Brain Circulation最新文献

Background: Expression profiles and clinical significance of circular RNAs (circRNAs) in intracranial atherosclerotic stenosis (ICAS) patients have not been investigated yet.

Materials and methods: A circRNA microarray was employed to identify differentially expressed circRNAs (DEcircRNAs) in peripheral neutrophils of ICAS patients. The levels of upregulated hsa-circRNA-087631/hsa-circRNA-101141 and downregulated hsa-circRNA-100914/hsa-circRNA-001082 were verified using quantitative real-time polymerase chain reaction (qRT-PCR). In addition, we compared the levels of those four DEcircRNAs before endovascular treatment (pre-E) and 24 h after endovascular treatment (post-E) and between patients with adverse event and severe adverse event (AE/SAE) and those without. Their area under the curve from the receiver operating characteristic (ROC) curve was calculated as well. Bioinformatic analyses of DEcircRNAs host genes and targeted genes in DEcircRNA-miRNA-mRNA regulatory network were further performed.

Results: A total of 70 circRNAs were identified as differentially expressed in patients with ICAS; of these, 7 were upregulated and 63 were downregulated. qRT-PCR-based validation results of the four DEcircRNAs corresponded with the microarray data. The upregulated hsa-circRNA-087631 and hsa-circRNA-101141 were significantly downregulated 24 h post-E; moreover, they were significantly increased in patients with perioperative AE/SAE compared to those without AE/SAE. ROC analysis further supported their potential to be exploited as diagnostic biomarkers for ICAS. The validated DEcircRNA-miRNA-mRNA regulatory network and further bioinformatic analysis supported the core roles of hsa-circRNA-101141 in regulating target genes mainly related to actin or microtubule-based process.

Conclusions: DEcircRNAs in peripheral neutrophils could serve as biomarkers for the diagnostic and AE prediction in ICAS patients receiving endovascular treatment. Moreover, these DEcircRNAs, especially hsa-circRNA-101141-hsa-miRNA-181d axis, might participate in the pathogenesis of ICAS by acting on actin or microtubule-based cytoskeleton organization processes in neutrophils.

Trial registration: The CRTICAS study has been registered previously in the ClinicalTrial.gov database (NCT01994161).

Ischemic stroke is a leading cause of mortality and disability worldwide. Emerging evidence has highlighted a strong link between genetically predisposed risk factors, such as depression and chronic mental stress, and worsens stroke outcomes. This mini review explores the multifaceted role of mental stress in exacerbating ischemic injury. We discuss mechanisms at the cellular, subcellular, and epigenetic levels, including differential brain cell sensitivity, mitochondrial dysfunction, and novel epigenetic modifications like lactylation. This review provides a theoretical framework and scientific basis for understanding the clinical implications of mental stress in ischemic stroke management. The findings underscore the importance of further research to clarify these mechanisms and develop targeted interventions to mitigate the adverse effects of mental stress on stroke outcomes.

Introduction: Ischemic stroke leads to significant morbidity and mortality. Although research into the field has remained pervasive over time, few studies have investigated how ischemic stroke research has changed. In the present study, we strive to characterize the changes in ischemic stroke research between 2012 and 2022 in order to gain insight into the major topics of interest and contributors to the field.

Methods: The Web of Science database isolated 92,535 articles. Subsequently, networks were constructed for the top keywords, terms, countries, and journals. The clusters in these networks were compared between 2012 and 2022 to isolate the items with the greatest changes. The degree of connectivity for items within the network was measured as link strengths for keywords, countries, and journals. Meanwhile, relevancy scores were determined for the top terms.

Results: Keywords were categorized into five major clusters: cellular changes, risk factors, biological recovery, medical therapies, and cardiac associations. Among these, "stroke" remained the most popular keyword, showing the greatest increase in link strength over time. In addition, the terms "thrombectomy" and "atrial fibrillation" increased by 4,797 and 2,057, respectively. When examining individual countries, the United States had the greatest average link strength (1,664) between 2012 and 2022, with the largest number of documents in 2012 (1,720). However, by 2022, China produced the greatest number of documents (3,678).

Conclusions: Ischemic stroke literature has increased in prevalence. The growth of research in this stems from the development of endovascular techniques and the increasing incidence of atrial fibrillation with modern monitoring devices leading to greater awareness and identification, although the prevalence of atrial fibrillation itself is likely unchanged. Furthermore, both China and the United States continue to maintain the largest influence on ischemic stroke research. As both countries progress in ischemic stroke research, it will be important to continue to understand how areas of exploration change within the field.

A significant subgroup of stroke patients require oral anticoagulants (OACs) for the prevention of recurrence of thromboembolic events. For a long time, clinicians have been using conventional warfarin as OAC in stroke prevention. However, the discovery of newer OACs that do not require strict monitoring with an international normalized ratio (INR) has resulted in changes in guidelines for stroke prevention. For the last 10 years, there has been a flood of literature on the use of Vitamin K antagonist (VKA) versus non-vitamin K antagonist oral anticoagulants (NOACs) in stroke prevention. More than 100 meta-analyses, randomized trials, and more than six new guidelines or comparisons of guidelines are available in the medical literature. Hence, we have planned to write a review on this topic to compile all new findings and recommendations. Therefore, now, clinicians have to use currently available knowledge and guidelines for choosing appropriate OAC in stroke settings. The current review is divided into 6 segments: 1) general information and protocol for VKA use; 2) current definition to describe "valvular" versus "non-valvular" AF; 3) to describe current recommendations for uses of VKA and NOACs for recurrent stroke prevention; 4) how to use VKA/NOACs in special populations; 5) perioperative management of patients on OAC; and 6) OAC recommendations for Asian population. This narrative review can help for the better understanding and clear clinical decision making for selection of OAC in stroke patients. Further, it will highlight the gray areas with no clearcut guidance for the selection of OAC.

Background and purpose: Detecting the proximal occlusion site (POS) and distal boundary of the occlusion (DBO) of arterial occlusion is very important for the prognosis of endovascular treatment. Recent studies have shown that magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are also beneficial for preoperative patient selection for endovascular therapy. High-resolution vessel wall MRI (HRVW-MRI) for intraluminal detection of arterial largevessel occlusions (LVOs) is receiving increasing attention. The purpose of this study was to evaluate the diagnostic efficacy of HRVW-MRI for POS and DBO.

Materials and methods: The data of 42 patients with acute anterior circulation cerebral infarction were retrospectively analyzed. By comparing with digital subtraction angiography (DSA), the POS and DBO were analyzed to determine the efficacy of HRVW-MRI for LVO location.

Results: Good to excellent interobserver consistency was achieved in the analysis and evaluation of all image data (k > 0.70). There was better concordance for the POS between HRMRI and DSA than that between MRA and DSA (k = 0.834 vs. k = 0.309). Compared with DSA, HRVW-MRI showed an advantage over DSA in terms of clearly determining DBO (χ² = 9.389, P < 0.01).

Conclusion: HRVW-MRI demonstrated a comparative advantage over Time-of-flight-MRA for differentiating the POS, with accuracy near-equivalent to that of DSA and a clear advantage over DSA for DBO detection. HRVW-MRI has the potential to improve preoperative planning for endovascular therapy.

Background: Nexfin, a noninvasive blood pressure (BP) monitoring system, can provide continuous real-time measurements of BP, which can be useful for patients with acute neurological injury who require urgent neuroendovascular interventions. While Nexfin has shown promising reliability for other clinical scenarios, its performance has not been demonstrated during neuroendovascular procedures for patients with neurological injury.

Methods: This was a single-center retrospective study. Consecutive patients who underwent neuro-endovascular procedures with Nexfin BP monitoring were identified at a single institution. Mean arterial pressure (MAP) and systolic BP (SBP) from Nexfin, conventional oscillometric cuff, and arterial line were recorded every 5 to 15 min Concordance between measurement modalities was assessed. Nexfin's ability to detect the significant drops in BP (MAP decrease of 10 or more or SBP decrease of 20 or more) on the arterial line was also assessed and compared with cuff.

Results: A total of 620 blood measurements (264 Nexfin, 197 cuff, and 159 arterial line) from 33 patients who underwent neuro-endovascular procedures were collected. Overall, Nexfin measurements correlated well with the arterial line measurements for MAP (Pearson's R = 0.74, P < 0.001) and SBP (Pearson's R = 0.67, P < 0.001). Overall, Nexfin performed similarly to cuff in estimating arterial line measurements; however, Nexfin was more sensitive for detecting MAP drops than conventional cuff (70.6% vs. 50.0%), while maintaining similar specificity (92.8% vs. 91.1%). This culminated in higher positive predictive value (60.0% vs. 50.0%), negative predictive value (95.4% vs. 91.1%), and F1-score (0.65 vs. 0.50). Similar results were seen for detecting SBP drops, where Nexfin also outperformed cuff.

Conclusions: For patients undergoing neuro-endovascular treatments, Nexfin performed as well as conventional cuffs in estimating intraoperative BP measurements from arterial lines, and it was more sensitive than cuffs in detecting intraprocedural relative hypotension without compromising specificity.

Peripheral nerve injuries (PNIs) present significant clinical challenges and affect a substantial portion of the population. Current treatments often fall short of desirable outcomes, leading to a diminished quality of life for patients. Advancements in neuron scaffolding materials offer promising solutions to enhance the clinical management of PNIs and address the limitations of traditional treatments. This paper assesses the current state of treatments, examines the anatomy and physiology of peripheral nerves, and discusses the mechanisms of PNIs and their impact on recovery. It also explores the principles of neuron scaffolding and recent advancements in various natural and synthetic biomaterials. This review focuses on collagen, fibrin, chitosan, poly (lactic acid), poly (glycolic acid), and polycaprolactone (PCL), detailing each material's advantages and challenges in neuron scaffolding applications. This review paper focuses on the innovative use of neuron scaffolding in the treatment of PNIs, emphasizing the potential of both natural and synthetic biomaterials to enhance nerve regeneration. The study underlines the promising future of neuron scaffolding while acknowledging the current limitations that need to be addressed for more effective treatment outcomes.

Significant advancements over the past decade have transformed reperfusion therapy for acute ischemic stroke. Standard treatments, including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT), offer distinct benefits, with recent innovations expanding their efficacy and applicability. IVT, previously limited by a narrow therapeutic window, has seen enhancement with alternative agents such as tenecteplase, which may deliver comparable or superior outcomes to alteplase in selected cases. Expanding indications for EVT, particularly for large vessel occlusions and in extended time windows, have demonstrated promising results, underscoring its effectiveness beyond conventional time constraints. Recent trials further support the use of EVT for patients with large infarct cores in the anterior circulations, although mortality outcomes remain sensitive to treatment timing. In addition, mobile stroke units (MSUs) and prehospital management strategies have emerged as critical components for minimizing delays and improving clinical outcomes. Future research should focus on optimizing reperfusion therapies to individual patient profiles, investigating neuroprotective adjuncts, and expanding the global availability of MSUs to facilitate timely, accessible stroke care.