most studies reported low stroke risk factor awareness. Hypertension was most frequently identified, followed by smoking, dyslipidaemia, and diabetes. Sedentary lifestyle, alcohol consumption, ethnicity, and atrial fibrillation were least recognised. <strong>Risk of bias assessment revealed sampling and generalisability concerns in most studies. Most reported associations were unadjusted for potential confounders.</strong> Higher education was linked to greater awareness. <strong>Marked geographical clustering occurred, with 65 % of studies from Middle Eastern countries, predominantly Saudi Arabia.</strong></div></div><div><h3>Discussion</h3><div>This review uniquely identifies critical evidence gaps including under-representation of diverse populations, lack of standardised awareness metrics, and predominance of unadjusted analyses in HIC stroke risk factor awareness research.</div></div><div><h3>Conclusion</h3><div>Stroke risk factor awareness gaps are prevalent and may limit prevention efforts. <strong>Large-scale, methodologically robust studies across diverse geographical, socioeconomic, and ethnic populations within HICs are urgently needed, as awareness characteristics may vary dramatically even within high-income settings.</strong> Targeted education is necessary for primary prevention strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108501"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592709","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}
Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108505
Xiangliang Chen , Liyuan Wang , Yunyun Xiong , Zhenqiang Zhao , Kailai Huang , Zhenhui Duan , Kangmeng Wang , Chunhua Yun , Meipin Yang , Tianyi Xu , Wenhua Liu , Wei Li
Background and purpose
Edaravone dexborneol (ED) is a novel cytoprotective drug for treating acute ischemic stroke (AIS) with synergistic antioxidant and anti-inflammatory effects. This study aimed to assess the efficacy and safety of ED in acute large vessel occlusion (LVO) patients with successful recanalization after endovascular treatment (EVT).
Methods
Data from three comprehensive stroke centers of consecutive AIS-LVO patients treated with EVT were retrospectively included in this study. Patients were divided into ED and non-ED groups. The primary efficacy outcome was the shift of the modified Rankin Scale (mRS) score at 90 days. The secondary efficacy outcomes included functional independence (mRS score 0–2) and excellent outcome (mRS 0–1) at 90 days. Safety outcomes included mortality within 90 days and symptomatic intracranial hemorrhage (sICH) within 48 h.
Results
A total of 231 patients with successful recanalization after EVT were included in the analysis, of whom 84 (36.4 %) were in the ED group and 147 (63.6 %) were in the non-ED group. After adjustment for potential confounders, ED was associated with a favorable shift in the 90-day mRS score (common adjusted odds ratio [aOR], 2.09; 95 % confidence interval [CI], 1.05–4.14; P = 0.035). The proportions of sICH (4.76 % vs. 7.41 %; aOR, 0.44; 95 % CI, 0.10–2.02; P = 0.290) and 90-day mortality (6.41 % vs. 8.8 %; aOR, 0.37; 95 %CI, 0.06–2.31; P = 0.280) were numerically lower in the ED group than in the non-ED group, but these differences were not statistically significant.
Conclusions
Among AIS-LVO patients with successful recanalization after EVT, ED may be associated with an improved functional outcome without an increased risk of sICH and mortality.
背景与目的依达拉奉dexborneol （ED）是一种具有协同抗氧化和抗炎作用的治疗急性缺血性脑卒中（AIS）的新型细胞保护药物。本研究旨在评估ED在血管内治疗（EVT）后血管再通成功的急性大血管闭塞（LVO）患者中的疗效和安全性。方法回顾性分析三个综合脑卒中中心接受EVT治疗的连续AIS-LVO患者的数据。患者分为ED组和非ED组。主要疗效指标为90天时改良Rankin量表（mRS）评分的变化。次要疗效指标包括90天的功能独立性（mRS评分0-2）和良好预后（mRS评分0-1）。结果共纳入EVT术后再通成功患者231例，其中ED组84例（36.4%），非ED组147例（63.6%）。在对潜在混杂因素进行校正后，ED与90天mRS评分的有利变化相关（常见校正优势比[aOR]， 2.09； 95%可信区间[CI]， 1.05-4.14; P = 0.035）。ED组siich的比例（4.76% vs. 7.41%; aOR, 0.44; 95% CI, 0.10-2.02; P = 0.290）和90天死亡率（6.41% vs. 8.8%; aOR, 0.37; 95% CI, 0.06-2.31; P = 0.280）在数值上低于非ED组，但差异无统计学意义。结论：在EVT后再通成功的AIS-LVO患者中，ED可能与功能结果的改善有关，而不会增加sICH和死亡率的风险。
{"title":"Efficacy and safety of edaravone dexborneol in acute large vessel occlusion patients with successful recanalization after endovascular treatment","authors":"Xiangliang Chen , Liyuan Wang , Yunyun Xiong , Zhenqiang Zhao , Kailai Huang , Zhenhui Duan , Kangmeng Wang , Chunhua Yun , Meipin Yang , Tianyi Xu , Wenhua Liu , Wei Li","doi":"10.1016/j.jstrokecerebrovasdis.2025.108505","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108505","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Edaravone dexborneol (ED) is a novel cytoprotective drug for treating acute ischemic stroke (AIS) with synergistic antioxidant and anti-inflammatory effects. This study aimed to assess the efficacy and safety of ED in acute large vessel occlusion (LVO) patients with successful recanalization after endovascular treatment (EVT).</div></div><div><h3>Methods</h3><div>Data from three comprehensive stroke centers of consecutive AIS-LVO patients treated with EVT were retrospectively included in this study. Patients were divided into ED and non-ED groups. The primary efficacy outcome was the shift of the modified Rankin Scale (mRS) score at 90 days. The secondary efficacy outcomes included functional independence (mRS score 0–2) and excellent outcome (mRS 0–1) at 90 days. Safety outcomes included mortality within 90 days and symptomatic intracranial hemorrhage (sICH) within 48 h.</div></div><div><h3>Results</h3><div>A total of 231 patients with successful recanalization after EVT were included in the analysis, of whom 84 (36.4 %) were in the ED group and 147 (63.6 %) were in the non-ED group. After adjustment for potential confounders, ED was associated with a favorable shift in the 90-day mRS score (common adjusted odds ratio [aOR], 2.09; 95 % confidence interval [CI], 1.05–4.14; <em>P</em> = 0.035). The proportions of sICH (4.76 % <em>vs.</em> 7.41 %; aOR, 0.44; 95 % CI, 0.10–2.02; <em>P</em> = 0.290) and 90-day mortality (6.41 % <em>vs.</em> 8.8 %; aOR, 0.37; 95 %CI, 0.06–2.31; <em>P</em> = 0.280) were numerically lower in the ED group than in the non-ED group, but these differences were not statistically significant.</div></div><div><h3>Conclusions</h3><div>Among AIS-LVO patients with successful recanalization after EVT, ED may be associated with an improved functional outcome without an increased risk of sICH and mortality.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108505"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623649","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}
Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108506
Oscar H. Del Brutto MD , Eduardo J. Guzmán MD , Rafael Caputi MD , Denisse A. Rumbea MHA , Víctor J. Del Brutto MD, MS
Background
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of thunderclap headache, often triggered by environmental or pharmacologic stressors.
Methods
A 56-year-old women presented with thunderclap headache and focal neurological signs following high-altitude exposure and coca leaf tea consumption
Results
Neuroimaging demonstrated acute ischemic lesions in different arterial territories and severe narrowing of all medium-diameter intracranial arteries. She was started on dual antiplatelet therapy, intravenous fluids, and was instructed to remain in bed in a strictly flat position. Repeated MRI showed marked improvement of both ischemic lesions and the arterial vasospasm.
Conclusion
High-altitude hypoxia and sympathomimetic alkaloids may synergistically precipitate RCVS. Awareness of traditional remedies and environmental exposures is essential in evaluating acute neurological syndromes in travelers.
{"title":"Reversible cerebral vasoconstriction syndrome presenting as thunderclap headache following high-altitude exposure and coca leaf tea consumption","authors":"Oscar H. Del Brutto MD , Eduardo J. Guzmán MD , Rafael Caputi MD , Denisse A. Rumbea MHA , Víctor J. Del Brutto MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108506","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108506","url":null,"abstract":"<div><h3>Background</h3><div>Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of thunderclap headache, often triggered by environmental or pharmacologic stressors.</div></div><div><h3>Methods</h3><div>A 56-year-old women presented with thunderclap headache and focal neurological signs following high-altitude exposure and coca leaf tea consumption</div></div><div><h3>Results</h3><div>Neuroimaging demonstrated acute ischemic lesions in different arterial territories and severe narrowing of all medium-diameter intracranial arteries. She was started on dual antiplatelet therapy, intravenous fluids, and was instructed to remain in bed in a strictly flat position. Repeated MRI showed marked improvement of both ischemic lesions and the arterial vasospasm.</div></div><div><h3>Conclusion</h3><div>High-altitude hypoxia and sympathomimetic alkaloids may synergistically precipitate RCVS. Awareness of traditional remedies and environmental exposures is essential in evaluating acute neurological syndromes in travelers.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108506"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623647","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}
Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108513
Mustafa Naguib BS , Brett C. Meyer MD , Francesca Felipe , Raphael E. Cuomo PhD , Michael Wilkinson MD , Ehtisham Mahmud MD , Pam Taub MD , Harpreet S. Bhatia MD, MAS , Mattheus Ramsis MD
<div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for myocardial infarction and stroke. Elevated Lp(a) >50 mg/dL (>125 nmol/L) is common and present in about 1 in 5 individuals. Although Lp(a) may be a cause of young ischemic stroke (age ≤60), limited data on national testing trends in this population are available, testing in the general population remains low overall, and different organizations have varying guidelines for testing. By determining the degree to which this population is tested, information on national testing trends of Lp(a) in young ischemic stroke patients may influence future guideline recommendations to increase Lp(a) testing. This study aims to use a large, real-world dataset to assess trends of Lp(a) testing in young ischemic stroke patients in the United States from 2015-2024.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of Lp(a) testing in young ischemic stroke patients across the United States from January 1, 2015 to December 31, 2024 using Epic Cosmos, a nationwide, de-identified electronic health record (EHR) dataset comprising over 300 million patient records from over 1,715 hospitals and 41,000 clinics, including from all 50 states, Washington D.C., Lebanon, and Saudi Arabia. The current count values for patients, hospitals, and clinics are available on the Epic Cosmos website. Although the Epic Cosmos data dictionary includes Lebanon and Saudi Arabia as standardized site locations, no patients from these countries were present in our analytic cohort; thus, all analyses were restricted to individuals within the United States. We evaluated the number of young ischemic stroke patients, defined as age ≤60 with history of an ischemic cerebrovascular accident (CVA), who had ever undergone Lp(a) testing, the testing rate per annual young ischemic stroke patients, geographical variation, and percentages of patients tested stratified by age, sex, ethnicity, race, and diagnosis of coronary artery disease (CAD). Testing rates were calculated as the number of distinct patients tested per year and as the testing rate per annual patient population. For each stratum we calculated the proportion tested with Wilson 95 % confidence intervals and assessed between-group differences using chi square or Fisher exact tests as appropriate. Annual trends in the testing proportion were modeled using a binomial generalized linear model with a logit link, treating the annual number tested as the numerator and the annual young ischemic stroke population as the denominator, and we report the odds ratio per calendar year with robust standard errors. Geographical variation was visualized using a heat map of testing by state. All analyses were descriptive and intended to characterize population-level patterns of ischemic stroke within the Cosmos network rather than infer causal associations. Given the exploratory design, no additional model-based adjustment for confoundin
{"title":"Lipoprotein(a) testing trends in young ischemic stroke patients from 2015-2024: An analysis of 188,000 individuals","authors":"Mustafa Naguib BS , Brett C. Meyer MD , Francesca Felipe , Raphael E. Cuomo PhD , Michael Wilkinson MD , Ehtisham Mahmud MD , Pam Taub MD , Harpreet S. Bhatia MD, MAS , Mattheus Ramsis MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108513","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108513","url":null,"abstract":"<div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for myocardial infarction and stroke. Elevated Lp(a) >50 mg/dL (>125 nmol/L) is common and present in about 1 in 5 individuals. Although Lp(a) may be a cause of young ischemic stroke (age ≤60), limited data on national testing trends in this population are available, testing in the general population remains low overall, and different organizations have varying guidelines for testing. By determining the degree to which this population is tested, information on national testing trends of Lp(a) in young ischemic stroke patients may influence future guideline recommendations to increase Lp(a) testing. This study aims to use a large, real-world dataset to assess trends of Lp(a) testing in young ischemic stroke patients in the United States from 2015-2024.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of Lp(a) testing in young ischemic stroke patients across the United States from January 1, 2015 to December 31, 2024 using Epic Cosmos, a nationwide, de-identified electronic health record (EHR) dataset comprising over 300 million patient records from over 1,715 hospitals and 41,000 clinics, including from all 50 states, Washington D.C., Lebanon, and Saudi Arabia. The current count values for patients, hospitals, and clinics are available on the Epic Cosmos website. Although the Epic Cosmos data dictionary includes Lebanon and Saudi Arabia as standardized site locations, no patients from these countries were present in our analytic cohort; thus, all analyses were restricted to individuals within the United States. We evaluated the number of young ischemic stroke patients, defined as age ≤60 with history of an ischemic cerebrovascular accident (CVA), who had ever undergone Lp(a) testing, the testing rate per annual young ischemic stroke patients, geographical variation, and percentages of patients tested stratified by age, sex, ethnicity, race, and diagnosis of coronary artery disease (CAD). Testing rates were calculated as the number of distinct patients tested per year and as the testing rate per annual patient population. For each stratum we calculated the proportion tested with Wilson 95 % confidence intervals and assessed between-group differences using chi square or Fisher exact tests as appropriate. Annual trends in the testing proportion were modeled using a binomial generalized linear model with a logit link, treating the annual number tested as the numerator and the annual young ischemic stroke population as the denominator, and we report the odds ratio per calendar year with robust standard errors. Geographical variation was visualized using a heat map of testing by state. All analyses were descriptive and intended to characterize population-level patterns of ischemic stroke within the Cosmos network rather than infer causal associations. Given the exploratory design, no additional model-based adjustment for confoundin","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108513"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673380","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}
Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108503
Zheng Wang , Wenhao Zheng , Yang Cao , Letian Xue , Zhijin Wang , Bingcheng Zhu , Quan Du
Background
Subarachnoid hemorrhage (SAH) is a severe cerebrovascular event often associated with high mortality and significant neurological impairment. Neuroinflammation is a hallmark of early brain injury (EBI), which substantially determines clinical outcomes. Interleukin-33 (IL-33) is a cytokine within the IL-1 family, known to regulate inflammatory and immune reactions through binding to its specific receptor, suppression of tumorigenicity 2 (ST2). This study focuses on clarifying how IL-33/ST2 signaling participates in the pathophysiological process following SAH in male mice..
Methods
A mouse model of SAH was induced by prechiasmatic cistern injection. These mice received prophylactic administration of recombinant IL-33. Neurological function, brain edema, neuronal apoptosis, and neuroinflammation were comprehensively evaluated. Additionally, in vitro experiments using BV2 microglial cells were conducted to elucidate the mechanism. Furthermore, protein sequencing was carried out to delineate potential mechanistic pathways.
Results
IL-33 treatment significantly improved neurological function, reduced brain edema, and attenuated neuronal death after SAH. Mechanistically, IL-33 shifted microglial polarization from the detrimental M1 phenotype towards a protective state, thereby decreasing intracellular ROS levels and supporting mitochondrial metabolic activity, resulting in reduced cellular stress. This protective effect appeared to be mediated via the PPAR-γ pathway, as inhibition of this pathway with GW9662 attenuated the beneficial effects of IL-33.
Conclusion
Our findings demonstrate that IL-33 confers robust neuroprotection against SAH-induced early brain injury by modulating microglial polarization via the PPAR-γ pathway. This positions the IL-33/ST2 axis as a promising novel immunomodulatory strategy for the treatment of SAH.
{"title":"IL-33 confers neuroprotection by activating the ST2/PPAR-γ signaling axis in microglia following subarachnoid in male mice","authors":"Zheng Wang , Wenhao Zheng , Yang Cao , Letian Xue , Zhijin Wang , Bingcheng Zhu , Quan Du","doi":"10.1016/j.jstrokecerebrovasdis.2025.108503","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108503","url":null,"abstract":"<div><h3>Background</h3><div>Subarachnoid hemorrhage (SAH) is a severe cerebrovascular event often associated with high mortality and significant neurological impairment. Neuroinflammation is a hallmark of early brain injury (EBI), which substantially determines clinical outcomes. Interleukin-33 (IL-33) is a cytokine within the IL-1 family, known to regulate inflammatory and immune reactions through binding to its specific receptor, suppression of tumorigenicity 2 (ST2). This study focuses on clarifying how IL-33/ST2 signaling participates in the pathophysiological process following SAH in male mice..</div></div><div><h3>Methods</h3><div>A mouse model of SAH was induced by prechiasmatic cistern injection. These mice received prophylactic administration of recombinant IL-33. Neurological function, brain edema, neuronal apoptosis, and neuroinflammation were comprehensively evaluated. Additionally, in vitro experiments using BV2 microglial cells were conducted to elucidate the mechanism. Furthermore, protein sequencing was carried out to delineate potential mechanistic pathways.</div></div><div><h3>Results</h3><div>IL-33 treatment significantly improved neurological function, reduced brain edema, and attenuated neuronal death after SAH. Mechanistically, IL-33 shifted microglial polarization from the detrimental M1 phenotype towards a protective state, thereby decreasing intracellular ROS levels and supporting mitochondrial metabolic activity, resulting in reduced cellular stress. This protective effect appeared to be mediated via the PPAR-γ pathway, as inhibition of this pathway with GW9662 attenuated the beneficial effects of IL-33.</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate that IL-33 confers robust neuroprotection against SAH-induced early brain injury by modulating microglial polarization via the PPAR-γ pathway. This positions the IL-33/ST2 axis as a promising novel immunomodulatory strategy for the treatment of SAH.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108503"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598249","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}
Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108499
Minyu Duan (Master of Medicine), Nan Zhang (Master of Medicine), Shuyin Ma (Master of Medicine), Xiaodong Zhang (Master of Medicine), Kaili Shi (Master of Medicine), Tiantian Gao (Bachelor of Medicine), Han Yang (Bachelor of Medicine), Xiaodong Ma (Bachelor of Medicine), Yuxuan Cheng (Master of Medicine), Huiyang Qu (Master of Medicine), Jiaxin Fan (Master of Medicine), Qingling Yao (Master of Medicine), Shuqin Zhan (Doctor of MedicineDoctor of Philosophy)
Background
To explore the association between remnant cholesterol (RC) and intracranial and extracranial vascular in-stent restenosis (ISR).
Methods
This prospective cohort study followed 392 patients who had undergone intracranial or extracranial vascular stent implantation from 2021 to 2022 over two years. The main outcome was the occurrence of ISR after stent placement. The association between RC levels and the occurrence of ISR was evaluated using a Cox hazards regression model, subgroup analysis, restricted cubic spline (RCS) plots and receiver operating characteristic (ROC) curve analysis.
Results
The median follow-up for the 392 participants was 595 days, during which 80 ISR events occurred. The participants were divided into four groups based on the quartiles of RC levels. The cumulative incidence rates of ISR in quartiles Q1 to Q4 were 7.1 %, 14.6 %, 20.7 %, and 37.8 % (p < 0.001). Multivariate cox regression confirmed RC acts as an independent risk factor for intracranial vascular ISR but not extracranial vascular, the hazard ratios (HRs) with 95 % confidence intervals (CIs) for Q4 were 8.410 (3.239-21.831, p < 0.001). A linear dose-response relationship was observed between RC levels and ISR risk (p-non-linear = 0.660, p < 0.001).The predictive value of RC for intracranial vascular ISR is reflected by an area under curve (AUC) of 0.749 (95 % CI: 0.683-0.814, p < 0.001). The optimal cut-off level is 0.440 mmol/L, yielding a sensitivity of 71.4 %, specificity of 72.2 %, and a Youden index (YI) of 0.437.
Conclusions
RC level is an independent risk factor for intracranial vascular ISR.
{"title":"Association between Remnant Cholesterol and In-Stent Restenosis in Intracranial and Extracranial Vessels","authors":"Minyu Duan (Master of Medicine), Nan Zhang (Master of Medicine), Shuyin Ma (Master of Medicine), Xiaodong Zhang (Master of Medicine), Kaili Shi (Master of Medicine), Tiantian Gao (Bachelor of Medicine), Han Yang (Bachelor of Medicine), Xiaodong Ma (Bachelor of Medicine), Yuxuan Cheng (Master of Medicine), Huiyang Qu (Master of Medicine), Jiaxin Fan (Master of Medicine), Qingling Yao (Master of Medicine), Shuqin Zhan (Doctor of MedicineDoctor of Philosophy)","doi":"10.1016/j.jstrokecerebrovasdis.2025.108499","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108499","url":null,"abstract":"<div><h3>Background</h3><div>To explore the association between remnant cholesterol (RC) and intracranial and extracranial vascular in-stent restenosis (ISR).</div></div><div><h3>Methods</h3><div>This prospective cohort study followed 392 patients who had undergone intracranial or extracranial vascular stent implantation from 2021 to 2022 over two years. The main outcome was the occurrence of ISR after stent placement. The association between RC levels and the occurrence of ISR was evaluated using a Cox hazards regression model, subgroup analysis, restricted cubic spline (RCS) plots and receiver operating characteristic (ROC) curve analysis.</div></div><div><h3>Results</h3><div>The median follow-up for the 392 participants was 595 days, during which 80 ISR events occurred. The participants were divided into four groups based on the quartiles of RC levels. The cumulative incidence rates of ISR in quartiles Q1 to Q4 were 7.1 %, 14.6 %, 20.7 %, and 37.8 % (p < 0.001). Multivariate cox regression confirmed RC acts as an independent risk factor for intracranial vascular ISR but not extracranial vascular, the hazard ratios (HRs) with 95 % confidence intervals (CIs) for Q4 were 8.410 (3.239-21.831, p < 0.001). A linear dose-response relationship was observed between RC levels and ISR risk (p-non-linear = 0.660, p < 0.001).The predictive value of RC for intracranial vascular ISR is reflected by an area under curve (AUC) of 0.749 (95 % CI: 0.683-0.814, p < 0.001). The optimal cut-off level is 0.440 mmol/L, yielding a sensitivity of 71.4 %, specificity of 72.2 %, and a Youden index (YI) of 0.437.</div></div><div><h3>Conclusions</h3><div>RC level is an independent risk factor for intracranial vascular ISR.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108499"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582845","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}
Pub Date : 2025-12-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108502
Chuang Yang , Mengmeng Ma , Xin Jiang , Lidan Zhang , Yang Zhang , Muke Zhou , Li He , Jinghuan Fang
Background and purpose
No prior study has investigated the potential of the cholesterol, high-density lipoprotein, and glucose (CHG) index as a predictor of clinical outcomes in patients with acute ischemic stroke (AIS) undergoing endovascular treatment (EVT). This study aimed to assess the effect of the CHG index on functional prognosis and build a better predictive model.
Methods
We retrospectively analyzed AIS patients receiving EVT between January 2016 and March 2025. The primary outcome was poor functional outcome, defined as a modified Rankin scale (mRS) score of 3 – 6 at 90 days. Logistic regression and restricted cubic splines (RCS) were used to examine the relationship between the CHG index and clinical outcomes. Receiver operating characteristic (ROC) curve was constructed to evaluate the prognostic capacity of the CHG index.
Results
A total of 934 patients were included. Logistic regression analysis indicated that a higher CHG index was associated with worse functional outcome at 90 days and increased 90-day mortality. A RCS model revealed a linear association between the CHG index and poor outcome at 90 days, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. In ROC curve analysis, the predictive ability of the traditional risk factor model was significantly enhanced by incorporating the CHG index for poor outcome at 90 days and for mortality at 90 days.
Conclusion
In patients with AIS undergoing EVT, a higher CHG index was associated with poorer functional outcomes and increased 90-day mortality. Furthermore, the incorporation of the CHG index into standard risk factors significantly enhanced the predictive accuracy for poor outcomes.
{"title":"Association of the CHG index with 90-day functional outcomes and mortality in acute ischemic stroke after endovascular therapy: A retrospective study","authors":"Chuang Yang , Mengmeng Ma , Xin Jiang , Lidan Zhang , Yang Zhang , Muke Zhou , Li He , Jinghuan Fang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108502","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108502","url":null,"abstract":"<div><h3>Background and purpose</h3><div>No prior study has investigated the potential of the cholesterol, high-density lipoprotein, and glucose (CHG) index as a predictor of clinical outcomes in patients with acute ischemic stroke (AIS) undergoing endovascular treatment (EVT). This study aimed to assess the effect of the CHG index on functional prognosis and build a better predictive model.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed AIS patients receiving EVT between January 2016 and March 2025. The primary outcome was poor functional outcome, defined as a modified Rankin scale (mRS) score of 3 – 6 at 90 days. Logistic regression and restricted cubic splines (RCS) were used to examine the relationship between the CHG index and clinical outcomes. Receiver operating characteristic (ROC) curve was constructed to evaluate the prognostic capacity of the CHG index.</div></div><div><h3>Results</h3><div>A total of 934 patients were included. Logistic regression analysis indicated that a higher CHG index was associated with worse functional outcome at 90 days and increased 90-day mortality. A RCS model revealed a linear association between the CHG index and poor outcome at 90 days, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. In ROC curve analysis, the predictive ability of the traditional risk factor model was significantly enhanced by incorporating the CHG index for poor outcome at 90 days and for mortality at 90 days.</div></div><div><h3>Conclusion</h3><div>In patients with AIS undergoing EVT, a higher CHG index was associated with poorer functional outcomes and increased 90-day mortality. Furthermore, the incorporation of the CHG index into standard risk factors significantly enhanced the predictive accuracy for poor outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108502"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598235","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}
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