Prevention of stroke: a global perspective

Flavonoids from Polypodium hastatum as neuroprotective agents attenuate cerebral ischemia/reperfusion injury in vitro and in vivo via activating Nrf2

OBJECTIVES

Cerebral ischemic stroke is a leading cause of death worldwide. Though timely reperfusion reduces the infarction size, it exacerbates neuronal apoptosis due to oxidative stress. Nuclear factor erythroid 2-related factor 2 (Nrf2) is a transcription factor regulating the expression of antioxidant enzymes. Activating Nrf2 gives a therapeutic approach to ischemic stroke.

METHODS

Herein we explored flavonoids identified from Polypodium hastatum as Nrf2 activators and their protective effects on PC12 cells injured by oxygen and glucose deprivation/restoration (OGD/R) as well as middle cerebral artery occlusion (MCAO) mice.

RESULTS

The results showed among these flavonoids, AAKR significantly improved the survival of PC12 cells induced by OGD/R and activated Nrf2 in a Keap1-dependent manner. Further investigations have disclosed AAKR attenuated oxidative stress, mitochondrial dysfunction and following apoptosis resulting from OGD/R. Meanwhile, activation of Nrf2 by AAKR was involved in the protective effects. Finally, it was found that AAKR could protect MCAO mice brains against ischemia/reperfusion injury via activating Nrf2.

DISCUSSION

This investigation could provide lead compounds for the discovery of novel Nrf2 activators targeting ischemia/reperfusion injury.

Inhibition of the cGAS-STING pathway: contributing to the treatment of cerebral ischemia-reperfusion injury

The cGAS-STING pathway plays an important role in ischemia-reperfusion injury in the heart, liver, brain, and kidney, but its role and mechanisms in cerebral ischemia-reperfusion injury have not been systematically reviewed. Here, we outline the components of the cGAS-STING pathway and then analyze its role in autophagy, ferroptosis, cellular pyroptosis, disequilibrium of calcium homeostasis, inflammatory responses, disruption of the blood-brain barrier, microglia transformation, and complement system activation following cerebral ischemia-reperfusion injury. We further analyze the value of cGAS-STING pathway inhibitors in the treatment of cerebral ischemia-reperfusion injury and conclude that the pathway can regulate cerebral ischemia-reperfusion injury through multiple mechanisms. Inhibition of the cGAS-STING pathway may be helpful in the treatment of cerebral ischemia-reperfusion injury.

The effect of hypertension, obesity, and type 2 diabetes on lacunar stroke: A network Mendelian randomization study

BACKGROUND AND AIMS

Previous studies have reported an association of lacunar stroke with hypertension, obesity, and type 2 diabetes (T2D). The aim of this study was to investigate whether the association was causal and whether body mass index mediated the effect of hypertension on lacunar stroke.

METHODS AND RESULTS

The independence and causal association of hypertension, obesity, and T2D with lacunar stroke were assessed by multivariate Mendelian randomization (MVMR) and network Mendelian randomization (NMR) with inverse variance weighting (IVW). The reliability of the results was increased by sensitivity analyses including MR-Egger, Cochrane's Q test, Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO), and leave-one-out. MVMR analysis found that genetically predicted hypertension had a 42 % higher lacunar stroke risk (OR: 1.42, 95 % CI: 1.29-1.56, P < 0.001) when adjusted for obesity and T2D, genetically predicted T2D had a 9 % higher lacunar stroke risk (OR: 1.09, 95 % CI: 1.03-1.16, P < 0.004) when adjusted for hypertension and obesity, and genetically predicted obesity had a 15 % lower lacunar stroke risk (OR: 0.85, 95 % CI: 0.77-0.93, P < 0.001) when adjusted for hypertension and T2D. NMR found that 44 % of the association between hypertension and lacunar stroke risk was mediated by obesity.

CONCLUSION

This genetic association study found novel independent genetic associations between hypertension and T2D with high risk of lacunar stroke, whereas obesity attenuated the risk of lacunar stroke. The findings emphasize the importance of individualized lacunar stroke prevention strategies rather than uniform weight management optimize medical care in high-risk populations.

Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate the disease burden of ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and overall stroke among young adults (aged 15-49 years) in 204 countries and territories from 1990 to 2021, along with the associated risk factors.

METHODS

GBD (Global Burden of Disease Study) 2021 data were used to assess the burden and trends via age-standardized rates and their estimated annual percentage changes.

RESULTS

Although age-standardized rates generally declined from 1990 to 2021, the number of incident and prevalent stroke cases among young adults increased by 36% (95% uncertainty interval, 31%-41%) and 41% (95% uncertainty interval, 38%-43%), respectively. Notably, from 2015 to 2021, the age-standardized incidence of ischemic stroke and subarachnoid hemorrhage among young adults increased, with estimated annual percentage changes of 0.65 (95% CI, 0.39-0.92) and 0.58 (95% CI, 0.47-0.69), respectively. High systolic blood pressure was the primary risk factor for stroke-related disability-adjusted life-years among young adults. However, other risk factors varied by region, with higher proportions of smoking, high low-density lipoprotein cholesterol, and high body mass index in high sociodemographic index regions, and higher proportions of household air pollution from solid fuels and diet low in vegetable in low sociodemographic index regions. From 1990 to 2021, the total number of stroke-related disability-adjusted life-years among young adults due to risk factors increased by 12% (95% uncertainty interval, 2%-22%), driven principally by high systolic blood pressure, ambient particulate matter pollution, high body mass index, high low-density lipoprotein cholesterol, and high fasting blood glucose.

CONCLUSIONS

Since 2015, there has been a concerning rebound in the age-standardized incidence rates of ischemic stroke and subarachnoid hemorrhage among young adults globally. Given regional and sociodemographic index variations in risk factors, targeted and cost-effective policies and interventions are urgently needed to reduce stroke burden in this demographic.

Deep learning for cerebral vascular occlusion segmentation: A novel ConvNeXtV2 and GRN-integrated U-Net framework for diffusion-weighted imaging

Cerebral vascular occlusion is a serious condition that can lead to stroke and permanent neurological damage due to insufficient oxygen and nutrients reaching brain tissue. Early diagnosis and accurate segmentation are critical for effective treatment planning. Due to its high soft tissue contrast, Magnetic Resonance Imaging (MRI) is commonly used for detecting these occlusions such as ischemic stroke. However, challenges such as low contrast, noise, and heterogeneous lesion structures in MRI images complicate manual segmentation and often lead to misinterpretations. As a result, deep learning-based Computer-Aided Diagnosis (CAD) systems are essential for faster and more accurate diagnosis and treatment methods, although they can sometimes face challenges such as high computational costs and difficulties in segmenting small or irregular lesions. This study proposes a novel U-Net architecture enhanced with ConvNeXtV2 blocks and GRN-based Multi-Layer Perceptrons (MLP) to address these challenges in cerebral vascular occlusion segmentation. This is the first application of ConvNeXtV2 in this domain. The proposed model significantly improves segmentation accuracy, even in low-contrast regions, while maintaining high computational efficiency, which is crucial for real-world clinical applications. To reduce false positives and improve overall accuracy, small lesions (≤5 pixels) were removed in the preprocessing step with the support of expert clinicians. Experimental results on the ISLES 2022 dataset showed superior performance with an Intersection over Union (IoU) of 0.8015 and a Dice coefficient of 0.8894. Comparative analyses indicate that the proposed model achieves higher segmentation accuracy than existing U-Net variants and other methods, offering a promising solution for clinical use.

Global burden of ischemic stroke in adults aged 60 years and older from 1990 to 2021: Population-based study

BACKGROUND

Ischemic stroke is an important public health problem. However, comprehensive data on its burden in aging populations is limited. The aim of this study is to provide an up-to-date assessment of the prevalence, incidence, mortality, disability-adjusted life years, and risk factors for ischemic stroke globally in adults aged 60 years and older from 1990 to 2021 based on population changes.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 served as the data source for this study. Average annual percentage changes were estimated over the study period to quantify temporal patterns and assess trends in age-standardized rates of the prevalence, incidence, mortality, and disability-adjusted life-years of ischemic stroke.

RESULTS

The significant increase in the prevalence and incidence of ischemic stroke is mainly related to population ageing and the significant increase in the number of people over 60 years of age, with the significant increase in the population over 60 years of age being the main driving force, while epidemiological changes have had the opposite effect. Critically, using the entire age population for calculations will prompt us to underestimate the burden of ischemic stroke. The burden of ischemic stroke disease is highest in older men than in older women, and the age-standardized prevalence rates, incidence rates, mortality rates, and disability-adjusted life-years rates are 26-35% higher in men than in women. High-middle sociodemographic index and Sub-Saharan Africa regions suffer the heaviest burden. Ischemic stroke health inequities widen, with less developed regions bearing a heavier ischemic stroke burden and the disparity in that burden becoming more pronounced over time.

CONCLUSION

Population aging is the primary driver of the growing burden of ischemic stroke. Our findings indicate that prevention and control of this disease remain critical public health challenges. Targeted interventions addressing modifiable risk factors could significantly reduce the global burden of ischemic stroke.

Co-occurrence patterns and related risk factors of ischaemic heart disease and ischaemic stroke across 203 countries and territories: a spatial correspondence and systematic analysis

BACKGROUND

Ischaemic heart disease (IHD) and ischaemic stroke are leading causes of death worldwide. Although extensively studied, previous research has predominantly addressed these two diseases in isolation. Comorbidity research faces challenges both at the patient level and in terms of study methods. We aimed to characterise the global co-occurrence pattern of IHD and ischaemic stroke from a spatial perspective and to identify the corresponding risk factors of the comorbidity.

METHODS

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 database, we extracted incidence rates of IHD and ischaemic stroke and exposure rates of the 68 most detailed risk factors among individuals aged 25 years or older from 203 countries and territories. Based on the four quartiles of global incidence rates for both diseases, we proposed the comorbidity's co-occurrence patterns and classified the 203 countries or territories into three distinct regions (consistent, IHD-dominant, and ischaemic stroke-dominant areas). We used machine learning and negative binomial regression to screen and quantify the effects of corresponding risk factors and computed the population-attributable fraction and composite risk index to evaluate the global disease burden of IHD and ischaemic stroke.

FINDINGS

89 countries were classified as consistent, 59 as IHD-dominant, and 55 as ischaemic stroke-dominant. The spatial distribution of the three co-occurrence patterns overlapped with exposure to environmental, dietary, and behavioural risk factors. Nine risk factors were identified and functionally classified into common and specific features. Most countries are simultaneously exposed to the combined effects of multiple risk factors. Overall, 45·43% of IHD incidence and 38·53% of ischaemic stroke incidence is attributable to cumulative exposure to the respective risk factors, with specific combinations and variations of these factors greatly influencing the global disparities and patterns of incidence.

INTERPRETATION

The comorbidity of IHD and ischaemic stroke is a pervasive global health issue. Intervening corresponding modifiable risk factors can fundamentally reduce the global burden of these diseases.

FUNDING

National High Level Hospital Clinical Research Funding.

Four Comparative Effectiveness of Rehabilitation Methods Combined With rTMS on Cognition, Mood, and Quality of Life in Stroke Patients

OBJECTIVE

To conduct systematic review and network meta-analysis to evaluate the effectiveness of combining repetitive transcranial magnetic stimulation (rTMS) with various rehabilitation methods in improving cognitive function, negative mood, and quality of life in stroke patients.

DATA SOURCES

A systematic search was conducted across six databases to identify relevant studies. The time frame of the search was from January 1980 to September 2024.

STUDY SELECTION

A total of 21 randomized controlled trials involving 1074 stroke patients were included in the analysis based on predefined eligibility criteria.

DATA EXTRACTION

Outcome indicators assessed included cognitive function, negative mood, and quality of life. Data were extracted and analyzed using Stata for net meta-analysis to evaluate the relative effectiveness of each combined intervention.

DATA SYNTHESIS

Registration number: CRD42024603130. The results indicated that speech rehabilitation (SR) combined with rTMS was the most effective in improving cognitive function (SMD=0.40; 95% CI, -0.08 to 0.87; SUCRA=95.1%). Cognitive rehabilitation (CR) combined with rTMS was found to be the most effective in reducing negative mood (SMD=0.91; 95% CI, 0.45-3.23; SUCRA=84.5%) and improving quality of life (SMD=0.49; 95% CI, -0.33 to 1.30; SUCRA=99.4%).

CONCLUSIONS

The combination of SR with rTMS is effective for enhancing cognitive function, whereas CR with rTMS is superior in alleviating negative emotions and improving quality of life. These findings suggest prioritizing these combined interventions in clinical rehabilitation settings.

Propensity Score Matching Analysis on Risk Factors and Their Diagnostic Value of Frailty in Elderly Patients With Cerebral Infarction

OBJECTIVES

Cerebral infarction is an acute ischemic cerebrovascular disease; elderly patients with cerebral infarction often have frailty syndrome. Therefore, the aim of this study was to analyze the risk factors and their diagnostic value of frailty in elderly patients with cerebral infarction.

METHODS

In this retrospective cohort study, the medical records (from October 2017 to September 2020) of patients with cerebral infarction (n=395) were analyzed. According to different frailty statuses, patients were divided into the health group (n=166) and the prefrailty group (n=229). The diagnostic value of various parameters for the occurrence of pre-frailty was assessed by the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). The risk factors were analyzed by single-factor and multi-factor analyses.

RESULTS

Interleukin-6 (IL-6, P<0.001), C-reactive protein (CRP), prealbumin (PA, P<0.001), albumin (ALB, P<0.001), and brain natriuretic peptide (BNP, P<0.001) had higher diagnostic value for the occurrence of prefrailty in elderly patients with cerebral infarction. Single-factor and multi-factor analysis results revealed that the length of stay (LOS), comorbidity with nervous system diseases, high Charlson comorbidity index (CCI), high National Institute of Health stroke scale score, IL-6, BNP, ALB, PA, and creatine kinase might risk the factors for prefrailty occurrence (P<0.05). After the elimination of interference factors, LOS, high CCI, IL-6, and ALB were confirmed to be key risk factors for the occurrence of prefrailty (P<0.05).

CONCLUSION

LOS, high CCI, IL-6, and ALB are the underlying risk factors for the occurrence of prefrailty in elderly patients with cerebral infarction, which provides a theoretical basis for clinical disease diagnosis.

ILC2 instructs neural stem and progenitor cells to potentiate neurorepair after stroke

Stroke affects approximately 1 in 6 individuals globally and is the leading cause of adult disability, which is attributed to neuronal damage and neurological impairments. The mechanisms by which the brain tissue microenvironment supports neurogenesis and neurorepair post-stroke remain to be fully elucidated. In this study, we report that group 2 innate lymphoid cells (ILC2s) accumulate within the lesion core and subventricular zone (SVZ) during brain recovery following cerebral ischemia. Mice with ILC2 deficiency display impaired neurological scoring post-stroke. Mechanistic studies reveal that brain ILC2s enhance the proliferation of neural stem and progenitor cells (NSPCs) through the secretion of amphiregulin (Areg). Adoptive transfer of ILC2s or administration of Areg markedly improves neurological outcomes post-stroke. These findings demonstrate that ILC2s and their secreted products may represent a promising therapeutic strategy for enhancing neurorepair following brain injury.

StimEMG: An Electromyogram Recording System With Real-Time Removal of Time-Varying Electrical Stimulation Artifacts

A closed-loop Functional Electrical Stimulation (FES) system that incorporates electromyogram (EMG) signal feedback provides more effective assistance to paralytic patients in maintaining and recovering their motor abilities. However, the closed-loop FES system with real-time adjustment of stimulation parameters tends to introduce time-varying stimulation artifacts in EMG signals, challenging the removal of stimulation artifacts that aims at more accurate monitoring of muscle contraction status. Therefore, an EMG acquisition system that embeds a stimulation artifact generation (SAG) circuit and the Recursive Least Squares (RLS) adaptive filter was developed in this study and named StimEMG. The SAG-RLS strategy was tested using the simulated contaminated EMG signals and the StimEMG system was tested in an experimental study with 8 subjects. Both the simulation and the experimental study showed that the SAG-RLS method obtained a higher correlation (R ${}^{{2}}\text {)}$ between the denoised EMG and the corresponding clean EMG or EMG segments compared with the current Gram-Schmidt-based (GSB) method (simulation study, $0.98\pm 0.0044$ v.s. $0.65\pm 0.3217$ ; experimental study, $0.99\pm 0.0024$ v.s. $0.52\pm 0.2105$ ). Meanwhile, the SAG-RLS method can suppress stimulation artifact more effectively, resulting a higher signal-to-noise ratio (simulation study: $12.83\pm 2.1745$ v.s. $1.54\pm 1.3106$ ) and higher noise rejection ratio (experimental study: $2.32\pm 0.7046$ v.s. $1.92\pm 0.8014$ ). The significantly improved performance is speculated to result from the ability of the SAG unit to precisely and timely capture the variation of the stimulation artifacts caused by the change of stimulation parameters, unlike previous methods relying on the stability of the characteristic of stimulation artifacts in the contaminated EMG signals. The developed StimEMG system provides a robust EMG acquisition module for the closed-loop FES system.

Systematic analysis of the burden of ischemic stroke attributable to high LDL-C from 1990 to 2021

Background

Low-density lipoprotein cholesterol (LDL-C) is a public health concern linked to ischemic stroke. The study aimed to describe the epidemiological characteristics of ischemic stroke attributable to high LDL-C from 1990 to 2021.

Methods

In this study, we analyzed data from the Global Burden of Disease 2021 to present trends in ischemic stroke related to high LDL-C over the past 30 years. The relationship between disease burden and the Socio-Demographic Index (SDI) was examined. To assess international health disparities, we applied the Slope Index of Inequality (SII) and the Concentration Index (CI). Furthermore, we conducted a frontier analysis to identify areas for improvement and developmental gaps among nations, and employed the Bayesian Age-Period-Cohort (BAPC) model to forecast the disease burden for the next 15 years.

Results

In 2021, the incidence of ischemic stroke attributed to high LDL-C significantly increased compared to 1990, with a more pronounced growth rate in males. The burden mainly affects individuals aged 70 to 84. Analysis using the age-period-cohort model indicates that mortality rates and DALYs rise with age, while period and cohort effects exhibit a gradual decline. Across different SDI regions, trends generally follow a similar downward path, with a narrowing gap in disease burden among regions with varying SDI levels. However, the disease burden in high SDI countries remains significant, indicating potential for reduction. Predictions for the next 15 years suggest that while the global disease burden will decrease, there may be an increase among individuals under 55.

Conclusion

Compared to 1990, the overall age-standardized burden of ischemic stroke related to high LDL-C has been controlled. However, disparities persist across different SDI regions. We have observed an increasing burden among younger populations. Consequently, countries and regions must adopt new measures tailored to their SDI levels, with a specific emphasis on younger individuals. It is essential to develop prevention and treatment strategies aimed at high-risk groups.

Stroke in Young Adults: An Overview and Non-Pharmacological Preventive Strategies

Stroke is one of the most common causes of death and disability worldwide, with significant impact on both physical and cognitive health. Although strokes are less common in young adults, they still occur in this population, particularly in those with certain comorbidities, such as Autosomal Dominant Polycystic Kidney Disease (ADPKD). Despite the lack of specific guidelines for stroke prevention in young adults, certain preventive measures can be implemented. Smoking cigarettes is the most significant stroke risk factor in this group. Additionally, psychosocial stress, often exacerbated by academic, career, and financial pressures, is emerging as a modifiable risk factor for stroke in young adults. Key preventive measures include dietary changes, management of underlying health conditions, incorporating regular physical activity into daily routines, smoking cessation, and effective stress management techniques such as mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT). Promoting mental health awareness, directing public health campaigns toward young adults, educating them on recognizing stroke symptoms and administering first aid, and improving the quality of healthcare for this population all play a vital role in preventing stroke in young adults.

Public Awareness and Attitude Towards Stroke in the Southern Region of Saudi Arabia: A Cross-Sectional Study

Introduction Stroke is a leading cause of morbidity and mortality globally. Recognizing risk factors, identifying warning signs, and seeking timely medical intervention are crucial for preventing stroke and improving outcomes. This study aims to assess stroke awareness and attitudes among residents in southern Saudi Arabia and determine predictors of stroke knowledge. Methods A cross-sectional study was conducted among residents aged ≥18 years in the southern region of Saudi Arabia excluding individuals with a history of stroke and healthcare workers. A sample size of 576 participants was calculated. Data were collected conveniently via a self-administered online Arabic questionnaire that was adopted from the literature. The questionnaire assessed demographic characteristics, stroke knowledge, attitudes, and symptom responses. Data analysis was performed using multiple linear regression to identify predictors of awareness of stroke. Results A total of 510 participants (median age: 29 years, interquartile range: 24, 40) were included, with 288 (56%) being male. Stroke was identified as a brain disease by 287 (56%), and 371 (73%) recognized its preventability. Awareness of stroke symptoms ranged from 332 (65%) for sudden dizziness to 399 (78%) for speech difficulties. The most recognized risk factors were hypertension (443, 87%), smoking (395, 77%), and diabetes mellitus (342, 67%). Better general awareness was associated with being married (β: 0.34, 95% CI: 0.07-0.61), divorced (β: 0.34, 95% CI: 0.07-0.61), or having a family history of stroke (β: 0.46, 95% CI: 0.22-0.70). Higher symptom awareness was linked to a family history of stroke (β: 0.92, 95% CI: 0.38-1.50) and earning 3000-10,000 RAS (β: 0.82, 95% CI: 0.11-1.50). For risk factor awareness, family history of stroke (β: 0.96, 95% CI: 0.32-1.60) and earning 3000-10,000 RAS (β: 0.96, 95% CI: 0.12-1.80) were significant predictors. Awareness of stroke's consequence was higher among older participants (β: 0.02, 95% CI: 0.00-0.04) and those with a family history of stroke (β: 0.45, 95% CI: 0.09-0.81), while males (β: -0.32, 95% CI: -0.61 to -0.03) had lower scores. Conclusion The study highlights significant gaps in stroke awareness, particularly in recognizing symptoms with moderate overall knowledge of stroke risk factors. Targeted educational campaigns and community outreach programs for at-risk populations are essential to improving stroke awareness and ensuring timely medical intervention.

Reassessing the Association of Sedentary Behavior and Physical Activity with Ischemic Stroke: A Mendelian Randomization Study

PURPOSE

Findings from previous Mendelian randomization (MR) studies disagreed with the current scientific consensus regarding the role of physical activity (PA) and sedentary behavior in ischemic stroke (IS). We reassessed these associations with a focus on etiological subtypes of IS and the potential mediating roles of cardiometabolic traits and brain imaging-derived phenotypes (IDPs).

METHODS

We performed MR analyses using summary statistics from genome-wide association studies of sedentary behavior and PA ( n = 88,411 ~ 608,595), cardiometabolic traits ( n = 393,193 ~ 694,649), brain IDPs ( n = 33,224), and the latest IS data (62,100 cases and 1,234,808 controls). Inverse-variance weighted regression was used as the primary method, complemented by several sensitivity analyses. A two-step MR approach was employed to assess the mediating effects of cardiometabolic traits and brain IDPs.

RESULTS

Genetic liability to leisure-time moderate-to-vigorous PA (MVPA) and higher overall PA (OPA) were associated with reduced risks of IS and small vessel stroke (Benjamini-Hochberg adjusted P < 0.05). Suggestive associations were observed between longer leisure-screen time and higher IS risk and between higher OPA and lower cardioembolic stroke risk ( P < 0.05). The isotropic volume fraction in the anterior limb of the left internal capsule, as well as some cardiometabolic metrics, partially mediated these associations. There was no evidence for causal effects of overall MVPA, overall light-intensity PA, or overall sedentary duration on IS.

CONCLUSIONS

Longer leisure screen time, less OPA, and not engaging in MVPA during leisure time were associated with higher risk of IS. The associations between PA and IS depended on different subtypes and were mediated by changes in anterior limb of the left internal capsule and cardiometabolic biomarkers.

Examining a role for irisin in treating cerebral ischemia

Stroke is a leading cause of death and disability, with ischemic stroke representing most cases. Age is the most significant nonmodifiable risk factor for stroke, and with an aging population, there is an urgent need for effective prevention and treatment strategies. Physical inactivity is a strong risk factor for stroke, and exercise has long been held as a promising approach to improve poststroke outcomes. During exercise, the myokine irisin is released as a product of a type 1 membrane protein cleavage that is encoded by the fibronectin type III domain containing 5 (FNDC5) gene. This review summarizes recent literature on irisin's role in ischemic stroke, examining central effects, stroke risk, poststroke functional outcomes, and exogenous administration. Irisin has value as a prognostic marker for risk stratification. Low levels of irisin correlate with worse outcomes and higher mortality in patients with ischemic stroke. Irisin may also be a key to the benefits of exercise, particularly for high-intensity resistance training, which significantly increases irisin levels. Beyond exercise, exogenous irisin is neuroprotective in murine models, reducing brain edema, inflammation, and apoptosis, and increasing blood-brain barrier integrity and brain-derived neurotrophic factor levels. This underscores irisin's potential to mitigate ischemic damage and promote recovery. Human trials are necessary to validate these findings and explore the feasibility of irisin-based interventions in acute stroke care. This review lays a foundation for future research to clarify irisin's therapeutic benefits, establish optimal exercise protocols, and explore exogenous irisin as a novel intervention for ischemic stroke.

Global, Regional, and National Burden of Subarachnoid Hemorrhage: Trends From 1990 to 2021 and 20-Year Forecasts

BACKGROUND

Subarachnoid hemorrhage (SAH) is a critical condition that has far-reaching implications for public health systems globally due to its severe consequences and long-term disabilities. This study aims to provide a comprehensive analysis of SAH trends from 1990 to 2021 and project future trends up to 2041, aiding in better understanding and management of its global burden.

METHODS

We utilized data from the GBD (Global Burden of Disease) 2021 database, using joinpoint regression, frontier, and decomposition analyses to assess changes in SAH burden. Bayesian Age-Period-Cohort modeling was implemented to predict future trends. Our study included populations from 204 countries and territories.

RESULTS

From 1990 to 2021, SAH incidence decreased by -1.03% for men and -1.16% for women, while mortality rates declined by -2.56% for men and -2.69% for women. Middle sociodemographic index locations and East Asia experienced substantial declines, particularly among women. However, countries like the Philippines and Turkmenistan showed increasing trends. Population aging and growth significantly contributed to these trends, while epidemiological changes led to reductions in SAH burden. The prediction model forecasts continued decreases in SAH mortality and disability-adjusted life years over the next 20 years, although incidence rates may slightly increase.

CONCLUSIONS

The global burden of SAH has significantly diminished from 1990 to 2021, with considerable variations across regions, sexes, and countries. Ongoing and future research should prioritize high-risk populations and develop innovative interventions to further decrease SAH incidence and enhance outcomes.

The Naples prognostic score as a nutritional and inflammatory biomarkers of stroke prevalence and all-cause mortality: insights from NHANES

BACKGROUND

Stroke is a complex neurological condition characterized by high rates of incidence, recurrence, disability, and mortality, making it one of the leading causes of death and disability worldwide. The Naples prognostic score (NPS), an index that combines markers of inflammation and nutritional status, has demonstrated prognostic value in various diseases. This research investigated the relationships among NPS, stroke prevalence, and overall mortality in stroke individuals, drawing on data from the National Health and Nutrition Examination Survey from 2007 to 2018.

METHODS

The cross-sectional analysis included 20,798 participants aged beyond 40 years with 1155 persons with stroke analyzed for mortality. Stroke prevalence was self-reported, and the NPS was derived from serum albumin, total cholesterol, the neutrophil-to-lymphocyte ratio, and the lymphocyte-to-monocyte ratio (Galizia et al. in Cancer 60:1273-1284, 2017). Weighted Logistic regression and Cox models assessed associations among NPS, stroke, and mortality, adjusting for demographic and clinical factors.

RESULTS

Higher NPS scores were linked to increased stroke prevalence (OR 3.573, 95% CI 2.745-4.652, P < 0.001) and elevated all-cause mortality risk (HR 3.281, 95% CI 1.978-5.442, P < 0.001) in stroke individuals. The triglyceride-glucose index (TYG) significantly modified the relationship between the NPS and stroke prevalence.

CONCLUSION

This study supports the clinical utility of the NPS as a predictor of both stroke prevalence and all-cause mortality. The NPS may serve as a valuable tool for risk stratification in stroke prevention and long-term prognosis.

Comprehensive analysis of the ischemic stroke burden at global, regional, and national levels (1990-2021): trends, influencing factors, and future projections

Background and purpose

Estimating the global burden of ischemic strokes (IS) is crucial for enhancing prevention and control strategies.

Methods

We collected four epidemiological indicators-prevalence, incidence, deaths, and disability-adjusted life years (DALYs)-for ischemic stroke (IS) from the Global Burden of Disease (GBD) database, which covers the years 1990 to 2021. Our research analyzed the features of the IS burden and described the trends of these four indicators.

Results

The Joinpoint and age-period-cohort models reflected the changing trends in age-standardized indicators. Decomposition analysis examined the factors influencing each epidemiological indicator. The Bayesian Age-Period-Cohort (BAPC) model detailed changes in the number and rate of IS from 1990 to 2021 and projected trends through 2046. The Norpred model was used to verify the stability of the BAPC prediction results. The prevalence, incidence, deaths, and DALYs due to IS generally exhibited a downward trend. However, the predictions indicated that while the age-standardized incidence rate decreased from 1990 to 2015, this trend reversed between 2016 and 2021 and is expected to continue until 2046. This reversal is likely driven by factors such as population aging, given that age is a strongly correlated risk factor for IS. The IS burden was negatively associated with socio-demographic index (SDI) levels, with high systolic blood pressure identified as the largest risk factor for DALYs and deaths. The consistency between the BAPC and Norpred models enhances the reliability of these projections.

Conclusion

Over the past two decades, trends in prevalence, incidence, deaths, and DALYs have all declined. However, projections suggest that incidence will show an upward trend over the next two decades.

Vortioxetine alleviates motor, cognitive and emotional disorders in post-stroke rats by regulating the TLR-2/NF-κB pathway

Cognitive impairments following post-stroke significantly hinder neurological recovery and exacerbate patient morbidity, underscoring urgent need for effective therapeutic strategies. Vortioxetine (VTX), a prominent Selective Serotonin Reuptake Inhibitor (SSRI), boasts notable antidepressant, cognition-enhancing, and anti-inflammatory properties. This investigation delves into VTX's influence on motor skills, spatial learning-memory capabilities, and depressive behaviors in Middle Cerebral Artery Occlusion (MCAO) rats, alongside its underlying mechanisms. Our findings reveal that while VTX fails to entirely reverse ischemic-reperfusion damage, it substantially ameliorates spontaneous locomotor functions, augments post-stroke learning-memory capacities, and exhibits potent antidepressant and anxiety-like efficacy. Preliminary data propose that these beneficial effects may stem from inflammation modulation via the Toll-Like Receptor 2 (TLR-2)/Nuclear Factor-Kappa B (NF-κB) signaling pathway. Collectively, our work underscores VTX's promising role in enhancing motor, cognitive functions, and mitigating depressive symptoms following cerebrovascular accidents, potentially through inflammation regulation. These insights pave the way for novel interventions addressing post-stroke complications, warranting further exploration.

Global Burden of the Key Components of Cardiovascular-Kidney-Metabolic Syndrome

Background

Cardiovascular-kidney-metabolic (CKM) syndrome highlights the interconnected nature of metabolic diseases, CKD, and cardiovascular diseases, representing a significant and growing public health burden. This study aimed to quantify the global burden of CKM syndrome by examining its key components, including high body mass index, diabetes, CKD, atrial fibrillation and flutter, lower extremity peripheral arterial disease, ischemic heart disease, and stroke.

Methods

Data were derived from the Global Burden of Disease 2021 platform, which provided estimates for incidence, prevalence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs). A decomposition analysis was performed to assess the contributions of population growth, aging, and epidemiologic changes to the burden of CKM syndrome. A NORDPRED model was used to project future trends in DALYs, years of life lost, and years lived with disability through 2046.

Results

Globally, ischemic heart disease and stroke were the major contributors to the CKM syndrome–related burden in 2021. Regions with a middle sociodemographic index (SDI), such as Southeast Asia and the Western Pacific, experienced the largest burden. However, age-standardized DALY rates were inversely related to SDI, with regions of lower SDI exhibiting higher rates. From 1990 to 2021, DALYs for the seven key components of CKM syndrome increased, primarily driven by population growth and aging. However, age-standardized DALY rates varied across components, with stroke (−38.7% [95% uncertainty interval: −43.4% to −34.0%]), peripheral arterial disease (−30.1% [−33.5% to −27.2%]), and ischemic heart disease (−28.8% [−32.5% to −25.2%]) showing a declining trend, whereas diabetes (38.2% [29.7%–47.0%]) and high body mass index (25.5% [16.6%–33.7%]) exhibited an increasing trend. Further projection analysis suggested a consistent trend in the changes in CKM syndrome–related burden from 2022 to 2046, with increases ranging from 55.9% for stroke to 105.7% for atrial fibrillation and flutter.

Conclusions

The findings of this study highlight the substantial and growing CKM syndrome–related burden.

Advancements in the investigation of gut microbiota-based strategies for stroke prevention and treatment

Stroke represents a predominant cause of mortality and disability on a global scale, impacting millions annually and exerting a considerable strain on healthcare systems. The incidence of stroke exhibits regional variability, with ischemic stroke accounting for the majority of occurrences. Post-stroke complications, such as cognitive impairment, motor dysfunction, and recurrent stroke, profoundly affect patients' quality of life. Recent advancements have elucidated the microbiota-gut-brain axis (MGBA), underscoring the complex interplay between gut health and brain function. Dysbiosis, characterized by an imbalance in gut microbiota, is significantly linked to an elevated risk of stroke and unfavorable outcomes. The MGBA plays a crucial role in modulating immune function, neurotransmitter levels, and metabolic byproducts, which may intensify neuroinflammation and impair cerebral health. This review elucidates the role of MGBA in stroke pathophysiology and explores potential gut-targeted therapeutic strategies to reduce stroke risk and promote recovery, including probiotics, prebiotics, pharmacological interventions, and dietary modifications. However, the current prevention and treatment strategies based on intestinal flora still face many problems, such as the large difference of individual intestinal flora, the stability of efficacy, and the long-term safety need to be considered. Further research needs to be strengthened to promote its better application in clinical practice.

Spatial-temporal variations of stroke mortality worldwide from 2000 to 2021

BACKGROUND

Stroke is a leading cause of premature death worldwide. Spatial-temporal characteristics are important for evidence-based stroke care planning and resource allocation. However, long-term global variations of stroke are still lacking.

OBJECTIVE

To identify the characteristics of the global spatial distribution of age-standardized mortality rate (ASMR) due to stroke during 2000-2021, thereby informing the efficient allocation of global health care resources.

METHODS

Based on age-standardized mortality rate (ASMR) due to stroke from the Global Health Estimates database, we analyzed stroke variation from 2000 to 2021 in 183 countries worldwide using Moran's I, Getis-Ord Gi*, and Standard Deviation Ellipse. We stratified the 183 countries into different income groups according to World Bank classification to identify the socioeconomic influence on stroke mortality.

RESULTS

The result showed that ① From 2000 to 2021, the number of stroke deaths increased worldwide, but the AMSR due to stroke showed a downward trend; ② The spatial distribution of the global AMSR due to stroke varies across geographic regions. with the highest in Asia and southern Africa, and the lowest in Europe and North America; ③ The spatial pattern of hot and cold spots of AMSR due to stroke remained relatively stable from 2000 to 2021, with the greatest changes in Africa and Asia; ④ Generally, countries belong to higher economic groups have lower stroke mortality rate, and this pattern persisted throughout the study period.

CONCLUSIONS

Our findings provide evidence on spatial variations of stroke mortality worldwide over 20 years, and are informative on evidence-based allocation of medical resources globally.

CLINICAL TRIAL NUMBER

Not applicable.

Interaction of Triglyceride-Glucose Index and Metabolic Syndrome with Risk of Incident Stroke Among Middle-Aged and Older Chinese Adults

Objective

The triglyceride-glucose (TyG) index, a reliable surrogate marker of insulin resistance, has been shown as an independent risk factor for stroke. Still, the interaction between metabolic syndrome (MetS) and the TyG index in determining stroke risk remains to be clarified, which may help optimize stroke prevention strategies. This study aims to explore whether metabolic syndrome (MetS) influences the association between the TyG index and the risk of stroke.

Methods

A total of 7770 middle-aged and older participants free of stroke at baseline were enrolled from the China Health and Retirement Longitudinal Study. The TyG index was calculated as ln (triglyceride [mg/dL] × fasting glucose [mg/dL]/2). MetS was defined following the modified International Diabetes Federation criteria. The outcome was self-reported, physician-diagnosed, incident stroke during follow-up. Cox proportional hazard models were used to examine whether MetS influences the associations between the TyG index and the risk of incident stroke.

Results

A total of 568 (7.3%) incident stroke cases occurred after a median observation time of 7.0 years. After adjusting for potential confounders, a higher TyG level was associated with an increased risk of incident stroke (hazard ratio (HR) 1.19, 95% CI 1.05-1.33, P = 0.016). The association was significant in participants without MetS (HR 1.69, 95% CI 1.40-1.97, P < 0.001), but not in those with MetS (HR 1.05, 95% CI 0.88-1.21, P = 0.599). The interaction between the TyG index and MetS on the risk of incident stroke was significant (P = 0.004).

Conclusion

MetS influenced the association of the TyG index with the risk of incident stroke among middle-aged and older Chinese adults. The TyG index may be more effective for stroke risk stratification in populations without MetS compared to those with MetS.

Artificial intelligence in stroke risk assessment and management via retinal imaging

Retinal imaging, used for assessing stroke-related retinal changes, is a non-invasive and cost-effective method that can be enhanced by machine learning and deep learning algorithms, showing promise in early disease detection, severity grading, and prognostic evaluation in stroke patients. This review explores the role of artificial intelligence (AI) in stroke patient care, focusing on retinal imaging integration into clinical workflows. Retinal imaging has revealed several microvascular changes, including a decrease in the central retinal artery diameter and an increase in the central retinal vein diameter, both of which are associated with lacunar stroke and intracranial hemorrhage. Additionally, microvascular changes, such as arteriovenous nicking, increased vessel tortuosity, enhanced arteriolar light reflex, decreased retinal fractals, and thinning of retinal nerve fiber layer are also reported to be associated with higher stroke risk. AI models, such as Xception and EfficientNet, have demonstrated accuracy comparable to traditional stroke risk scoring systems in predicting stroke risk. For stroke diagnosis, models like Inception, ResNet, and VGG, alongside machine learning classifiers, have shown high efficacy in distinguishing stroke patients from healthy individuals using retinal imaging. Moreover, a random forest model effectively distinguished between ischemic and hemorrhagic stroke subtypes based on retinal features, showing superior predictive performance compared to traditional clinical characteristics. Additionally, a support vector machine model has achieved high classification accuracy in assessing pial collateral status. Despite this advancements, challenges such as the lack of standardized protocols for imaging modalities, hesitance in trusting AI-generated predictions, insufficient integration of retinal imaging data with electronic health records, the need for validation across diverse populations, and ethical and regulatory concerns persist. Future efforts must focus on validating AI models across diverse populations, ensuring algorithm transparency, and addressing ethical and regulatory issues to enable broader implementation. Overcoming these barriers will be essential for translating this technology into personalized stroke care and improving patient outcomes.

Race/ethnicity-specific association between the American Heart Association's new Life's Essential 8 and stroke in US adults with nonalcoholic fatty liver disease: Evidence from NHANES 2005-2018

BACKGROUND

The Life's Essential 8 (LE8) is a recently introduced assessment of cardiovascular health (CVH) by the American Heart Association (AHA). Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease and is associated with an increased risk of stroke. We aimed to explore the association of LE8 with stroke in NAFLD using a national cross-sectional study.

METHODS

Eligible participants with NAFLD aged 20-85 years in NHANES 2005-2018 were included. LE8 was assessed according to AHA criteria and categorized into metabolic and behavioral factors. US Fatty Liver Index (USFLI) ≥ 30 and exclusion of other chronic liver diseases suggested NAFLD. Stroke was diagnosed according to self-report on standardized questionnaires.

RESULTS

After adjusting for all confounders, each point increase in LE8, LE8 metabolic factors, and LE8 behavioral factors was associated with a 4.4 %, 1.8 %, and 2.5 % reduction in stroke prevalence in NAFLD, respectively. Both moderate and high CVH assessed by LE8 and LE8 behavioral factors were associated with reduced odds of stroke compared with low CVH. Stroke prevalence declined progressively with increasing number of ideal LE8 components, with the lowest odds of stroke at 3 + ideal LE8 components for both LE8 metabolic and behavioral factors. Restricted cubic spline suggested dose-response associations. Race/ethnicity was a significant effect modifier, and this association was present only among non-Hispanic white population and other Hispanic population. FLI as a diagnostic indicator of NAFLD yielded generally consistent results.

CONCLUSIONS

Higher LE8 score, especially LE8 behavioral factors, was associated with reduced prevalence of stroke in NAFLD, especially among non-Hispanic white population and other Hispanic population. The odds of stroke declined progressively with increased ideal LE8 component number. These findings underscore the preventive value of adherence to high CVH for stroke prevention in NAFLD.

Electro-acupuncture Suppresses Ferroptosis to Alleviate Cerebral Ischemia-Reperfusion Injury Through KAT3B-Mediated Succinylation of ACSL4

Electro-acupuncture (EA) is identified as an effective therapeutic method for cerebral ischemia/reperfusion injury (CIRI), which is a combination of Chinese traditional acupuncture and modern electro-therapy. However, the downstream molecular mechanisms of EA in CIRI process remains largely unknown. The purpose of the present study is to unveil the therapeutic effect of EA on CIRI rat and its regulatory mechanisms. At first, we constructed middle cerebral artery occlusion (MCAO) rat models and then treated them with EA to observe the pathological changes. The results indicated that EA decreased the infarct volume (43.81 ± 3.34 vs 15.96 ± 2.22) and the neurological scores (3.33 ± 0.52 vs 1.67 ± 0.52) and suppressed the apoptosis in MCAO model rats. For ferroptosis analysis, EA decreased the Fe2 + (0.08 ± 0.01 vs 0.06 ± 0.01), MDA (36.61 ± 4.29 vs 21.72 ± 2.79), and LPS (5.25 ± 0.69 vs 2.89 ± 0.42) contents and increased the GSH (4.94 ± 1.04 vs 11.69 ± 1.88) content in MCAO model rats. We next detected whether succinylation mediated EA-treated I/R injury. According to immunoprecipitation and western blot analysis, EA treatment could lower both levels of succinylation and KAT3B in MCAO rats. Moreover, mechanism experiments unveiled that KAT3B promoted the succinylation of the ferroptosis-related protein ACSL4 at K661 site and thus stabilizing ACSL4. Finally, EA-treated MCAO rats were further injected with KAT3B expression vector. The results showed that KAT3B overexpression increased the infarct volume (31.44 ± 3.92 vs 7.94 ± 2.84) and the neurological scores (2.67 ± 0.51 vs 1.33 ± 0.51) and promoted the apoptosis in EA treated MCAO model rats. For ferroptosis analysis, KAT3B overexpression increased the Fe2 + (0.08 ± 0.01 vs 0.05 ± 0.01), MDA (29.24 ± 4.30 vs 22.06 ± 1.89), and LPO (5.07 ± 0.45 vs 2.88 ± 0.49) contents and decreased the GSH (7.86 ± 1.09 vs 11.06 ± 1.76) content in EA treated MCAO model rats. Collectively, our study demonstrates that EA plays a therapeutic role in CIRI through suppressing KAT3B-induced stabilization of ACSL4 to inhibit ferroptosis. These findings contribute to our understanding of the molecular mechanisms underlying the neuroprotective effects of EA and open new avenues for the development of innovative therapeutic strategies for CIRI.

Sex-specific association of weight-adjusted waist index with mortality in stroke survivors: A national longitudinal cohort study

BACKGROUND AND AIMS

The weight-adjusted waist index (WWI) is a novel indicator of obesity, and its association with mortality in stroke patients remains unknown. We aimed to explore these associations through a national longitudinal cohort study.

METHODS AND RESULTS

We included stroke survivors from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 who were followed up until December 31, 2019. The study outcomes were all-cause and cardiovascular disease (CVD) mortality in stroke patients. A total of 1427 stroke patients were enrolled, and after a median follow-up duration of 83 months, 624 stroke patients died, including 251 from CVD. Kaplan‒Meier survival analyses indicated that WWI was significantly associated with the probability of survival over time in stroke patients (log-rank tests, both p < 0.0001). After adjusting for confounders, WWI was significantly and positively associated with all-cause and CVD mortality after stroke. Restricted cubic spline analysis revealed that WWI was linearly associated with all-cause mortality and nonlinearly associated with CVD mortality. Stratified analyses suggested that sex significantly influenced the effect of WWI on all-cause mortality in stroke patients. Additional body mass index (BMI) adjustments did not significantly change the results.

CONCLUSION

WWI was positively associated with all-cause and CVD mortality in stroke patients, independent of BMI. These effects were present only in men. These findings suggest that WWI is an independent prognostic factor in stroke patients and that maintaining appropriate WWI values can help improve the prognosis of stroke survivors.

Protective effects of PIK3CG knockdown against OGD/R-induced neuronal damage via inhibition of autophagy through the AMPK/mTOR pathway

BACKGROUND

Ischemic stroke represents an urgent need for more efficacious therapies owing to modest effectiveness of current treatment.

METHODS

Download data from stroke patients and collect blood samples from clinical patients to analyze phosphatidylinositol-3 kinase catalytic subunit γ (PIK3CG) expression. To establish a brain damage model, oxygen glucose deprivation/reperfusion (OGD/R) was applied to SH-SY5Y cells. Impact of PIK3CG on AMPK/mTOR autophagy pathway was verified treating cells with AMPK activator metformin. Proliferation and apoptosis were identified by CCK8 and flow cytometry.

RESULTS

Differential expression analysis and clinical testing show that PIK3CG is highly expressed in patients. Prolonged ODG/R exposure increased PIK3CG levels, supressed cell proliferation, and induced apoptosis. KEGG pathway analysis implicated PIK3CG in autophagy pathway. Knockdown of PIK3CG supressed OGD/R-induced reductions in cell proliferation and OGD/R-induced increases in apoptosis and expressions of Beclin 1 and LC3 II. Following OGD/R, AMPK phosphorylation was upregulated while mammalian target of rapamycin (mTOR) phosphorylation was downregulated, indicating AMPK/mTOR autophagy activation. Knockdown of PIK3CG opposed metformin-induced rises in Beclin 1, LC3 II and apoptosis along with decreases in proliferation.

CONCLUSION

PIK3CG knockdown protects neuronal cells by inhibiting AMPK/mTOR autophagy pathway and further inhibiting autophagy.

Exploring and validating associations between six systemic inflammatory indices and ischemic stroke in a middle-aged and old Chinese population

BACKGROUND

Inflammation and maladaptive immune mechanisms have been substantiated as integral components in the critical pathological processes of the injury cascade in ischemic stroke (IS). This study aimed to explore the associations between six systemic inflammatory indices and IS in a Chinese population.

METHODS

This was a case-control study based on the retrospective review of electronic medical records from two hospitals in Shandong Province, China. Systemic inflammatory indices, including the systemic inflammation response index (SIRI), systemic immune inflammation index (SII), pan-immune-inflammation value (PIV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR), were calculated. Logistic regression models and classification analyses were employed to evaluate associations and discriminatory abilities.

RESULTS

In total, 9392 participants aged 40-83 years old were included in the discovery (3620 pairs of IS-present cases and healthy controls) and validation (1076 pairs of IS-present cases and IS-absent controls with IS mimics) datasets. After adjusting for potential confounding factors, IS was found to be associated with all six systemic indices in the discovery dataset, including SIRI (odd ratio [OR] 8.77, 95% confidence interval [CI] 7.48-10.33), SII (1.03, 1.01-1.04), PIV (1.01, 1.01-1.01), NLR (2.23, 2.08-2.39), PLR (1.01, 1.01-1.01), and LMR (0.77, 0.75-0.78). Notably, only LMR exhibited significant associations with IS in both discovery and validation datasets (0.88, 0.83-0.93), suggesting an independent protective role of this index. SIRI, SII, PIV, NLR, and LMR showed good discriminative ability between IS patients and healthy controls in the discovery dataset (AUCs > 0.70). However, they performed poorly in distinguishing IS patients from IS mimics in the validation dataset (AUCs < 0.60).

CONCLUSION

This study provides valuable insights into the associations between systemic inflammatory indices and IS, offering potential implications for risk stratification. While these inflammatory indices are potential indicators for distinguishing IS from healthy conditions, additional biomarkers may be needed when differentiating IS from other chronic inflammatory conditions in clinical practice.

The impact of reduced skeletal muscle mass at stroke onset on 3-month functional outcomes in acute ischemic stroke patients

INTRODUCTION

Sarcopenia, characterized by reduced skeletal muscle mass (RMM), is increasingly recognized as a significant factor influencing outcomes in various health conditions, including stroke. Although most studies focus on sarcopenia developing during stroke rehabilitation, the impact of sarcopenia present at the onset of acute ischemic stroke remains underexplored. This study aims to evaluate the effect of RMM at stroke onset on 3-month functional outcomes in acute ischemic stroke patients.

MATERIALS AND METHODS

We prospectively enrolled acute ischemic stroke patients admitted between May 2019 and December 2019. Muscle mass was accessed early during hospitalization using whole-body dual-energy X-ray absorptiometry (DXA), and patients were categorized into RMM and normal muscle mass (NMM) groups based on the Asian Working Group for Sarcopenia (AWGS) criteria. Functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS), with unfavorable outcomes defined as mRS scores 2-5. Multivariable logistic regression and SHAP (Shapley Additive exPlanations) analyses were used to evaluate the independent impact of RMM on 3-months functional outcomes.

RESULTS

A total of 99 patients were analyzed. The RMM group had a significantly higher prevalence of unfavorable outcomes at 3 months compared to the NMM group (p < 0.001). Patients with RMM were older and presented with more severe strokes. Multivariable analysis confirmed RMM as an independent predictor of unfavorable outcomes (adjusted OR: 8.07, 95% CI: 1.603-40.66, p = 0.011), even after adjusting for age and initial stroke severity. SHAP analysis ranked RMM as the second most influential predictor of unfavorable outcomes, following NIHSS on admission. These findings indicate that RMM not only worsens initial stroke severity but also independently hinders post-stroke recovery.

CONCLUSIONS

Reduced muscle mass at the onset of acute ischemic stroke is a significant, independent predictor of unfavorable outcomes at 3 months. In addition to its impact on recovery, RMM is linked to older age and more severe strokes, worsening prognosis. Maintaining muscle mass is also crucial for stroke prevention, as it supports cardiovascular health and resilience. Early identification and intervention for sarcopenia can improve recovery and reduce future stroke risk.

Epidemiological trends and age-period-cohort effects on ischemic stroke burden across the BRICS-plus from 1992 to 2021

BACKGROUND

Ischemic stroke, accounting for 85% of stroke cases, leads to severe disabilities and increased mortality. Its global incidence rose by 87.55% from 1990 to 2019, posing significant health and economic burdens. The BRICS-plus nations-Brazil, Russia, India, China, South Africa, and five others-represent a large global population, presenting unique public health challenges. This study aims to evaluate the epidemiological trends and variations in the burden of ischemic stroke across BRICS-plus nations in a timely manner.

METHODS

Data on the number, all-age rate, age-standardized rate, and relative change in ischemic stroke disability-adjusted life years (DALYs) from 1992 to 2021 within BRICS-plus were obtained from the Global Burden of Disease Study (GBD) 2021. Relationships between the DALYs rate and the Socio-demographic Index (SDI) were evaluated using Pearson correlation analyses. Additionally, age-period-cohort modeling was employed to estimate net drift, local drift, age, period, and cohort effects over the past three decades.

RESULTS

From 1992 to 2021, total DALYs due to ischemic stroke increased by 47.14%, while the age-standardized DALYs rate decreased by 33.79%. All BRICS-plus countries exhibited a declining trend in the age-standardized DALYs rate over the past three decades. Egypt reported the highest age-standardized DALYs rate (2,462.60 per 100,000 population) in 2021, whereas the most substantial reduction of 59.37% was observed in Brazil. The annual net drift in the ischemic stroke DALYs rate ranged from -3.04% for Brazil to -0.48% for Egypt among the ten countries. A significant positive correlation was observed between the DALYs rate of ischemic stroke and SDI values. Countries exhibited similar age effect patterns, with an increasing risk of DALYs rate with advancing age. Period and cohort effects highlighted declines in observed nations, indicating improved ischemic stroke management strategies.

CONCLUSION

The burden of ischemic stroke showed an overall declining trend across the BRICS-plus from 1992 to 2021, but persistent health inequalities between these countries were driven by socioeconomic disparities. Furthermore, it emphasizes the necessity for targeted interventions across age, period, and cohort dimensions to address the distinct challenges posed by ischemic stroke in these rapidly developing countries.

Altered Static and Dynamic Functional Network Connectivity and Combined Machine Learning in Stroke

Stroke is a condition characterized by damage to the cerebral vasculature from various causes, resulting in focal or widespread brain tissue damage. Prior neuroimaging research has demonstrated that individuals with stroke present structural and functional brain abnormalities, evident through disruptions in motor, cognitive, and other vital functions. Nevertheless, there is a lack of studies on alterations in static and dynamic functional network connectivity in the brains of stroke patients. Fifty stroke patients and 50 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning. Initially, the independent component analysis (ICA) method was utilized to extract the resting-state network (RSN). Subsequently, the disparities in static functional network connectivity both within and between networks among the two groups were computed and juxtaposed. Following this, five consistent and robust dynamic functional network connectivity (dFNC) states were derived by integrating the sliding time window method with k-means cluster analysis, and the distinctions in dFNC between the groups across different states, along with the intergroup variations in three dynamic temporal metrics, were assessed. Finally, a support vector machine (SVM) approach was employed to discriminate stroke patients from HCs using FC and FNC as classification features. Comparing the stroke group to the healthy control (HC) group, the stroke group exhibited reduced intra-network functional connectivity (FC) in the right superior temporal gyrus of the ventral attention network (VAN), the left calcarine of the visual network (VN), and the left precuneus of the default mode network (DMN). Regarding static functional network connectivity (FNC), we identified increased connectivity between the executive control network (ECN) and dorsal attention network (DAN), salience network (SN) and DMN, SN-ECN, and VN-ECN, along with decreased connectivity between DAN-DAN, ECN-SN, SN-SN, and DAN-VN between the two groups. Noteworthy differences in dynamic FNC (dFNC) were observed between the groups in states 3 to 5. Moreover, stroke patients demonstrated a significantly higher proportion of time and longer mean dwell time in state 4, alongside a decreased proportion of time in state 5 compared to HC. Finally, utilizing FC and FNC as features, stroke patients could be distinguished from HC with an accuracy exceeding 70% and an area under the curve ranging from 0.8284 to 0.9364. In conclusion, our study reveals static and dynamic changes in large-scale brain networks in stroke patients, potentially linked to abnormalities in visual, cognitive, and motor functions. This investigation offers valuable insights into the neural mechanisms underpinning the functional deficits observed in stroke, thereby aiding in the diagnosis and development of targeted therapeutic interventions for affected individuals.

The association between the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio and delirium in ischemic stroke patients

Background

Delirium is a severe neuropsychiatric symptom following acute ischemic stroke (IS) and is associated with poor outcomes. Systemic inflammation and immune dysregulation are believed to contribute to the pathophysiology of delirium. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are widely recognized as convenient and reliable biomarkers of systemic inflammation. However, their association with delirium after IS remains unclear.

Methods

In this study, we identified IS patients requiring ICU admission from the Medical Information Mart for Intensive Care (MIMIC)-IV database. We employed multivariable logistic regression and restricted cubic splines (RCS) to assess the association between the NLR, PLR, and LMR and delirium. Two-sample Mendelian randomization (MR) analysis was performed to further explore their causal relationship at the genetic level.

Results

A total of 1,436 patients with IS were included in this study, of whom 214 (14.9%) had delirium. In the multivariate logistic regression analysis, after adjustment for confounders, the patients in the highest quartile of the NLR (odds ratio [OR] 2.080, 95% confidence interval [CI], 1.282-3.375) and LMR (OR 0.503, 95% CI 0.317-0.798) and the patients in the second quartile of the PLR (OR 1.574, 95% CI 1.019-2.431) were significantly associated with delirium. The RCS function showed a progressive increase in the risk of delirium with higher NLR and PLR and lower LMR. In the MR analysis, only the PLR was negatively associated with the risk of delirium.

Conclusion

The observational studies found significant associations between the NLR, PLR, and LMR and delirium. However, the MR analysis only demonstrated a potential protective causal relationship between the PLR and delirium. Further prospective studies are needed to validate their association and to elucidate the underlying mechanisms.

Association of sleep duration and sleep disorders with post-stroke depression and all-cause and cardiovascular disease mortality in US stroke survivors: results from NHANES 2005-2018

BACKGROUND

Sleep disturbance is a common concern among stroke survivors, yet the association of sleep duration and sleep disorders with post-stroke depression and all-cause and cardiovascular disease (CVD) mortality remains elusive. We aimed to explore these associations using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

Adult stroke survivors from NHANES 2005-2018 were included. Sleep information and stroke diagnoses were derived from self-reports on relevant questionnaires. Mortality data were collected by prospectively matching to the National Death Index. Multivariate logistic regression and Cox proportional hazards regression were used to explore these associations and calculate the odds ratio (OR) and hazard ratio (HR), respectively.

RESULTS

A total of 1101 stroke participants were included. In the fully adjusted model, sleep disorders were associated with increased odds of post-stroke depression (OR 2.689, p = 0.0146). Sleep duration was inversely associated with the odds of post-stroke depression; compared to normal sleep duration, short sleep duration was associated with increased odds of post-stroke depression (OR 2.196, p = 0.0059), whereas long sleep duration was not (p = 0.1435). Sleep disorders were associated with CVD mortality (HR of 1.948, p = 0.026) but not all-cause mortality (p = 0.224) in stroke survivors. Sleep duration was positively associated with all-cause mortality in stroke survivors (HR 1.075, p = 0.042); however, neither short nor long sleep duration was associated with mortality compared to normal sleep duration. Restricted cubic spline modeling suggested that sleep duration was nonlinearly and linearly associated with post-stroke depression and all-cause mortality, respectively. Age influenced the association between sleep disorders and CVD mortality in stroke survivors.

CONCLUSIONS

Sleep disorders and short sleep duration were associated with increased odds of post-stroke depression, whereas sleep disorders were associated with increased CVD mortality in stroke survivors. These findings underscore that achieving normal sleep duration and improving sleep disorders may reduce the odds of post-stroke depression and mortality.

Impact of a Visual-Auditory-Kinesthetic Model-Based Educational Package on Knowledge Regarding Stroke Among Security Guards in a Tertiary Care Teaching Hospital

Background

Stroke is a fatal disease with huge burden worldwide. Nonetheless, it is preventable, provided risk factors are controlled. Modifiable risk factors are associated with 90% of attributable risk for stroke. The growing burden of stroke indicates that the current stroke prevention strategies are either not used properly or insufficiently effective. The study aimed to assess the prevalence of risk factors of stroke and to assess the impact of a VAK (visual-auditory-kinesthetic) model-based educational program on knowledge of stroke among security guards.

Materials and Methods

The data were collected in two phases. In the first phase, prevalence of risk factors of stroke among security guards was assessed. In the second phase, the security guards who were found to have high risk of stroke were given the educational package employing the VAK model. The educational package included researcher-developed videos on risk factors and management of stroke, a poster on Act FAST, and a card game on symptoms of stroke. Paired t-test was used to compare the means of knowledge score before and after intervention.

Result

The security guards had risk factors for stroke including hypertension (12.7%), smoking (59%), and obesity (29.4%). The security guards showed improvement in knowledge score regarding stroke from a mean score of 9.2 ± 1.9 to a mean score of 16.3 ± 1.2 (P < 0.001) after the educational intervention.

Conclusion

Hypertension, smoking, and obesity were the most common risk factors of stroke among security guards. The VAK model-based educational package was effective in improving knowledge of security guards regarding signs, symptoms, risk factors, and action to be taken on any sign of stroke.

PhenoAge and PhenoAgeAccel in the context of dyslipidemia: association with stroke and potential as a new predictor in the US general population

BACKGROUND

The challenges posed by an aging society are increasingly recognized, particularly regarding the potential impacts of high-fat diets and the trend toward younger ages of disease onset. The purpose of this study was to clarify the relationships between the prevalence of stroke in the general US population and PhenoAge (PA) and PhenoAgeAccel (PAA).

METHODS

Key methods included a correlation heatmap to explore linear relationships between some of the variables and weighted multivariable logistic regression to assess associations between PA, PAA, and stroke. Restricted cubic spline (RCS) analysis was used to investigate nonlinear relationships and dose-response effects. The ability of the PAA to predict stroke risk was assessed by a nomogram model and a receiver operating characteristic curve.

RESULTS

After adjusting for confounding variables, both continuous and categorical PA and PAA were significantly associated with stroke prevalence. RCS analysis revealed a significant nonlinear relationship between PA and stroke prevalence. Further subgroup RCS analysis indicated that maintaining PA below 31.6 could provide greater benefits across all races and genders, specifically for individuals aged 40-80 years and those who are overweight or obese.

CONCLUSION

This study highlights the importance of stroke prevention in overweight and obese populations. Monitoring intermediary factors such as high-density lipoprotein cholesterol and waist circumference may reduce stroke risk. Additionally, PA and PAA may serve as novel markers for stroke, offering new directions for health management in an aging society.

Global and Regional Burden of Ischemic Stroke Disease from 1990 to 2021: An Age-Period-Cohort Analysis

Ischemic stroke is a significant global public health issue that impacts health burdens across various regions. This study analyzed data from the Global Burden of Disease Study 2021 to assess the incidence, mortality, and disability-adjusted life years (DALYs) associated with ischemic stroke worldwide and across different Socio-demographic Index (SDI) regions. Using joinpoint regression and age-period-cohort (APC) models, we examined trends in disease burden and made projections for 2022 to 2035. As of 2021, approximately 7,804,449 (95% UI, 6,719,760-8,943,692) individuals were affected by ischemic stroke, resulting in 3,591,499 (95% UI, 3,213,281-3,888,327) deaths and 70,357,912 (95% UI, 64,329,576-76,007,063) DALYs. These numbers represent increases of 88.0%, 55.0%, and 52.4% since 1990. Despite these increases, age-standardized incidence, mortality, and DALYs rates are declining, with annual percentage change rates (AAPC) of - 0.578%, - 0.927%, and - 14.372%, consistent across all SDI regions. The global rates of IS are influenced by age, period, and cohort, showing increased rates with age but declining over time, particularly in high SDI regions. Major risk factors include hypertension, environmental pollution, and low-density lipoprotein cholesterol (LDL-C). Projections indicate that by 2035, incidence, mortality, and DALYs will rise among those aged 45 and above, while decreasing for those under 35. This highlights the urgent need for preventive and therapeutic strategies targeting ischemic stroke, particularly for individuals over 45, while addressing the impact of major risk factors in high-burden regions.

Adherence to the Mediterranean diet and risk of stroke in a Chilean population: a case-control study

Introduction

Introduction: Ñuble is the region of Chile with the highest stroke incidence rates in the country. The aim was to estimate the association between adherence to the MED diet and the first ischemic stroke in adult patients living in the Ñuble region. Methods: a case-control hospital-based study. The cases (n = 89) were patients with first ischemic stroke, and controls (n = 178) were admitted to the same hospital during the same month the cases were recruited. We selected two controls for one case and paired them for sex and age (± 5 years). We used the food frequency questionnaire and the adherence Mediterranean diet questionnaire. A descriptive analysis of the variables and a conditional logistic regression to determine the association between variables. Results: 71 % of the sample was ≥ 65 years old and 64 % were male. Cases smoked (11.2 %), consumed at least one drink per month (41.6 %), and had a diagnosis of hypertension (76.4 %) more frequently than controls. In the model adjusted for all variables, it is observed that those who are in quartile 2 of adherence (6-7 points) are 42 % less likely to have a cerebral infarction compared to those who have a lower score (p < 0.005). Conclusions: our findings suggest that moderate adherence to a Mediterranean diet, defined by the PREDIMED score and adjustment for other variables, reduces the probability to first ischemic stroke.

Changes in the metabolic score for insulin resistance index for risk prediction of stroke in middle-aged and older Chinese population

Background

As a major noncommunicable disease, stroke poses a major threat to public health. In the context of predictive, preventative, and personalised medicine (PPPM/3PM), early identification of high-risk individuals is crucial for targeted prevention and personalised treatment for stroke. This study aimed to investigate the association between changes in the Metabolic Score for Insulin Resistance Index (METS-IR) and incident stroke. From the perspective of PPPM/3PM, we hypothesised that monitoring dynamic changes of the METs-IR levels and targeting cumulative METs-IR index contribute to risk prediction, targeted prevention, and personalised management of stroke.

Methods

All data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), a nationwide prospective cohort study. The individuals were categorised into four subgroups based on the quartiles (Q) of the cumulative METS-IR index as a reflection of changes in the METS-IR values from 2012 to 2015. Logistic regression was employed to examine the association between cumulative METS-IR index and stroke incidence. Additionally, restricted cubic spline regression analysis was used to assess potential linearity.

Results

Among the 4288 participants, 275 (6.4%) experienced a stroke. The risk of stroke events increased with higher cumulative METS-IR index levels. Compared with the lowest quartile (Q1), the OR of having a stroke was 1.20 (0.81, 1.78) for Q2, 1.51 (1.04, 2.21) for Q3 and 2.17 (1.52, 3.10) for the highest quartile (Q4). After adjusting for multiple potential confounders, Q4 (OR: 1.57, 95% CI: 1.04, 2.35) remained significantly associated with stroke. The association between the cumulative METS-IR index and stroke incidence was linear in males, females, and the overall population (all P values for nonlinearity > 0.05).

Conclusions

A higher cumulative METS-IR index was associated with an increased risk of incident stroke among middle-aged and older Chinese individuals. In the context of PPPM/3PM, incorporating metabolic health into stroke risk assessment advances the prediction, prevention and personalised management of stroke.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-024-00388-y.

Meteorological factors and risk of ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage: A time-stratified case-crossover study

BACKGROUND

Stroke risks associated with rapid climate change remain controversial due to a paucity of evidence.

AIMS

To examine the risk of subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH), and ischemic stroke (IS) associated with meteorological parameters.

METHODS

In this time-stratified case-crossover study, adult patients hospitalized for their first stroke between 2011 and 2020 from the insurance claims data in Taiwan were identified. The hospitalization day was designated as the case period, and three or four control periods were matched by the same day of the week and month of each case period. Daily mean and 24-h variations in ambient temperature, relative humidity, air pressure, and apparent temperature were measured. Conditional logistic regression models were applied to assess the risk of stroke associated with exposure to weather variables, using the third quintile as a reference, controlling for air pollutant levels.

RESULTS

There were 7161 patients with SAH, 40,426 patients with ICH, and 107,550 patients with IS. There was an inverse linear relationship between mean daily temperature and apparent temperature with ICH. Elevated mean daily atmospheric pressure was associated with an increased risk of ICH. A greater decrease in apparent temperature over a 24-h period was associated with increased risk of ICH but decreased risk of IS (odds ratio (95% confidence interval) for the first vs. third quintile of changes in apparent temperature, 1.141 (1.053-1.237) and 0.946 (0.899-0.996), respectively).

CONCLUSIONS

There were considerable differences in short-term associations between meteorological parameters and three main pathological types of strokes.

DATA ACCESS STATEMENT

The authors have no permission to share the data.

Serum liver enzymes and risk of stroke: Systematic review with meta-analyses and Mendelian randomization studies

BACKGROUND AND PURPOSE

Previous observational studies have identified correlations between liver enzyme levels and stroke risk. However, the strength and consistency of these associations vary. To comprehensively evaluate the relationship between liver enzymes and stroke risk, we conducted meta-analyses complemented by Mendelian randomization (MR) analyses.

METHODS

Following the PRISMA guidelines, we performed meta-analyses of prospective studies and conducted subgroup analyses stratified by sex and stroke subtype. Subsequently, adhering to the STROBE-MR guidelines, we performed two-sample bidirectional univariable MR (UVMR) and multivariable MR (MVMR) analyses using the largest genome-wide association studies summary data. Finally, the single-nucleotide polymorphisms associated with liver enzymes on sex differences underwent gene annotation, gene set enrichment, and tissue enrichment analyses.

RESULTS

In the meta-analyses of 17 prospective studies, we found the relative risks for serum γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) were 1.23 (95% CI: 1.16-1.31) and 1.3 (95% CI: 1.19-1.43), respectively. Subgroup analyses revealed sex and stroke subtype differences in liver enzyme-related stroke risk. Bidirectional UVMR analyses confirmed that elevated GGT, alanine aminotransferase, and aspartate aminotransferase levels were associated with increased stroke occurrence. The primary results from the MVMR analyses revealed that higher ALP levels significantly increased the risk of stroke and ischemic stroke. Gene set and tissue enrichment analyses supported genetic differences in liver enzymes across sexes.

CONCLUSIONS

Our study provides evidence linking liver enzyme levels to stroke risk, suggesting liver enzymes as potential biomarkers for early identification of high-risk individuals. Personalized, sex-specific interventions targeting liver enzymes could offer new strategies for stroke prevention.

Telomere length as a biomarker for cerebrovascular diseases: current evidence

Cerebrovascular disease (CVD) includes a range of conditions affecting the brain's blood vessels, which can result in reduced blood flow to brain tissue. The most common manifestation of CVD is stroke, the second leading cause of death and the third leading cause of disability worldwide. Major risk factors for CVD encompass gender, age, smoking, hypertension, diabetes, physical inactivity, obesity, alcohol consumption, and metabolic syndrome. Research suggests a link between telomere length and an increased risk of CVD, particularly in ischemic stroke cases. This review highlights key findings on the relationship between telomere length and CVD, underscoring its clinical importance. The analysis utilizes scientific literature from PubMed, Scopus, and SciELO up to 2024. Results show that shorter telomere length is associated with various types of CVD, including stroke, ischemic stroke, hemorrhagic stroke, and cardioembolic stroke. Some studies propose that telomere length measurement could be a valuable biomarker for CVD, potentially improving prevention, diagnosis, and management strategies.

Migraine and the correlation between stroke: A systematic review and meta-analysis

BACKGROUND

This study aims to analyze and evaluate the correlation between migraines and the onset of stroke, and further explore whether migraines increase the risk of stroke.

METHODS

Two researchers independently conducted a comprehensive search of Chinese biomedical literature databases (CBM disc), PubMed, Embase, Cochrane Library, and Web of Science databases, using a combination of subject terms and free words. Literature that met the inclusion and exclusion criteria was selected, and quality assessment was performed using The Newcastle-Ottawa Scale (NOS). Data necessary for the study were extracted as effect size as needed, and meta-analysis was conducted using Review Manager 5.4 software and Stata 16 software to calculate the combined odds ratio and its 95% confidence interval. The relevant data were analyzed, and publication bias was evaluated.

RESULTS

After conducting a meta-analysis of the 9 final included articles, the heterogeneity test showed chi2 = 10.7, df = 8 (P = .22), I2 = 25%. Therefore, a fixed-effect model was used for analysis. The combined odds ratio (OR) for the risk of stroke in migraine patients compared to non-migraine patients was 2.04, with a 95% confidence interval [1.73, 2.4], which was statistically significant. In the analysis of migraine with aura, the respective ORs were 2.32 with a 95% CI of [1.70-3.18] and 1.77 with a 95% CI of [1.34-2.33]. Subgroup analysis of female migraine patients and young migraine patients showed statistically significant results, with ORs of 2.26 (95% CI [1.67-3.05]) and 2.39 (95% CI [1.9-3.01]), respectively. The relevant literature and results were evaluated for publication bias and assessed using the NOS, indicating the reliability of the results.

CONCLUSION

The results of the meta-analysis indicate that there is a certain relationship between migraine and the onset of stroke, and the results are relatively reliable. The analysis of migraine with aura shows that both the presence and absence of aura are associated with an increased risk of stroke. Subgroup analysis based on gender and age shows that the increased risk of stroke is associated with females and young individuals. However, due to the limited data in subgroup analysis, the above conclusions still require further research for validation.

Characteristics associated with 30-day post-stroke readmission within an academic urban hospital network

OBJECTIVES

Hospital readmissions are associated with poor health outcomes including illness severity and medical complications. The objective of this study was to identify characteristics associated with 30-day post-stroke readmission in an academic urban hospital network.

MATERIALS AND METHODS

We collected data on patients admitted with stroke from 2017 through 2022 who were readmitted within 30 days of discharge and compared them to a subset of non-readmitted stroke patients. Chart review was used to collect demographics, characteristics of the stroke, co-morbid conditions, in-hospital complications, and post-discharge care. Univariate analyses followed by regression analysis were used to assess characteristics associated with post-stroke readmission.

RESULTS

We identified 4743 patients with stroke (18 % hemorrhagic, mean age 70.1 (standard deviation (SD) 17.2), 47.3 % female) discharged from the stroke services, of whom 282 (5.9 %) patients were readmitted within 30 days of index hospitalization. Univariate analyses identified 18 significantly different features between admitted and readmitted patients. Regression analysis revealed characteristics associated with readmission included private insurance (odds ratio (OR) 0.4, confidence interval (CI) 0.3-0.6, p < 0.001), comorbid peripheral vascular disease (PVD) (OR 2.7, CI 1.3-5.5, p = 0.009), malignancy (OR 1.6, CI 1.0-2.6, p = 0.04), seizure (OR 3.4, CI 1.4-8.2, p = 0.007), thrombolytic administration (OR 0.4, CI 0.2-0.7, p = 0.003), undergoing thrombectomy (OR 5.4, CI 2.9-10.1, p < 0.001), and higher discharge modified Rankin Scale score (OR 1.2, CI 1.0-1.3, p = 0.047).

CONCLUSIONS

Our data demonstrate that thrombectomy, high discharge Rankin score, comorbid malignancy, seizure or PVD, and lack of thrombolytic administration or private insurance predict readmission.

French Version of the User Mobile Application Rating Scale: Adaptation and Validation Study

Background

Managing noncommunicable diseases effectively requires continuous coordination and monitoring, often facilitated by eHealth technologies like mobile health (mHealth) apps. The end-user version of the Mobile Application Rating Scale is a valuable tool for assessing the quality of mHealth apps from the user perspective. However, the absence of a French version restricts its use in French-speaking countries, where the evaluation and regulation of mHealth apps are still lacking, despite the increasing number of apps and their strong relevance in health care.

Objective

This study aims to translate and culturally adapt a French version of the user Mobile Application Rating Scale (uMARS-F) and to test its overall and internal reliability.

Methods

Cross-cultural adaptation and translation followed the universalist approach. The uMARS-F was evaluated as part through a cohort study using the French mHealth app "MonSherpa" (Qare). Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical limitations. They assessed the app using the uMARS-F twice (T1 and T2) 1 week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test and presented as mean (SD), and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using intraclass correlation coefficients and internal reliability using Cronbach α. Concordance between the 3 subscales (objective quality, subjective quality, and perceived impact), 4 sections, and 26 items at T1 and T2 was evaluated using the paired t test (2-tailed) and Pearson correlation.

Results

In total, 167 participants assessed the app at both T1 and T2 (100% compliance). Among them, 49.7% (n=83) were female, and 50.3% (n=84) were male, with a mean age of 43 (SD 16) years. The uMARS-F intraclass correlation coefficients were excellent for objective quality (0.959), excellent for subjective quality (0.993), and moderate for perceived impact (0.624). Cronbach α was good for objective quality (0.881), acceptable for subjective quality (0.701), and excellent for perceived impact (0.936). The paired t tests (2-tailed) demonstrated similar scores between the 2 assessments (P>.05), and the Pearson correlation coefficient indicated high consistency in each subscale, section, and item (r>0.76 and P<.001). The reliability and validity of the measures were similar to those found in the original English version as well as in the Spanish, Japanese, Italian, Greek, and Turkish versions that have already been translated and validated.

Conclusions

The uMARS-F is a valid tool for end users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the French version of the Mobile Application Rating Scale could enable health care professionals and public health authorities to identify reliable, high-quality, and valid apps for patients and should be part of French health care education programs.

Association between tea consumption and stroke in the American adult females: analyses of NHANES 2011-2018 data

Background

Epidemiological surveys show that there is a significant gender difference in the incidence of stroke, with females having a noticeably higher rate than males. Accordingly, it is crucial to seek preventive measures for stroke specifically targeted at females. Although previous studies have shown that tea has been proven to be negatively correlated with stroke, the relationship between tea and stroke in American adult females is still unclear. Therefore, we aimed to investigate the relationship between tea consumption and the occurrence of stroke in American adult females.

Methods

The data analyzed is derived from the NHANES database between 2011 and 2018. The quantity of tea consumed was gathered from a 24-h dietary review. Stroke was identified by using questionnaire. The association between tea consumption and stroke was investigated using a weighted regression model. Then we used interaction testing and subgroup analysis to conduct a thorough analysis. Simultaneously, the association between the sugar content in tea and stroke was examined.

Results

This study included 5731 adult females aged between 20 and 60 years. Compared to those who did not consume tea, the likelihood of stroke decreased by 9% for each additional 100 g of tea ingested by participants (OR = 0.91, 95%CI: 0.83-1.00). In the unadjusted model, those who drank 307.5-480 g of tea per day had a substantially decreased risk of stroke than those who did not drink tea (OR = 0.23, 95%CI: 0.08-0.64). After adjustment, this relationship also persisted (Model II: OR = 0.23, 95% CI: 0.08-0.64; Model III: OR = 0.23, 95% CI: 0.08-0.66). In both Model II and Model III, there was a statistically significant relationship between consuming 480-744 g of tea per day and the risk of stroke (Model II: OR = 0.39, 95%CI: 0.16-0.94; Model III: OR = 0.42, 95% CI: 0.18-0.98). Subgroup analysis revealed an interaction only with level of education (P = 0.031). Ultimately, we also demonstrated that people who drink sugar free tea have a lower risk of stroke, and even after adjusting for mixed factors.

Conclusion

This study suggested that proper tea consumption was associated with a lower risk of stroke in adult females, which recommended drinking sugar free tea.

Risk factors for intracerebral hemorrhage by five specific bleeding sites: Japan Public Health Center-based Prospective Study

BACKGROUND

Evaluating the risk factors for intracerebral hemorrhage is indispensable for primary prevention. However, the pathogenesis varies depending on the bleeding site, and few prospective studies have explored risk factors in detail for each site.

PARTICIPANTS AND METHODS

The Japan Public Health Center-based Prospective Study is a prospective study comprising a population-based sample of Japanese adults in 1990 (Cohort I) and in 1993 (Cohort II). A total of 34,137 participants (11,907 men and 22,230 women) were enrolled in this study and followed up until 2009 for Cohort I and until 2012 for Cohort II. The association between risk factors (age, sex, blood pressure, serum cholesterol, triglycerides, blood glucose, body mass index, smoking, and drinking status) and intracerebral hemorrhage by its bleeding site (lobes, putamen, thalamus, cerebellum, and brainstem) was assessed using Cox proportional hazards analysis.

RESULTS

During a median 20-year follow-up, 571 intracerebral hemorrhage events occurred. Hypertension was associated with an increased risk of total intracerebral hemorrhage, but not lobar hemorrhage. The multivariable hazard ratio (95% confidence intervals) was 2.09 (1.75-2.50) for total intracerebral hemorrhage. In contrast, a low serum total cholesterol level was associated only with lobar hemorrhage (1.73 (1.01-2.96)). Heavy drinking was associated with the risk of total and putamen hemorrhage, and obesity was associated with the risk of putamen hemorrhage.

DISCUSSION AND CONCLUSION

The present study identified different risk factors depending on the bleeding site of intracerebral hemorrhage.

Super Learner Algorithm for Carotid Artery Disease Diagnosis: A Machine Learning Approach Leveraging Craniocervical CT Angiography

This study introduces a machine learning (ML) approach to diagnosing carotid artery diseases, including stenosis, aneurysm, and dissection, by leveraging craniocervical computed tomography angiography (CTA) data. A meticulously curated, balanced dataset of 122 patient cases was used, ensuring reproducibility and data quality, and this is publicly accessible at (insert dataset location). The proposed method integrates a super learner model which combines adaptive boosting, gradient boosting, and random forests algorithms, achieving an accuracy of 90%. To enhance model robustness and generalization, techniques such as k-fold cross-validation, bootstrapping, data augmentation, and the synthetic minority oversampling technique (SMOTE) were applied, expanding the dataset to 1000 instances and significantly improving performance for minority classes like aneurysm and dissection. The results highlight the pivotal role of blood vessel structural analysis in diagnosing carotid artery diseases and demonstrate the superior performance of the super learner model in comparison with state-of-the-art (SOTA) methods in terms of both accuracy and robustness. This manuscript outlines the methodology, compares the results with state-of-the-art approaches, and provides insights for future research directions in applying machine learning to medical diagnostics.