Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions

The prognostic significance of stress-phenotyping for stroke incidence: the Malmö Diet and Cancer Study

BACKGROUND

Self-reported mental stress is not consistently recognized as a risk factor for stroke. This prompted development of a novel algorithm for stress-phenotype indices to quantify chronic stress prevalence in relation to a modified stroke risk score in a South African cohort. The algorithm is based on biomarkers adrenocorticotrophic hormone, high-density lipoprotein cholesterol, high-sensitive cardiac-troponin-T, and diastolic blood pressure which exemplifies the stress-ischemic-phenotype index. Further modification of the stroke risk score to accommodate alcohol misuse established the stress-diabetes-phenotype index. Whether positive stress-phenotype individuals will demonstrate a higher incidence of stroke in an independent Swedish cohort was unknown and investigated.

METHODS

Stress-phenotyping was done at baseline for 50 participants with incident stroke and 100 age-, and sex matched controls (aged 76 ± 5 years) from 2,924 individuals in southern Sweden. The mean time from inclusion to first stroke event was 5 ± 3 years. Stress-phenotyping comparisons and stroke incidence risk were determined.

RESULTS

A positive stress-ischemic-phenotype reflected higher incident stroke (72% vs. 28%, p = 0.019) and mortality rates (41% vs. 23%, p = 0.019). Whereas a positive stress-diabetes-phenotype reflected a higher incident stroke rate (80% vs. 20%, p = 0.008) but similar mortality rate (38% vs. 25%, p = 0.146). Both the positive stress-ischemic (OR: 2.9, 95% CI: 1.3-6.5, p = 0.011) and stress-diabetes-phenotypes (OR: 3.7, 95% CI: 1.5-8.9, p = 0.004) showed large effect size associations with incident stroke independent of cardiovascular risk confounders.

CONCLUSION

Positive stress-phenotype indices demonstrated a higher incidence of stroke. Ultimately the Malan stress-phenotype algorithms developed in South Africa could confirm incident stroke in an independent Swedish cohort. Stress-phenotyping could thus be useful in clinical routine practice in order to detect individuals at higher stroke risk.

Targeting capabilities of engineered extracellular vesicles for the treatment of neurological diseases

Recent advances in research on extracellular vesicles have significantly enhanced their potential as therapeutic agents for neurological diseases. Owing to their therapeutic properties and ability to cross the blood-brain barrier, extracellular vesicles are recognized as promising drug delivery vehicles for various neurological conditions, including ischemic stroke, traumatic brain injury, neurodegenerative diseases, glioma, and psychosis. However, the clinical application of natural extracellular vesicles is hindered by their limited targeting ability and short clearance from the body. To address these limitations, multiple engineering strategies have been developed to enhance the targeting capabilities of extracellular vesicles, thereby enabling the delivery of therapeutic contents to specific tissues or cells. Therefore, this review aims to highlight the latest advancements in natural and targeting-engineered extracellular vesicles, exploring their applications in treating traumatic brain injury, ischemic stroke, Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, glioma, and psychosis. Additionally, we summarized recent clinical trials involving extracellular vesicles and discussed the challenges and future prospects of using targeting-engineered extracellular vesicles for drug delivery in treating neurological diseases. This review offers new insights for developing highly targeted therapies in this field.

Telencephalic stab wound injury induces regenerative angiogenesis and neurogenesis in zebrafish: unveiling the role of vascular endothelial growth factor signaling and microglia

JOURNAL/nrgr/04.03/01300535-202510000-00025/figure1/v/2024-11-26T163120Z/r/image-tiff After brain damage, regenerative angiogenesis and neurogenesis have been shown to occur simultaneously in mammals, suggesting a close link between these processes. However, the mechanisms by which these processes interact are not well understood. In this work, we aimed to study the correlation between angiogenesis and neurogenesis after a telencephalic stab wound injury. To this end, we used zebrafish as a relevant model of neuroplasticity and brain repair mechanisms. First, using the Tg( fli1:EGFP × mpeg1.1:mCherry ) zebrafish line, which enables visualization of blood vessels and microglia respectively, we analyzed regenerative angiogenesis from 1 to 21 days post-lesion. In parallel, we monitored brain cell proliferation in neurogenic niches localized in the ventricular zone by using immunohistochemistry. We found that after brain damage, the blood vessel area and width as well as expression of the fli1 transgene and vascular endothelial growth factor ( vegfaa and vegfbb ) were increased. At the same time, neural stem cell proliferation was also increased, peaking between 3 and 5 days post-lesion in a manner similar to angiogenesis, along with the recruitment of microglia. Then, through pharmacological manipulation by injecting an anti-angiogenic drug (Tivozanib) or Vegf at the lesion site, we demonstrated that blocking or activating Vegf signaling modulated both angiogenic and neurogenic processes, as well as microglial recruitment. Finally, we showed that inhibition of microglia by clodronate-containing liposome injection or dexamethasone treatment impairs regenerative neurogenesis, as previously described, as well as injury-induced angiogenesis. In conclusion, we have described regenerative angiogenesis in zebrafish for the first time and have highlighted the role of inflammation in this process. In addition, we have shown that both angiogenesis and neurogenesis are involved in brain repair and that microglia and inflammation-dependent mechanisms activated by Vegf signaling are important contributors to these processes. This study paves the way for a better understanding of the effect of Vegf on microglia and for studies aimed at promoting angiogenesis to improve brain plasticity after brain injury.

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.

Perilipin-2 mediates ferroptosis in oligodendrocyte progenitor cells and myelin injury after ischemic stroke

JOURNAL/nrgr/04.03/01300535-202507000-00024/figure1/v/2024-09-09T124005Z/r/image-tiff Differentiation of oligodendrocyte progenitor cells into mature myelin-forming oligodendrocytes contributes to remyelination. Failure of remyelination due to oligodendrocyte progenitor cell death can result in severe nerve damage. Ferroptosis is an iron-dependent form of regulated cell death caused by membrane rupture induced by lipid peroxidation, and plays an important role in the pathological process of ischemic stroke. However, there are few studies on oligodendrocyte progenitor cell ferroptosis. We analyzed transcriptome sequencing data from GEO databases and identified a role of ferroptosis in oligodendrocyte progenitor cell death and myelin injury after cerebral ischemia. Bioinformatics analysis suggested that perilipin-2 (PLIN2) was involved in oligodendrocyte progenitor cell ferroptosis. PLIN2 is a lipid storage protein and a marker of hypoxia-sensitive lipid droplet accumulation. For further investigation, we established a mouse model of cerebral ischemia/reperfusion. We found significant myelin damage after cerebral ischemia, as well as oligodendrocyte progenitor cell death and increased lipid peroxidation levels around the infarct area. The ferroptosis inhibitor, ferrostatin-1, rescued oligodendrocyte progenitor cell death and subsequent myelin injury. We also found increased PLIN2 levels in the peri-infarct area that co-localized with oligodendrocyte progenitor cells. Plin2 knockdown rescued demyelination and improved neurological deficits. Our findings suggest that targeting PLIN2 to regulate oligodendrocyte progenitor cell ferroptosis may be a potential therapeutic strategy for rescuing myelin damage after cerebral ischemia.

Huang-Lian-Jie-Du decoction inhibits CD4+ T cell infiltration into CNS in MCAO rats by regulating BBB

BACKGROUND

Stroke, especially ischemic stroke (IS), represents a major global health challenge due to its high incidence, disability, mortality, recurrence, and economic impact. The limited therapeutic window for thrombolysis underscores the need for new treatments. The blood-brain barrier (BBB), which protects the brain, becomes compromised following ischemia-reperfusion injury, allowing peripheral immune cell infiltration and subsequent neuroinflammation. Huang-Lian-Jie-Du Decoction (HLJDT), a traditional formula with significant neuroprotective effects demonstrated in preliminary studies and literature reviews, has not yet been fully explored for its potential to inhibit peripheral immune cell infiltration through BBB protection.

PURPOSE

This study aims to: (1) Evaluate the efficacy of HLJDT in treating MCAO. (2) Observe the regulatory effect of HLJDT on the infiltration of CD4+ T cells into the central nervous system. (3) Investigate the effect of HLJDT on the Wnt/β-Catenin Signaling Pathway.

METHODS

A focal MCAO reperfusion model will be used to evaluate HLJDT's effects on neurological function (Zea Longa and Garcia scores), infarction volume (TTC staining), and pathological changes (HE and NISSL staining). Immune-inflammatory responses will be assessed using ELISA for cytokines, flow cytometry for T lymphocyte distribution, and immunofluorescence staining for CD4+ T cell infiltration. The interaction of T cell antigens (LFA-1) and endothelial adhesion molecules (ICAM-1) will be studied with ELISA and immunofluorescence. BBB protection will be evaluated with Evans blue staining and transmission electron microscopy. Mechanisms of T cell infiltration will be examined using transmission electron microscopy and Western blotting (WB) for key proteins. Additionally, the impact of HLJDT on the Wnt/β-catenin pathway will be assessed with WB.

RESULTS

HLJDT significantly improves neurological scores, reduces infarction volume, and mitigates pathological damage. It balances CD4+ T cell responses by inhibiting pro-inflammatory cytokines and enhancing anti-inflammatory ones, reducing CD4+ T cell CNS infiltration. HLJDT inhibits LFA-1/ICAM-1 interactions. It can also inhibit CD4+ T cell infiltration by repairing paracellular and transcellular structures of the BBB, with the Wnt/β-catenin signaling pathway playing a key role in this process.

CONCLUSION

We have innovatively demonstrated for the first time that HLJDT can regulate the balance between peripheral and central immune inflammation. It inhibits LFA-1/ICAM-1-mediated cell adhesion and, by modulating the Wnt/β-catenin pathway, improves the paracellular and transcellular structures of the blood-brain barrier, thereby suppressing CD4+ T cell infiltration and providing multifaceted protective effects for MCAO rats.

Association Between Monounsaturated Fatty Acid Intake and Risk of Total Stroke and Its Subtypes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies

CONTEXT

There are contradictory results regarding the relationship between dietary intakes of monounsaturated fatty acids (MUFAs) and risk of stroke.

OBJECTIVE

The purpose of this study was to review the existing body of research on the relationship between MUFA consumption and stroke risk through a systematic review and meta-analysis.

DATA SOURCE

PubMed, Scopus, and ISI Web of Science were all systematically searched up to January 2023.

DATA EXTRACTION

A total of 11 prospective cohort studies that investigated MUFA consumption in relation to stroke risk were included.

DATA ANALYSIS

Relative risk (RR) and 95% CIs for the highest vs lowest category of dietary MUFA intake were combined using a random-effects model. Linear and nonlinear dose-response relations were assessed through 1-stage weighted mixed-effects meta-analysis. These studies included 475 207 participants and 8438 cases. In highest vs lowest consumption analysis, MUFA intake was inversely associated with total stroke (RR: 0.80; 95% CI: 0.67, 0.96; I2 =65.2%, Q-test P = .001; n = 11) and hemorrhagic stroke (RR: 0.80; 95% CI: 0.68, 0.95; I2 = 0.0%, Q-test P = .77; n = 5) risk. Conversely, this association was not significant for ischemic stroke (RR: 0.86; 95% CI: 0.69, 1.07; I2 =62.3%, Q-test P = .01; n = 8). An inverse association was observed between each 10-g/d MUFA intake and hemorrhagic stroke (RR: 0.79; 95% CI: 0.65, 0.96) but not total and ischemic stroke. We did not find any evidence for a nonlinear association between MUFA intake and total stroke and its subtypes.

CONCLUSION

This meta-analysis shows that higher MUFA intake could lower the risk of total and hemorrhagic, but not ischemic, stroke. This could be important for public health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023458555.

Post-stroke spontaneous motor recovery in mice can be predicted from acute-phase local field potential using machine learning

Stroke remains a leading cause of long-term disability, underscoring the urgent need for effective predictors of motor recovery. Understanding the electrophysiological changes underlying spontaneous recovery could offer critical insight into recovery mechanisms and aid in predicting individual rehabilitation trajectories. In this study, we investigated the predictive power of local field potentials recorded 2 days post-stroke to forecast 1 month motor recovery in a mouse model of ischemic stroke. By employing a comprehensive machine learning approach, we identified key electrophysiological features that significantly enhanced prediction accuracy. Through nested leave-one-animal-out cross-validation, we achieved high prediction accuracy, correctly identifying motor recovery status in 15 out of 16 mice. Our findings also revealed that pre-stroke brain activity did not contribute to prediction accuracy, suggesting that post-stroke dynamics are the primary determinants of recovery. Notably, we found that features from the contralesional hemisphere were particularly influential in predicting recovery outcomes, underscoring the critical role of the non-lesioned hemisphere in motor recovery. Our data-driven methodology underscores the importance of balancing feature selection to optimize predictive performance, particularly in the context of spontaneous recovery, where insight into natural recovery processes can guide the development of targeted rehabilitation strategies. Ultimately, our findings advocate for a deeper understanding of post-stroke brain dynamics to improve clinical outcomes for stroke patients.

Understanding the Causes of Delayed Decision-Making by Family Members of Stroke Patients Eligible for Thrombolytic Therapy

ABSTRACT

BACKGROUND: Thrombolytic therapy is an effective intervention for acute ischemic stroke. However, the timely administration of this treatment can be hindered by delayed decision-making on the part of family members. Little is known about the reasons for their delay in making decisions. METHODS: This qualitative interview study used face-to-face, individual, semistructured interviews with 16 participants from 2 tertiary hospital neurology wards in Guangdong, China. The interviews were analyzed using inductive content analysis, and descriptive statistics were used to summarize participants' characteristics. RESULTS: Three main themes emerged: a large family communication network, struggling with bleeding risk, and seeking distance treatment advice. CONCLUSION: In China, family members make decisions on behalf of patients and are affected by various factors in the decision-making process, resulting in delayed decision-making. They may experience psychological conflicts when deciding whether to permit thrombolysis, and they tend to seek information from external sources without understanding thrombolysis. Healthcare professionals caring for stroke patients eligible for thrombolytic therapy should provide decision-making support programs tailored to the specific needs of these family members to reduce delayed decision-making.

Rapid synergistic thrombolysis of ischemic stroke guided by high-resolution and high-speed photoacoustic cerebrovascular imaging

Thrombosis is the major cause of ischemic stroke and poses a serious health burden globally. Current thrombolytic strategies, such as systematic administration of recombinant human tissue plasminogen activator (rt-PA), are challenged by limited thrombolysis efficiency due to low targeting ability and a short plasma half-life. Here, we report a rapid synergistic strategy that integrates sonothrombolysis and rt-PA mediated pharmacological thrombolysis to achieve accurate and efficient treatment of ischemic stroke. The strategy (PLPA@PFP) uses a platelet-biomimetic membrane as a carrier to deliver both perfluoropentane (PFP) and rt-PA, prolonging half-life and effectively accumulating at the thrombus within 0.5 hours. Upon exposure to focused ultrasound, PFP-based cavitation effects significantly enhance thrombus breakdown and rt-PA penetration, enabling synergistic sono/pharmacological thrombolysis both in vitro and in vivo. High-resolution photoacoustic (PA) imaging provides direct assessment of vascular reperfusion following therapeutic intervention in a murine model of ischemic stroke, offering important guidance for clinical treatment.

Usability testing a web application to support evidence-based commissioning decisions for implementing mobile stroke units

Commissioning of innovations in healthcare is a complex socio-technical process, ideally informed by high quality evidence. However, evidence is not always prepared and presented in a format usable for commissioning decisions. Agile methodology, combined with qualitative co-design, were used to develop a digital web application incorporating machine learning models of stroke outcomes to inform commissioning decisions for the implementation of mobile stroke units (MSUs) in England, followed by usability testing using think aloud methodology. Sixteen stakeholders involved in developing consensus on model parameters and pathways participated with data thematically analysed. Required improvements to the web application were identified and novel insights into the complexity of context-specific commissioning decisions were generated, which also informed participants' views on the viability of MSUs. This study provides empirical evidence in support of developing innovative and accessible digital dissemination methods to engage with commissioning processes and prospectively understand commissioning challenges.

Nanobiotechnologies for stroke treatment

Stroke has brought about a poor quality of life for patients and a substantial societal burden with high morbidity and mortality. Thus, the efficient stroke treatment has always been the hot topic in the research of medicine. In the past decades, nanobiotechnologies, including natural exosomes and artificial nanomaterials, have been a focus of attention for stroke treatment due to their inherent advantages, such as facile blood - brain barrier traversal and high drug encapsulation efficiency. Recently, thanks to the rapid development of nanobiotechnologies, more and more efforts have been made to study the therapeutic effects of exosomes and artificial nanomaterials as well as relevant mechanisms in stroke treatment. Herein, from recent studies and articles, the application of natural exosomes and artificial nanomaterials in stroke treatment are summarized. And their prospects of clinical translation and future development are also discussed in further detail.

Feasibility of HABIT-ILE@home in children with cerebral palsy and adults with chronic stroke: A pilot study

INTRODUCTION

Children with cerebral palsy (CP) and adults with chronic stroke (CS) usually have disabilities in voluntary motor control. Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), an evidence-based therapy, has always been provided during day camps. This pilot study investigates if HABIT-ILE@home, a remote neurorehabilitation, is feasible for children with CP and adults with CS.

METHODS

Four children with CP (5-18y) and three adults with CS were recruited. They received 15h (5x3h) of HABIT-ILE@home provided by a caregiver with a remote supervision of 30min at the beginning and end of each session. A large touch screen, the REAtouch Lite, was used as a support for the therapy. An interview based on a questionnaire (n = 73 items for CP/ n = 74 items for stroke patients; scored from 0 "disagree" to 3 "agree", a higher rating meaning a more positive aspect of the therapy) was conducted with patients and their caregivers after 15h of supervised home-therapy to assess their adherence to the treatment and the feasibility of HABIT-ILE@home. Performance and satisfaction in achieving functional goals were assessed before and after the intervention using the Canadian Occupational Performance Measure (COPM).

RESULTS

Caregivers felt sufficiently supported by the supervision team (medians = 3) to carry out HABIT-ILE@home sessions thanks to an adequate clinical supervision (CP median = 2.6; CS median = 2.9). HABIT-ILE principles were transferable at patients' home (CP median = 2.6; CS median = 2.8). The impact of the therapy on daily organization was more problematic for children's caregivers (median = 1.5) than for adults' caregivers (median = 3). Children with CP enjoyed the therapy (median = 2) but felt that it was too long (median = 1) and significant fatigue was present (median = 1.3). CS adults did not find the therapy fun (median = 1) but considered it as extremely useful (median = 3). Although the motivational source differed between children and adults, this did not seem to strongly affect adherence to treatment. Performance and satisfaction in achieving functional goals improved over the MCID (2 points) for all CS participants and for 3 out 4 CP children.

CONCLUSION

HABIT-ILE@home seems to be feasible for children with CP and adults with CS. It may allow more patients to benefit from an efficient neurorehabilitation, whatever sanitary conditions or patients' home geographical locations.

LncRNA SERPINB9P1 Mitigates Cerebral Injury Induced by Oxygen‒Glucose Deprivation/Reoxygenation by Interacting with HSPA2

Dysregulation of long non-coding RNAs (lncRNAs) is implicated in the pathophysiology of ischemic stroke (IS). However, the molecular mechanism of the lncRNA SERPINB9P1 in IS remains unclear. Our study aimed to explore the role and molecular mechanism of the lncRNA SERPINB9P1 in IS. This study revealed downregulation of the lncRNA SERPINB9P1 in the peripheral blood of IS patients, which was corroborated by the GSE140275 dataset. Furthermore, high lncRNA SERPINB9P1 expression was associated with lower National Institutes of Health Stroke Scale (NIHSS) scores and favorable outcome. Clinically, lncRNA SERPINB9P1 expression was correlated with inflammation and coagulation parameters in IS patients. Furthermore, lncRNA SERPINB9P1 silencing inhibited cell viability, induced apoptosis and inflammatory response under oxygen-glucose deprivation/reperfusion ; however, these effects were reversed upon its overexpression. Additionally, Chromatin Isolation by RNA Purification and mass spectrometry (CHIRP-MS) and western blot confirmed that the lncRNA SERPINB9P1 was involved in the pathological process of IS through binding to heat shock protein 2 (HSPA2). HSPA2 was upregulated in IS patients, and its protein interaction network was significantly enriched in IS-related pathways. In conclusion, the lncRNA SERPINB9P1 may ameliorate neurological injury in IS patients by interacting with the HSPA2 protein and engaging in IS-related pathways, providing new insights into treatment strategies for IS.

Self-reported physical activity more than 1 year after stroke and its determinants in relation to the WHO recommendations

BACKGROUND

Physical activity (PA) after stroke has significant health benefits if it is conducted regularly, with sufficient intensity and duration. Because of the health benefits, it is important to identify those below the World Health Organization (WHO) recommended level of PA. However, few studies have assessed the level of PA after stroke in relation to the WHO recommendations and which sociodemographic factors and stroke characteristics are associated with those below the WHO recommendations.

OBJECTIVE

To assess survivors of stroke at least 1 year after onset and (1) describe their self-reported level of PA; (2) explore the association between PA, sociodemographics, and stroke characteristics, and (3) determine the characteristics of those below the WHO recommended level of PA.

DESIGN

Cross-sectional descriptive survey.

SETTING

Community settings.

PARTICIPANTS

Data were collected from 160 survivors of stroke (mean age 73 years, 46% women, mean time since stroke onset 35 months).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Swedish National Board of Health and Welfare Physical Activity Questionnaire and the following sociodemographics and stroke characteristics: gender, age, marital status, vocational situation, need for home help, use of mobility devices, time since stroke onset, first-time stroke, type of stroke, location of stroke, and stroke treatment.

RESULTS

Two thirds (66.3%) of the participants were below the WHO recommendations. The hierarchical regression analysis explained 13% of the variance in PA with need for home help as a single significant contributor. Those who did not meet the WHO recommendations were significantly older, more likely to live alone, and in need of home help and mobility devices.

CONCLUSIONS

A majority of survivors of stroke do not meet the WHO recommended level of PA. Future studies should assess how other factors characterize those who are physically inactive. This knowledge could help rehabilitation professionals to target interventions and self-management programs to promote PA among survivors of stroke.

Effects of Robot-Assisted Therapy for Upper Limb Rehabilitation After Stroke: An Umbrella Review of Systematic Reviews

BACKGROUND

Robotic rehabilitation, which provides a high-intensity, high-frequency therapy to improve neuroplasticity, is gaining traction. However, its effectiveness for upper extremity stroke rehabilitation remains uncertain. This study comprehensively reviewed meta-analyses on the effectiveness of upper extremity robot-assisted therapy in patients with stroke.

METHODS

We combined results from 396 randomized controlled trials (RCTs) in 16 meta-analyses and conducted a new meta-analysis using nonoverlapping RCTs and 6 additional RCTs published after 2024. Duplicate studies were removed, all data were from RCTs, and a random-effects model resolved heterogeneity. Effects were analyzed by comparing robot-assisted therapy with conventional therapy at the same dose and as an add-on to conventional therapy.

RESULTS

Compared with conventional therapy, the effect of robot-assisted therapy on the Fugl-Meyer assessment was summarized as a significant standardized mean difference (SMD) of 0.29 (95% CI, 0.14-0.44; number of individual RCTs reanalyzed, 100 RCTs), and the additional effect of robot-assisted therapy was an SMD of 0.42 (95% CI, 0.23-0.61; 16 RCTs). However, these Fugl-Meyer assessment improvements did not meet the minimum clinically important difference thresholds identified in previous studies: 12.4 for subacute and 3.5 for chronic stroke. For activities of daily living, only the additional effect was significant by SMD of 0.35 (95% CI, 0.17-0.54; 26 RCTs), muscle strength was significant by SMD of 0.46 (95% CI, 0.22-0.70; 31 RCTs), and spasticity was not significant by SMD of -0.25 (95% CI, -0.55 to 0.06; 25 RCTs).

CONCLUSIONS

Robot-assisted therapy shows statistically significant improvements in motor recovery as measured by the Fugl-Meyer assessment in patients with stroke, both at the same dose and as an add-on to conventional therapy; however, these improvements do not meet the minimum clinically important difference. These benefits are consistent across different stages of stroke recovery, different types of robotic devices, duration of intervention, and training sites. However, the heterogeneity of included studies in patient population, stroke severity, intervention protocol, and robot type limits generalizability. High-quality trials are needed to better define the value of robot-assisted therapy across various devices and strategies.

Novel Network Analysis of County- and Individual-Level Factors Associated With Functional Outcomes After Stroke

BACKGROUND

Social determinants are known to impact stroke risk and poststroke outcomes. Using complexity science, we examined interrelations between county- and individual-level social and clinical determinants influencing stroke functional outcomes.

METHODS

We examined a retrospective cohort of 2 961 664 patients diagnosed with acute ischemic or hemorrhagic stroke from 2218 US hospitals participating in the Get With The Guidelines-Stroke Registry from 2013 to 2019, linked by ZIP code with the county-level institute for health metrics and evaluation data. We constructed multilayer networks, estimating mixed graphical models of 32 nodes representing social and clinical factors. Networks included 4 layers of factors: (1) county-level social, (2) individual-level social, (3) clinical comorbidities, and (4) hospital encounters. Networks were estimated for patients with less favorable (modified Rankin Scale score 3-6) versus favorable (modified Rankin Scale score 0-2) outcomes. We compared network structure and node centrality measures between groups using bootstrap permutation analyses, identifying influential (hub) nodes.

RESULTS

The overall influence of social determinants (global connectivity) was greater in patients with less favorable outcomes (P<0.001). Homelessness and Black race were hub nodes, indicating their role in mediating relationships between social and downstream clinical factors in patients with less favorable outcomes. Being uninsured had greater influence (closeness centrality; P<0.001) in patients with less favorable outcomes, indicating its role in amplifying the effects of social determinants. Greater county-level high school completion (P<0.001) and a lower proportion of the population living below the US poverty line (P=0.030) were directly associated with faster onset-to-arrival time in patients with less favorable functional outcomes. The clinical-social determinant network explained 34% of the variance of modified Rankin Scale scores.

CONCLUSIONS

Social determinants have a substantial influence on functional outcomes after stroke. County-level poverty directly affected onset-to-arrival time and quality of care. Health insurance status and homelessness were influential and modifiable patient-level factors that may serve as critical leverage points for future interventions aimed at improving outcomes.

Comparison of Factors Affecting Quality of Life in Patients with Acute Ischemic Stroke Across Different Stroke Severities

INTRODUCTION

Research investigating the differences in determinants affecting the quality of life (QoL) in patients with acute ischemic stroke (AIS) of varying severities remains limited, and how these factors influence QoL remains unclear. The aim of this study was to address this critical issue, refining treatments to enhance long-term QoL and optimize resource use.

METHODS

In this multicenter prospective study conducted in China, patients with AIS were assessed using the EuroQol-5 Dimension (EQ-5D) questionnaire at admission and 1 year later. Univariate and multivariate analyses were conducted to identify QoL determinants. Motor function-related outcomes (MFRO) and non-motor function-related outcomes (NMFRO) were defined based on the EQ-5D questionnaire to explore how factors influence outcomes through mediation analysis.

RESULTS

The study included 8598 patients with AIS (median age 64 years; 65.7% male), 3927 of whom had minor stroke severity (National Institutes of Health Stroke Scale [NIHSS] scores ≤ 3). The median QoL score improved from 0.597 at admission to 1.000 after 1 year. Compared to patients with minor stroke, more patients with non-minor stroke had non-motor function-related problems (NMFRP) at admission (78.2% vs. 56.6%). Age, stroke history, QoL at admission, infection, hospitalization costs, and discharge outcomes were found to be factors influencing QoL in both cohorts. In the non-minor stroke cohort, analysis revealed that additional factors include diabetes mellitus, geographical region, speech impairment, and thrombolysis, while in the minor stroke cohort, hypertension, coronary heart disease, cancer, prolonged length of stay, and hemorrhage were found to be relevant factors. The impact of most factors on QoL was mediated by MFRO, while the effects of age, speech impairment, and geographical region were also mediated by NMFRO. Hospitalization costs beyond 15,000 China Yuan (CNY) did not improve QoL for the patients with non-minor stroke, with a threshold of 10,000 CNY for the patients with minor stroke.

CONCLUSIONS

Over half of the patients in the study population had NMFRP, necessitating greater medical attention. Patients with different stroke severities had distinct QoL determinants. Age, speech impairment, and geographical region may exert an impact partly mediated through NMFRO. Higher hospitalization costs did not consistently improve QoL beyond a certain threshold.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02470624.

A novel stroke classification model based on EEG feature fusion

Stroke is the leading cause of disability and death worldwide. It severely affects patients' quality of life and imposes a huge burden on the society in general. The diagnosis of stroke relies predominantly on the use of neuroimaging. The identification of stroke using electroencephalogram (EEG) in the clinical assessment of stroke has been underutilized. An EEG feature fusion based light gradient-boosting machine (LightGBM) model was proposed to achieve a fast diagnosis of non-stroke, ischemic stroke, and hemorrhagic stroke. This study aims to capture the essential difference between non-stroke, ischemic stroke, and hemorrhagic stroke. An optimal fusion feature set originated from approximate entropy and fuzzy entropy of EEG signal was constructed. To verify the effectiveness of the EEG fusion feature, the Tree-structured Parzen Estimator optimized LightGBM classifier (TPELGBM) was used for the classification. The ZJU4H EEG dataset used for analysis in this study was obtained from the Fourth Affiliated Hospital of Zhejiang University, China. The proposed ApFu-TPELGBM model exhibited excellent classification results, which achieved a precision of 0.9676, recall of 0.9669, and f1-score of 0.9672. To our knowledge, it was the most accurate classifier for EEG-based stroke diagnosis so far. The ApFu-TPELGBM model can determine the stroke type anywhere EEG signals can be collected, even before the patient is admitted to a hospital. Rapid and accurate diagnosis of stroke using EEG signals may become a promising approach in the clinical assessment of stroke.

Identification of Mitochondrial and Succinylation Modification-Related Gene Signature in Ischemic Stroke

Ischemic stroke (IS) is a leading cause of death and disability worldwide, often associated with immune dysregulation, mitochondrial dysfunction, and altered protein succinylation. This study aimed to identify mitochondrial and succinylation-related gene signatures with diagnostic potential in IS. Differentially expressed genes (DEGs) associated with IS were identified using transcriptome expression profiles from merged GSE16561 and GSE58294 GEO datasets. Functional enrichment and WGCNA identified hub genes. Mitochondrial and succinylation-related gene expression was assessed via ssGSEA. Feature genes were selected using machine learning. A prognostic nomogram was constructed. PPI networks were generated using GeneMANIA. Immune infiltration was assessed through ssGSEA. Drug-gene interactions were explored using DGIdb. qRT-PCR validation was performed on blood samples from IS patients and controls. We identified 317 DEGs enriched in immune response and inflammation pathways in 108 IS patients and 47 healthy controls using data from the merged datasets. WGCNA identified 101 hub genes in the yellow module and 65 in the brown module. Seven overlapping genes related to mitochondrial and succinylation processes were identified. Feature gene analysis revealed six key genes (MRPL41, NGRN, SLC25A42, SPTLC2, TUBB, and TXN) with robust diagnostic potential across both the merged and individual datasets (all AUCs > 0.7). Nomogram integration demonstrated predictive reliability. Feature genes exhibited significant correlations with immune cell infiltration. qRT-PCR validation confirmed the differential expression of four feature genes. TUBB and TXN showed interactions with various drugs. Mitochondrial and succinylation-related genes have diagnostic significance in IS, providing insights into disease pathogenesis and clinical applications.

Appraising non-HDL-C, systolic pressure, and a nomogram-based diagnostic model as auxiliary biomarkers in confirming acute ischemic stroke and transient ischemic attack

Acute ischemic stroke (AIS) is characterized by the abrupt onset of neurological dysfunction stemming from focal brain ischemia, confirmed through imaging evidence of infarction. In contrast, transient ischemic attack (TIA) manifests with neurological deficits in the absence of infarction, with imaging serving as the definitive diagnostic criterion. This study aims to assess the diagnostic value of combining non-high-density lipoprotein cholesterol (non-HDL-C) and blood pressure (BP) in differentiating AIS from TIA. We recruited 207 untreated AIS patients diagnosed within 72 h and 99 age- and gender-matched TIA patients. Upon admission, serum non-HDL-C levels, other lipid profiles, and BP measurements were obtained. Binary logistic regression was employed to identify risk factors, while receiver operator characteristic (ROC) curves were used to evaluate diagnostic performance. Furthermore, least absolute shrinkage and selection operator (LASSO) regression coupled with multivariate logistic regression was utilized to develop a nomogram model. The AIS group exhibited higher prevalence rates of hypertension, diabetes, family history of diabetes, and smoking (P < 0.05). Notably, non-HDL-C, systolic BP, diastolic BP, and other lipid markers were significantly elevated in the AIS group (P < 0.05). Multivariate analysis pinpointed non-HDL-C (OR [odds ratio] = 1.663, 95% CI [confidence interval]: 1.239-2.234, P < 0.01) and systolic BP (OR = 1.035, 95% CI: 1.012-1.057, P < 0.01) as independent risk factors. ROC analysis revealed that systolic BP alone achieved an AUC of 0.686 (sensitivity: 78.7%, specificity: 51.5%), whereas the combination of systolic BP and non-HDL-C enhanced diagnostic accuracy (AUC [area under the ROC curve] = 0.736, sensitivity: 75.4%, specificity: 64.6%). A nomogram incorporating low-density lipoprotein cholesterol (LDL-C), glucose (GLU), homocysteine, and smoking demonstrated high predictive accuracy, with training and validation AUCs of 0.769 and 0.704, respectively. Non-HDL-C and systolic BP emerge as independent risk factors for AIS, and their combined use augments diagnostic precision in differentiating AIS from TIA. A nomogram model presents a practical differentiation tool, particularly in settings with limited resources.

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.

Targeting the Ischemic Core: A Therapeutic Microdialytic Approach to Prevent Neuronal Death and Restore Functional Behaviors

Ischemic stroke leads to cerebral ionic imbalance, increases acidosis, oxidative stress and release of glutamate and inflammatory mediators. Removing solute or stimulants from the ischemic core may block cell-damaging events and confer neuroprotection. In this study, we developed a minimally invasive therapeutic microdialysis (tMD) method, choosing to include serum albumin in the buffer because it is a multifunctional protein with osmotic properties. Aiming at the ischemic core, continuous perfusion of buffer supplemented with osmotic agents removes mediators of inflammation/cell damage/death from the lesion. This tMD treatment significantly removed the glutamate and zinc ions from the core, thereby reducing infarct volumes and affording high-grade neurobehavioral protection against ischemic stroke. The tMD treatment effectively protected neurons and reduced microglial activation. Furthermore, this tMD approach extended the therapeutic window to protect beyond 6 h after stroke onset. These findings support the potential clinical feasibility of applying tMD to patients with ischemic stroke, potentially without adverse effects.

Research Hotspots and Trends of Virtual Reality Intervention for Stroke: Bibliometric Analysis

Background

Virtual reality (VR) is a rapidly developing technology that has gained significant traction in the treatment and rehabilitation of individuals with stroke. Research on VR-based stroke treatment has garnered increasing attention.

Objective

The aim of this study is to present a bibliometric analysis of VR for stroke studies to identify the application status, research hotspots, and emerging trends and guide future scientific research.

Methods

We included studies and reviews on the topic of VR-based stroke treatment and rehabilitation from 1999 to 2023 were retrieved from Web of Science Core Collection database. Citespace 6.3.1 and VOSviewer 1.6.20 software was used for the visual analysis of publications, institutions, authors, journals, citations, and Scimago Graphica software was used for the geographic visualization of published countries or regions.

Results

Our study analyzed 1171 papers on VR-based stroke rehabilitation published between 1999 and 2023, revealing a gradual increase in annual publications over the past 2 decades, peaking at 154 in 2022. North America and Western Europe were identified as major contributors, with significant input from their institutions, researchers, and publications. The Journal of NeuroEngineering and Rehabilitation emerged as the leading journal in this field, while Calabrò Rocco Salvatore was recognized as the most prolific author, focusing on the neurophysiological impacts of VR on patients with stroke. Keywords with notable citation bursts, such as "environment," "trial," "arm," and "motor learning," highlighted the core research themes in this domain.

Conclusions

Our study provides valuable insights into the current research hotspots and emerging trends in VR-based stroke treatment and rehabilitation. Current research primarily focuses on evaluating the effectiveness of VR in improving upper limb function and balance in patients with stroke. Future directions are shifting towards integrating VR with rehabilitation techniques, such as physiotherapy and occupational therapy, while advancements in VR technology continue to garner increasing attention.

Machine Learning-Based Classification of Anterior Circulation Cerebral Infarction Using Computational Fluid Dynamics and CT Perfusion Metrics

Background: Intracranial atherosclerotic stenosis (ICAS) is a leading cause of ischemic stroke, particularly in the anterior circulation. Understanding the underlying stroke mechanisms is essential for guiding personalized treatment strategies. This study proposes an integrated framework that combines CT perfusion imaging, vascular anatomical features, computational fluid dynamics (CFD), and machine learning to classify stroke mechanisms based on the Chinese Ischemic Stroke Subclassification (CISS) system. Methods: A retrospective analysis was conducted on 118 patients with intracranial atherosclerotic stenosis. Key indicators were selected using one-way ANOVA with nested cross-validation and visualized through correlation heatmaps. Optimal thresholds were identified using decision trees. The classification performance of six machine learning models was evaluated using ROC and PR curves. Results: Time to Maximum (Tmax) > 4.0 s, wall shear stress ratio (WSSR), pressure ratio, and percent area stenosis were identified as the most predictive indicators. Thresholds such as Tmax > 4.0 s = 134.0 mL and WSSR = 86.51 effectively distinguished stroke subtypes. The Logistic Regression model demonstrated the best performance (AUC = 0.91, AP = 0.85), followed by Naive Bayes models. Conclusions: This multimodal approach effectively differentiates stroke mechanisms in anterior circulation ICAS and holds promise for supporting more precise diagnosis and personalized treatment in clinical practice.

Lactate dehydrogenase to albumin ratio and poor prognosis after thrombolysis in ischemic stroke patients: developing a novel nomogram

BACKGROUND

Ischemic stroke (IS) is associated with high disability and mortality. This study aimed to identify the prognostic predictors and develop a nomogram for a prediction model for ischemic stroke patients after thrombolysis.

METHODS

We retrospectively analyzed data from 359 IS patients who underwent thrombolysis. Clinical characteristics, laboratory parameters, and prognosis data were collected. One-third of the subjects were randomly selected as a validation set (n = 108) for internal validation. Logistic regression analysis was used to derive independent risk indicators. A nomogram was constructed using these indicators, and the performance of the nomogram was assessed by the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC). The agreement of the model predictions with actual observations was assessed via calibration curves, and the clinical utility of the nomogram was assessed via decision curve analysis.

RESULTS

Multivariate logistic regression analysis showed that age, leukocytes, Lactate Dehydrogenase to Albumin Ratio (LAR) and NIHSS were independent predictors of three-month post-thrombolysis prognosis in IS patients. We created a nomogram based on the weighting coefficients of these factors. The AUC curves showed that our model including age, leukocytes, LAR and NIHSS was more accurate in predicting prognosis than a single factor. The calibration curves showed a good fit between actual and predicted probabilities in both the training and validation groups.

CONCLUSION

LAR has a good predictive power for the prognosis of IS patients 3 months after thrombolytic therapy and can be used as a new clinical indicator to establish a practical nomogram.

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.

The impact of comorbidity burden on outcomes following endovascular thrombectomy for acute ischemic stroke: A nationwide prospective observational study

INTRODUCTION

Patients with substantial comorbidity burden are underrepresented in clinical trials on endovascular thrombectomy (EVT), despite being common in clinical routine care. Therefore, analysis of observational data is needed to evaluate how increasing comorbidity burden affects procedural success rate, complication rate, and clinical outcome following EVT.

PATIENTS AND METHODS

We conducted a register-based observational study involving pre-stroke functionally independent patients treated with EVT in Sweden 2015-2021. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI) and categorized as no (CCI 0), moderate (CCI 1), severe (CCI 2), and very severe (CCI ⩾3). The primary outcome was favorable 90-day outcome (modified Rankin Scale 0-2). Secondary outcomes included successful recanalization, and peri- and postoperative complications.

RESULTS

Of 4735 included patients, 40% had no comorbidity (CCI 0), 15% had moderate (CCI 1), 21% had severe (CCI 2), and 24% had very severe comorbidity burden (CCI ⩾3). The yearly proportion of patients with very severe comorbidity burden increased from 16% to 30% during the study period. Increasing comorbidity levels were associated with decreased odds ratio (OR) of favorable outcome compared to patients without comorbidity: CCI 1 adjusted OR (aOR) 0.64, 95% CI 0.57-0.85; CCI 2 aOR 0.59, 95% CI 0.47-0.74; and CCI ⩾3 aOR 0.38, 95% CI 0.30-0.47, but there were no significant differences in successful recanalization rates. Patients with CCI 2 had higher OR for perioperative and postoperative complications (OR 1.43, 95% CI 1.09-1.88, and OR 1.41, 95% CI 1.15-1.71), and patients in the CCI ⩾3 group had higher OR of postoperative complications (OR 1.34, 95% CI 1.14-1.67), compared to patients in the CCI 0 group. Successful recanalization was associated with favorable functional outcome in all CCI-groups.

DISCUSSION AND CONCLUSION

Severe and very severe comorbidity burden are increasingly common among EVT-treated patients in routine healthcare and are linked to poorer outcomes. However, our results suggest that successful EVT is associated with functional independency, also in patients with severe and very severe comorbidity burden.

Bilirubin as a predictor of severity and adverse clinical outcomes of acute ischemic stroke: a systematic review and meta-analysis

BACKGROUND

This review aims to comprehensively examine the role of bilirubin in predicting severity and adverse clinical outcomes in patients with acute ischemic stroke (AIS).

METHODS

We searched the electronic PubMed, Embase, Scopus, and Web of Science repositories for articles published in English available before the 15th of June 2024. The outcomes assessed were stroke severity, haemorrhagic transformation, symptomatic intracranial haemorrhage (sICH), mortality, and poor functional results.

RESULTS

We analysed data from 13 studies. Our meta-analysis showed that both total bilirubin (RR, 1.10; 95% CI, 1.01-1.19) and direct bilirubin (RR, 1.79; 95% CI, 1.33-2.42) were independently associated with the severity of AIS. Higher quartiles of total bilirubin were associated with an increased risk of haemorrhagic transformation, but without statistical significance (RR, 2.34; 95% CI, 0.90-6.07). In addition, each unit increase in direct (RR, 1.25; 95% CI, 1.09-1.43) and indirect (RR, 1.09; 95% CI, 1.02-1.17) bilirubin levels was significantly associated with a higher risk of haemorrhagic transformation. Moreover, each unit increases in total (RR, 1.08; 95% CI, 1.04-1.12), direct (RR, 1.28; 95% CI, 1.13-1.44), and indirect (RR, 1.10; 95% CI, 1.03-1.18) bilirubin levels was significantly associated with a higher risk of sICH. Data on mortality and poor functional outcomes were insufficient.

CONCLUSION

Serum bilirubin levels were positively associated with the severity of AIS. The evidence suggests that bilirubin may be a potential indicator for haemorrhagic transformation and sICH after AIS.

Development and evaluation of a stroke research Public Patient Involvement Panel

Background

Public and patient involvement (PPI) is important in stroke research to ensure that research conducted reflects the priorities and needs of people after stroke. Several factors have been found to affect PPI, including location of the research and time requirements for participation. The incidence of stroke is rising, and can result in symptoms including fatigue, depression, and physical/cognitive impairments.

Aims

1) Describe the development of a PPI panelpanel and a healthcare professional panelpanel for stroke rehabilitation research and 2) to explore the perspectives of the members of the PPI groups on being involved in the research process.

Methods

A stakeholder panel consisting of up to 20 people with stroke, members of the public and healthcare professionals will be formed. A pragmatic purposive sampling technique using snowball sampling will be used to recruit members. The PPI panel will meet four times and will be supported by the guidelines developed from the INVOLVE framework. The PPI panel will be involved as co-researchers in the conceptualisation of future stroke rehabilitation research, the delivery of such studies, the analysis and dissemination of findings. Following the development of the panel, we will conduct a semi-structured focus groups to collect qualitative data, examining the perspectives of members. Data will be transcribed and analysed using Braun and Clarke's Reflexive Thematic Analysis. This will result in a set of themes and subthemes describing participants' opinions and experience of being on a PPI panel in stroke rehabilitation research.

Conclusions

PPI is an essential part of research in stroke. Stakeholders can provide key insights into the research processes. The results of this qualitative study will provide insight into the barriers and enablers of their participation in PPI in stroke rehabilitation research.

Prospective Study of ADAMTS13 and von Willebrand Factor's Role in the Prediction of Outcomes in Acute Ischemic Stroke

Background: In this prospective study, the prognostic role of ADAMTS13 activity and von Willebrand (VWF) antigen (VWF: Ag) levels in ischemic stroke outcomes was investigated. Methods: Patients diagnosed with acute ischemic stroke were prospectively enrolled in this study, while samples for ADAMTS13 activity and VWF: Ag level measurements were collected upon their admission to our unit. The National Institutes of Health Stroke Scale (NIHSS) score was estimated upon admission and at discharge. The modified Rankin scale for neurologic disability (Rankin) score was estimated based on the patient's history before the stroke onset, during admission (RankinAdm), and at discharge (RankinDis). Results: In the study, 29 patients with a median age of 82.5 (51, 92) were included. In univariate analysis, ADAMTS13 activity during admission was associated with platelet values at the same time point (r = 0.12, p = 0.01) and VWF: Ag levels were associated with age (r = 0.439, p = 0.04), previous ischemic stroke (r = 0.9176, p = 0.031), and glucose levels (r = 0.64, p = 0.049). Associations between ADAMTS13/VWF: Ag Ratio with RankinDis (r = 0.3253, p = 0.03), and the change between RankinDis and RankinAdm (r = 0.1589, p = 0.014) were identified. Additionally, VWF: Ag levels during admission were correlated with RankinDis (r = 0.0072, p = 0.049). Conclusions: These markers might be useful as biomarkers for the prediction of poor outcomes after stroke.

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

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

Evolution of Medical and Surgical Management of Carotid Disease from Carotid Endarterectomy to Transfemoral Carotid Stenting to TCAR

Patients with carotid stenosis can be broadly classified into 2 categories: symptomatic and asymptomatic. While there is little disagreement about surgical management of symptomatic carotid stenosis, the optimal management strategy for the patients with asymptomatic carotid disease has undergone significant evolution over past 5 decades. With increasing focus on role of plaque morphology on the etiology of symptoms, there has been an increased focus on optimizing the medical management targeted at plaque stabilization, especially for the patients with asymptomatic carotid disease, while reserving the most aggressive surgical treatment options for the patients with symptomatic carotid stenosis. This review summarizes the scientific evidence based on multiple large clinical studies showing how the modern-day management of carotid stenosis has evolved. Multiple, large randomized clinical trials have established carotid endarterectomy (CEA) as the treatment of choice for symptomatic patients with symptomatic, >50% stenosis of carotid artery or those who have asymptomatic high-grade carotid stenosis. With the advancements in endovascular techniques, the technique of transfemoral carotid artery stenting (TF-CAS) was popularized, but after multiple, large randomized controlled trials demonstrated superiority of CEA, the indications for TF-CAS as the initial operation of choice for carotid disease for all patients have been reduced. In the past 5 years, the introduction of the newer technique of trans carotid artery revascularization (TCAR) has shown promising results with significant reduction in the incidence of perioperative complications as compared to CEA and TF-CAS; however, there have been no randomized controlled trials comparing TCAR to either CEA or TF-CAS. Moreover, with the developments in the medical field with introduction of several new medications which have been demonstrated to successfully change the plaque morphology, there has been a renewed interest in exploring if the indications for surgical management for the asymptomatic carotid disease should be revisited.

Post-Stroke Recovery: A Review of Hydrogel-Based Phytochemical Delivery Systems

Stroke remains a leading cause of disability worldwide, underscoring the urgent need for novel and innovative therapeutic strategies to enhance neuroprotection, support regeneration, and improve functional recovery. Previous research has shown that phytochemicals such as curcumin, tannic acid, gallic acid, ginsenosides, resveratrol, and isorhamnetin display extensive neuroprotective properties, including antioxidant, anti-inflammatory, and anti-apoptotic effects. These natural compounds could also promote neurogenesis, angiogenesis, and the preservation of the blood-brain barrier. Despite their promising bioactivities, clinical application is often limited by poor solubility, bioavailability, and suboptimal pharmacokinetics. Hydrogels offer a promising solution by encapsulating and controlling the gradual release of these phytochemicals directly at the site of injury. Recent advancements in hydrogel formulations, constructed from biopolymers and functionalized using nanotechnological approaches, could significantly improve the solubility, stability, and targeted delivery of phytochemicals. Controlled release profiles from pH-sensitive and environment-responsive hydrogels could ensure that the compounds' therapeutic effects are optimally timed with individual and critical stages of post-stroke repair. Moreover, hydrogel scaffolds with tailored material properties and biocompatibility can create a favorable microenvironment, reducing secondary inflammation, enhancing tissue regeneration, and potentially improving functional and cognitive outcomes following stroke. This review explores the potential of integrating phytochemicals within hydrogel-based delivery systems specifically designed for post-stroke recovery. The design and synthesis of biocompatible, biodegradable hydrogels functionalized especially with phytochemicals and their applications are also discussed. Lastly, we emphasize the need for additional robust and translatable preclinical studies.

Effects of virtual reality with different modalities on upper limb recovery: a systematic review and network meta-analysis on optimizing stroke rehabilitation

Background

As a major cause of disability worldwide, stroke affects about 80% of survivors with upper limb (UL) motor dysfunction, significantly impairing their quality of life. Virtual reality (VR) has been recognized as an innovative rehabilitation tool; however, the effectiveness of VR systems with different immersion modalities is still uncertain. This systematic review and network meta-analysis (NMA) aims to evaluate the comparative effectiveness of intervention measures, including non-immersive gaming consoles, immersive VR (IVR), non-immersive VR (NIVR), and conventional therapy (CT) on upper limb motor function in stroke rehabilitation.

Materials and methods

A systematic search of PubMed, Embase, Cochrane Library, and Scopus identified randomized controlled trials (RCTs) published up to 12 June 2024. UL motor recovery was assessed using the Fugl-Meyer Upper Extremity (FMUE) scale. The NMA was performed using the Bayesian approach with the BUGSnet package in R software to calculate the relative effectiveness of each intervention.

Results

34 RCTs involving 1,704 participants were included. Among non-immersive gaming systems, Microsoft Kinect demonstrated the greatest effective in enhancing UL motor function, followed by Nintendo Wii, then NIVR and IVR head-mounted devices. CT showed the least effective. Specifically, Microsoft Kinect significantly improved FMUE scores (mean difference [MD] = 7.27, 95% confidence interval [CI]: 0.59 to 13.77, p < 0.05), followed by Nintendo Wii (MD = 4.53, 95% CI: 0.87 to 8.14, p < 0.05), and NIVR (MD = 3.57, 95% CI: 1.18 to 6.01, p < 0.05). In contrast, IVR head-mounted devices showed no statistically significant differences in outcomes, with MD of 4.16 (95% CI: -0.02 to 8.38).

Conclusion

Non-immersive gaming console of Microsoft Kinect is the most effective intervention for improving UL motor function in stroke survivors. In contrast, IVR head-mounted devices did not offer significant advantages over CT. These findings suggest that non-immersive gaming consoles of Microsoft Kinect could be a more cost-effective and accessible alternative for stroke rehabilitation.

Mechanism of disturbed endothelial cell function on angiogenesis following ischemic brain stroke (Review)

The present study focused on the mechanisms of post-ischemic stroke (IS) angiogenesis from the perspective of endothelial cells (ECs) dysfunction. First, it emphasized the importance of hypoxia-inducible factor-1α in the function of ECs under hypoxic conditions, particularly in promoting angiogenesis and improving cerebral blood supply. Secondly, inflammatory cytokines and adhesion factors (for example, selectins, the immunoglobulin superfamily and integrins) influence the function and angiogenesis of ECs through various mechanisms and signaling pathways following IS. In addition, the effects of oxidative stress on ECs function and angiogenesis were explored, along with the potential of antioxidant strategies to improve EC function and promote angiogenesis. Based on these insights, the present study proposed new therapeutic strategies to ameliorate endothelial dysfunction and promote angiogenesis following IS, including small-molecule drugs targeting specific molecules, gene therapy and traditional Chinese medicine treatments. Finally, the importance of translating these laboratory findings into clinical applications was emphasized, alongside the need for advanced imaging techniques to monitor the dynamic processes of post-IS angiogenesis and evaluate the efficacy of novel therapeutic interventions. These explorations aimed at providing a more comprehensive understanding of EC function and the regulatory mechanisms of a deeper understanding of angiogenesis following IS, offering new intervention strategies for IS treatment.

Caffeine improves hypoxia/reoxygenation induced neuronal cell injury through inhibiting cellular ferroptosis: an in vitro study

OBJECTIVE

Ferroptosis, a regulated cell death pathway driven by lipid peroxidation and iron overload, is implicated in neuronal injury caused by hypoxia/reoxygenation (H/R). Caffeine, a widely consumed psychoactive compound, has shown neuroprotective effects in various central nervous system disorders, but its role in regulating ferroptosis remains unclear. This study investigates the neuroprotective effects of caffeine on ferroptosis and its regulation of ACSL4, a key ferroptosis-related protein.

METHODS

Molecular docking was performed to evaluate the interaction between caffeine and ferroptosis-related proteins ACSL4 and GPX4. HT-22 cells were subjected to H/R to establish an in vitro injury model, followed by treatment with caffeine at varying concentrations. ACSL4 was silenced or overexpressed to explore its role in caffeine-mediated ferroptosis regulation. Cell viability, inflammatory cytokines, ferroptosis markers, and mitochondrial function were assessed.

RESULTS

Molecular docking revealed favorable binding affinities of caffeine with ACSL4 (-5.6 kcal/mol) and GPX4 (-4.6 kcal/mol). Caffeine treatment dose-dependently improved cell viability, reduced TNF-α, IL-1β, and IL-6 levels, and inhibited ferroptosis by downregulating ACSL4 and upregulating GPX4. Overexpression of ACSL4 reversed these protective effects, increasing lipid peroxidation markers (iron, Fe2+, ROS, and MDA) and reducing GSH levels and mitochondrial membrane potential. Conversely, silencing ACSL4 enhanced caffeine's protective effects, confirming its role as a critical target of caffeine-mediated ferroptosis inhibition.

CONCLUSION

Caffeine protects against H/R-induced neuronal injury by regulating ACSL4-mediated ferroptosis, reducing oxidative stress and inflammation. These findings highlight ACSL4 as a therapeutic target and provide mechanistic insights into caffeine's neuroprotective potential.

FLAIR Vascular Hyperintensities as Imaging Biomarker in Pediatric Acute Ischemic Stroke

BACKGROUND

Fluid-attenuated inversion recovery vascular hyperintensities (FVH) are high signal intensities on magnetic resonance imaging resulting from sluggish or stagnant flow through vessels. This investigation describes the prevalence, risk factors, and outcomes associated with FVH in pediatric arterial ischemic stroke (AIS).

METHODS

Retrospective review of children aged 29 days to 18 years in a single institution stroke registry from 2006 to 2022 with AIS. Magnetic resonance imaging were assessed for large vessel occlusion (LVO), FVH score, modified Alberta Stroke Program Early Computed Tomography Score, and AIS volume. The association between demographic and imaging factors with the presence of and high FVH burden was assessed using Fisher exact, Pearson χ2, or Kruskal-Wallis tests. Wilcoxon rank-sum test evaluated the association of FVH score with the presence of LVO and poor outcome. The relationship between FVH score and age, time to magnetic resonance imaging, stroke volume, modified Alberta Stroke Program Early Computed Tomography Score, Pediatric National Institutes of Health Stroke Scale, and Pediatric Stroke Outcome Measure score were assessed using Spearman correlation. A multivariable logistic regression was used to evaluate predictors of FVH.

RESULTS

In total, 273 patients with AIS were screened, and 83 met the inclusion criteria. Patients were a median age of 11.6 years (range, 1 month-18 years) and 37% were female. FVH were present in 53% of the cohort. Median FVH score was 0 (interquartile range, 0-2) in those without LVO and 5.5 (interquartile range, 3-7) in those with LVO (P<0.0001). There was a positive correlation between FVH score and Pediatric National Institutes of Health Stroke Scale (rs=0.40; P=0.003), modified Alberta Stroke Program Early Computed Tomography Score (rs=0.62; P<0.0001), stroke volume (rs=0.58; P<0.0001) and Pediatric Stroke Outcome Measure at 1 year (rs=0.32; P=0.012). In the multivariable logistic regression, older age (odds ratio, 1.38 [95% CI, 1.08-1.77]; P=0.009) and the presence of LVO (odds ratio, 301.97 [95% CI, 10.89-8373.16]; P=0.001) were associated with high FVH burden.

CONCLUSIONS

FVH are prevalent in children with AIS. FVH are associated with LVO, larger infarct size, and worse outcomes. Further study is needed to determine whether FVH can be used to identify patients who would benefit most from recanalization therapies.

High-Resolution Magnetic Resonance Imaging Radiomics for Identifying High-Risk Intracranial Plaques

The rupture of vulnerable plaques is the principal cause of luminal thrombosis in acute ischemic stroke. The identification of plaque features that indicate risk for disruption may predict cerebrovascular events. Here, we aimed to build a high-risk intracranial plaque model that differentiates symptomatic from asymptomatic plaques using radiomic features based on high-resolution magnetic resonance imaging (HRMRI). One hundred and seventy-two patients with 188 intracranial atherosclerotic plaques (100 symptomatic and 88 asymptomatic) with available HRMRI data were recruited. Clinical characteristics and conventional plaque features on HRMRI were measured, including high signal on T1-weighted images (HST1), the degree of stenosis, normalized wall index, remodeling index, and enhancement ratio (ER). Univariate and multivariate analyses were performed to build a traditional model to differentiate between symptomatic and asymptomatic plaques. Radiomic features were extracted from pre-contrast and post-contrast HRMRI. A radiomic model based on HRMRI was constructed using random forests, ridge, least absolute shrinkage and selection operator, and deep learning (DL). A MIX model was constructed based on the radiomic model and the traditional model. Gender, HST1, and ER were associated with symptomatic plaques and were included in the traditional model, which had an area under the curve (AUC) of 0.697 in the training set and 0.704 in the test set. The radiomic model achieved an AUC of 0.982 in the training set and 0.867 in the test dataset for identifying symptomatic plaques. In the training set, the MIX model showed an AUC of 0.977. In the test set, the MIX model exhibited an improved AUC of 0.895, which outperformed the traditional model (p = 0.032). Radiomic analysis based on DL and machine learning can accurately identify high-risk intracranial plaques.

Effect of hospital-community-home collaborative health management on symptoms, cognition, anxiety, and depression in high-risk individuals for stroke

BACKGROUND

Effective health management for high-risk stroke populations is essential. The hospital-community-home (HCH) collaborative health management (CHM) model leverages resources from hospitals, communities, and families. By integrating patient information across these three domains, it facilitates the delivery of tailored guidance, health risk assessments, and three-in-one health education.

AIM

To explore the effects of the HCH-CHM model on stroke risk reduction in high-risk populations.

METHODS

In total, 110 high-risk stroke patients screened in the community from January 2019 to January 2023 were enrolled, with 52 patients in the control group receiving routine health education and 58 in the observation group receiving HCH-CHM model interventions based on routine health education. Stroke awareness scores, health behavior levels, medication adherence, blood pressure, serum biochemical markers (systolic/diastolic blood pressure, total cholesterol, and triglyceride), and psychological measures (self-rating anxiety/depression scale) were evaluated and compared between groups.

RESULTS

The observation group showed statistically significant improvements in stroke awareness scores and health behavior levels compared to the control group (P < 0.05), with notable enhancements in lifestyle and dietary habits (P < 0.05) and reductions in postintervention systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, self-rating anxiety scale, and self-rating depression scale scores (P < 0.05).

CONCLUSION

The HCH-CHM model had a significant positive effect on high-risk stroke populations, effectively increasing disease awareness, improving health behavior and medication adherence, and appropriately ameliorating blood pressure, serum biochemical marker levels, and negative psychological symptoms.

Investigating the Potential Therapeutic Targeting of the JAK-STAT Pathway in Cerebrovascular Diseases: Opportunities and Challenges

Cerebrovascular disease (CVD) is a significant neurological condition resulting from pathological changes in the brain's blood supply and is currently the leading cause of death and disability worldwide. The progression of CVD is closely associated with endothelial damage, plaque formation, and thrombosis, driven by long-term alterations in vascular endothelial cells, smooth muscle cells, microglia, and other immune-inflammatory cells. Among the key molecular pathways involved, the Janus kinase/signal transducer and activator of transcription (JAK-STAT) signaling pathway plays a central role. Dysregulation of the JAK-STAT pathway is implicated in the pathogenesis of CVD by influencing the aforementioned cell types and associated pathological processes. Importantly, the role of the JAK-STAT pathway varies across different types of CVD and throughout different stages of disease progression (e.g., pre-morbid, acute, and chronic phases). This review examines the composition, activation, and regulation of the JAK-STAT pathway and summarizes recent findings on its involvement in CVD. We discuss the distinct roles of JAK-STAT signaling in various CVD conditions, the potential reasons for these differences, and explore the clinical translational prospects and technical challenges of targeting the JAK-STAT pathway for therapeutic intervention in CVD.

The critical role of Sirt1 in ischemic stroke

Ischemic stroke, the most prevalent form of stroke, is responsible for the highest disability rates globally and ranks as the primary cause of mortality worldwide. Sirt1, extensively investigated in neurodegenerative disorders, is the most well-known and earliest member of the sirtuins family. However, its mechanism of action during ischemic stroke remains ambiguous. The literature examination revealed the intricate involvement of Sirt1 in regulating both physiological and pathological mechanisms during ischemic stroke. Sirt1 demonstrates deacetylation effects on PGC-1α, HMGB1, FOXOs, and p53. It hinders the activation of NLRP3 inflammasome and NF-κB while also engaging with AMPK. It regulates inflammatory response, oxidative stress, mitochondrial dysfunction, autophagy, pro-death, and necrotic apoptosis. Therefore, the potential of Sirt1 as a therapeutic target for the management of ischemic stroke is promising.

Prevalence of large vessel occlusions in an unselected hospital-based stroke cohort in Sweden

Introduction

Determining the prevalence of large vessel occlusions (LVOs) is important for planning and accessing mechanical thrombectomy treatment. Previous estimates vary greatly in studies, which might be related to different inclusion criteria and/or selection bias. In this cohort study, we aimed to determine the presence of LVO in an unselected, i.e., untriaged, hospital-based stroke cohort in Sweden.

Methods

Stroke patients treated at Karolinska Huddinge University Hospital were consecutively collected during the years 2008 through 2015, identified by an ICD-10 diagnosis of ischemic stroke (I63). Patients with LVO were selected through radiology reports indicating LVO.

Results

A total of 3,152 consecutive patient events had received a diagnosis of ischemic stroke during the study period. A total of 356 occlusion events were found in the internal carotid artery, the first two segments of the middle cerebral artery (M1, M2), and anterior cerebral artery (A1, A2), the vertebral artery, basilar artery and the first two segments of the posterior cerebral artery (P1, P2). This resulted in an LVO prevalence of 11.3% in this cohort. Seventy-six percent of occlusions were located in the anterior circulation, and 24% in the posterior circulation. The most frequent occluded vessel was M1 (n = 166, 39%).

Conclusion

In this study of consecutively collected stroke patients the prevalence of LVO was lower compared to other studies, possibly related to our unselected patient cohort, limited use of CT angiography, and/or the LVO definition used. These results are of importance for decision-making regarding the capacity of comprehensive stroke centers.

Novel Hypochlorous Acid-Activated Near-Infrared Probe Monitors the Dynamic Changes of Myeloperoxidase Activity in Ischemic Brain

Myeloperoxidase (MPO) contributes to the progression of ischemic damage. To fully understand MPO biology, highly sensitive and specific probes that can trace the activity of endogenous MPO fluxes are indispensable. Here, we developed two hypochlorous acid (HClO)-activated near-infrared probes to image MPO activity in a noninvasive manner. The probe MPO-NIR-II could track MPO-induced HClO in real time and in situ upon various stimuli with high sensitivity and specificity. Furthermore, MPO-NIR-II could monitor the MPO activity by in vivo fluorescence imaging and confocal laser scanning microscopy in mice with ischemic stroke. Moreover, a high-content screening system for MPO inhibitors was established by combining MPO-NIR-II with MPO-overexpressed cells and mouse brain slices with ischemic stroke, and the candidate compound AZD5904 was found to effectively attenuate ischemic brain injury. Overall, this work provides a versatile fluorescence tool that holds great promise for visualizing endogenous MPO fluxes of brain ischemia.

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.

Discovery of Isobenzofuran-1(3H)-one Derivatives as Selective TREK-1 Inhibitors with In Vitro and In Vivo Neuroprotective Effects

TREK-1 regulates neuronal excitability and neuronal cell apoptosis, and inhibition of TREK-1 is a potential strategy to prevent cell death and achieve neuroprotection in an ischemic stroke. In this work, a series of novel isobenzofuran-1(3H)-one derivatives were designed and synthesized as TREK-1 inhibitors, and extensive structure-activity relationships led to the discovery of potent and selective TREK-1 inhibitors having IC50 values of a low micromolar level. Among them, Cpd8l potently and selectively inhibited TREK-1 (IC50 = 0.81 μM, selectivity >30 fold over other K+, Na+, and TRP channels). Cpd8l remarkably reduced the neuron death in the OGD/R-induced cortical neuronal injury model, while adenovirus silencing TREK-1 reduced its neuroprotective effect. Furthermore, Cpd8l could effectively ameliorate brain injury in MCAO/R model mice. Collectively, this work demonstrates that Cpd8l may serve as a novel lead compound to develop a highly potent and selective TREK-1 inhibitor for ischemic stroke treatment.

Association between triglyceride glucose-waist height ratio and stroke: a population-based study

Background

Stroke poses a substantial threat to global public health. The triglyceride glucose-waist height ratio (TyG-WHtR), which incorporates the TyG metric with obesity-related WHtR, has demonstrated superior diagnostic and predictive value compared to the TyG index alone. Nevertheless, there is still a lack of in-depth exploration into the relationship between TyG-WHtR and stroke. This study seeks to address this gap by extracting information from the National Health and Nutrition Examination Survey (NHANES) to elucidate the potential association between TyG-WHtR levels and stroke.

Methods

This study included 8,757 individuals from four research cycles conducted between 2011 and 2018. To examine the potential relationship between TyG-WHtR and stroke, we conducted multivariable logistic regression analysis. In addition, smooth curve fitting was applied to display the nonlinear association. Subgroup analyses and sensitivity analyses contributed to examining the robustness and consistency of the relationship between TyG-WHtR and stroke. The receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic capability of TyG-WHtR and TyG.

Results

After adjusting for relevant covariates, a positive association between TyG-WHtR levels and stroke occurrence was observed (OR: 1.26, 95% CI: 1.02-1.55). Specifically, each unit increase in TyG-WHtR was associated with a 26% higher likelihood of stroke. The findings of sensitivity analysis further demonstrated the stability of this positive relationship. Subgroup analysis revealed that this association was significant among participants who did not engage in moderate exercise and those without coronary heart disease or angina pectoris. ROC analysis demonstrated that TyG-WHtR exhibited superior predictive value compared to TyG.

Conclusion

This study identified an association between elevated TyG-WHtR levels and an increased prevalence of stroke, suggesting that TyG-WHtR may serve as a valuable predictive tool for stroke risk, with potential implications for clinical prevention and early intervention.

A Novel Explainable Attention-Based Meta-Learning Framework for Imbalanced Brain Stroke Prediction

The accurate prediction of brain stroke is critical for effective diagnosis and management, yet the imbalanced nature of medical datasets often hampers the performance of conventional machine learning models. To address this challenge, we propose a novel meta-learning framework that integrates advanced hybrid resampling techniques, ensemble-based classifiers, and explainable artificial intelligence (XAI) to enhance predictive performance and interpretability. The framework employs SMOTE and SMOTEENN for handling class imbalance, dynamic feature selection to reduce noise, and a meta-learning approach combining predictions from Random Forest and LightGBM, and further refined by a deep learning-based meta-classifier. The model uses SHAP (Shapley Additive Explanations) to provide transparent insights into feature contributions, increasing trust in its predictions. Evaluated on three datasets, DF-1, DF-2, and DF-3, the proposed framework consistently outperformed state-of-the-art methods, achieving accuracy and F1-Score of 0.992189 and 0.992579 on DF-1, 0.980297 and 0.981916 on DF-2, and 0.981901 and 0.983365 on DF-3. These results validate the robustness and effectiveness of the approach, significantly improving the detection of minority-class instances while maintaining overall performance. This work establishes a reliable solution for stroke prediction and provides a foundation for applying meta-learning and explainable AI to other imbalanced medical prediction tasks.