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Quantification of leptomeningeal collateral blood flow in hypertensive rats during ischemic stroke 缺血性脑卒中期间高血压大鼠脑膜侧支血流的定量分析
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108195
Magdalena Litman MPharm , Kristy Martin BSc (Hons) , Neil J Spratt FRACP, PhD , Daniel J Beard PhD

Objectives

There is increasing evidence that poor leptomeningeal collateral blood flow in hypertensive animals is due to increased vascular myogenic tone, indicating that therapies to enhance collateral blood flow during ischemic stroke may be particularly effective. To develop such therapies, we need a greater understanding of the factors that regulate collateral blood flow in the setting of hypertension. Therefore, we aimed to quantify blood flow velocity, diameter and absolute blood flow in individual collateral vessels in an ischemic stroke model in spontaneously hypertensive rats (SHRs) and determine which factors had the greatest influence on blood flow.

Materials and methods

We quantified collateral flow velocity and vessel diameter and calculated absolute collateral blood flow in SHRs (n = 5) during 70 min of middle cerebral artery occlusion (MCAO), using a fluorescent microsphere method.

Results

Average collateral blood flow significantly increased post-occlusion relative to baseline (pre-MCAO: 16.8 ± 7.1nL/min vs. post-MCAO: 146.4 ± 37.7nL/min, p = 0.02). Within animal linear regression analysis showed a strong positive correlation between changes in collateral blood flow versus changes in collateral diameter during stroke (r = 0.7–0.99, p = 0.3–0.002). In contrast, collateral blood flow was only weakly correlated with collateral blood flow velocity during stroke (r = −0.03–0.97, p = 0.9–0.1).

Conclusions

Collateral blood flow and velocity significantly increased post-occlusion. Collateral flow was strongly influenced by vessel diameter, likely because of marked baseline vasoconstriction of collaterals which is flow-limiting.
目的：越来越多的证据表明，高血压动物的小脑膜侧支血流量不足是由于血管肌原性张力增加，这表明在缺血性卒中期间增强侧支血流量的治疗可能特别有效。为了开发这样的治疗方法，我们需要对高血压患者侧支血流量的调节因素有更深入的了解。因此，我们旨在量化自发性高血压大鼠（SHRs）缺血性卒中模型中单个侧支血管的血流速度、直径和绝对血流，并确定哪些因素对血流的影响最大。材料与方法：采用荧光微球法定量测定大脑中动脉闭塞（MCAO） 70 min时SHRs （n = 5）侧支血流速度和血管直径，计算绝对侧支血流。结果：闭塞后平均侧支血流量较基线显著增加（mcao前：16.75±7.1nL/min vs. mcao后：146.4±37.7nL/min, p=0.02）。动物线性回归分析显示卒中时侧支血流量变化与侧支直径变化呈正相关（r = 0.7-0.99,p = 0.3-0.002）。相比之下，卒中时侧支血流量与侧支血流速仅呈弱相关（r = -0.03-0.96,p=0.9-0.1）。结论：闭塞后侧支血流量和血流速度明显增加。侧枝血流受到血管直径的强烈影响，可能是因为侧枝明显的基线血管收缩，这是血流限制。
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引用次数: 0
Mendelian randomization and mediation examination of the immune cell-mediated link between sphingomyelin and stroke 神经鞘磷脂与脑卒中之间免疫细胞介导联系的孟德尔随机化和中介检验。
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108205
Cong Xu , Yonghong Xu , Jianglei Ma , Guangming Wang

Objective

The study established a direct link between stroke and sphingomyelin. The precise biology underlying this connection is yet unknown, though. As a result, we decided to investigate the potential causal relationship between Sphingomyelin and genetic vulnerability to stroke, as well as the potential mediating function that immune cells may play in this process, using Mendelian randomization (MR) approaches.

Methods

A published genome-wide association study (GWAS) dataset of European populations served as the foundation for the MR Study. The inverse variance weighting (IVW) model is the main technique. Four additional statistical techniques (MR Egger, Weighted median, Simple mode, and Weighted mode) were also employed to enhance the verification process. Reverse MR Analysis was utilized to reinforce the findings, and heterogeneity and horizontal pleipotency were assessed. Additionally, this study looked into potential immune cell mediating roles in the causal link between sphingomyelin and stroke using two-step MR techniques.

Result

The IVW metod's results indicated that sphingomyelin genetic susceptibility was linked to a high risk of stroke (OR = 1.045 [95 %CI, 1.004–1.087; P = 0.031). Additionally, the statistical result of SSC−A on CD8br and stroke was IVW [P = 0.007, OR(95 % CI) 1.020 (1.005–1.034)], which was proportionate to the increased risk of stroke. A lower incidence of stroke IVW is linked to CD45 on CD8br [P = 0.004, OR(95 % CI) 0.993 (0.988-0.998)]. Furthermore, our results imply that SSC−A on CD8br and CD45 on CD8br contribute to the causative relationship between sphingomyelin and stroke. The percentages of conciliation are 5.38 %, 22.7 %, 33.5 %), and 0.000999, 0.0152, 0.0132, respectively.

Conclusion

We confirmed the effect of sphingomyelin on stroke and conducted in-depth studies. SSC−A on CD8br and CD45 on CD8br is latent stroke mediators associated with sphingomyelin. Through two-step mediated Mendelian randomization analysis, we provide new insights into the etiology and treatment of stroke.
目的：建立脑卒中与鞘磷脂之间的直接联系。然而，这种联系背后的确切生物学原理尚不清楚。因此，我们决定使用孟德尔随机化（MR）方法研究鞘磷脂与中风遗传易感性之间的潜在因果关系，以及免疫细胞在这一过程中可能发挥的潜在介导作用。方法：已发表的欧洲人群全基因组关联研究（GWAS）数据集作为MR研究的基础。反方差加权（IVW）模型是主要的方法。另外四种统计技术（MR Egger，加权中位数，简单模式和加权模式）也被用来加强验证过程。利用反向MR分析来加强研究结果，并评估异质性和水平多能性。此外，本研究利用两步磁共振技术研究了神经鞘磷脂和中风之间因果关系中潜在的免疫细胞介导作用。结果：IVW方法结果显示鞘磷脂遗传易感性与卒中高风险相关(OR = 1.045 [95%CI, 1.004-1.087； = 0.031页)。此外，SSC-A对CD8br和卒中的统计结果为IVW [P = 0.007，OR(95% CI) 1.020(1.005-1.034)]，与卒中风险增加成正比。卒中IVW发生率较低与CD8br上的CD45有关[P=0.004， OR(95% CI) 0.993(0.988-0.998)]。此外，我们的研究结果表明，CD8br上的SSC-A和CD8br上的CD45参与了鞘磷脂和脑卒中之间的因果关系。调解比例分别为5.38%、22.7%、33.5%,0.000999、0.0152、0.0132。结论：我们证实了鞘磷脂对脑卒中的作用，并进行了深入的研究。CD8br上的SSC-A和CD8br上的CD45是与鞘磷脂相关的潜在卒中介质。通过两步介导的孟德尔随机化分析，我们为中风的病因和治疗提供了新的见解。
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引用次数: 0
Screening prediction models using artificial intelligence for moderate-to-severe obstructive sleep apnea in patients with acute ischemic stroke 急性缺血性脑卒中患者中重度阻塞性睡眠呼吸暂停的人工智能筛选预测模型。
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108214
Huan-Jan Lin MD , Tian-Hsiang Huang PhD , Hui-Ci Huang , Pao-Li Hsiao MD , Wen-Hsien Ho PhD

Background

Obstructive sleep apnea (OSA) is common after stroke. Still, routine screening of OSA with polysomnography (PSG) is often unfeasible in clinical practice, primarily because of how limited resources are and the physical condition of patients. In this study, we used several artificial intelligence techniques to predict moderate-to-severe OSA and identify its features in patients with acute ischemic stroke.

Methods

A total of 146 patients with acute ischemic stroke underwent PSG screening for OSA. Their baseline demographic characteristics, including age, sex, body mass index (BMI), Epworth Sleepiness Scale (ESS) score, and stroke risk factors, were recorded. Logistic regression analysis was conducted to identify significant features associated with moderate-to-severe OSA in patients with stroke. These significant features were used with six machine learning and ensemble learning algorithms, namely decision tree, support vector machine, random forest, extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), and gradient boosting, to compare the performance of several predictive models.

Results

Multivariate logistic regression analysis revealed that age, sex, BMI, neck circumference, and ESS score were significantly associated with the presence of moderate-to-severe OSA. According to the machine learning and ensemble learning results, the XGBoost model achieved the highest performance, with an area under the receiver operating characteristic curve of 0.89 and an accuracy and F1 score of 0.80.

Conclusion

This study identified key factors contributing to moderate-to-severe OSA in patients with ischemic stroke. The XGBoost model exhibited high predictive performance, indicating it has potential as a supporting tool for decision-making in health-care settings.
背景：阻塞性睡眠呼吸暂停（OSA）在卒中后很常见。然而，在临床实践中，常规的多导睡眠图（PSG）筛查OSA往往是不可行的，主要是因为资源有限和患者的身体状况。在这项研究中，我们使用了几种人工智能技术来预测急性缺血性卒中患者的中重度OSA，并确定其特征。方法：对146例急性缺血性脑卒中患者进行PSG筛查。记录他们的基线人口统计学特征，包括年龄、性别、体重指数（BMI）、爱普沃斯嗜睡量表（ESS）评分和中风危险因素。进行Logistic回归分析，以确定与卒中患者中至重度OSA相关的显著特征。将这些显著特征与六种机器学习和集成学习算法（即决策树、支持向量机、随机森林、极端梯度增强（XGBoost）、自适应增强（AdaBoost）和梯度增强）一起使用，比较几种预测模型的性能。结果：多因素logistic回归分析显示，年龄、性别、BMI、颈围、ESS评分与中重度OSA存在显著相关。从机器学习和集成学习结果来看，XGBoost模型取得了最高的性能，其接收器工作特征曲线下的面积为0.89，精度和F1分数为0.80。结论：本研究确定了缺血性卒中患者中至重度OSA的关键因素。XGBoost模型显示出很高的预测性能，表明它有潜力作为卫生保健机构决策的辅助工具。
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引用次数: 0
LDL-cholesterol lowering agents (statins and PCSK9 inhibitors) and the risk of intracerebral hemorrhage: A network meta-analysis 低密度脂蛋白胆固醇降低剂（他汀类药物和PCSK9抑制剂）与脑出血的风险：一项网络荟萃分析
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108224
Wangwen Li M.M. , Chuyue Wu M.D, Ph.D. , Wenkui Li M.M. , Li Li M.M.

Background and Purpose

Statin therapy reduces the risk of ischemic stroke; however, certain studies have observed an increased incidence of intracerebral hemorrhage (ICH). Moreover, proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors have emerged as a powerful class of lipid-lowering medications, potentially with a lower propensity for causing hemorrhagic events. To investigate this matter further, we conducted a network meta-analysis of randomized controlled trials (RCTs) involving statins and PCSK-9 inhibitors that reported occurrences of ICH.

Methods

We performed a literature search of Medline, Web of Science, and The Cochrane Library from database inception until August 2023. All randomized controlled trials of statin therapy and PCSK-9 inhibitors that reported ICH or hemorrhagic stroke were included. The primary outcome variable was ICH. The risk of bias of each included study was assessed by using the Cochrane Handbook for Systematic Reviews of Interventions. We performed network meta-analysis to compare and rank statin and PCSK-9 inhibitors therapies. This study is registered (2023110026. inplasy.com).

Results

A total of 26251 citations were identified by the search, and 38 potentially eligible articles were included. In total, data from 271411 individuals were analyzed. The data showed that there was not a significant increased risk of intracerebral hemorrhage for all statins and PCSK-9 inhibitors compared with placebo. atorvastatin and rosuvastatin were associated with a lower risk of death than placebo (ORs ranging between 0.79 and 0.82). For risk of intracerebral hemorrhage and mortality. there was not a significant increased risk among all drugs.

Conclusions

LDL-Cholesterol lowering agents (statins and PCSK-9 inhibitors) was not associated with a significant increased risk of ICH. Our network meta-analysis provides strong evidence for the safety of statins and PCSK-9 inhibitors, but more studies are needed to further validate this conclusion.
背景和目的：他汀类药物治疗可降低缺血性卒中的风险；然而，某些研究已经观察到脑出血（ICH）的发生率增加。此外，蛋白转化酶枯草杆菌素/酮素9型（PCSK-9）抑制剂已成为一类强有力的降脂药物，可能导致出血事件的倾向较低。为了进一步研究这一问题，我们对涉及他汀类药物和PCSK-9抑制剂的报告发生脑出血的随机对照试验（rct）进行了网络荟萃分析。方法：我们检索了Medline、Web of Science和Cochrane Library从数据库建立到2023年8月的文献。所有报告脑出血或出血性卒中的他汀类药物治疗和PCSK-9抑制剂的随机对照试验均被纳入。主要结局变量为脑出血。每项纳入研究的偏倚风险均通过Cochrane干预措施系统评价手册进行评估。我们进行了网络荟萃分析来比较和排名他汀类药物和PCSK-9抑制剂治疗。本研究注册号码为2023110026。结果：共有26251条引用被检索到，38篇可能符合条件的文章被纳入。总共分析了271411人的数据。数据显示，与安慰剂相比，所有他汀类药物和PCSK-9抑制剂的脑出血风险没有显著增加。与安慰剂相比，阿托伐他汀和瑞舒伐他汀与较低的死亡风险相关（or范围在0.79至0.82之间）。有脑出血和死亡的风险。在所有药物中，风险并没有显著增加。结论：低密度脂蛋白胆固醇降低药物（他汀类药物和PCSK-9抑制剂）与脑出血风险的显著增加无关。我们的网络荟萃分析为他汀类药物和PCSK-9抑制剂的安全性提供了强有力的证据，但需要更多的研究来进一步验证这一结论。
{"title":"LDL-cholesterol lowering agents (statins and PCSK9 inhibitors) and the risk of intracerebral hemorrhage: A network meta-analysis","authors":"Wangwen Li M.M. ,&nbsp;Chuyue Wu M.D, Ph.D. ,&nbsp;Wenkui Li M.M. ,&nbsp;Li Li M.M.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108224","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108224","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Statin therapy reduces the risk of ischemic stroke; however, certain studies have observed an increased incidence of intracerebral hemorrhage (ICH). Moreover, proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors have emerged as a powerful class of lipid-lowering medications, potentially with a lower propensity for causing hemorrhagic events. To investigate this matter further, we conducted a network meta-analysis of randomized controlled trials (RCTs) involving statins and PCSK-9 inhibitors that reported occurrences of ICH.</div></div><div><h3>Methods</h3><div>We performed a literature search of Medline, Web of Science, and The Cochrane Library from database inception until August 2023. All randomized controlled trials of statin therapy and PCSK-9 inhibitors that reported ICH or hemorrhagic stroke were included. The primary outcome variable was ICH. The risk of bias of each included study was assessed by using the Cochrane Handbook for Systematic Reviews of Interventions. We performed network meta-analysis to compare and rank statin and PCSK-9 inhibitors therapies. This study is registered (2023110026. <span><span>inplasy.com</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>A total of 26251 citations were identified by the search, and 38 potentially eligible articles were included. In total, data from 271411 individuals were analyzed. The data showed that there was not a significant increased risk of intracerebral hemorrhage for all statins and PCSK-9 inhibitors compared with placebo. atorvastatin and rosuvastatin were associated with a lower risk of death than placebo (ORs ranging between 0.79 and 0.82). For risk of intracerebral hemorrhage and mortality. there was not a significant increased risk among all drugs.</div></div><div><h3>Conclusions</h3><div>LDL-Cholesterol lowering agents (statins and PCSK-9 inhibitors) was not associated with a significant increased risk of ICH. Our network meta-analysis provides strong evidence for the safety of statins and PCSK-9 inhibitors, but more studies are needed to further validate this conclusion.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108224"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stimulant use disorder and the likelihood of stroke: Analysis of a national database in the United States 兴奋剂使用障碍与中风的可能性：美国国家数据库分析》。
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108178
Akash Venkataramanan MD , Divya Nayar MD , Sama Almasri MD , Thirumalaivasan Dhasakeerthi MD , Sowmya Jayachandran MD , Suryansh Bajaj MD , Cheran Elangovan MD

Background

Stimulant use has been associated with an increased risk of stroke, though data on clinical characteristics and exact risk are limited. This retrospective case-control study examines stroke risk in individuals with stimulant use disorder using data from a national U.S. database.

Methods

Data was obtained from the 2019 National Readmission Database (NRD) using ICD-10 codes to identify relevant diagnoses. A multivariate logistic regression analyzed the impact of stimulant use disorder on stroke admission odds, adjusting for alcohol use disorder, tobacco use, diabetes, hypertension, dyslipidemia, age, insurance status, and median income. Outcomes like total hospitalization charge, length of stay, and in-hospital mortality were assessed with multivariate regression. Gender-specific analyses were also conducted. Statistical significance was set at p < 0.05.

Results

A total of 4,821 adults with stimulant use disorder and stroke were compared to 542,618 stroke patients without stimulant use disorder. Patients with stimulant use disorder (PWSU) had significantly higher odds of hemorrhagic and ischemic stroke admissions, especially hemorrhagic strokes in women. PWSU with hemorrhagic strokes also had higher odds of in-hospital mortality.

Conclusions

Stimulant use disorder is associated with higher odds of admission for stroke, especially in women with an overall elevated mortality from hemorrhagic strokes. These findings underscore the need for further research and emphasize the importance of stroke prevention and treatment in individuals with stimulant use disorder.
背景：使用兴奋剂与中风风险增加有关，但有关临床特征和确切风险的数据有限。这项回顾性病例对照研究利用美国国家数据库的数据，对兴奋剂使用障碍患者的中风风险进行了研究：研究方法数据来自 2019 年国家再入院数据库（NRD），使用 ICD-10 编码确定相关诊断。多变量逻辑回归分析了兴奋剂使用障碍对中风入院几率的影响，并对酒精使用障碍、吸烟、糖尿病、高血压、血脂异常、年龄、保险状况和收入中位数进行了调整。住院总费用、住院时间和住院死亡率等结果均通过多变量回归进行了评估。此外，还进行了性别分析。统计显著性以 p < 0.05 为标准：将 4,821 名患有兴奋剂使用障碍并中风的成人患者与 542,618 名未患有兴奋剂使用障碍的中风患者进行了比较。患有兴奋剂使用障碍的患者（PWSU）发生出血性和缺血性中风的几率明显更高，尤其是女性出血性中风患者。出血性中风患者的院内死亡率也较高：结论：兴奋剂使用障碍与较高的中风入院几率有关，尤其是女性出血性中风的总体死亡率较高。这些发现强调了进一步研究的必要性，并强调了预防和治疗兴奋剂使用障碍患者中风的重要性。
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引用次数: 0
Biomarkers for the detection of covert atrial fibrillation after ischemic stroke: NT-proBNP or BNP?
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108239
Hiroshi Shiroto, Joji Hagii

Background: Atrial fibrillation often leads to ischemic stroke. For secondary prevention, clinicians typically switch from antiplatelet to anticoagulant therapy for patients with confirmed atrial fibrillation. This study examined the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) for detecting covert paroxysmal atrial fibrillation (PAF) in patients with ischemic stroke (PWIS).

Methods: We enrolled 438 patients with acute stroke in sinus rhythm on admission from July 2021 to March 2023 and measured their NT-proBNP and BNP levels to evaluate their association with PAF detection. Data analysis included logistic regression, receiver operating characteristic curves, and integrated discrimination improvement (IDI).

Results: Among our 438 enrolled participants, 43 (9.8%) were in the PAF group and the remaining were in the non-PAF group. PAF group patients were older than those in the non-PAF group (PAF group vs. non-PAF group; 84 [78-89] vs. 79 [71-85] years) and had higher levels of both NT-proBNP (581.0 [264.5-1,234.5] vs. 168.0 [76.0-412.5] pg/mL) and BNP (186.0 [100.4-313.0] vs. 56.4 [26.9-118.0] pg/mL). The PAF group also had a higher prevalence of chronic heart failure (30% vs. 10%). Both biomarkers were independent predictors of PAF detection, and there was no significant difference in their predictive accuracy for PAF. However, BNP had a slight advantage in the IDI score over NT-proBNP (-0.03 [-0.05 to -0.01]).

Conclusion: NT-proBNP and BNP can both effectively predict covert PAF in PWIS in sinus rhythm. Thus, either biomarker should be incorporated into treatment planning strategies for these patients.

{"title":"Biomarkers for the detection of covert atrial fibrillation after ischemic stroke: NT-proBNP or BNP?","authors":"Hiroshi Shiroto, Joji Hagii","doi":"10.1016/j.jstrokecerebrovasdis.2025.108239","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108239","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation often leads to ischemic stroke. For secondary prevention, clinicians typically switch from antiplatelet to anticoagulant therapy for patients with confirmed atrial fibrillation. This study examined the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) for detecting covert paroxysmal atrial fibrillation (PAF) in patients with ischemic stroke (PWIS).</p><p><strong>Methods: </strong>We enrolled 438 patients with acute stroke in sinus rhythm on admission from July 2021 to March 2023 and measured their NT-proBNP and BNP levels to evaluate their association with PAF detection. Data analysis included logistic regression, receiver operating characteristic curves, and integrated discrimination improvement (IDI).</p><p><strong>Results: </strong>Among our 438 enrolled participants, 43 (9.8%) were in the PAF group and the remaining were in the non-PAF group. PAF group patients were older than those in the non-PAF group (PAF group vs. non-PAF group; 84 [78-89] vs. 79 [71-85] years) and had higher levels of both NT-proBNP (581.0 [264.5-1,234.5] vs. 168.0 [76.0-412.5] pg/mL) and BNP (186.0 [100.4-313.0] vs. 56.4 [26.9-118.0] pg/mL). The PAF group also had a higher prevalence of chronic heart failure (30% vs. 10%). Both biomarkers were independent predictors of PAF detection, and there was no significant difference in their predictive accuracy for PAF. However, BNP had a slight advantage in the IDI score over NT-proBNP (-0.03 [-0.05 to -0.01]).</p><p><strong>Conclusion: </strong>NT-proBNP and BNP can both effectively predict covert PAF in PWIS in sinus rhythm. Thus, either biomarker should be incorporated into treatment planning strategies for these patients.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108239"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124017","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
Endovascular thrombectomy for acute ischemic stroke complicated with systemic light chain amyloidosis: Two case reports 血管内取栓治疗急性缺血性脑卒中合并全身轻链淀粉样变性2例报告。
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108181
Yongjie Bai, Bingjie Sun, Jiahui Su
Systemic light chain amyloidosis (AL) is a non-proliferative plasma cell disease characterized by the deposition of fragments of immunoglobulin light or heavy chain in tissues. There has been no relevant report on the treatment of vascularization during the acute stage of acute ischemic stroke (AIS) complicated with AL. This paper presented two cases of AIS complicated with AL that were treated with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). The combination of aspiration thrombectomy and IVT might be feasible for patients with AIS complicated with AL.
系统性轻链淀粉样变性（AL）是一种以免疫球蛋白轻链或重链片段在组织中沉积为特征的非增生性浆细胞疾病。AIS合并AL急性期血管化治疗尚未见相关报道，本文报道了2例AIS合并AL分别行静脉血栓置换术和静脉血栓置换术治疗的病例，认为抽吸取栓联合静脉血栓置换术治疗AIS合并AL可能是可行的。
{"title":"Endovascular thrombectomy for acute ischemic stroke complicated with systemic light chain amyloidosis: Two case reports","authors":"Yongjie Bai,&nbsp;Bingjie Sun,&nbsp;Jiahui Su","doi":"10.1016/j.jstrokecerebrovasdis.2024.108181","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108181","url":null,"abstract":"<div><div>Systemic light chain amyloidosis (AL) is a non-proliferative plasma cell disease characterized by the deposition of fragments of immunoglobulin light or heavy chain in tissues. There has been no relevant report on the treatment of vascularization during the acute stage of acute ischemic stroke (AIS) complicated with AL. This paper presented two cases of AIS complicated with AL that were treated with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). The combination of aspiration thrombectomy and IVT might be feasible for patients with AIS complicated with AL.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108181"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stroke recurrence and all-cause mortality in CPAP-treated sleep-disordered-breathing patients cpap治疗的睡眠呼吸障碍患者卒中复发和全因死亡率。
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108204
Jeppe Suusgaard MD , Anders Sode West PhD, MD , Laura B. Ponsaing PhD, MD , Helle Klingenberg Iversen DMSC (Associate Professor) , Katrin Rauen DMSC , Poul Jørgen Jennum DMSC (Professor)

Background

Obstructive sleep apnea (OSA) affects about 70 % of stroke patients and is closely linked to stroke development. It is unclear whether treatment with continuous positive airway pressure (CPAP) reduces the risk of stroke recurrence or mortality in post-stroke patients, partly due to limited follow-up time and small sample sizes of previous studies. To close this knowledge gap, this study investigated changes in stroke recurrence and mortality among CPAP-treated post-stroke patients with sleep-disordered breathing.

Methods

We conducted a retrospective cohort study using data from the Danish National Patient Registry covering the period from 2003 to 2016, involving 1821 patients diagnosed with sleep-disordered breathing and a prior ischemic stroke or transient ischemic attack (TIA). Patients were categorized into three groups: CPAP users, CPAP-non-users, and no CPAP treatment. We used Cox hazard regression to assess the risk of recurrent stroke or TIA over a 5-year follow-up period, and all-cause mortality over a 14-year follow-up period.

Results

CPAP treatment improved survival rate in CPAP users compared to patients categorized as no CPAP treatment (hazard ratio 0.75, 95 % CI [0.60;0.92], p = 0.007). This effect persisted after adjusting for age, sex, and pre-existing comorbidities within three years (the Quan-updated Charlson Comorbidity Index). There was no difference in recurrence of stroke/TIA among the three CPAP groups.

Conclusions

In this registry-based study, we found that CPAP was associated with a reduction in all-cause mortality in post-stroke/TIA patients with sleep-disordered breathing. CPAP treatment did not seem to affect the risk of re-stroke/TIA during the five years of follow-up.
背景：阻塞性睡眠呼吸暂停（OSA）影响约70%的卒中患者，与卒中发展密切相关。目前尚不清楚持续气道正压通气（CPAP）治疗是否能降低卒中后患者卒中复发或死亡的风险，部分原因是由于既往研究的随访时间有限和样本量小。为了缩小这一知识差距，本研究调查了cpap治疗的卒中后睡眠呼吸障碍患者卒中复发率和死亡率的变化。方法：我们使用2003年至2016年丹麦国家患者登记处的数据进行了一项回顾性队列研究，涉及1821名诊断为睡眠呼吸障碍和既往缺血性卒中或短暂性脑缺血发作（TIA）的患者。患者被分为三组：CPAP使用者、CPAP非使用者和未接受CPAP治疗。我们使用Cox风险回归来评估5年随访期间卒中或TIA复发的风险，以及14年随访期间的全因死亡率。结果：与未接受CPAP治疗的患者相比，CPAP治疗提高了CPAP使用者的生存率（风险比0.75,95% CI [0.60;0.92], p = 0.007）。在调整了年龄、性别和三年内已存在的合并症（全更新的Charlson合并症指数）后，这种效果仍然存在。三个CPAP组卒中/TIA的复发率无差异。结论：在这项基于登记的研究中，我们发现CPAP与卒中/TIA后睡眠呼吸障碍患者全因死亡率的降低有关。在5年的随访中，CPAP治疗似乎没有影响再卒中/TIA的风险。
{"title":"Stroke recurrence and all-cause mortality in CPAP-treated sleep-disordered-breathing patients","authors":"Jeppe Suusgaard MD ,&nbsp;Anders Sode West PhD, MD ,&nbsp;Laura B. Ponsaing PhD, MD ,&nbsp;Helle Klingenberg Iversen DMSC (Associate Professor) ,&nbsp;Katrin Rauen DMSC ,&nbsp;Poul Jørgen Jennum DMSC (Professor)","doi":"10.1016/j.jstrokecerebrovasdis.2024.108204","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108204","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive sleep apnea (OSA) affects about 70 % of stroke patients and is closely linked to stroke development. It is unclear whether treatment with continuous positive airway pressure (CPAP) reduces the risk of stroke recurrence or mortality in post-stroke patients, partly due to limited follow-up time and small sample sizes of previous studies. To close this knowledge gap, this study investigated changes in stroke recurrence and mortality among CPAP-treated post-stroke patients with sleep-disordered breathing.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the Danish National Patient Registry covering the period from 2003 to 2016, involving 1821 patients diagnosed with sleep-disordered breathing and a prior ischemic stroke or transient ischemic attack (TIA). Patients were categorized into three groups: CPAP users, CPAP-non-users, and no CPAP treatment. We used Cox hazard regression to assess the risk of recurrent stroke or TIA over a 5-year follow-up period, and all-cause mortality over a 14-year follow-up period.</div></div><div><h3>Results</h3><div>CPAP treatment improved survival rate in CPAP users compared to patients categorized as no CPAP treatment (hazard ratio 0.75, 95 % CI [0.60;0.92], p = 0.007). This effect persisted after adjusting for age, sex, and pre-existing comorbidities within three years (the Quan-updated Charlson Comorbidity Index). There was no difference in recurrence of stroke/TIA among the three CPAP groups.</div></div><div><h3>Conclusions</h3><div>In this registry-based study, we found that CPAP was associated with a reduction in all-cause mortality in post-stroke/TIA patients with sleep-disordered breathing. CPAP treatment did not seem to affect the risk of re-stroke/TIA during the five years of follow-up.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108204"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effects of multicomponent rehabilitation exercise plus soymilk on cognitive impairment and ischemic lesion growth in stroke patients: A randomized controlled trial 多组分康复训练加豆浆对脑卒中患者认知功能障碍和缺血性病变生长的影响：一项随机对照试验。
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108207
Babak Esmealy , Leyla Esmealy , Leila Gholizadeh , Saeid Nikookheslat , Vahid Sari-Sarraf

Objectives

This study aimed to examine the effects of a multicomponent rehabilitation exercise, coupled with soymilk intake post-exercise, on cognitive impairment and ischemic lesion growth among acute stroke patients.

Methods

In a four-arm, single-blind, randomized clinical trial, 120 patients with acute stroke were randomly allocated to one of the following groups: 1) the MRE + soymilk, 2) the MRE, 3) the soymilk, and 4) the control group. Each group underwent their respective intervention for a continuous duration of 20 days. Cognitive impairment was assessed using the Montreal Cognitive Assessment, and the growth of ischemic lesions was evaluated through CT scans.

Results

The MRE combined with soymilk intervention demonstrated statistically significant improvements in cognitive impairment among acute stroke patients (χ² = 51.055, p = 0.000). Group differences began to emerge from Week, with improvements observed across all dimensions of cognitive function, except for abstraction. No significant differences were observed between groups in terms of ischemic lesion growth (χ² =0.934, p = 0.810).

Conclusion

The incorporation of a multicomponent rehabilitation exercise combined with soymilk ingestion demonstrated effectiveness in alleviating cognitive impairment among acute stroke patients. Nevertheless, it did not influence the growth of ischemic lesions.
目的：本研究旨在探讨多组分康复运动，以及运动后豆浆摄入对急性脑卒中患者认知功能障碍和缺血性病变生长的影响。方法：在一项四组、单盲、随机临床试验中，120例急性脑卒中患者随机分为以下组：1)MRE + 豆浆组，2)MRE组，3)豆浆组，4)对照组。每组分别进行连续20天的干预。使用蒙特利尔认知评估评估认知功能障碍，并通过CT扫描评估缺血性病变的生长情况。结果：MRE联合豆浆干预对急性脑卒中患者认知功能障碍的改善有统计学意义（χ² = 51.055,p = 0.000）。从周开始，组间的差异开始显现，除了抽象之外，认知功能的各个方面都有所改善。两组间缺血性病变生长无显著性差异（χ²=0.934,p= 0.810）。结论：多组分康复训练结合豆浆摄入可有效缓解急性脑卒中患者的认知功能障碍。然而，它不影响缺血性病变的生长。
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引用次数: 0
Gut microbiota and hemorrhagic stroke: Emerging insights and future perspectives 肠道微生物群和出血性中风：新兴的见解和未来的观点。
IF 2 4区 医学 Q3 NEUROSCIENCES
Journal of Stroke & Cerebrovascular Diseases
Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108212
Chenyang Zang MD , Zheng Xiao MD , Luo Zhou MD
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引用次数: 0
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