Temporal trend and attributable risk factors of stroke burden in China, 1990–2019: an analysis for the Global Burden of Disease Study 2019

Impact of sodium butyrate on stroke-related intestinal injury in diabetic mice: Interference with Caspase-1/GSDMD pyroptosis pathway and preservation of intestinal barrier

Diabetic stroke-associated acute intestinal injury is characterized by high mortality, disability, and poor prognosis due to the lack of effective therapies. Our prior research demonstrated that administration of 300 mg/kg sodium butyrate (NaB) can improve neurological outcomes post-diabetic stroke. Nonetheless, whether the effect of NaB is related to intestinal regulation, along with its underlying mechanisms, remains uncertain. This study aims to investigate the effects and mechanistic pathways of NaB on diabetic stroke-associated acute intestinal injury. A middle cerebral artery occlusion/reperfusion model was established in mice with streptozotocin-induced diabetes. The results demonstrated that NaB alleviated colonic injury 24 h after reperfusion in diabetic stroke. Pyroptosis-related protein levels in colonic tissues were significantly elevated following diabetic stroke but were markedly reduced with NaB treatment. NaB also improved gut barrier integrity and reduced inflammation, promoting epithelial barrier self-repair. In the NaB combined with lipopolysaccharide group, lipopolysaccharide administration induced a significant inflammatory response in the colonic tissue. Conversely, treatment with NaB and VX-765 (an inhibitor for Caspase-1) led to a notable alleviation in intestinal inflammation. These findings suggest that NaB mitigates colonic injury and enhances barrier function following diabetic stroke, potentially through the Caspase-1/Gasdermin D pyroptosis pathway. This study may provide a novel strategy and direction for intestinal rehabilitation in diabetic stroke patients.

A review: Carrier-based hydrogels containing bioactive molecules and stem cells for ischemic stroke therapy

Ischemic stroke (IS), a cerebrovascular disease, is the leading cause of physical disability and death worldwide. Tissue plasminogen activator (tPA) and thrombectomy are limited by a narrow therapeutic time window. Although strategies such as drug therapies and cellular therapies have been used in preclinical trials, some important issues in clinical translation have not been addressed: low stem cell survival and drug delivery limited by the blood-brain barrier (BBB). Among the therapeutic options currently sought, carrier-based hydrogels hold great promise for the repair and regeneration of neural tissue in the treatment of ischemic stroke. The advantage lies in the ability to deliver drugs and cells to designated parts of the brain in an injectable manner to enhance therapeutic efficacy. Here, this article provides an overview of the use of carrier-based hydrogels in ischemic stroke therapy and focuses on the use of hydrogel scaffolds containing bioactive molecules and stem cells. In addition to this, we provide a more in-depth summary of the composition, physicochemical properties and physiological functions of the materials themselves. Finally, we also outline the prospects and challenges for clinical translation of hydrogel therapy for IS.

Global Changes in Ischemic Stroke Burden Attributable to Ambient PM2.5: Trends From 1990 to 2020 and Projections to 2050

BACKGROUND AND OBJECTIVES

Ischemic stroke (IS) is a leading cause of disability and mortality worldwide, with ambient fine particulate matter (PM2.5) exposure being a significant modifiable risk factor. While PM2.5 concentrations have declined in some regions, global assessments examining how these changes affect the IS burden remain limited. The aim of this study was to quantify changes in IS burden attributable to PM2.5 from 1990 to 2020 and project future trends to 2050.

METHODS

We used data from the 2021 Global Burden of Disease study, including population estimates, IS incidence rates, and PM2.5 concentrations, for 204 countries and World Bank regions. The Environmental Benefits Mapping and Analysis Program algorithm was applied to estimate IS cases attributable to PM2.5. Future projections were calculated using an autoregressive integrated moving average model.

RESULTS

Between 1990 and 2020, global PM2.5 concentrations decreased by 8.18 μg/m3. This reduction was associated with approximately 920,245 avoided IS cases, equivalent to 12.11% of the global IS incidence in 2020. The East Asia and Pacific region experienced the greatest benefit, with 699,218 IS cases avoided (19.09% of the region's IS incidence in 2020). By 2050, PM2.5 concentrations are projected to decline by 33.64 μg/m3 relative to 1990, potentially preventing an additional 6,004,854 IS cases. However, significant disparities persist, particularly in low-income regions where PM2.5 exposure and limited health care infrastructure continue to pose challenges.

DISCUSSION

Our findings highlight the substantial public health benefits of PM2.5 reductions in mitigating the IS burden. While high-income regions have seen substantial gains due to stringent air quality regulations, low-income regions remain disproportionately affected. Addressing these disparities requires targeted pollution control policies and equitable health care resource allocation. Sustained efforts in air quality management are critical to reducing the global IS burden and improving health outcomes, particularly in vulnerable populations.

HMGB1: A New Target for Ischemic Stroke and Hemorrhagic Transformation

Stroke in China is distinguished by its high rates of morbidity, recurrence, disability, and mortality. The ultra-early administration of rtPA is essential for restoring perfusion in acute ischemic stroke, though it concurrently elevates the risk of hemorrhagic transformation. High-mobility group box 1 (HMGB1) emerges as a pivotal player in neuroinflammation after brain ischemia and ischemia-reperfusion. Released passively by necrotic cells and actively secreted, including direct secretion of HMGB1 into the extracellular space and packaging of HMGB1 into intracellular vesicles by immune cells, glial cells, platelets, and endothelial cells, HMGB1 represents a prototypical damage-associated molecular pattern (DAMP). It is intricately involved in the pathogenesis of atherosclerosis, thromboembolism, and detrimental inflammation during the early phases of ischemic stroke. Moreover, HMGB1 significantly contributes to neurovascular remodeling and functional recovery in later stages. Significantly, HMGB1 mediates hemorrhagic transformation by facilitating neuroinflammation, directly compromising the integrity of the blood-brain barrier, and enhancing MMP9 secretion through its interaction with rtPA. As a systemic inflammatory factor, HMGB1 is also implicated in post-stroke depression and an elevated risk of stroke-associated pneumonia. The role of HMGB1 extends to influencing the pathogenesis of ischemia by polarizing various subtypes of immune and glial cells. This includes mediating excitotoxicity due to excitatory amino acids, autophagy, MMP9 release, NET formation, and autocrine trophic pathways. Given its multifaceted role, HMGB1 is recognized as a crucial therapeutic target and prognostic marker for ischemic stroke and hemorrhagic transformation. In this review, we summarize the structure and redox properties, secretion and pathways, regulation of immune cell activity, the role of pathophysiological mechanisms in stroke, and hemorrhage transformation for HMGB1, which will pave the way for developing new neuroprotective drugs, reduction of post-stroke neuroinflammation, and expansion of thrombolysis time window.

Association between particulate matter exposure and acute ischemic stroke admissions in less-polluted areas: a time-series study using a distributed lag nonlinear model

Purpose

China has experienced a heavy public health burden due to the increasing incidence of ischemic stroke (IS). Few studies have evaluated the relationship between particulate matter (PM) exposure and acute ischemic stroke (AIS) in relatively less-polluted areas, and the results have been inconsistent. As a result, this study aimed to investigate and evaluate the association between PM exposure and hospitalizations for AIS in an area with less air pollution.

Methods

Through collecting daily AIS hospitalizations, air pollution data and meteorological data from July 1, 2017 to June 30, 2020 in Nanning, this paper explored the association between short-term exposure to PM (PM2.5, PM10 and PMc) and daily hospital admissions for AIS using a distributed lag non-linear model based on time-series. To further identify the susceptible populations, stratified analyses were performed by age and gender.

Results

During the study period, a total of 2382 patients were admitted to hospital with AIS, with the ratio of male to female reached 2.03: 1. No statistical association was found between PM exposure and AIS admissions in the total population. Subgroup analysis showed that PM2.5, PM10 and PMc exposures were significantly associated with AIS admissions in male at lag29-lag30, lag27-lag30 and lag25-lag27, respectively. In addition, PMc exposure was also relevant to admissions for AIS with aged < 65 years at lag18-lag23.

Conclusions

Short-term exposure to ambient PM was not associated with hospital admissions for AIS in the general population, but males and young adults (aged < 65 years) were more susceptible to PM exposure. Even in areas with relatively low air pollution, appropriate measures should be adopted to intervene in the adverse effects of air pollution on vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-024-00926-w.

Comprehensive analysis of stroke epidemiology in Vietnam: Insights from GBD 1990-2019 and RES-Q 2017-2023

Background

Stroke is a significant health burden in Vietnam, with substantial impacts on mortality, morbidity, and healthcare resources. An up-to-date report on stroke epidemiology and associated risk factors in Vietnam was missing.

Method

We analyzed the data published in the Global Burden of Disease (GBD) 2019, in combination with the first-time analysis of the Registry of Stroke Care Quality Improvement (RES-Q) initiative in Vietnam from 2017 to 2023.

Findings

Comparative analysis globally revealed that Vietnam had one of the highest stroke incidence and prevalence rates in Southeast Asia and ranked 4th in stroke mortality among 11 neighbouring countries. In the RES-Q dataset, 95,696 patients (77 %) were ischemic stroke, 23,203 (18 %) were intracerebral haemorrhage, and 2816 (2 %) were subarachnoid haemorrhage. In GBD 2019, stroke was the leading cause of death among cardiovascular diseases in Vietnam, accounting for 135,999 fatalities. The incidence of stroke was 222 (95 % UIs 206-242) per 100,000 population, with a prevalence of 1541 (1430-1679) per 100,000. Results align with the report from the RES-Q dataset in two megacities of Vietnam: Hanoi (incidence rate of 168.9, prevalence rate of 1182.2) and Ho Chi Minh City (incidence rate of 207.1, prevalence rate of 1221.8). Key risk factors for stroke mortality are high systolic blood pressure (79,000 deaths), unhealthy dietary (43,000 deaths), high fasting plasma glucose (35,000 deaths), and air pollution (33,000 deaths). Incidence is lower in rural Vietnam, but availability and quality of care are higher in megacities.

Interpretation

The results promote a further understanding of stroke and risk factors for the Vietnamese population and suggest prevention and treatment strategies for the Vietnamese government, including facility and capacity improvement and applications of advanced technologies.

Effect of Huatuo Zaizao Pill on Neurological Function and Limb Motor Recovery in Ischemic Stroke Patients During Convalescence: An Open-Labelled, Randomized Controlled Trial

OBJECTIVE

To evaluate the effects of Chinese patent medicine Huatuo Zaizao Pill (HTZZ) on neurological function and limb motor in ischemic stroke (IS) patients during convalescence.

METHODS

This is a prospective, open-labelled, randomized controlled trial. Patients with IS were recruited from the Neurology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences from May 2021 to June 2023. Eligible participants were randomly assigned to the HTZZ (40 cases) or control group (40 cases) at a ratio of 1:1. The HTZZ group was treated with oral HTZZ (8 g, thrice daily) combined with conventional treatment, while the control group received only conventional treatment. The treatment duration was 12 weeks. The primary outcome was the change in Modified Ashworth Scale (MAS) score from baseline to week 6 and 12. Secondary outcomes included changes in scores of National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FM), and Barthel Index (BI) from baseline to week 6 and 12, as well as lipid indices after 12 weeks. All adverse events (AEs) were recorded and liver and kidney indices were evaluated.

RESULTS

A total of 72 patients completed the study (38 in the HTZZ group and 34 in the control group). Compared with the control group, the HTZZ group demonstrated significant improvements in MAS, NIHSS, FM, and BI scores following 6 and 12 weeks of treatment in both intent-to-treat and per-protocol analyses (all P<0.05). No significant differences were noted between groups in lipid indices, AEs, and liver and kidney dysfunction after 12 weeks (P>0.05).

CONCLUSIONS

HTZZ alleviated spasticity and enhanced neurological function and prognosis of IS patients during convalescence. However, further evaluation of HTZZ's effect on IS outcomes is warranted in clinical trials with larger sample sizes and extended observation periods. (Trial registration No. NCT04910256).

Depressive symptoms changes in the new-onset stroke patients: A cross-lagged panel network analysis

BACKGROUND

Each year, there are approximately 10.3 million new stroke cases worldwide, with 2 million occurring in China. Post-stroke depression (PSD) is a common complication that negatively affects rehabilitation outcomes and increases long-term mortality.

OBJECTIVE

This study used network analysis to investigate the cross-sectional and longitudinal networks between depressive symptoms in new-onset stroke patients with PSD, aiming to identify the key symptoms and predictive relationships among distinct symptoms during the acute phase and 6 months after the stroke.

METHODS

This longitudinal descriptive study collected data from October 2022 to December 2023, including eligible new-onset stroke patients. Depressive symptoms were assessed using the CES-D scale, and network analysis was used to analyze the interactions between symptoms.

RESULTS

613 participants completed the data collection. The study found that D3 (Felt sadness) emerged as the central depressive symptom at both baseline and follow-up (EI value = 1.215 and 1.168, respectively). In the longitudinal network analysis, D7 (Sleep quality) displayed the strongest out-Expected Influence (value = 1.728), while D4 (Everything was an effort) showed the strongest in-Expected Influence (value = 1.322).

LIMITATIONS

The self-report measure is adopted for all depressive symptoms in the study, and there may be some deviation.

CONCLUSION

These symptom-level associations at cross-sectional and longitudinal networks extend our understanding of PSD symptoms in new-onset stroke patients by pointing to specific key depressive symptoms that may aggravate PSD. Recognizing these symptoms is imperative for the development of targeted interventions and treatments aimed at addressing PSD in new-onset stroke patients.

Exposure to greenness modifies the association between extreme temperature events and ischemic stroke recurrence in Tianjin, China

Few studies have found an association between extreme temperature events and an increased risk of recurrent ischemic stroke (IS). We examined associations between extreme temperature events (heat waves, cold spells) and recurrent IS risk in Tianjin, China (2019-2020), using a time-stratified case-crossover design, while evaluating greenness's moderating role. Significant heat wave effects peaked at lag 8, with severe intensity events increasing IS recurrence risk by 39.8% (OR = 1.398, 95% CI:1.032-1.894). Cold spell impacts peaked at lag 3, with moderate intensity cold spells elevating risk by 20.3% (OR = 1.203, 95% CI: 1.052-1.377) and severe intensity cold spells elevating risk by 98.2% (OR = 1.982, 95% CI: 1.407-2.791). Greenness modified these associations: low-greenness areas strengthened heat wave effects(lag9:OR = 2.309,95%CI:1.024-5.209) but weakened cold spell impacts(OR = 1.557,95%CI:1.037-2.340), whereas high-greenness areas attenuated heat wave links(lag8:OR = 1.402,95%CI:1.022-1.924) and nullified cold spell associations. Age and sex disparities emerged - younger individuals and males showed higher susceptibility to heat waves, while older individuals and males were more vulnerable to cold spells. The findings highlight greenness as a potential modifier of extreme temperature events-related IS recurrence risks and underscore demographic-specific vulnerabilities.

Associations between self-efficacy and health-related quality of life in haemorrhagic stroke survivors: a longitudinal study

BACKGROUND

The impact of recovery self-efficacy on health-related quality of life in haemorrhagic stroke survivors remains unclear. This longitudinal study examined this association through a one-year follow-up after discharge.

METHODS

A prospective, longitudinal design was conducted. A total of 184 haemorrhagic stroke survivors in a tertiary hospital in western China from January 2020 to December 2021 were recruited by the convenience sampling method. The three-level EuroQol five-dimension questionnaire (EQ-5D-3 L) and Stoke Self-efficacy Questionnaire (SSEQ) were assessed at four post-discharge time points: 1 month (T1), 3 months (T2), 6 months (T3), and 12 months (T4). The generalized estimating equation analysis was used to evaluate the associations between recovery self-efficacy and health-related quality of life.

RESULTS

The mean age of included participants were 54.0, with 65.2% of female. Generalized estimating equation analysis revealed significant interactions between time and SSEQ on EQ-5D-3 L (p < 0.001). The simple effects of time showed significant increases in EQ-5D-3 L scores from T3 to T4 in the low SSEQ group (β = 0.113-0.203, p < 0.001) and from T2 to T4 in the high SSEQ group (β = 0.038-0.054, p < 0.05). The simple effects of SSEQ showed that patients with higher SSEQ scores had significantly higher EQ-5D-3 L scores at T1 (β = 0.187, 95%CI: 0.132-0.242, p < 0.001), T2 (β = 0.154, 95%CI: 0.111-0.196, p < 0.001), and T3 (β = 0.084, 95%CI: 0.054-0.113, p < 0.001), but not at T4 (p = 0.803).

CONCLUSION

Recovery self-efficacy significantly interacted with time in shaping haemorrhagic stroke survivors' health-related quality of life recovery. Higher self-efficacy was associated with earlier improvements, while lower self-efficacy was associated with delayed but larger improvements of health-related quality of life levels, with effects diminishing by one year after stroke.

Dyadic effects of eHealth literacy on health-promoting behaviors in older adults with stroke and their family caregivers: The mediating role of self-efficacy

AIM

Health-promoting behaviors (HPB) are crucial for older adults with stroke and their family caregivers. This study aimed to explore the dyadic effects of eHealth literacy (eHL) on HPB among older adults with stroke and their family caregivers, as well as whether self-efficacy (SE) mediated this relationship.

METHODS

A cross-sectional approach was used to collect data from 293 survivor-caregiver dyads. Questionnaires measuring eHL, SE, and HPB were completed by participants. Data analysis was conducted using the actor-partner interdependence mediation model.

RESULTS

In terms of actor effects, eHL of both survivors and caregivers was positively associated with their HPB through their respective SE (survivor: β = 0.142, P < 0.001; caregiver: β = 0.167, P < 0.001). Regarding partner effects, caregivers' eHL was positively associated with survivors' HPB, with this relationship mediated by survivors' SE (β = 0.112, P < 0.001).

CONCLUSIONS

There were intrapersonal and interpersonal associations among eHL, SE, and HPB in older adults with stroke and their family caregivers. It suggested that eHL was positively related to HPB in dyads and revealed the potential mediating role of SE. It provides valuable guidance for dyadic interventions to enhance HPB and improve the overall well-being of older adults with stroke and their family caregivers.

Association between triglyceride glucose weight adjusted waist index and stroke risk in different glucose metabolism status

The triglyceride glucose-weight adjusted waist index (TyG-WWI) has emerged as a straightforward and reliable alternative for assessing insulin resistance (IR). However, the relationship between the TyG-WWI index and the incidence of stroke, especially in individuals with different glucose metabolism status, is still unclear. The data for this study was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The primary endpoint was the occurrence of stroke events. We utilized multivariate Cox proportional hazard models and restricted cubic spline (RCS) analysis to examine the relationship between the TyG-WWI index and the risk of stroke in individuals with different glycemic metabolic states. A total of 8895 participants were included in this study, 831 (9.3%) stroke events were recorded during the follow-up period. After fully adjusting for covariates, per SD increase in the TyG-WWI index was associated with a 11% increase in stroke risk (HR: 1.11, 95% CI 1.02, 1.20) in all participants. The TyG-WWI index was further categorized into quartiles, the adjusted HRs (95% CIs) for Q2, Q3, and Q4 compared to Q1 being 1.37 (95% CI 1.09, 1.72), 1.42 (95% CI 1.13, 1.78), and 1.50 (95% CI 1.17, 1.93), respectively. Furthermore, high levels of the TyG-WWI index were found to be linked to an increased risk of stroke in prediabetes mellitus (Pre-DM) participants across Cox models. However, this association was not observed in participants with normal glucose regulation (NGR) and diabetes mellitus (DM) (all P > 0.05). RCS analysis also demonstrated that higher baseline TyG-WWI index levels were associated with higher HRs for stroke in all participants and those with Pre-DM. The TyG-WWI index significantly associates with stroke risk in middle-aged and elderly Chinese populations. Moreover, this relationship exhibits distinct characteristics influenced by the individual's glucose metabolism status.

Association Between Estimated Glucose Disposal Rate and Stroke in Middle-Aged and Older Chinese Adults: A Nationwide Prospective Cohort Study

BACKGROUND

The estimated glucose disposal rate (eGDR) is recognized as a reliable marker of insulin resistance. However, the association between eGDR and the risk of stroke remains unclear.

METHODS AND RESULTS

A total of 13 706 middle-aged and older participants were enrolled from CHARLS (China Health and Retirement Longitudinal Study). The primary end point was the occurrence of stroke events. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between eGDR and the risk of stroke according to sex, age, and glycemic status. A total of 1101 stroke events were recorded. Our findings revealed a significant nonlinear relationship between eGDR and the occurrence of stroke. The association was similar between men (hazard ratio [HR], 0.83 [95% CI, 0.80-0.87]) and women (HR, 0.86 [95% CI, 0.80-0.87]), as well as among participants with normal glucose tolerance (HR, 0.83 [95% CI, 0.79-0.87]), prediabetes (HR, 0.85 [95% CI, 0.82-0.89]), and diabetes (HR, 0.87 [95% CI, 0.82-0.92]). However, the association was stronger in middle-aged participants (HR, 0.82 [95% CI, 0.78-0.86]) compared with older individuals (HR, 0.87 [95% CI, 0.83-0.90]; P for interaction=0.019).

CONCLUSIONS

This study demonstrates that lower eGDR levels are significantly linked to increased stroke risk. The relationship between eGDR and stroke risk was similar across different sexes and glycemic statuses and was stronger in middle-aged participants compared with older participants.

Global, Regional, and National Burden of Stroke on Children and Adolescents Aged Under 20 Years From 1990 to 2021, With Projections of Disability-Adjusted Life Year to 2050: A Comprehensive Demographic Analysis for the Global Burden of Disease Study 2021

BACKGROUND

Stroke in children is a global epidemic.

METHODS

Data on stroke, including incidence, DALYs, mortality, and associated risk factors from 1990 to 2021, were obtained from the Global Burden of Disease (GBD) study, 2021. Estimated annual percentage changes were calculated to evaluate changes in the age-standardized rates of incidence (ASIR), DALYs (ASDR), and mortality (ASMR), as well as trends by age, sex, and sociodemographic index (SDI). Projections of DALYs to 2050 were made.

RESULTS

In 2021, there were 310,133 incident stroke cases, accounting for 24,807 deaths and 2,414,655 DALYs among children and adolescents. The global ASIR, ASDR, and ASMR for stroke were 11.8, 93.9, and 1.0 per 100,000 population, respectively. Middle-to-low-SDI regions accounted for 81.6% of incident cases, 90.2% of DALYs, and 92.7% of deaths. A reversed V-shaped association was observed between SDI and ASRs. Children < 1 year had the highest ASRs, with rates generally decreasing with age, and the highest incidence of hemorrhagic stroke. Adolescents aged 15-19 years had the highest incidence of ischemic stroke. Non-optimal temperature contributed the most to the DALYs and death rates for stroke. By 2050, it is projected that 282,404 DALYs will be lost due to stroke.

CONCLUSIONS

Stroke burden varies by the GBD region, country, age, sex, and SDI. Despite declines in ASRs, stroke remains a significant burden, especially in middle-to-low-SDI regions, among children < 1 year, and among those with intracerebral hemorrhage. Non-optimal temperature emerges as the leading modifiable risk factor for children stroke; targeted interventions can prevent this.

Burden of neurological disorders in China and its provinces, 1990-2021: Findings from the global burden of disease study 2021

BACKGROUND

The burden of neurological disorders in China has not been systematically analyzed. We aim to provide a comprehensive estimation of the national and subnational neurological burden across China from the Global Burden of Disease Study (GBD) 2021.

METHODS

We assessed burden estimates for 16 neurological disorders by age, sex, and province from 1990 to 2021, with prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). We performed decomposition analysis to determine contributing factors for DALYs and used the socio-demographic index (SDI) to assess relations with development level.

FINDINGS

In 2021, there were 468.29 million prevalent cases of neurological disorders in China, corresponding to 78.10 million DALYs. Intracerebral hemorrhage was the leading cause of DALYs, followed by ischemic stroke, dementias, and migraine. DALYs of neurological disorders were higher in males than females, peaking at 70-74 years. From 1990 to 2021, the number and age-standardized rate of DALYs significantly decreased for idiopathic epilepsy and subarachnoid hemorrhage, primarily attributed to the reduction in YLLs, while the number of DALYs disproportionately increased for dementias, Parkinson's disease, and ischemic stroke contributed by population aging. The age-standardized DALY rates of seven neurological disorders had more than 5-fold variation between western and eastern provinces, despite reduced burdens with rising SDI.

CONCLUSIONS

Neurological disorders pose a large and growing burden on public health, primarily driven by population aging. Our findings could inform priority setting and targeted strategies to optimize neurological service delivery.

FUNDING

The funding information is presented in the acknowledgments.

Trends and burden of cardiovascular diseases among children and adolescents in China from 1990 to 2021

BACKGROUND AND AIM

There are currently no reports on the burden and trends of cardiovascular disease among children and adolescents in China. This study aims to investigate the burden and epidemiological characteristics of Cardiovascular Diseases (CVD) within the Chinese population by analyzing the trends and burden of CVD among children and adolescents of different genders and age groups in China from 1990 to 2021.

METHODS AND RESULTS

Utilizing data from the Global Burden of Diseases Study 2021, we estimated the incidence, mortality, and disability-adjusted life years (DALYs) associated with CVD among children and adolescents aged 0-19 years in China from 1990 to 2021. During this period, both the rate of death and exhibited a declining trend, while incidence rate showed a slowly declining trend. The incidence rate of CVD increased with age, especially in the population aged ≥5years. Various diseases demonstrated different the estimated annual percent change (EAPC) during 1990-2021 and almost all diseases had a decreasing trend. The ranking of incident cases, deaths and DALYs of CVD and changes indicated that stroke, rheumatic heart disease were the most important diseases.

CONCLUSIONS

Despite a consistent decline in the incidence, mortality, and DALY rates of CVD over the past three decades, children and adolescents in China continue to face substantial cardiovascular health challenges. We need to focus on CVD in children and adolescents continuously and develop health policies and practical strategies based on the current trends to address this health challenge.

Relationship between the hemoglobin-to-red cell distribution width ratio and post-stroke cognitive impairment: a prospective study

Background

Post-stroke cognitive impairment (PSCI) is one of the main complications after stroke. The association between the hemoglobin-to-red cell distribution width ratio (HRR) and PSCI remains inadequately explored. Consequently, we performed a prospective study to assess whether HRR levels are associated with changes in cognitive function after acute ischemic stroke (AIS).

Methods

A total of 296 AIS patients were recruited. HRR was measured within 24 h of admission, and cognitive function was assessed using the Mini-Mental State Examination (MMSE) one month post-onset. Logistic regression analysis was performed to identify independent risk and protective factors for the occurrence of PSCI. Restricted cubic splines (RCS) were used to explore the dose-response relationship between HRR and PSCI.

Results

129 of 296 participants (43.6%) developed cognitive impairment at 1 month. HRR in PSCI group was significantly lower than that in non-cognitive impairment group (P < 0.001). When HRR was taken as the categorical variable and with Q4 as the reference, the risk of PSCI in Q1 was the highest after adjusting multiple potential confounding factors (odds ratio [OR] = 2.702, 95% confidence interval [CI]= 1.222-5.977, P = 0.014). In addition, RCS curve exhibited that the relationship between HRR and PSCI was linear (P for nonlinear = 0.972, P for overall = 0.012). Subgroup analysis verified the stability of the results.

Conclusion

Reduced HRR levels were linked to an increased risk of cognitive impairment, indicating that HRR may serve as a predictive factor for PSCI.

Evaluating the visceral adiposity inflammatory index for enhanced stroke risk assessment

Stroke is a leading cause of global morbidity and mortality, with risk factors like visceral adiposity and inflammation playing significant roles. This study introduces the Visceral Adiposity Inflammatory Index (VAII), combining the Visceral Adiposity Index (VAI) and high-sensitivity C-reactive protein (CRP), to better predict stroke risk. Analyzing data from 8415 participants in the China Health and Retirement Longitudinal Study over 9 years, the study found that higher VAII levels were strongly associated with increased stroke incidence, with a hazard ratio of 1.91 for the highest quartile. VAII outperformed VAI and CRP alone in predictive accuracy, enhancing traditional risk models as shown by improved Net Reclassification Index and Integrated Discrimination Improvement Index. Furthermore, blood pressure and the triglyceride-glucose index were identified as mediators in the VAII-stroke relationship. These findings underscore VAII as a promising tool for stroke risk assessment, suggesting that public health interventions targeting VAII reduction could help mitigate stroke risk.

A bibliometric analysis of electroencephalogram research in stroke: current trends and future directions

Background

Electroencephalography (EEG) has become an indispensable tool in stroke research for real-time monitoring of neural activity, prognosis prediction, and rehabilitation support. In recent decades, EEG applications in stroke research have expanded, particularly in areas like brain-computer interfaces (BCI) and neurofeedback for motor recovery. However, a comprehensive analysis of research trends in this domain is currently unavailable.

Methods

The study collected data from the Web of Science Core Collection database, selecting publications related to stroke and EEG from 2005 to 2024. Visual analysis tools such as VOSviewer and CiteSpace were utilized to build knowledge maps of the research field, analyzing the distribution of publications, authors, institutions, journals, and collaboration networks. Additionally, co-occurrence, clustering, and burst detection of keywords were analyzed in detail.

Results

A total of 2,931 publications were identified, indicating a consistent increase in EEG research in stroke, with significant growth post-2017. The United States, China, and Germany emerged as the leading contributors, with high collaboration networks among Western institutions. Key research areas included signal processing advancements, EEG applications in seizure risk and consciousness disorder assessment, and EEG-driven rehabilitation techniques. Notably, recent studies have focused on integrating EEG with machine learning and multimodal data for more precise functional evaluations.

Conclusion

The findings reveal that EEG has evolved from a diagnostic tool to a therapeutic support platform in the context of stroke care. The advent of deep learning and multimodal integration has positioned EEG for expanded applications in personalized rehabilitation. It is recommended that future studies prioritize interdisciplinary collaboration and standardized EEG methodologies in order to facilitate clinical adoption and enhance translational potential in stroke management.

Current Snapshots on Stroke Prevention and Control and More Proactive National Strategies Against It in China

Background and Purpose

Stroke has become a major public health problem. This paper aims to briefly review the current epidemiological characteristics, preliminary achievements, and national action strategies related to stroke prevention and control in China.

Methods

English and Chinese literature were searched on stroke epidemiological characteristics and more proactive strategies for its prevention and control in China. Potential papers related to this topic were identified from PubMed, Medline, Embase, Cochrane Library, Wanfang Database, SINOMED, and China National Knowledge Infrastructure databases, as well as the annual reports and websites of the People's Daily, the State Council, and the National Health Commission of the People's Republic of China.

Results

Stroke has been ranked among the top three causes of death in China, and has become a public health problem endangering people's health. High rates of incidence, mortality, and disability bring a heavy burden to stroke patients, families, and society. With China's economic development, urbanization, and population aging, the prevalence and incidence of stroke are still rising. Although some progress has been made in specialized stroke prevention and treatment in China, there is still much room for improvement. Curbing increasing stroke due to increased prevalence and suboptimal control of risk factors and unhealthy lifestyles is no longer just the efforts of medical service institutions. It still requires a more proactive national strategy and general mobilization of the whole people. Increased prevalence of stroke, survivors' unfavorable outcomes, and suboptimal rehabilitation also need specialized stroke care and the perfect Hierarchical Medical System within the regional medical consortium in China.

Conclusions

The current situation of stroke prevention and treatment is still very serious in China. In the future, the stroke prevention and treatment model will change from passive stroke treatment and risk factor control to a more proactive prevention model of health factor management.

Burden of Urological Cancers in the Labour Force from 1990 to 2021 and Projections to 2050

BACKGROUND

Urological cancers represent an increasing public health concern in the labour force, mainly including prostate cancer (PCA), kidney cancer (KCA), testicular cancer (TCA), and bladder cancer (BLCA). Limited data exist on their occurrence, deaths, and disability-adjusted life years (DALYs). The objective of this study was to analyse three-decade trends in these cancers globally and forecast future patterns.

METHODS

The study used Global Burden of Disease 2021 data from 1990 to 2021 to evaluate urological cancer stats, including prevalence, incidence, mortality, and DALYs. For people aged 15-64 years, it was then manually age-standardized once. Herein, we employed a range of analytical techniques, including decomposition analysis, a Bayesian Age-Period-Cohort model, a Concentration index and slope index, and frontier analysis, to examine the trends in 204 countries and regions. Furthermore, the relationship between the Socio-Demographic Index (SDI) and the burden of disease is addressed.

RESULTS

Over the past 30 years, PCA, TCA, and KCA rates have risen among the global labour force population. North America, North Asia, and Europe have high incidence and mortality rates. TCA mortality and BLCA and TCA prevalence are expected to continue rising globally until 2050. Urological cancer impacts vary by region and development with more burden in areas with a higher SDI.

CONCLUSIONS

Urological cancers represent a substantial disease burden on labour force populations, emphasizing the imperative for targeted interventions and healthcare resources for affected populations. It is therefore crucial to have a comprehensive understanding of the global and regional epidemiological trends, as well as the findings of health economics studies.

Stroke attributed to kidney dysfunction from 1990 to 2021 and the prediction for 2040: an analysis of national data in China based on the Global Burden of Disease 2021 database

BACKGROUND

Stroke is the leading cause of permanent disability and death worldwide and the third leading cause of death in China, bringing a heavy disease and economic burden to the country. Notably, stroke mortality in China was significantly higher than the global level, highlighting the severity of the stroke problem in China. Kidney dysfunction has been associated with stroke risk, but the burden of stroke attributable to kidney dysfunction remains unclear. Our study aimed to systematically assess the burden of stroke and subtypes attributable to kidney dysfunction by analyzing the long-term trends from 1990 to 2021 in China, as well as making projections to 2040.

METHODS

Relevant data revealing burden estimates of stroke and subtypes attributed to kidney dysfunction were obtained from the Global Burden of Disease (GBD) 2021 database. To assess the burden of the disease, we appraised the age-standardized mortality rates (ASMRs) and age-standardized disability-adjusted life-year rates (ASDRs) by gender and stroke subtypes. Among them, kidney dysfunction-related stroke subtypes included ischemic stroke (IS) and intracerebral hemorrhage (ICH), while subarachnoid hemorrhage attributed to kidney dysfunction has an extremely low mortality and was therefore not included in the GBD database. Moreover, the average annual percentage change (AAPC) was applied to assess the overall trend from 1990 to 2021, and the effects of age, period, and birth cohort on stroke mortality due to kidney dysfunction were estimated using an age-period-cohort model. Furthermore, the Nordpred model was conducted to predict the mortality of kidney dysfunction related stroke and the subtypes for 2040 in China.

RESULTS

In China, the ASMRs of stroke attributed to kidney dysfunction decrease from 19.8 per 100,000 population in 1990 to 10.2 in 2021, with the AAPCs of -2.17 (confidence interval [CI], -2.50 to -1.84), and ASDRs declined from 393.0 in 1990 to 198.8 in 2021, with AAPCs of -2.22 (95% CI: -2.51 to -1.93). Regarding stroke subtypes, the ASMRs showed similar decrease trends from 6.9 to 4.9 for IS, and from 12.9 to 5.3 for ICH. The ASDRs were observed from 129.9 to 92.7 for IS, and from 263.1 to 106.2 for ICH. Moreover, the net and local drift curves indicated the proportion of stroke and IS mortality was rising among both younger (< 40-44 years) and older (> 70-74 years) age groups. Meanwhile, the proportion of ICH mortality increased in the age groups under 45-49 years old and over 80-84 years old. The longitudinal age curves revealed that stroke and subtypes mortality due to kidney dysfunction increased dramatically with age, particularly among the elderly. Significantly, men exhibited a higher mortality, while a more modest decline compared to women. Lastly, the projection modeling suggested that the ASMRs of kidney dysfunction-related stroke and the subtypes would continue to decline, and the kidney dysfunction-related ASMRs for IS would be higher than that for ICH by 2040 in China.

CONCLUSIONS

Kidney dysfunction was a significant contributor to stroke mortality in China, particularly in men and elderly. The downward trends suggested that the current prevention for stroke related to kidney dysfunction were effective. However, the ASMRs of IS associated with kidney dysfunction is expected to exceed that for ICH, highlighting further interventions to reduce the burden of IS in vulnerable populations.

TREK- 1 Ameliorates Secondary Brain Injury by Regulating Inflammatory Microenvironment via CX3 CL1-CX3 CR1 Pathway After Intracerebral Hemorrhage

Neuroinflammation plays a pivotal role in the pathogenesis of secondary brain injury (SBI) after intracerebral hemorrhage (ICH). TREK-1 is a background potassium channel, and its role in regulating neuroinflammation after ICH remains unclear. In this study, ICH models were induced in wide-type (WT) and TREK knockout mice via intra-striatal administration of collagenase. Additionally, WT ICH mice were treated with the TREK-1 agonist ML67-33. Immunofluorescence, western blot, quantitative real-time PCR, enzyme-linked immunosorbent assay, and RNA-sequencing were performed to determine the role and the mechanism of TREK-1 in regulating neuroinflammation after ICH. The results indicate that TREK-1 deficiency exacerbated microglia/macrophages activation and pro-inflammatory polarization, as well as the influx of inflammatory cytokines and peripheral inflammatory cells compared to WT ICH mice. Conversely, activation of TREK-1 attenuated the inflammatory response and SBI post-ICH. These effects may be mediated through the CX3CL1-CX3CR1 pathway, as validated by specific inhibitors AZD8797. This study identified TREK-1 as a crucial modulator in alleviating SBI by regulating the inflammatory microenvironment via the CX3CL1-CX3CR1 pathway.

Circulating Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Infection and Poststroke Fatigue Affecting Long-Term Neurological Outcomes in Stroke Patients

Background: Since peripheral leukocytes may contribute to the pathophysiology of stroke, the aim of this study was to elucidate the relationship between leukocytes and stroke outcomes and identify which leukocyte subtypes most accurately predict functional outcomes and poststroke fatigue (PSF) in stroke patients. Methods: A total of 788 ischemic stroke patients within 72 h of onset of disease were admitted in our study. Stroke-associated infection (SAI) and PSF were evaluated according to diagnosis standards by a special neurologist. Analyses were performed using SPSS 23.0 and GraphPad Prism 10.0. Results: Neutrophil-to-lymphocyte ratio (NLR) has discriminative power in predicting stroke outcome, and the area under the curve (AUC) of NLR to distinguish stroke outcomes was 0.689 (95% confidence interval, 0.646-0.732). Positive correlation was found between NLR levels and NIHSS score on admission (r = 0.2786, p < 0.001). Risk model for predicting stroke outcome was constructed using age, NIHSS, previous stroke history, triglycerides, glucose and hemoglobin levels, thrombolysis treatment, and NLR, with an AUC of 0.865. Patients who developed SAI and PSF both had significantly higher NLR levels at admission than those patients not diagnosed with SAI and PSF (p < 0.0001). A risk model was constructed to predict PSF based on parameters including age, NIHSS score, lipoprotein(a) and NLR, and an AUC of 0.751. Conclusions: Higher NLR levels in the acute phase of stroke might indicate a higher incidence of SAI and PSF. Therefore, higher NLR is associated with a poor stroke prognosis.

The value of the CRP-albumin-lymphocyte index (CALLY index) as a prognostic biomarker in acute ischemic stroke

This study aims to evaluate the predictive capability of CRP-albumin-lymphocyte (CALLY) index in relation to hemorrhagic transformation (HT) and functional outcome in acute ischemic stroke (AIS). A total of 439 AIS patients were included in this analysis. Multivariate logistic regression was conducted to examine the relationship between the CALLY index, HT, and functional outcomes. To address its non-linear association, a restricted cubic spline (RCS) model identified an optimal threshold for the CALLY index. Subgroup analyses further explored the association between the CALLY index and HT. The receiver operating characteristic (ROC) curve, the net reclassification index (NRI), and the integrated discrimination index (IDI) were used to assess and compare the predictive performance of the CALLY index with established models for HT. Furthermore, mediation analysis was performed to elucidate the causal pathways linking the CALLY index, HT, and functional outcomes. Among the participants, 9.79% (43/439) experienced HT, and 49.32% (182/369) encountered adverse outcomes. A higher CALLY index was associated with a lower risk of developing HT (OR 0.449, 95% CI 0.283-0.713) and poor outcome (OR 0.691, 95% CI 0.558-0.855). RCS curves demonstrated an increased risk of HT when the CALLY index fell below 1.188. Compared to existing HT prediction models, the CALLY index demonstrates superior predictive performance, with an AUC of 0.746. Furthermore, the CALLY index exhibits improved reclassification ability, as indicated by enhanced NRI and IDI values. The CALLY index independently predicts HT and adverse outcomes in AIS, demonstrating superior accuracy to existing risk scores and offering a practical biomarker for clinical prognosis.

Prevalence and network structure of depression and its association with quality of life among older stroke survivors: findings from a national survey in China

Background

Post-stroke depression (PSD) is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life (QoL). To date, few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.

Aims

This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.

Methods

This study was based on the 2017-2018 collection of data from a large national survey in China. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CESD), while QoL was measured with the World Health Organization Quality of Life-brief version. Network analysis was employed to explore the structure of PSD, using expected influence (EI) to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.

Results

A total of 1123 stroke survivors were included, with an overall prevalence of depression of 34.3% (n=385; 95% confidence interval 31.5% to 37.2%). A higher risk of PSD was significantly associated with limited activities of daily living (odds ratio (OR)=1.340; p=0.048), presence of heart diseases (OR=1.589; p=0.002) and more severe anxiety symptoms (OR=1.472; p<0.001). In the network model of depression, the most central symptoms were CESD3 ('feeling blue/depressed', EI: 1.180), CESD6 ('feeling nervous/fearful', EI: 0.864) and CESD8 ('loneliness', EI: 0.843). In addition, CESD5 ('hopelessness', EI: -0.195), CESD10 ('sleep disturbances', EI: -0.169) and CESD4 ('everything was an effort', EI: -0.150) had strong negative associations with QoL.

Conclusion

This study found that PSD was common among older Chinese stroke survivors. Given its negative impact on QoL, appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.

Decoding immune cell dynamics in ischemic stroke: insights from single-cell RNA sequencing analysis

Background

Ischemic stroke (IS) is a leading cause of adult disability worldwide. The inflammatory processes involved are complex, making it challenging to fully understand the pathological mechanisms of IS. Phagocytosis plays an important role in eliminating neurotoxic or damaged neurons resulting from inflammatory responses. This study employed bioinformatics methods to analyze single-cell RNA sequencing (scRNA-seq) data to investigate the cell types and molecular biological processes involved in IS.

Methods

scRNA-seq data for IS were obtained from the Gene Expression Omnibus (GEO). Following sample screening and reprocessing, 5,582 single cells were identified from healthy controls and patients with IS. Uniform manifold approximation and projection (UMAP) was utilized to further explore the cellular composition in IS. Functional enrichment analysis of differentially expressed genes was conducted to identify transcriptional regulators, whereas cell developmental trajectories were predicted to uncover potential cell fate decisions. iTALK was employed to identify potential ligand-receptor axes within the cell-type immune microenvironment of IS.

Results

Based on scRNA-seq data analysis, we identified four cell types and their associated subclusters, along with genes exhibiting significant differential expression within these subclusters. Phagocytosis was significantly enriched in cell types linked to IS, while the differentiation trajectories of subpopulations in IS was different. Additionally, multiple receptor-ligand axes were identified, indicating diverse interactions within the immune microenvironment of IS.

Conclusion

This study demonstrated that phagocytosis in IS cell types critically influences disease progression. It also predicted the trajectories of infarct cells. These findings provide valuable insights into the molecular and cellular mechanisms underlying IS and highlight potential pathways for therapeutic intervention.

Interactive Effect of Air Temperature and Fine Particulate Matter on the Hospital Admissions for Stroke in Shenzhen, China

BACKGROUND

Stroke is a major health challenge in China. Numerous studies have linked stroke with temperature and fine particulate matter (PM2.5), but findings varied by stroke subtypes and regions, and few explored the interactive effects of air temperature and PM2.5. This study examines the association between air temperature, PM2.5, and stroke hospital admissions in Shenzhen, a subtropical monsoon city in southern China.

METHODS AND RESULTS

We applied time-series generalized additive models to estimate the individual and interactive effects of air temperature and PM2.5 on stroke hospital admissions using daily records from 2015 to 2016. Subgroup analysis by sex, age, and education level was conducted, assessing admissions for hemorrhagic (n=8752) and ischemic (n=33 233) stroke separately. For hemorrhagic stroke, a 1 °C increase in temperature was significantly associated with a 2.3% (95% CI, -3.2% to -1.3%) decrease in hospital admissions, whereas higher levels of PM2.5 indicated an increased risk, though not significant. Conversely, for ischemic stroke, a 1 °C rise was significantly associated with a 1.0% (95% CI, 0.4%-1.6%) increase in admissions. The impact PM2.5 on stroke was more pronounced at higher concentrations, while showing no evident effects at lower levels. Interaction effects between temperature and PM2.5 were statistically significant for both stroke types, with stronger effects observed at 10 to 20 °C and PM2.5 concentration around 80 to 100 μg/m3.

CONCLUSIONS

This study suggests lower air temperature may increase hemorrhagic stroke risk, whereas higher temperature and higher PM2.5 exposure may increase ischemic stroke risk. Interactive effects between temperature and PM2.5 were observed for both stroke types in Shenzhen.

Neurotoxic effects of aluminum and manganese: From molecular to clinical effects

The existing data demonstrate that aluminum (Al) and manganese (Mn) possess neurotoxic effects upon overexposure due to induction of neuronal oxidative stress and apoptosis, synaptic dysfunction and neurotransmitter metabolism, neuroinflammation, and cytoskeletal pathology. However, systematic evidence regarding contribution of these metals to development of neurological diseases are lacking. Therefore, in this review we provide a summary of the existing data on contribution of Al and Mn exposure to brain diseases and its symptoms. Causal relations were demonstrated for development of parkinsonism upon exposure to high doses of Mn, whereas Al overload is considered the key contributor to dialysis encephalopathy. Certain studies demonstrate that Al and Mn overexposure is associated with neurodegenerative diseases including Alzheimer's and Parkinson's diseases, as well as neurodevelopmental disorders like autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Although laboratory studies demonstrate the potential contribution of Al and Mn to molecular pathogenesis of these diseases, clinical findings supporting the causal role of metals is these pathologies are yet insufficient. Therefore, estimation of the contribution of these metals to neurological disorders is essential for development of more effective early diagnostics and prevention of diseases under exposure to adverse neurological effects of Al and Mn compounds.

Relationship between De Ritis and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage: Insights from the LongTEAM registry

Elevated aspartate aminotransferase-to-alanine aminotransferase ratio (De Ritis) has been associated with cardiovascular diseases and mortality. The clinical significance of De Ritis in the prognosis of hemorrhagic stroke has yet to be established. We aimed to investigate the associations between De Ritis levels and clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH). We retrospectively reviewed all aSAH patients admitted to their institution between January 2015 and September 2022 in the LongTEAM registry. Patients with aSAH were divided into four groups by quartiles of De Ritis, and two groups according to De Ritis < 1 and De Ritis ≥ 1. The functional outcomes at discharge and 90 days after discharge were assessed using the modified Rankin Scale (mRS). Multivariable logistic regression for poor functional outcome (mRS 3-6 and mRS 4-6) and in-hospital complications were adopted to explore the associations between De Ritis and clinical outcomes. Furthermore, restricted cubic spline models were used to assess the dose-response relationships between De Ritis and clinical outcomes. A total of 1,098 aSAH patients were included. The median De Ritis was 1.20 (interquartile range [IQR], 0.98-1.58). After adjusting for all the potential covariates and compared with those in the reference quartile, patients in the Q2 (0.89 to < 1.20) had a lower risk of unfavorable functional outcome (both mRS 3-6 and mRS 4-6) at discharge assessment (OR 0.623, 95% CI 0.408-0.951; OR 0.547, 95% CI 0.318-0.943 respectively), patients in the Q2 had a higher risk of MACE (OR 1.550, 95% CI 1.039-2.312), Q3 (1.20 to < 1.58) a higher risk of DCI (OR 1.569, 95%CI 1.047-2.353), and Q4 (≥ 1.58) with a higher risk of anemia (OR 1.662, 95%CI 1.092-2.530). Furthermore, patients with higher levels of De Ritis had lower risk of hepatic function (Q2, Q3, and Q4) and disorder of lipoprotein metabolism (Q3 and Q4) in fully-adjusted models. Restricted cubic spline models showed a non-linear associations between De Ritis levels and risk of mRS 4-6 at discharge assessment, MACE, abnormal hepatic function, anemia and disorders of lipoprotein metabolism. There was no significant difference between the TAPS model (AUC: 0.801) and the TAPS plus De Ritis index model (AUC: 0.801) (P = 0.345). No improvement was observed (net reclassification improvement [NRI]: 0.0022 [-0.0409-0.0384], P = 0.9457; integrated discrimination improvement [IDI]: 0.0183 [-0.0008-0.0007], P = 0.8522). Similar associations were also observed when De Ritis ≥ 1 compared with De Ritis < 1. Similar findings were robust after excluding participants with De Ritis > 2. We speculated that elevated De Ritis was associated with higher risk of unfavorable functional outcome at discharge, MACE, DCI and anemia. Given that postoperative De Ritis levels could help to identify high-risk patients with aSAH, these findings are of clinical relevance.

Efficacy and Safety of Early Use of Naoxueshu Within 72 hours in the Treatment of Spontaneous Intracerebral Hemorrhage: A Real-World Retrospective Cohort Study

Background

Naoxueshu Oral Liquid (NXS) is the only traditional Chinese medicine approved for the treatment of spontaneous intracerebral hemorrhage (ICH). While randomized controlled trials have demonstrated its ability to promote hematoma absorption and improve neurological function prognosis, the efficacy and safety of NXS early use (within 72 hours) remain unclear. This study aims to evaluate the efficacy and safety of early NXS administration (within 72 hours) in a real-world setting.

Methods

Data were collected from 34 tertiary hospitals in China. Patients were enrolled from March 25, 2019 to December 31, 2023. NXS administration was defined as the exposure. The primary outcome was hematoma volume at 14 days after onset. We employed the 1:1 propensity score matching (PSM) method to deal with confounding factors.

Results

A total of 1602 patients were enrolled after PSM, including 872 NXS users (exposed group) and 730 non-NXS users (control group). At baseline, there was no significant difference in hematoma volumes between the two groups (21.46±19.47 vs 22.01±14.26mL, P=0.55), the NXS group showed significantly less hematoma volume by day 14 (6.87±8.62 vs 5.43±5.35mL, P<0.001). There was no statistically significant difference in the incidence rate of serious adverse events between the two groups. Subgroup analysis indicated that NXS might have a more pronounced effect on hematoma absorption in supratentorial hemorrhage patients, with earlier administration potentially enhancing efficacy.

Conclusion

This retrospective study explored the efficacy and safety of NXS in promoting hematoma absorption within 72 hours in real-world ICH patients, but its effect on short-term neurological improvement remains inconclusive. Further studies with longer follow-up periods and more comprehensive functional assessments are warranted to explore the long-term neurological benefits of NXS in ICH patients.

Metabolic diseases in the East Asian populations

East Asian populations, which account for approximately 20% of the global population, have become central to the worldwide rise of metabolic diseases over the past few decades. The prevalence of metabolic disorders, including type 2 diabetes mellitus, hypertension and metabolic dysfunction-associated steatotic liver disease, has escalated sharply, contributing to a substantial burden of complications such as cardiovascular disease, chronic kidney disease, cancer and increased mortality. This concerning trend is primarily driven by a combination of genetic predisposition, unique fat distribution patterns and rapidly changing lifestyle factors, including urbanization and the adoption of Westernized dietary habits. Current advances in genomics, proteomics, metabolomics and microbiome research have provided new insights into the biological mechanisms that might contribute to the heightened susceptibility of East Asian populations to metabolic diseases. This Review synthesizes epidemiological data, risk factors and biomarkers to provide an overview of how metabolic diseases are reshaping public health in East Asia and offers insights into biological and societal drivers to guide effective, region-specific strategies.

Exploration of the shared gene signatures and molecular mechanisms between cardioembolic stroke and ischemic stroke

Introduction

This study aimed to investigate the shared molecular mechanisms underlying cardioembolic stroke (CS) and ischemic stroke (IS) using integrated bioinformatics analysis.

Methods

Microarray datasets for the CS (GSE58294, blood samples from CS and controls) and IS (GSE16561, blood from IS and controls; GSE22255, peripheral blood mononuclear cells from IS and matched controls) were acquired from the Gene Expression Omnibus database. Differential expression analysis and weighted gene co-expression network analysis were utilized to identify shared genes between the two diseases. Protein-protein interaction (PPI) network and topology analyses were conducted to identify the core shared genes. Three machine learning algorithms were employed to detect biomarkers from the core shared genes, and the diagnostic value of the hub genes was evaluated by establishing a predictive nomogram. Immune infiltration was evaluated using single-sample gene set enrichment analysis (ssGSEA), and pathways were analyzed with gene set enrichment analysis.

Results

There were 125 shared up-regulated genes and 2 shared down-regulated between CS and IS, which were mainly involved in immune inflammatory response-related biological functions. The Maximum Clique Centrality algorithm identified 25 core shared genes in the PPI network constructed using the shared genes. ABCA1, CLEC4E, and IRS2 were identified as biomarkers for both CS and IS and performed well in predicting the onset risk of CS and IS. All three biomarkers were highly expressed in both CS and IS compared to their corresponding controls. These biomarkers significantly correlated with neutrophil infiltration and autophagy activation in both CS and IS. Particularly, all three biomarkers were associated with the activation of neutrophil extracellular trap formation, but only in the IS.

Conclusion

ABCA1, CLEC4E, and IRS2 were identified as potential key biomarkers and therapeutic targets for CS and IS. Autophagy and neutrophil infiltration may represent the common mechanisms linking these two diseases.

Argatroban in patients with acute ischemic stroke with early neurological deterioration: a cost-effectiveness analysis from the perspective of Chinese healthcare system

Background and Objective

Studies have shown that argatroban improves 90-day functional outcomes in patients with acute ischemic stroke (AIS) with early neurological deterioration (END). However, its cost-effectiveness in this patient population remains unclear.

Methods

A combination of a short-term decision tree and a long-term Markov model was developed to calculate the total cost and effectiveness for Chinese patients with AIS with END treated with intravenous argatroban plus standard therapy or standard therapy alone. Cost data were accessed from our institution, the China National Stroke Registry, and other public sources, while effectiveness data were obtained from the EASE trial and the China Health Statistical Yearbook 2022. The primary outcome was the incremental cost-effectiveness ratio (ICER), with secondary outcomes including total cost, total effectiveness, and incremental effectiveness. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were performed to assess certainty, uncertainty, and robustness.

Results

For Chinese patients with AIS with END, treatment combining argatroban with standard therapy resulted in a lifetime cost of 138,812 Chinese Yuan (CNY), compared to 136,353 CNY for standard therapy alone. The combined treatment achieved 4.19 quality-adjusted life years (QALYs) (equivalent to 8.43 life years), while standard therapy yielded 3.78 QALYs (equivalent to 8.17 life years). This led to an ICER of 5968 CNY per QALY (9367 CNY per life year), below the willingness-to-pay threshold. One-way sensitivity analysis indicated that argatroban's efficacy was the primary driver of the ICER, consistently remaining below the threshold. PSA showed that argatroban was highly cost-effective in over 99% of cases and dominant in 0.54% of cases. Scenario analysis confirmed the robustness of these findings across various scenarios.

Conclusion

Argatroban is highly cost-effective for Chinese patients with AIS and END from the perspective of the Chinese healthcare system.

Electrolyte Levels in Poor Prognosis and Early Neurological Deterioration in Patients With Acute Ischemic Stroke

Discrepancies in serum electrolyte levels have been observed between stroke patients and healthy individuals. Previous studies have indicated an association between electrolytes and all-cause mortality as well as cardiovascular events in stroke patients. However, there still lacks comprehensive analysis on the connection between electrolytes and negative outcomes in hypertensive individuals with early neurological deterioration (END). Totally 1341 patients treated with thrombolysis for acute ischemic stroke at the First Affiliated Hospital of Wenzhou Medical University were included. Outcomes included END, 3-month, 6-month, and 1-year poor prognosis. Logistic regression assessed the correlation and restricted cubic spline analysis examined dose-response relationships. Subgroup analysis validated the relationship between electrolytes and prognosis in hypertensive patients. A total of 242 patients exhibited a 3-month poor prognosis. Significant differences were observed in Cl-, Ca2+, and Mg2+ levels between mRS binary classification. Logistic regression identified Cl- as the strongest predictor for 3-month, 6-month, and 1-year mRS score and Ca2+ for END. Restricted cubic spline analysis revealed relationships between higher concentrations of Na+ and poorer prognosis. In the hypertension subgroup, a higher concentration of Na+ indicated worse 6-month and 1-year outcomes and a lower concentration of Ca2+ was linked to a higher risk of END. The concentration of Na+ is related to adverse clinical outcomes, while that of Cl- and Ca2+ are associated with END. Among hypertensive patients, elevated levels of Na+ and Ca2+ concentration are respectively associated with 6-month poor prognosis and END. Monitoring the electrolytes may promote the early identification of individuals at high risk of poor functional outcomes.

Steatotic Liver Disease Prevalence in China: A Population-Based Study and Meta-Analysis of 17.4 Million Individuals

BACKGROUND

Steatotic liver disease (SLD), including metabolic dysfunction-associated SLD (MASLD), has emerged as a leading cause of chronic liver disease in China.

AIMS

We aimed to provide a comprehensive and updated description of SLD prevalence in China.

METHODS

We described the prevalence, subgroup distribution, and clinical characteristics of SLD in the Taizhou Study of Liver Diseases (T-SOLID). Additionally, we searched for studies reporting SLD prevalence in five databases. Eligible data were analysed using a generalised linear mixed model. Linear regression was applied to estimate the annual average percentage change (AAPC).

RESULTS

Of the 28,623 participants in T-SOLID, 30.8% were diagnosed with SLD, among which 83.8% were classified as MASLD. Prevalence of SLD increased from 22.1% in 2018 to 36.7% in 2021. The meta-analysis included 792 publications and 17,404,296 subjects. Nationwide, the pooled SLD prevalence rose from 23.8% (95% CI 21.9%-25.9%) during 2001-2010 to 27.9% (26.0%-29.8%) during 2016-2023 in the general population (AAPC = 2.56, p < 0.0001), equating to approximately 402.0 million cases. An increase in SLD prevalence was observed in subpopulations by region, sex, and age, and in high-risk groups. Northeast China had the highest prevalence (35.0%). Males had a higher prevalence rate than females (35.0% vs. 20.6%). SLD prevalence increased with age, ranging from 8.1% in children and adolescents to 31.8% in the elderly. Meta-regression identified calendar period, age, sex, geographical area, and residence area as significant determinants of SLD prevalence.

CONCLUSION

The ubiquitously rising prevalence of SLD in Chinese populations underscores the urgent need for targeted public health interventions.

Sex-Specific Impact of Serum Calcium Levels on Acute Coronary Syndrome Risk: A 19-Year Cohort Study in Korea

Background: This study aims to investigate the association between serum calcium levels and acute coronary syndrome (ACS) risk, examining whether this relationship differs by sex, given the known differences in calcium metabolism and hormonal influences between males and females. Methods: Utilizing the Korean Genome Epidemiology Study (KoGES) prospective cohort data, our primary exposure variables were serum calcium level and sex. The incidence of ACS served as the main outcome of interest. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression analysis. An interaction analysis was conducted to assess the interaction effect of calcium level and sex on ACS incidence. Results: After adjusting for confounding variables, high calcium intake did not significantly increase ACS incidence, with a hazard ratio (HR) of 1.07 (95% CI: 0.90-1.26). There was also no significant difference in ACS risk between females and males (HR: 0.81, 95% CI: 0.61-1.04). However, interaction effect analysis revealed that higher calcium levels were associated with an increased risk of ACS only in females (HR: 1.24, 95% CI: 1.07-1.58), whereas the association in males was not statistically significant (HR: 0.90, 95% CI: 0.71-1.15). Conclusion: Our study results indicate that elevated serum calcium levels alone did not independently increase the risk of ACS; however, high serum calcium levels were associated with an increased risk of ACS in females but not in males, underscoring the importance of sex-specific factors in assessing and managing ACS risk and highlighting the necessity for personalized medical approaches to improve cardiovascular health outcomes for women.

Pharmacogenetics polygenic response score predicts outcomes in aspirin-treated stroke patients

Background

Aspirin is a cornerstone medication for acute ischemic stroke (AIS), but its efficacy varies significantly among individuals. This study aimed to develop a pharmacogenetic polygenic response score (PgxRS) to predict the incidence of adverse outcomes in aspirin-treated AIS patients.

Methods

We conducted a retrospective study involving 828 AIS patients who received aspirin therapy. Fifteen candidate single nucleotide variants (SNPs) in genes related to aspirin's mechanism of action, transport, metabolism, and platelet function were genotyped. The association between SNPs and the risk of unfavorable prognosis (defined as modified Rankin Scale score >1 at 90 days) was assessed using logistic regression analysis. Multivariable models incorporating SNPs and clinical factors were developed to predict adverse outcomes.

Results

The rs1045642GG genotype in the ABCB1 gene was significantly associated with a lower risk of unfavorable prognosis, while the rs1371097T allele in the P2Y1 gene was linked to a higher risk. A prediction model incorporating these two SNPs along with clinical variables demonstrated moderate diagnostic accuracy for predicting unfavorable prognosis (AUC = 0.78, 95% CI: 0.74-0.81).

Conclusion

Our findings suggest that rs1045642 and rs1371097 genotypes contribute to variability in aspirin response among AIS patients. The developed PgxRS, incorporating these SNPs and clinical factors, can potentially aid in risk stratification and guide personalized antiplatelet therapy decisions. However, further validation in larger, diverse cohorts is warranted.

Association between bone mineral density and stroke: a meta-analysis

Objective

The correlation between bone mineral density (BMD) and stroke remains inconsistent. This study aims to determine whether a reduction in BMD is associated with an increased risk of stroke.

Methods

We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews through January 2025 to identify cohort studies with follow-up that reported the influence of a reduction in BMD or low BMD status on the risk of any type of stroke. Pooled analyses were performed using random-effects models.

Results

This study included 13 studies with 146,758 individuals. A 1 SD reduction in BMD was associated with an increased risk of stroke (eight studies; RR, 1.24; 95% CI, 1.09-1.40; p < 0.001; I2 = 87%). Subgroup analysis showed that a per SD reduction in BMD was associated with incident stroke in female persons (eight studies; RR, 1.28; 95% CI, 1.09-1.51; p = 0.002; I2 = 87%), but not in male persons (four studies; RR, 1.04; 95% CI, 0.99-1.10; p = 0.15; I2 = 0%). People with osteoporosis or osteopenia had an increased risk of incident stroke (six studies; RR, 1.59; 95% CI, 1.22-2.08; p < 0.001; I2 = 92%), as well as male persons (two studies; RR, 3.16; 95% CI, 1.96-5.12; p < 0.001; I2 = 35%). Sensitivity analysis showed that the results were stable.

Conclusion

Reduction in BMD is associated with a significantly increased risk of stroke. Female individuals have a higher risk than male persons.

Association between C-reactive protein-triglyceride glucose index and stroke risk in different glycemic status: insights from the China Health and Retirement Longitudinal Study (CHARLS)

OBJECTIVE

C-reactive protein-triglyceride-glucose index (CTI) has been proposed as a novel biomarker for insulin resistance and inflammation. However, the association between CTI and the risk of stroke, particularly in individuals with different glycemic status, remains unclear.

METHODS

A total of 10,443 middle-aged and elderly participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS). The primary endpoint was the occurrence of stroke events. The CTI was calculated using the formula 0.412* Ln (CRP [mg/L]) + Ln (TG [mg/dl] × FPG [mg/dl])/2. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between CTI and the risk of stroke according to gender, age and glycemic status.

RESULTS

During a median follow-up of 9 years, 960 (9.2%) participants experienced a stroke. Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association was similar between male and female, despite the HR tended to be higher in females (HR 1.22, 95% CI 1.09, 1.36) than males (HR 1.15, 95% CI 1.02, 1.29), and similar in middle-aged (HR 1.25, 95% CI 1.11, 1.41) and elderly participants (HR 1.12, 95% CI 1.00, 1.26). In different glycemic status, high levels of CTI were found to be linked to an increased risk of stroke in individuals with normal glucose regulation (NGR) (HR 1.33, 95% CI 1.11, 1.59) and prediabetes mellitus (Pre-DM) (HR 1.20, 95% CI 1.04, 1.39). However, this association was not observed in individuals with diabetes mellitus (DM).

CONCLUSIONS

Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association between CTI and stroke was similar between male and female, and similar in middle-aged and elderly participants. In different glycemic status, the association was significant in individuals with NGR and Pre-DM.

Mediation Role of Behavioral Decision-Making Between Self-Efficacy and Self-Management Among Elderly Stroke Survivors in China: Cross-Sectional Study

Background: Identifying the factors that impact self-management is crucial, as elderly stroke survivors frequently face challenges in self-management. Self-efficacy and behavioral decision-making are reported as influencing factors of self-management, but their relationship within the elderly population remains unconfirmed. This study aimed to explore whether self-efficacy impacts self-management through the mediating role of behavioral decision-making among elderly stroke survivors. Methods: A cross-sectional design and convenience sampling method were used in this study. A total of 291 elderly stroke survivors were recruited from a tertiary hospital in Henan Province, China, between March and July of 2024. Questionnaires were distributed to collect sociodemographic, self-efficacy, behavioral decision-making, and self-management data. A path analysis and correlation analysis were used to analyze the data. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Elderly stroke survivors reported having a moderate level of self-management. There was a positive correlation between self-efficacy, behavioral decision-making, and self-management (all p < 0.01). The mediation model indicated that behavioral decision-making mediated the association of self-efficacy and self-management in the regression model (95% CI 0.03 to 0.14), and the effect value was 0.08. It was also confirmed that behavioral decision-making mediated the impact of self-efficacy and self-management, accounting for 25.81% of the total effect. Conclusion: Self-efficacy is not solely a key factor influencing self-management in elderly stroke survivors, but it also improves their self-management behaviors by facilitating behavioral decision-making. As a result, healthcare professionals should consider self-efficacy and behavioral decision-making as crucial elements for assessing elderly stroke survivors during discharge and follow-up.

Associations between short-term exposure to fine particulate matter with ischemic stroke mortality and the role of green space: a time-series study in Zibo, China

Background

Previous studies on associations between short-term exposure to fine particulate matter (PM2.5) and ischemic stroke (IS) mortality reported inconclusive results. Additionally, whether and how PM2.5 and green space interact to precipitate IS deaths remains unclear. We aimed to examine the impacts of short-term exposure to PM2.5 on IS mortality and the role of green space in the association.

Methods

We collected data on daily IS deaths, daily PM2.5 concentrations, and monthly normalized difference vegetation index (NDVI) in Zibo City from 2015 to 2019. Generalised additive models were adopted to investigate the short-term impacts of PM2.5 on IS mortality, and subgroup analyses were used to examine effect modification by population characteristics. Stratified analyses by green space levels and joint effect model were conducted to test the interactions of PM2.5 and green space on IS mortality.

Results

A total of 10 799 IS deaths were included in our study. Exposure to PM2.5 was associated with an increased risk of IS mortality, with odds ratios (ORs) of 1.0263 (95% confidence interval (CI) = 1.0017, 1.0516) for each interquartile range (IQR) increase in PM2.5 on lag0 and 1.0317 (95% CI = 1.0016, 1.0627) on lag01. The links between PM2.5 and IS mortality were not significantly different across genders, ages, or PM2.5 zones. Furthermore, our results showed that the effects of PM2.5 on IS mortality were higher in low levels of green space. Specifically, for each IQR increase in PM2.5, the ORs (95% CIs) of IS death in the low level and the high level of NDVI were 1.0287 (95% CI = 1.0019, 1.0563) and 0.9934 (95% CI = 0.9296, 1.0615), respectively. In addition, PM2.5 and NDVI exhibited significant interactive effects on IS mortality, with relative excess odds due to interaction (REOI) of greater than 0.

Conclusions

Our findings showed that PM2.5 was significantly associated with increasing odds of IS mortality. Furthermore, there were synergetic impacts between PM2.5 and lack of greenness on IS mortality. Our results suggest that expanding green spaces, such as increasing park coverage and street greening, along with regulating industrial emissions to reduce PM2.5 levels, can help prevent premature deaths from IS.

Effect of tirofiban arterial injection on neurological and endothelial function in acute ischemic stroke patients beyond the thrombolysis time window

OBJECTIVE

To evaluate the efficacy and safety of arterial tirofiban injection in patients with acute ischemic stroke (AIS) beyond the thrombolysis time window.

METHODS

In this retrospective single-center study, clinical data were analyzed from 230 AIS patients treated at the First Hospital of Yulin between July 2021 and January 2023. Patients were divided into two groups: the observation group (n=102) treated with tirofiban combined with dual antiplatelet therapy, and the control group (n=128) that received dual antiplatelet therapy alone. Post-treatment follow-up evaluated neurological function, endothelial function, and safety using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI). Endothelial function was assessed by measuring levels of endothelin-1 (ET-1), nitric oxide (NO), and von Willebrand factor (vWF). Baseline characteristics, treatment protocols, and complications were analyzed to ensure the reliability and scientific rigor of the results.

RESULTS

Compared to the control group, the observation group demonstrated significant improvements in NIHSS, mRS, and BI scores, indicating enhanced neurological function and self-care ability. Endothelial markers (ET-1, NO, and vWF) also significantly improved in the observation group, suggesting a beneficial effect on endothelial function. The overall efficacy rate at 90 days was 86.72% in the observation group, significantly higher than the 74.50% in the control group (P<0.05). In terms of safety, there were no significant differences in the incidence of adverse events between the two groups, indicating that tirofiban is well-tolerated. Multivariate analysis identified age, treatment protocol, and baseline NO levels as independent factors affecting the 90-day prognosis, underscoring the importance of individualized treatment strategies for AIS patients.

CONCLUSION

Arterial injection of tirofiban significantly improves neurological and endothelial function in AIS patients beyond the thrombolysis time window while maintaining a favorable safety profile. These findings support the use of tirofiban in patients who are ineligible for intravenous thrombolysis or endovascular treatment.

Temporal trends of ischemic stroke attributable to diet high in sodium in China from the global burden of disease study 2021

Background

Ischemic stroke is a significant global health burden, with high sodium intake recognized as a key risk factor. This study aimed to assess the disease burden of ischemic stroke attributable to diet high in sodium in China from 1990 to 2021. Additionally, we analyzed the influence of age, period, and cohort effects on the trends in ischemic stroke burden and projected the disease burden from 2022 to 2036.

Methods

Data from the Global Burden of Disease Study 2021 (GBD 2021) were used to analyze the ischemic stroke burden among high-risk populations in China. Annual average percent change (AAPC) was calculated using Joinpoint regression models to evaluate trends in ischemic stroke burden from 1990 to 2021. Age-period-cohort models were employed to estimate the independent effects of age, period, and cohort on the ischemic stroke burden, and to project the burden from 2022 to 2036 using Bayesian age-period-cohort models.

Results

From 1990 to 2021, ischemic stroke mortality attributable to diet high in sodium in China showed a continuous increase, while the age-standardized mortality and disability-adjusted life years (DALYs) significantly declined. In the age-period-cohort analysis, the age effect on ischemic stroke burden increased steadily over the study period. Period effects revealed an initial decline in the relative risk (RR) of ischemic stroke mortality and DALY rates, followed by an increase in cohorts born before 2004-2009, and a gradual decline in cohorts born after that period. Cohort effects demonstrated a continuous decline in the relative risk of ischemic stroke mortality and DALY rates from 1990 to 2021.

Conclusion

This study found that ischemic stroke attributable to a diet high in sodium in China fluctuated from 1990 to 2021, with a declining trend observed in recent years. Projections indicate that this downward trend will continue. Age and birth period are key factors influencing the disease burden, with older adults and men being particularly affected. Future policy efforts should focus on enhancing health management in high-risk populations to further reduce the burden of ischemic stroke linked to high sodium intake.

The immunomodulatory effects of GLP-1 receptor agonists in neurogenerative diseases and ischemic stroke treatment

Glucagon-like peptide-1 (GLP-1) receptor is widely distributed in the digestive system, cardiovascular system, adipose tissue and central nervous system. Numerous GLP-1 receptor-targeting drugs have been investigated in clinical studies for various indications, including type 2 diabetes and obesity (accounts for 70% of the total studies), non-alcoholic steatohepatitis, Alzheimer's disease, and Parkinson's disease. This review presented fundamental information regarding two categories of GLP-1 receptor agonists (GLP-1RAs): peptide-based and small molecule compounds, and elaborated their potential neuroprotective effects by inhibiting neuroinflammation, reducing neuronal apoptosis, and ultimately improving cognitive function in various neurodegenerative diseases. As a new hypoglycemic drug, GLP-1RA has a unique role in reducing the concurrent risk of stroke in T2D patients. Given the infiltration of various peripheral immune cells into brain tissue, particularly in the areas surrounding the infarct lesion, we further investigated the potential immune regulatory mechanisms. GLP-1RA could not only facilitate the M2 polarization of microglia through both direct and indirect pathways, but also modulate the quantity and function of T cell subtypes, including CD4, CD8, and regulatory T cells, resulting into the inhibition of inflammatory responses and the promotion of neuronal regeneration through interleukin-10 secretion. Therefore, we believe that the "Tregs-microglia-neuron/neural precursor cells" axis is instrumental in mediating immune suppression and neuroprotection in the context of ischemic stroke. Given the benefits of rapid diffusion, favorable blood-brain barrier permeability and versatile administration routes, these small molecule compounds will be one of the important candidates of GLP-1RA. We look forward to the further clinical evidence of small molecule GLP-1RA intervention in ischemic stroke or T2D complicated by ischemic stroke.

Socioeconomic variations in the proportions of stroke attributable to reproductive profiles among postmenopausal women in China

BACKGROUND

This prospective study aimed to examine the individual and combined population attributable fractions (PAFs) of stroke and its subtypes associated with reproductive factors among Chinese postmenopausal women, highlighting variations across socioeconomic status (SES) stratas.

METHODS

Data were from 138,873 Chinese postmenopausal women enrolled in the China Kadoorie Biobank. Reproductive factors evaluated in this study included early age at menarche, early age at menopause, advanced age at first live birth, high parity, history of stillbirth, history of miscarriage or termination, and non-lactation. PAFs were calculated using hazard ratios, estimated using Cox proportional hazard regression, and prevalence of the seven reproductive factors. PAF for each reproductive risk factor and combined PAFs for all factors were estimated in total population and across SES classes.

RESULTS

Of the 138,873 included participants, 17,042 developed strokes during a median follow-up period of 8.9 years. Across SES classes, the greatest attributable fractions of total stroke cases were observed for high parity among low-SES women (PAF 17.2%, 95% confidence interval [CI] 13.7%, 20.6%), history of miscarriage or termination among medium-SES women (PAF 11.4%, 95% CI 8.2%, 14.5%), and no history of lactation among high-SES women (PAF 3.1%, 95% CI 1.7%, 4.9%). A multiplicatively estimated 20.5% (95% CI 20.4%, 20.5%) and 3.1% (95% CI 1.7%, 4.9%) of stroke cases were attributable to the seven reproductive risk factors in low-SES and high-SES women, respectively.

CONCLUSIONS

A large fraction of stroke cases among Chinese postmenopausal women were associated with reproductive factors. Targeted cardiovascular prevention strategies are warranted among women with different SES to mitigate risks associated with different reproductive profiles.

Tenecteplase for ischemic stroke at 4.5 to 24 hours without thrombectomy: a cost-utility analysis from the perspective of Chinese healthcare system

Background

Tenecteplase improves functional outcomes in acute ischemic stroke (AIS) patients treated 4.5 to 24 h after symptom onset who do not undergo thrombectomy. However, its cost-utility remains unexamined.

Methods

A hybrid model combining a short-term decision tree and a long-term Markov model was developed to simulate the costs and quality-adjusted life years (QALYs) for Chinese patients with AIS at 4.5 to 24 h, who did not undergo thrombectomy. Clinical data were sourced from the TRACE-III trial, while cost data were obtained from the China National Stroke Registry and the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database. The primary outcome was the incremental cost-effectiveness ratio (ICER). Secondary outcomes included total costs, total QALYs and remaining life expectancy, as well as the incremental cost, incremental QALYs, and incremental remaining life expectancy. One-way sensitivity analysis, probabilistic sensitivity analysis (PSA), and scenario analysis were conducted to test the robustness of the results.

Results

For a Chinese patient with AIS treated within 4.5 to 24 h after symptom onset without thrombectomy, adding tenecteplase to standard care resulted in an incremental cost of 2,536 Chinese Yuan (CNY) and an increase of 0.40 QALYs, yielding an ICER of 6,386 CNY per QALY. One-way sensitivity analysis revealed that the most significant factors influencing the ICER were the efficacy and cost of tenecteplase. PSA and scenario analyses confirmed the robustness of these results.

Conclusion

Compared to standard medical treatment alone, administering intravenous tenecteplase between 4.5 and 24 h after onset for Chinese patients with AIS who did not undergo thrombectomy, is highly cost-effective.

Clinical factors influencing intravenous thrombolysis in patients with cerebral infarction: a retrospective cohort study comparing private car and ambulance transport in Jiaxing, China

OBJECTIVES

This study aims to evaluate and compare the clinical differences in intravenous thrombolytic therapy among patients with cerebral infarction transported to the hospital by private cars versus ambulances in Jiaxing, a non-supersized city in China. It also sought to examine the impact of different transportation methods on emergency department arrival times, delays in initiating thrombolytic therapy and final clinical prognosis. The findings aim to provide a basis for optimising emergency treatment protocols and improving outcomes for patients with cerebral infarction.

DESIGN

Data on age, gender, height, weight, body mass index, season, time of day (day vs night), modified Rankin Scale scores, door-to-needle time (DNT) and onset-to-needle time (ONT) were retrospectively collected from 808 patients admitted to the emergency department of the Affiliated Hospital of Jiaxing University for intravenous thrombolysis between January 2019 and September 2022. The data were analysed and compared.

SETTING

A retrospective cohort study conducted in Jiaxing, China.

OUTCOME MEASURES

The primary outcomes were DNT and ONT.

RESULTS

Among the 808 eligible patients, 279 (34.53%) were transported by ambulance, and 529 (65.47%) arrived by private car. Patients in the private car group were younger on average than those in the ambulance group (aged 64.70 vs 68.41 years). Although ambulance transport resulted in shorter prehospital transportation times (113.89 vs 127.38 min), patients arriving by private car had shorter thrombolytic therapy initiation times (39.90 vs 36.30 min). At admission, the National Institutes of Health Stroke Scale scores were higher in the ambulance group (4 vs 2), indicating more severe conditions and a greater proportion of patients requiring bridging thrombectomy after thrombolysis (7.53% vs 3.02%).

CONCLUSION

In non-supersized cities, private car transportation for acute patients with cerebral infarction may lead to shorter DNT and ONT compared with those in ambulance transport. However, patients transported by ambulance tended to have more severe conditions, highlighting the importance of tailored emergency response strategies.

Heart Failure Is Associated With Increased Stroke Severity, In-Hospital Mortality, Major Adverse Cardiovascular Events, and Complications: Insights From the Chinese Stroke Center Alliance

BACKGROUND

Heart failure (HF) constitutes the source of various damaging pathophysiological mechanisms in acute ischemic stroke (AIS). The effect of a previous HF on the in-hospital outcomes for patients with AIS still lacks effective research. We aimed to evaluate the severity of stroke, in-hospital mortality, major adverse cardiovascular events, and complications associated with a previous HF in these patients.

METHODS AND RESULTS

This cross-sectional study was conducted at 1476 hospitals in the Chinese Stroke Center Alliance. Multivariable logistic regression and propensity score-matched analyses were used to evaluate the association between a history of HF and in-hospital outcomes. Of 836 885 patients with AIS, 1.1% (n=8950) patients had a history of HF. Patients with a history of HF had a higher National Institutes of Health Stroke Scale score at admission (6.0 versus 3.0) than those without a history of HF. Multivariable analysis revealed that a history of HF was associated with an 80% higher risk of all-cause mortality (odds ratio [OR], 1.80 [95% CI, 1.54-2.10]), a 34% higher risk of major adverse cardiovascular events (OR, 1.34 [95% CI, 1.26-1.43]), and a 92% higher risk of complications (OR, 1.92 [95% CI, 1.83-2.02]). Further propensity score matching showed that patients with a history of HF had higher risks of adverse in-hospital outcomes (all-cause mortality: OR, 1.62 [95% CI, 1.30-2.02]; major adverse cardiovascular events: OR, 1.39 [95% CI, 1.26-1.53]; complications: OR, 1.70 [95% CI, 1.58-1.82]).

CONCLUSIONS

Patients with AIS and a history of HF have increased risks of severe stroke, in-hospital mortality, major adverse cardiovascular events, and complications. Systematic cardiovascular evaluation and integrated multidisciplinary care for patients with AIS in clinical practice are warranted.

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.