Current neurovascular research最新文献

Introduction: Headaches affect up to 95% of individuals during their lifetime and are a major global cause of disability. Intracranial Aneurysm (IA) is a cerebrovascular disorder affecting approximately 3.2% of the general population. Observational studies have suggested an association between headaches and IA, but the causal relationship remains unclear. This Mendelian Randomization (MR) analysis aims to elucidate the causal relationship between headaches and IA.

Methods: A two-sample bidirectional Mendelian Randomization (MR) analysis was performed using publicly available Genome-Wide Association Study (GWAS) data to assess the causal relationships between IA and four headache subtypes, namely, Chronic Headache (CH), Tension- Type Headache (TTH), Migraine Without Aura (MO), and Migraine With Aura (MA). The inverse variance weighted method was employed as the primary method, with sensitivity analyses conducted to evaluate the robustness of the results. Mediation analysis was performed to investigate the potential mediating role of hypertension.

Results: The MR analysis revealed that MO was associated with an increased risk of aneurysmal Subarachnoid Hemorrhage (aSAH) (Odds Ratio [OR] = 1.422, 95% Confidence Interval [CI]: 1.054.1.918, and P = 0.021), while MA (OR = 1.527, 95% CI: 1.115.2.091, and P = 0.008) was associated with an elevated risk of unruptured IA (uIA). Mediation analysis indicated that hypertension did not significantly mediate these associations.

Discussion: This study highlights the potential role of MO in aSAH and MA in uIA, where hypertension does not serve as a significant mediator. Further research is necessary to investigate the underlying mechanisms, which may offer valuable insights into the prevention and management of IA.

Conclusion: Bidirectional MR analysis of four headache subtypes and IA provides evidence that MO is associated with an increased risk of aSAH, while MA is linked to a higher risk of uIA. These findings contribute to a better understanding of the complex relationship between headaches and IA.

Background: Intracranial Atherosclerotic Stenosis (ICAS) is a prevalent etiology of acute ischemic stroke (AIS), leading to significant morbidity and mortality. The accurate diagnosis and treatment of ICAS-induced AIS are critical to improving outcomes. This study assesses the application of Computed Tomography Perfusion (CTP) in predicting ICAS in AIS patients and its potential impact on patient management.

Methods: A retrospective analysis was conducted on 224 AIS patients who underwent endovascular therapy (EVT) at one single Chinese Stroke Center between April 2022 and December 2023. Clinical and radiological data were collected, including patients' demographics, CTP parameters, and 90-day modified Rankin Scale (mRS) scores. Logistic regression and receiver operating characteristic (ROC) curves evaluated the predictive power of CTP parameters for ICAS.

Results: CTP analysis revealed significant differences in perfusion parameters between ICASinduced AIS and other etiologies. ICAS patients had a smaller ischemic volume on admission and higher mismatch ratios [Time to Maximum, T_max＞6s: Other Causes: 132.4 [70.5, 183.3] mL, ICAS: 96.3 [79.8, 107.3] mL, p =0.0064; relative cerebral blood flow, rCBF＜30%: Other Causes: 2.4 [0.0, 10.8] mL, ICAS: 0.6 [0.0, 7.0] mL, p =0.0145; mismatch ratio: 7.4 [2.5, 15.0], ICAS: 11.0 [4.6, 17.8], p =0.0285], indicating more salvageable brain tissue. The 90-day mRS showed better functional outcomes in the ICAS group, with a higher likelihood of minimal to no disability [mRS 90 equals 0-1: ICAS: 53.0% vs. Other Causes: 36.3%, p =0.0122]. The predictive model for ICAS, combining clinical manifestations and CTP parameters, yielded an area under the curve (AUC) of 0.7779, demonstrating good diagnostic performance.

Conclusion: CTP is a valuable diagnostic tool for ICAS-induced AIS, offering the potential for early identification and informing the decision for endovascular treatment. The positive correlation between CTP findings and patient outcomes supports its utility in clinical practice.

Background: Silent Brain Infarction (SBI) has been found to be linked to an increased risk of cognitive impairment and future symptomatic stroke. Atrial fibrillation is a significant risk factor for SBI. Even in low-risk atrial fibrillation patients, the incidence of SBI remains high. This study aims to investigate the risk factors for SBI in nonvalvular atrial fibrillation (NVAF) patients with a CHA₂DS₂-VASc score of 0 to 1.

Methods: A total of 301 consecutive low-risk NVAF patients (male: CHA₂DS₂-VASc=0, female: CHA₂DS₂-VASc=1) were enrolled. According to brain Magnetic Resonance Imaging (MRI), patients were divided into SBI (n=90) and non-SBI (n=211) groups. Baseline characteristics, blood parameters, and echocardiography results were analyzed. Multivariate logistic regression was performed to identify independent predictors. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the diagnostic power of the relevant risk factors.

Results: The study revealed that neutrophil count, monocyte count, Platelet-To-Lymphocyte Ratio (PLR), neutrophil-to-high density lipoprotein cholesterol ratio (NHR), and left atrial diameter (LAD) were significantly higher in the SBI group than non-SBI group (p <0.05). Multivariate logistic regression analysis identified PLR (OR, 1.004; 95%CI 1.001-1.007; p =0.026) and LAD (OR 1.092; 95%CI 1.054-1.130; p <0.001) as the independent risk factors associated with SBI. The ROC showed that the Area Under the Curve (AUC) of PLR is 0.589 (95%CI 0.515- 0.662; p =0.015) with an optimal cut-off point of 151 (sensitivity 43.3%, specificity 74.6%). The AUC of LAD is 0.676 (95%CI 0.606-0.746; p <0.001) with an optimal cut-off point of 39 mm (sensitivity 61.1%, specificity 72.0%). The AUC of PLR combined with LAD is 0.711 (95%CI 0.646-0.777; p <0.001) with a sensitivity of 63.3% and specificity of 73.5% for SBI.

Conclusion: PLR and LAD can be independent risk factors for SBI in NVAF patients with low CHA₂DS₂-VASc scores. The combination of the two factors can enhance the predictive ability of SBI in these patients.

Objective: To explore the effect of baseline Systemic Inflammatory Response reflected by platelet-to-lymphocyte ratio (PLR) and pre-thrombectomy cerebral edema reflected by Net Water Uptake (NWU) on futile recanalization in patients with Acute Ischemic Stroke (AIS) after successful thrombectomy, and to investigate the potential mediating role of baseline cerebral edema.

Methods: 134 Patients with anterior circulation ischemic stroke receiving successful thrombectomy were retrospectively studied. Their demographic and clinical characteristics were collected at admission, and the NWU was quantitatively calculated based on baseline computed tomography (CT). The predictive value of PLR for futile recanalization and the relationship between PLR, NWU, and futile recanalization using mediation analysis were explored. Patients were followed up for 90 days and were divided into a futile recanalization group and a favorable prognosis group [90-day modified Rankin Scale score of 0-2].

Results: High baseline PLR, NWU, no first-pass reperfusion, and large baseline ischemic core volume were independent predictors of futile recanalization after successful thrombectomy in patients with AIS. Mediation analysis results indicate that PLR may partially mediate the occurrence of futile recanalization through NWU.

Conclusion: Baseline PLR and NWU were independent predictors of futile recanalization, and higher PLR and NWU values were associated with a higher likelihood of futile recanalization. The findings suggest that early cerebral edema reflected by a high NWU value may be a mediator of PLR-affecting prognosis.

Background: With 301 million cases worldwide, anxiety disorders represent a serious public health concern. Many people endure ongoing distress while receiving several treatments because of the drawbacks of traditional therapy, such as adverse effects, dependence, and inconsistent efficacy. This emphasizes the absolute need for novel treatment approaches.

Objective: This review examines emerging pharmacological and non-pharmacological strategies for anxiety disorders, assessing existing and developing therapeutic options while examining the drawbacks of conventional therapies.

Methods: A comprehensive literature review was carried out using the NIH, PubMed, and Google Scholar databases. Studies from 2020-2025 were given priority in the inclusion criteria, with a few supporting references from earlier years. Personalized medicine, combination therapy, non-pharmacological interventions, and novel anxiolytic targets, etc., were among the keywords used.

Results: Conventional therapies, including benzodiazepines, SSRIs, and SNRIs, are still the major choices, but they have significant disadvantages. The protein kinase pathway, endocannabinoid and orexin systems, NK1R antagonists, and microbiome modulation are examples of emerging targets. Emerging strategies that show preliminary promise include digital therapeutics, gene therapy, optogenetics, personalized medicine, combination therapy, herbal therapy, and peptide-based medicines (e.g., NPY, NPS, oxytocin analogs, CRF, vasopressin, and melanocortin receptor antagonist). Several of these approaches modulate key neural circuits, such as the involvement of the amygdala-prefrontal cortex axis, via the HPA axis, and biomarker-informed personalization, among others; yet many remain in early-phase or preclinical investigation. However, limited comparative data exist between these novel strategies and standard therapies, underlining the need for rigorous head-to-head evaluations.

Conclusion: Advances in molecular neuroscience and precision medicine offer potential alternatives to conventional treatments. However, most emerging therapies require further clinical validation, large-scale trials, and translational refinement before they can be integrated into realworld decision-making for anxiety disorders.

Introduction: This study aims to investigate the effect of the serum Total Cholesterol (TC) to High-Density Lipoprotein cholesterol (HDL) ratio (T/H ratio) on Hemorrhagic Transformation (HT) after Intravenous Thrombolysis (IVT) in patients with Acute Cerebral Infarction (ACI).

Methods: Patients with ACI who received alteplase were enrolled. Subgroups were classified based on the occurrence of hemorrhagic transformation (HT) after intravenous thrombolysis (IVT), whether tirofiban was coadministered, and their 90-day prognosis. The primary observation indicators were HT and the 90-day prognosis. Single-factor and multi-factor analyses were performed to identify independent predictors of HT and prognosis.

Results: Age, TC, and HDL were identified as risk factors for ACI. The T/H ratio and HDL were statistically significant in relation to HT (p < 0.05). A correlation was observed between the T/H ratio and HT, with HT more likely to occur when the T/H ratio was greater than or equal to 3.25. The use of tirofiban after IVT did not increase the risk of HT. Significant differences were observed in HT, type of HT, age, hypertension, baseline National Institutes of Health Stroke Scale (NIHSS) score, platelet volume distribution width, TC, D-dimer, and fibrinogen degradation products between groups with different prognoses.

Discussion: The T/H ratio was statistically associated with HT-ACI and predicted HT-ACI to some extent. However, the study had two limitations: the small sample size and the assessment of prognosis through follow-up phone calls, which affected the final results.

Conclusion: Patients with ACI undergoing IVT who had higher baseline NIHSS scores, lower TC, higher HDL, and a higher T/H ratio were at increased risk of HT, which was also associated with long-term outcomes. The T/H ratio may be a valuable predictor of HT following IVT.

Introduction: Epilepsy is a neurological disorder characterized by recurrent seizures that can cause long-standing disturbance of normal brain function. It may adversely affect academic performance, behavior, emotional adjustment, social adaptability, and overall development in children. Neurotrophic factors and inflammatory markers are believed to play key roles in the pathogenesis of epilepsy. This study evaluated the effect of levetiracetam monotherapy and its combination with phenytoin on serum brain-derived neurotrophic factor (BDNF) levels, Interleukin-2 (IL-2) levels, and social adaptability/development in children with epilepsy.

Methods: Children with epilepsy, aged 1 to 12 years, were given levetiracetam monotherapy (n=30) and combination therapy of levetiracetam and phenytoin (n=30) for 20 weeks. Healthy controls (n=30) were also included. Serum BDNF and IL-2 levels were assessed at baseline and 20 weeks, along with social adaptability and development, using the Vineland Social Maturity Scale (VSMS) and Developmental Screening Test (DST) scores, respectively.

Results: Pretreatment, serum BDNF and IL-2 levels were significantly (p <0.001) lower and higher respectively, in both treatment groups compared to controls. After 20 weeks, BDNF and IL-2 levels were significantly (p <0.001) increased and decreased, respectively, in the monotherapy group and combination therapy group. VSMS and DST scores improved significantly (p <0.001).

Discussion: The findings suggest that levetiracetam and its combination with phenytoin modulate neurotrophic and inflammatory pathways in pediatric epilepsy, with parallel improvements in social and developmental outcomes.

Conclusion: Levetiracetam monotherapy and its combination therapy with phenytoin increased serum BDNF levels, decreased IL-2 levels, and improved VSMS and DST scores in pediatric epilepsy patients, suggesting that these treatments influence epileptogenesis.

Objective: Nearly half of Acute Ischemic Stroke (AIS) patients failed to achieve favorable outcomes despite successful reperfusion treatment. This phenomenon is referred to as Futile Recanalization (FR). Screening patients at risk of FR is vital for stroke management. Previous studies reported the diagnostic value of alkaline phosphatase (ALP) levels in certain aspects of stroke prognosis. However, the association between serum ALP level and FR among AIS patients treated with thrombectomy remained unclear.

Methods: We screened stroke patients who underwent thrombectomy at our center from January 2017 to June 2021, and those who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction score=3) were ultimately analyzed. Demographic information, vascular risk factors, and laboratory test results were collected at admission. The 3-month unfavorable outcome was defined as a modified Rankin Scale score of 3 to 6. The effect of ALP levels on FR was investigated with a logistic regression model.

Results: Of 788 patients who underwent thrombectomy, 277 achieved successful reperfusion. Among them, 142 patients (51.3%) failed to realize favorable outcomes at 3 months. After adjusting for confounding variables, higher ALP levels (p =0.002) at admission were independently associated with unfavorable outcomes at three months. Adding ALP values to conventional risk factors improved the performance of prediction models for FR.

Conclusion: The current study found that the serum ALP levels at admission emerged as a potential biomarker for futile reperfusion in stroke patients undergoing thrombectomy. Further studies are warranted to confirm the clinical applicability of ALP level for futile recanalization prediction.

Background: Parkinson's disease is an illness marked by a gradual mitigation of dopamine neurons within the substantia nigra, which eventually leads to a deficiency of dopamine that further gives rise to mobility as well as cognitive impairments. Through long-established traditions, a wide array of Traditional Chinese Medicines (TCM) have undergone testing and are employed to avoid neurodegenerative disorders. Plumbagin is the primary active component of a medication called Baihua Dan or Plumbago zeylanica L., which is clinically used in China.

Objectives: This study investigated plumbagin-induced alterations in a Parkinson's disease rat model instigated by subcutaneous rotenone injection.

Methods: Male rats were administered subcutaneous injections of rotenone at a dosage of 1.5 mg/kg, followed by the treatment with varying doses of plumbagin (10, 20, and 40 mg/kg) through the oral route. The rats underwent various motor ability tests, including the actophotometer, rotarod, open field, beam walk, gait evaluation, ability to grip, and catalepsy bar tests. Furthermore, the brain dopamine level was then estimated for the extracted tissues. Also, through molecular docking, the binding effectiveness of plumbagin was assessed for human MAO-B. After that, plumbagin was put through 100 ns of molecular dynamic simulations to examine the stability of its conformational binding to the target protein. Furthermore, ADMET tests were used to verify Plumbagin's druggability.

Results: Plumbagin was found to alleviate rotenone-induced motor abnormalities and restore brain dopamine levels. Furthermore, plumbagin showed excellent interactions with MAO-B (monoamine oxidase-B) when compared with selegiline (a standard drug for Parkinson's disease).

Conclusion: These findings underscore the potential therapeutic efficacy of plumbagin in mitigating behavioural deficits in rotenone-induced rodents. Considering this, plumbagin might be a feasible pharmacological strategy for the control of rotenone-triggered behavioural impairment in rats (in vivo), and it might display interesting interactions with MAO-B (in silico).

Introduction: Excellent reperfusion following mechanical thrombectomy (MT) is strongly associated with favorable clinical outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). This study aims to investigate the association between the cerebral blood volume (CBV) index-a surrogate marker of collateral status-and the likelihood of achieving excellent reperfusion after MT in AIS-LVO patients.

Methods: A retrospective analysis was conducted on a consecutive series of anterior circulation AIS-LVO patients undergoing MT. CBV index was calculated using RAPID software as the ratio of mean CBV in the penumbral region (Tmax > 6 seconds) to that in the unaffected brain region (Tmax≤4 seconds). The primary outcome was excellent reperfusion, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) score of 2c/3.

Results: Of the 245 patients (54.70% male, median age 71 years), 152 (62.04%) achieved excellent reperfusion. ROC analysis identified a CBV index ≥0.6 as the optimal cutoff for predicting excellent reperfusion (AUC=0.743). Multivariable logistic regression showed a positive association between the CBV index and excellent reperfusion (adjusted OR = 1.221 per 0.1-point increase, 95% CI: 1.028-1.449, p=0.023). Patients with a favorable CBV index (≥0.6) were significantly more likely to achieve excellent reperfusion (adjusted OR = 2.785, 95% CI: 1.258-6.164, p = 0.012).

Discussion: These findings suggest that the CBV index is an independent predictor of excellent reperfusion after MT in AIS-LVO patients. This association may reflect the importance of tissue- level collateral perfusion in achieving successful reperfusion. Limitations include the singlecenter, retrospective design and the potential for selection bias.

Conclusion: The CBV index is positively associated with excellent reperfusion in AIS-LVO patients undergoing MT. Further prospective studies are warranted to validate these findings and explore the underlying mechanisms.