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.

Four previously undescribed physalins (1-4), along with six known ones (5-10) were isolated and identified from the whole plants of Physalis minima L., a medicinal and edible plant traditionally used in southwest China. Their structures were established through comprehensive spectroscopic analyses, including high-resolution electrospray ionization mass spectrometry and 1D/2D nuclear magnetic resonance spectroscopy. Moreover, the absolute configurations of 1-3, 5 and 7 were examined by X-ray diffraction analyses. Compound 1, an undescribed sulfur-containing physalin, exhibited the most protective effect against oxygen-glucose deprivation/reperfusion (OGD/R)-stimulated ischemia-reperfusion (I/R) injury in PC12 cells. Meanwhile, compound 1 was found to reduce the inflammatory response, with mechanistic studies indicating that it decreased pyroptosis-associated proteins, such as cleaved-caspase1, NLRP3, and GSDMD N-terminus. Importantly, GSDMD knockdown significantly reversed the protective effects of compound 1, highlighting the involvement of pyroptosis in the compound's protective mechanism against OGD/R-induced I/R injury in PC12 cells in vitro.

Bile acids are implicated in the cholesterol synthesis and lipid metabolism. We aimed to prospectively investigate the relationships between serum TBA and adverse clinical outcomes after ischemic stroke.

Serum TBA levels at baseline were measured for 6609 ischemic stroke patients admitted at Minhang Hospital from January 2018 to December 2022. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale [mRS] score, 3-6) at 3 months after stroke onset, and secondary outcomes included major disability (mRS score, 3-5), death (mRS score, 6), and ordered 7-level categorical score of the mRS.

During the 3-month follow-up period, a total of 2118 (34.5 %) patients experienced primary outcome. After multivariate adjustment, the odds ratios of primary outcome for the highest versus the lowest quartile of TBA were 0.71 (95 % CI, 0.58-0.88; Ptrend = 0.001). Each SD increase of log-transformed TBA was associated with a 12 % (95 % CI, 5 %-18 %) decreased risk of the primary outcome. Multiple-adjusted spline regression model showed a linear association of serum TBA levels with the primary outcome (P for linearity = 0.005). Subgroup analyses further confirmed the inverse associations between serum TBA levels and the prognosis of ischemic stroke.

Elevated serum TBA levels were independently associated with a decreased risk of adverse outcomes at 3 months after ischemic stroke, indicating that TBA might be implicated in the development of ischemic stroke and might be a prognostic biomarker for ischemic stroke.

Several studies indicate that individuals with acute ischemic stroke (AIS) who have low levels of serum albumin (SA) have a dismal prognosis. However, intravenously administering albumin 25% at a dose of 2 g/kg did not lead to improved outcomes for patients with AIS after 90 days. Our objective was to examine the possible correlation between SA levels and stroke outcomes in a prospective cohort investigation.

The research included a total of 5111 participants diagnosed with AIS. The correlation between SA level and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. The relationships were examined employing restricted cubic splines. An investigation was conducted to ascertain the connection between SA levels and neurological functional results by employing mediation analysis, with the mediation impact of low-density lipoprotein (LDL) taken into account. In addition, the subgroup analyses were performed using the logistic regression.

The connection between levels of SA and neurological functional outcomes following AIS exhibited a U-shaped pattern. The likelihood of a negative result dropped significantly with an elevation in SA (per g/L: OR (odds ratio) 0.88; 95% CI (confidence interval) 0.847-0.913) among individuals with SA levels below 42.2 g/L. Conversely, the likelihood of a negative outcome rose with an increase in SA (per g/L: OR 1.033, 95% CI 1.009-1.058) among people with SA levels of 42.2 g/L or above. Comparable findings were seen for mortality outcomes. A mediation study revealed that LDL had a mediating function in the statistical connection between SA levels and neurological functional outcomes, accounting for 12.3% of the connection. No significant interactions were seen in any of the groupings.

Among patients with AIS, there was a U-shaped relationship between SA levels at admission and the likelihood of poor outcomes, which was partially mediated by LDL. There is a Graphical Abstract available for this article.

Intracerebral hemorrhage (ICH) is a common and fatal type of stroke, especially in central China. However, recent epidemiologic data are scarce. The study aimed to investigate the latest prevalence of ICH in central China and assess the risk of ICH in the next 10 years based on the Resident Health Records (RHR) data.

First, this cross-sectional study was based on a large-scale face-to-face investigation of ICH, which was launched on residents aged 20 years or older from January 1, 2021, to December 31, 2021, and estimated the prevalence of ICH in Hunan, a representative province in central China. Then, based on the RHR database, we assessed the ICH risk, population attributable fraction (PAF), and effects of ICH prevention under different risk factor control scenarios over the next decade by the China Kadoorie Biobank (CKB)-cardiovascular disease (CVD) model.

In 2021, 1.78 million participants enrolled in the investigation (mean age = 50.1 years; 51% male). The age-standardized prevalence rate of ICH was 159.2 (95% CI 153.7-164.9) per 100,000. The prevalence rate of ICH in men was 193.6 (95% CI 185.2-202.5) per 100,000, while in women was 124.0 (95% CI 117.1-131.3) per 100,000, and it increased with age. Spatial aggregation was observed, with the peak prevalence rate of ICH at 327.3 (95% CI 293.1-365.5) per 100,000 in Zhuzhou, followed by Changsha was 215.8 (95% CI 190.6-243.9) per 100,000, while Shaoyang had the lowest rate was 62.8 (95% CI 51.2-77.1) per 100,000. For the assessment of 10-year ICH risk, we included a total of 8.36 million participants aged 30-79 with the RHR database into the CKB-CVD model. We found that there will be 354,146 cases (ICH risk: 4.2%) of ICH among the participants in the next decade. Controlling hypertension showed the highest potential for ICH prevention, with a PAF of 8.6%. By controlling hypertension, smoking, waist circumference, and diabetes, 56,673 ICH cases (PAF 19.1%) can be avoided in the next decade.

The ICH prevalence in central China remained high. Strict blood pressure control could significantly reduce the risk of ICH in the next 10 years. It is important to continually improve ICH prevention strategies in the general population.

Stroke is a major cause of acquired disability and the second most frequent cause of dementia, while specific therapeutic rehabilitation strategies remain limited. Repetitive transcranial magnetic stimulation(rTMS) is a well-known rehabilitation modality after cerebral ischemic injury. White matter damage is an important contributor to motor and cognitive dysfunctions after stroke. This study aimed to evaluate the effect of rTMS on white matter recovery and neurological deficits in ischemic stroke. Grip strength test and novel object recognition test were conducted to assess motor and cognitive functions after middle cerebral artery occlusion(MCAO). MRI, including Diffusion tensor imaging (DTI) and Diffusion Tensor Tractography (DTT) were performed to evaluate white matter injury in MCAO rats. Moreover, Western blotting were detected to observe related myelin damage proteins in the ischemic brain. The results revealed that 10 Hz rTMS alleviated the motor and cognitive deficits in rats after ischemic surgery. Besides, the data from DTI and DTT showing that 10 Hz rTMS ameliorated the white matter lesion of rats after cerebral ischemia. In addition, 10 Hz rTMS attenuated significant loss of the myelin sheath by enhanced myelin associated proteins levels in the ischemic brain of ischemic rats. These findings suggest that 10 Hz rTMS exerted therapeutic neuroprotective properties after ischemic stroke, in a manner that may be associated with enhancing structural repairment of the white matter, which may provide a potential therapeutic strategy for ischemic stroke.

Previous studies have shown that elevated remnant cholesterol (RC) was associated with stroke risk. There is insufficient evidence on the relationship between 2-year changes in RC and stroke risk in the general population. Our aim was to explore the relationship between 2-year changes in RC and the risks of stroke and its subtypes in the general population.

The study included 62 443 individuals who were free of stroke from the Kailuan Study. Two-year changes in RC was defined as the difference between the RC in 2008 and that in 2006. Multivariable-adjusted Cox proportion models were used to examine the associations between 2-year changes in RC with the risks of stroke and its subtypes.

During a median follow-up period of 10.30 years, 3780 (6.38%) stroke events occurred. The changes in RC were positively associated with the risk of stroke, after adjustment for multiple potential confounders. The hazard ratio (HR) for the Q4 group versus the Q1 group was 1.14 (95%, CI, 1.02-1.28) for stroke, and 1.18 (95% CI, 1.04-1.32) for ischemic stroke. The risks of stroke were higher in the RC increased group than the RC nonincreased group. The HR was 1.12 (95% CI, 1.04-1.20) for stroke, and 1.15 (95% CI, 1.07-1.24) for ischemic stroke.

Substantial changes in RC are associated with increased risks of stroke in the general population. Monitoring long-term changes in RC may assist with the early identification of individuals at high risk of stroke.

High serum potassium, calcium, and magnesium levels have been reported to be associated with decreased risks of ischemic stroke, whereas their prognostic values in ischemic stroke remain unclear. We aimed to prospectively explore the associations of serum potassium, calcium, and magnesium levels with the prognosis of ischemic stroke.

We measured serum potassium, calcium, and magnesium levels at baseline among 5469 patients with ischemic stroke from the Minhang Stroke Cohort study. The primary outcome was the composite outcome of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke. Secondary outcomes included major disability, death, and the ordered 7-level categorical score of the modified Rankin Scale.

During 3-month follow-up, 1834 patients developed the primary outcome. After multivariate adjustment, the adjusted odds ratios of primary outcome for the highest versus the lowest quartile were 0.79 (95% CI, 0.68-0.93; Ptrend=0.007) for potassium, 0.69 (95% CI, 0.58-0.82; Ptrend<0.001) for calcium, and 0.83 (95% CI, 0.70-0.99; Ptrend=0.015) for magnesium. Multivariable-adjusted restricted cubic spline analyses showed linear dose-response relationships of serum potassium, calcium, and magnesium with the risk of primary outcome (all P for linearity<0.05).

High-normal serum potassium, calcium, and magnesium levels were associated with decreased risks of adverse outcomes at 3 months after ischemic stroke, suggesting that serum potassium, calcium, and magnesium might be valuable prognostic biomarkers for ischemic stroke.

Investigate the correlation between MCA stenosis severity and CTP parameter changes in ACI patients.

Sixty unilateral MCA stenosis-induced ACI patients (6 h-7 d post-onset) underwent CTA+CTP. Patients were stratified by stenosis degree: mild (<50%), moderate (50%-69%), severe (≥70%). CTP parameters were compared across groups. Patients with 50% to 100% stenosis were further analyzed by collateral circulation status (scores 2-3: good; 0-1: poor). Differences in CTP parameters and 90-day mRS were evaluated.

(1) Good collateral circulation (scores 2-3) was associated with higher CBF/CBV, prolonged TTP/MTT, and lower NIHSS/90-day mRS compared with poor circulation (scores 0-1). (2) Mild stenosis showed increased CBF/CBV in unaffected hemisphere. Moderate stenosis demonstrated reduced CBV and prolonged TTP/MTT in affected hemisphere. Severe stenosis exhibited increased CBF/CBV in unaffected hemisphere.

(1) CBV and CBF reduction positively correlated with stenosis severity. (2) Adequate collateral circulation was associated with reduced early neurological damage and disability.

Stroke, characterized as ischemic or hemorrhagic, leads to severe morbidity, mortality, and recurrence. This research analyzed stroke epidemiological trends from 1990-2021.

The Global Burden of Disease database provided stroke data including incidence, mortality, and disability-adjusted life-years (DALYs). Age-standardized rates (ASRs) and Estimated Annual Percent Changes (EAPC) measured incidence and mortality shifts. The sociodemographic index (SDI) was explored alongside stroke burden. Forecasting of stroke trends until 2035 utilized the Bayesian age-period-cohort (BAPC) model. The factors influencing the variability of stroke burden were subjected to decomposition analysis for a more in-depth examination. Additionally, frontier analysis was employed to visually illustrate the opportunities for alleviating burden in each nation or region, taking into account their respective stages of development.This study utilized the slope index of inequality (SII) and the concentration index, as defined by the World Health Organization (WHO), to assess absolute and relative inequalities in disease burden.

From 1990-2021, global stroke incidence increased by 15.03 %, with an overall decline in age-standardized incidence rate (ASIR). Lower in females than males, the incidence rise was larger in females. Stroke mortality declined by 2.60 % overall, with a rise in male mortality and decrease in female mortality. DALYs increased, with a 10.67 % decline by rate per 100,000 people. Eastern Europe, Central Asia, and East Asia experienced the highest incidence rates, with the greatest ASIR decline in the high-income Asia Pacific region. The decomposition analysis revealed a notable rise in Disability-Adjusted Life Years (DALYs) within the middle Socio-Demographic Index (SDI) quintile region, where factors such as aging and population growth were identified as primary contributing elements. Additionally, the frontier analysis indicated that nations or regions categorized within higher SDI quintiles are likely to exhibit greater potential for improvement. Projections for 2035 anticipate increased stroke cases alongside further ASIR and ASMR declines. Cross-country inequality analysis suggests that both absolute and relative health inequalities associated with the stroke burden have escalated during the period from 1990 to 2021.

Despite rising global stroke incidence and DALYs, decreases were seen in ASIR and ASMR since 1990. Incidence rates increased most quickly in females, with regional variation observable. High systolic blood pressure remained a key risk factor. Future efforts should target prevention and treatment to mitigate sex, age, and regional stroke disparities.

The Global Burden of Disease Study 2021 reports that stroke remains a leading cause of death, with ischemic stroke (IS) presenting significant challenges in screening, prevention, and treatment. We explored the causal effects of 1,400 plasma metabolites on IS outcomes using a two-sample Mendelian randomization (MR) framework. We assessed causal relationships between IS and 11 common clinical risk factors and further examined these relationships for metabolites. Mediation analysis identified mechanisms for metabolites affecting both IS and its risk factors. Finally, a phenome-wide association study (PheWAS) MR analysis evaluated the side effects and additional indications of IS-associated metabolites across 3,948 phenotypes from the UKBB GWAS. Nineteen metabolites showed a causal relationship with IS. MR analysis confirmed body mass index (BMI), high-density lipoprotein (HDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), and type 2 diabetes (T2D) as risk factors for IS. Among 136 metabolites associated with at least one IS risk factor, 132 were linked to risk factors but not directly to IS. BMI, DBP, and coffee intake mediated the causal relationship between IS and the levels of 1-stearoyl-GPG (18:0), 1-oleoyl-2-linoleoyl-GPE (18:1/18:2), Octadecadienedioate (C18:2-DC), and X-24,951. Phe-MR analysis indicated that these metabolites were protective and affected other indications similarly to IS. Our findings reveal causal pathways and identify four potential biomarkers for IS, providing new insights for its screening, prevention, and treatment.

In this study, we aimed to develop and validate an easy-to-use model to predict the risk of hospital-acquired pneumonia (HAP) in elderly patients with acute ischemic stroke (AIS).

A total of 2861 elderly AIS patients who were admitted to Jiading District Central Hospital Affiliated with Shanghai University of Medicine & Health Science from January 2016 to December 2023 were selected. Among these patients, 699 were diagnosed with HAP (HAP group), and 2162 patients were included in the control group (non-HAP group). Univariate and multivariate logistic regression analyses were performed to determine the risk factors for HAP after AIS. These factors were then used to establish a scoring system, from which a nomogram model was developed with R software.

Univariate analysis revealed 17 factors that were significantly associated with the development of HAP after AIS in elderly patients (P < 0.05). Multivariate logistic regression analysis including these factors revealed that age, the national institute of health stroke scale (NIHSS) score within 24 h of admission (Kwah LK. J Physiother 60:61, 2014), the stress hyperglycemia ratio (SHR), smoking status, and dysphagia status were independent risk factors for HAP after AIS. According to the oxfordshire community stroke project (OCSP) classification, patients classified as having the total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), and posterior circulation infarct (POCI) sub-types had a significantly increased risk of HAP compared with those classified as having the lacunar infarct (LACI) sub-type. A nomogram model constructed from these six risk factors yielded a C-index of 0.834 (95% confidence interval (CI): 0.811-0.857), indicating high accuracy. Calibration and clinical decision curve analyses revealed the reliability and clinical value of the proposed model.

Our proposed nomogram provides clinicians with a simple and reliable tool for predicting HAP from conventional data. The model can also help clinicians make personalized treatment decisions for patients at different risk levels.

Not applicable.

Ischemic stroke (IS) is a highly complex and heterogeneous disease involving multiple pathophysiological events. A better understanding of the pathophysiology of IS will enhance preventive, diagnostic and therapeutic strategies. Despite significant advances in modern medicine, the molecular mechanisms of IS are still largely unknown. The high-throughput omics approach opens new avenues for identifying IS biomarkers and elucidating disease pathogenesis mechanisms. Single-cell omics enables a more thorough and in-depth analysis of the cellular interactions and properties in IS. This will lead to a better understanding of the onset, treatment and prognosis of IS. In this paper, we first reviewed the disease signatures and mechanisms research of IS. Subsequently, the use of single-cell omics to comprehend the mechanisms of IS was discussed, along with some recent developments in the field. To further delineate the upstream pathogenic alterations and downstream molecular impacts of IS, we also discussed the current use of machine learning approaches to single-cell omics data analysis. Particularly, single-cell omics is being used to inform risk assessment, early patient diagnosis and treatment strategies, and their potential impact on precision medicine. Thus, we summarized the role of single-cell omics in precision medicine. Despite the relative youth of the field, the development of single-cell omics promises to provide a powerful tool for elucidating the pathogenesis of IS.

Acute ischemic stroke (AIS) is one of the leading causes of mortality and morbidity. This study aimed to identify risk factors, subtypes, and associated outcomes of AIS in the West Bank based on sex. We retrospectively analyzed medical records from 2018 to 2022 of stroke patients from four main hospitals in the West Bank (N = 711). The Modified Rankin Scale (mRS) assessed post-stroke disability on presentation day and thirty days later based on patient history and physical examination findings. An adjusted multinomial logistic regression model was implemented to calculate the adjusted odds ratios (OR) and the 95% confidence interval (CI). The significance level was set at P < 0.05. Out of 711 records, 118 were excluded. The final analysis included 593 AIS patients, with a median age of 63 and an interquartile range of 15. The majority of the patients (60.37%) were males and most of them (62.1%) were smokers. Males were less likely to have diabetes mellitus (DM) (P = 0.037, OR = 0.691) and atrial fibrillation (P = 0.039, OR = 0.627) compared to females. Small-volume strokes accounted for the majority of cases (60.7%). AIS had a thrombotic cause in (81.9%) of patients. On presentation, (40.4%) and (37.2%) of patients had more severe symptoms with mRS scores of 4 and 3, respectively. Males were more likely than females (P = 0.018, OR = 2.03) to present with more severe symptoms (mRS 3-4-5) on day one. An increase of one year in age resulted in a 9.8% higher risk of death (mRS 6) on day one (P = 0.016, OR = 1.098). Smoking history was associated with a seven-fold increase in mortality on day one (P = 0.049, OR = 7.396). Males developed AIS at a younger age while DM and atrial fibrillation were significantly more common in females. The majority of patients reported more severe symptoms on presentation, with notable differences observed between sexes. Male patients exhibited a higher prevalence of severe symptoms compared to female patients. Additionally, key risk factors such as smoking was significantly associated with the severity of symptoms at presentation, with variations observed across sexes. Prevention of risk factors (e.g., HTN, DM, atrial fibrillation, and smoking) is crucial, and further research is required.

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.

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).

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.

Nontraumatic subarachnoid hemorrhage (NSAH) is a type of hemorrhagic stroke with high mortality and low recovery rates. Although statins are commonly used in cardiovascular diseases, their impact on subarachnoid hemorrhage prognosis remains unclear. This study aimed to explore the relationship between statin use and short-term and long-term all-cause mortality in critically ill patients with NSAH.

Data from the Medical Information Mart for Intensive Care IV database were used to categorize critically ill patients with NSAH into statin and nonstatin groups. A Cox proportional hazards model assessed the association between statin use and all-cause mortality. Subgroup analyses were conducted to examine the consistency of statin effects on mortality.

The study included 750 patients, with 43% male. One-month mortality was 21%, and intensive care unit mortality was 17%. Cox regression analysis showed that statin use was independently associated with reduced intensive care unit mortality (hazard ratio [HR = 0.52; P = 0.010), 1-month mortality (HR = 0.49; P < 0.001), 3-month mortality (HR = 0.62; P = 0.012), and 1-year mortality (HR = 0.70; P = 0.040). Subgroup analyses showed no significant interactions. Simvastatin and atorvastatin both significantly reduced 1-month mortality.

Statin use may improve mortality outcomes in critically ill patients with NSAH, suggesting their potential benefit in this population.

Head and neck cancer (HNC) due to its nature and proximity to essential vasculature, along with different treatments, can lead to stroke, significantly contributing to morbidity and mortality. Our aim is to systematically evaluate the association of stroke incidence, mortality, and predictors with HNC treatment.

Pubmed, Web of Science, Embase, and ScienceDirect were searched from inception to July 2024 for articles reporting stroke incidences, mortality, or associated risk factors following treatment in HNC patients. A random-effects meta-analysis assessed cumulative incidence and mortality rates with proportional analysis and risk factors using hazard ratios (HRs) associated with HNC treatment. Subgroup analyses of incidence and mortality were conducted for pre- and post-2010 periods, reflecting changes in stroke protocols.

Out of 1561 studies, 69 studies with 258 850 HNC patients were included. The global cumulative incidence of stroke in HNC was 4.1% (95% CI: 3.3%-5.0%), with similar rates before and after 2010 (4.4% vs. 4.0%). In patients undergoing chemoradiotherapy (CRT), stroke incidence was 4.9% (95% CI: 3.5%-6.7%) with a median time to first stroke of 45 months (range: 14-51.7 months). Following radiation therapy (RT), stroke incidence was 3.8% (95% CI: 2.7%-5.3%) with a median time to stroke of 36 months (range: 6.8-130 months). The incidence rates of stroke in HNC patients were higher compared to the general population (HR: 1.69, 95% CI: 1.24-2.31, p = 0.001). Stroke mortality decreased from 28.5% (95% CI: 11.6%-54.9%) pre-2010 to 14.5% (95% CI: 11.6%-17.9%) 2010-2024. Stroke mortality was 39.3% (95% CI: 17.8%-66.0%) post-CRT and 21% (95% CI: 7.2%-47.7%) post-RT. Hypertension (HR = 1.75), diabetes (HR = 1.71), and age > 65 (HR = 2.17) increased stroke risk (p < 0.0001 for all). Geographically, South Korea (6.6%) had the highest incidence of stroke.

This is the first systematic review to analyze the association between stroke and HNC treatment. Stroke mortality decreased from 28.5% to 14.5% (pre-2010 vs. 2010-2024), with the highest mortality in the CRT group (39.3%). Given that stroke occurs 36-45 months after CRT, a screening protocol within 3-4 years is crucial.

The optimal systolic blood pressure (SBP) target in patients with increased cardiovascular risk remains uncertain. This study evaluated the efficacy and safety of intensive SBP control (<120 mm Hg) compared to standard SBP control (<140 mm Hg) in patients with increased cardiovascular risk.

We conducted a systematic search of PubMed, Embase, Web of Science, and Cochrane Library for RCTs published from database inception through November 2024 that compared intensive SBP control (<120 mm Hg) with standard SBP control (<140 mm Hg) in adults with high cardiovascular risk. Efficacy outcomes included all-cause mortality, major adverse cardiovascular events (MACE), cardiovascular death, stroke, myocardial infarction (MI), and heart failure. Safety outcomes included hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities.

Five RCTs comprising 39,434 patients were included. The all-cause mortality was significantly lower in the intensive SBP control group (672 of 19,712 [3.4%]) compared to the standard SBP control group (778 of 19,722 [3.9%]) (risk ratio 0.87 [95% confidence interval, 0.76-0.99, p = 0.03]). The incidence of MACE, cardiovascular death, MI, stroke, and heart failure was significantly lower in the intensive SBP control group as compared to standard SBP control group. The treatment effect (MACE) was consistent across all subgroups. Conversely, intensive SBP control was associated with an increased risk of hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities.

Targeting intensive SBP control to less than 120 mm Hg was associated with a lower incidence of all-cause mortality and MACE but a higher incidence of adverse events.

Approximately 20% of all transient ischaemic attacks (TIAs) and ischaemic strokes occur within the posterior circulation, with vertebrobasilar stenosis identified as the cause in roughly 25% of the cases. Studies have shown that about a quarter of these patients have atherosclerotic stenosis of at least 50% of the vertebrobasilar artery. Stenosis has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke, particularly in the first few weeks, which is significantly higher when compared with patients with stenosis of the anterior circulation. Therefore, aggressive treatment is important for the patient's prognosis. Stenting is emerging as a promising therapeutic strategy for persistent ischaemia events that do not respond to the best medical treatment, but it is not without complications. We systematically reviewed the literature on percutaneous transluminal angioplasty and stenting (PTAS) for intracranial vertebrobasilar artery stenosis (IVBS).

PubMed, Web-of-Science and Scopus were searched upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include prospective/retrospective cohort, randomised/non-randomised clinical trials and case series studies describing PTAS for IVBS. Pooled rates of intervention-related complications and outcomes were analysed with random-effect model meta-analysis using StataMP V.18.0 software.

31 studies were found eligible which included 1928 cases. 1103 basilar artery stenosis cases were reported in 27 studies 0.65 (95% CI 0.53, 0.76), I2: 99.72%. 648 vertebral cases were reported in 18 studies 0.60 (95% CI 0.49, 0.70), I2: 97.49%. In four studies, the rate of vertebrobasilar stenosis cases calculated as a proportion of the total sample size was 0.10 (95% CI 0.05, 0. 15). Mean stenosis in 21 included studies was found to be 0.83 (95% CI 0.79, 0.88), I2: 0.00%, which shows variation of baseline stenosis between studies was minimal. 51 deaths were recorded in 24 studies. Meta-analysis of mortality showed the overall rate of mortality was 0.03 (95% CI 0.02, 0.05), I2: 44.90%. In 14 studies, symptomatic intracranial haemorrhage events were recorded at an overall rate of 0.01 (95% CI 0.00, 0.02), I2: 0.00%. Generally, a follow-up period of at least 3 months was reported in the included studies. Furthermore, procedural stroke/TIA was evaluated in seven studies, four of which reported no events (0.03 (95% CI 0.00, 0.08), I2: 20.38%). Mean time from initial symptoms to recanalisation was 23.98 (95% CI 18.56, 29.40), I2=98.8%, p=0.00 days.

In certain individuals with medically unresolved, severe, symptomatic and non-acute IVBS, elective vertebrobasilar PTAS appears to be both safe and effective. Various stent designs and angioplasty-assisted techniques should be taken into consideration based on the specific clinical and radiological traits of the lesions. Future randomised controlled trials are required to verify these results.

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.

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.

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.

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.

The cardio-ankle vascular index (CAVI) is a new index of arteriosclerosis. The present study investigated the relationship between CAVI value and stroke in hypertension patients, especially the prevalence of stroke in patients with CAVI ≧9.

735 patients (M/F 293/442) with or without hypertension from Department of Vascular Medicine from 01/01/2012-31/21/2014 were divided into four groups: group 1: non-hypertension patients with CAVI<9, group 2: non-hypertension patients with CAVI ≧9, group 3: hypertension patients with CAVI<9, group 4: hypertension patients with CAVI ≧9. CAVI was measured by VS-1000 apparatus.

Prevalence of stroke and coronary artery disease were significantly higher in group 2 than in group 1. And the prevalence of stroke and coronary artery disease were also significantly higher in group 4 than in group 3. In addition, the level of right intima-media thickness (RIMT) was significantly higher in group 4 than in group 3 (0.102±0.025 vs 0.094±0.023, p<0.05). Multiple linear regressions showed that CAVI and age were independent associating factors of stroke in all patients (β=0.268, p=0.040; β=0.135, p<0.001; respectively). CAVI was an independent associating factors of stroke in hypertension patients (β=0.398, p<0.001).

The prevalence of stroke was higher in hypertension patients with CAVI ≧9 than in hypertension patients with CAVI<9, with higher level of right intima-media thickness. CAVI was an independent associating factors of stroke in hypertension patients.

Butylphthalide has shown significant potential in the treatment of ischemic stroke, but its precise mechanisms of action remain unclear. Long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) play crucial roles in the pathogenesis of ischemic stroke and may serve as potential therapeutic targets. This study investigated the effects of butylphthalide treatment on the lncRNA-mRNA co-expression network in ischemic stroke patients.

Peripheral blood samples were collected from ischemic stroke patients treated with butylphthalide and from control subjects. mRNA and lncRNA expression profiles were obtained using microarray scanning, and differentially expressed lncRNAs (DElncRNAs) were validated by qRT-PCR. Target genes interacting with DElncRNAs were predicted using the miRTargetLink database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on both DElncRNAs and differentially expressed mRNAs (DEmRNAs). A protein-protein interaction (PPI) network was constructed for proteins encoded by DEmRNAs. Co-expression analysis, based on Pearson correlation coefficients, identified the top five mRNAs and lncRNAs with high connectivity. Finally, molecular docking was performed to investigate the binding interaction between butylphthalide and key mRNAs.

A total of 86 differentially expressed mRNAs (69 upregulated, 17 downregulated) and 35 DElncRNAs (all upregulated) were identified. DEmRNAs were primarily associated with pathways related to cell receptors, signal transduction, cell proliferation, migration, and glucose metabolism, while DElncRNAs were involved in processes such as embryonic development, neuronal connectivity, and energy metabolism. Co-expression analysis identified key mRNA nodes (SETD9, ZNF718, AOC2, MPND, ODF1) and lncRNA nodes (IDH2-DT, CLEC12A-AS1, CARD8-AS1, LINC01275, ZNF436-AS1). Molecular docking analysis suggested that MT-CO1, SETD9, and ZNF718 could be potential targets of butylphthalide.

Butylphthalide may exert its therapeutic effects by regulating the LncRNA-mRNA co-expression network, influencing energy metabolism and neuronal development. This provides new insights into its mechanism of action and potential therapeutic targets.

Stroke is a sudden neurological decline caused by cerebrovascular diseases or impaired blood circulation. Research investigating the connection between glycated hemoglobin A1c (HbA1c) levels and stroke severity is limited. This study examined the connection between HbA1c levels and stroke severity in patients with acute ischemic stroke. A retrospective cross-sectional analysis of the medical records of 1103 patients with acute ischemic stroke from January 2020 to January 2024 was conducted. Patients were divided into seven groups on the basis of their HbA1c levels. Stroke severity within these groups was assessed via the National Institutes of Health Stroke Scale (NIHSS), with the aim of identifying correlations between stroke severity and glycemic status. This study examined the impact of various HbA1c levels on a range of demographic and clinical characteristics in stroke patients. The patients were grouped into seven categories on the basis of their HbA1c levels, and characteristics such as age; body mass index (BMI); LDL, HDL, and creatinine levels; and NIHSS scores at hospital admission were compared across these groups. Significant differences were observed in age, LDL levels (F = 3.999, P < 0.001), and creatinine levels (F = 1.303, P = 0.253) among the HbA1c categories. However, there were no significant differences in BMI, HDL levels, or length of hospital stay. A positive correlation was found between HbA1c levels and NIHSS scores, indicating that higher HbA1c levels are associated with greater stroke severity. This study revealed that the risk of severe stroke increases significantly when HbA1c levels exceed 6.5%. In contrast, maintaining HbA1c levels below 6.5% is linked to a reduced risk of severe stroke and lower mortality. Additionally, older adults are at greater risk and tend to experience more severe strokes.

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.

The incidence of acute ischemic stroke has been rising steadily in China and globally, with its high mortality and disability rates significantly affecting quality of life. As an important adjunct therapy, acupuncture has been widely implemented in stroke management. Emerging studies have investigated the effects of DU meridian and Chong Mai acupuncture on ischemic hemiparesis; however, the vascular protective mechanisms of electroacupuncture therapy targeting these meridians require further elucidation in stroke rehabilitation research.

This prospective cohort study aims to investigate the clinical efficacy and limitations of DU meridian acupuncture combined with Temporal Triple Needling (Sanjian) therapy in stroke rehabilitation. The intervention's therapeutic potential is evaluated through its modulatory effects on CD14+/CD14- monocyte subpopulations within peripheral blood mononuclear cells (PBMCs), with particular focus on angiogenesis-mediated vascular protection mechanisms.

Sixty-six patients with acute ischemic stroke will be randomly assigned 1:1 to control (conventional basal therapy, n = 33) and acupuncture (conventional standard stroke care + acupuncture, n = 33) groups for 10 days of intervention. The primary outcome is NIHSS score. The secondary outcomes: BMI and mRS scores, the level of TNF-A and IL-1B in serum, vascular endothelial growth factor (VEGF), Endocan ES, CD14+ and CD14- levels of peripheral blood mononuclear cells.

The aim of this study is to investigate whether electroacupuncture targeting the DU meridian combined with Temporal Triple Needling (Sanjian) improves cerebrovascular endothelial function in acute ischemic stroke patients, thereby reducing the NIHSS score and preventing further disease progression. This study also aims to contribute positively to the development of relevant clinical treatment protocols and to facilitate further research into the underlying mechanisms of these effects.

International Traditional Medicine Clinical Trial Registry ITMCTR2024000508.

Preclinical studies have suggested that Annexin A1 and Annexin A2 act as anti-inflammatory agents, slowing the progression of atherosclerosis and further potentially reducing the risk of ischemic stroke. Since the causality of Annexins and ischemic stroke remains uncertain, this study aimed to investigate the causal effects of both using a two-sample Mendelian randomization (MR) method.

The genetic instruments associated with Annexin A1 and Annexin A2 originated from a European-descent genome-wide association study (GWAS) of 50,000 participants from the INTERVAL study. Summary statistics for ischemic stroke and ischemic stroke subtypes were derived from the MEGASTROKE consortium's GWAS dataset, involving 40,585 cases and 406,111 controls of European ancestry. The inverse-variance weighted method was utilized in the main analysis, followed by a series of sensitivity analyses for robustness validation.

In the primary analysis, genetically predicted high Annexin A1 levels were associated with decreased risks of ischemic stroke (OR = 0.96; 95 % CI = 0.93-0.99; p = 0.023) and large artery stroke (OR = 0.88; 95 % CI = 0.81-0.96; p = 0.004). Similarly, genetically predicted high Annexin A2 levels also had significant associations with decreased risks of ischemic stroke (OR = 0.97; 95 % CI = 0.95-1.00; p = 0.019) and large artery stroke (OR = 0.90; 95 % CI = 0.85-0.96; p = 0.001).

In this two-sample MR study, we found that Annexins had causal protective effects against ischemic stroke, especially large artery stroke. Further basic mechanistic studies should be conducted to investigate the biological roles of these genes.

Recombinant tissue-type plasminogen activator (rt-PA), the primary drug for acute ischemic stroke (IS), has a narrow therapeutic window and carries a potential risk of hemorrhagic transformation (HT). Without rt-PA administration, patients may suffer permanent cerebral ischemia. Alpha-asarone (ASA), a natural compound derived from Acorus tatarinowii Schott, exhibits diverse neuropharmacological effects. This study aims to investigate whether ASA could improve outcomes in IS and be used to mitigate HT induced by rt-PA. We employed models of permanent middle cerebral artery occlusion (pMCAO) and photothrombotic cortical injury (PCI) to investigate both the therapeutic efficacy and underlying mechanisms of ASA during the acute and recovery periods following IS, respectively. Additionally, Sprague-Dawley rats were subjected to rt-PA treatment at 6-h post-PCI to mimic HT (rt-PA-HT). Our results revealed three key findings: (1) ASA demonstrated therapeutic effects in the acute phase of pMCAO rats by alleviating blood-brain barrier damage through inhibition of glial cell-mediated neuroinflammation; (2) administration of ASA 24 h after stroke ameliorated the neurological damage during the recovery phase in PCI mice by promoting neurogenesis via activation of the BDNF/ERK/CREB signaling pathway; (3) ASA attenuated rt-PA-HT injury by modulating the NLRP3/Caspase1/IL-1β and IL-18 pathways. Overall, our findings suggest that ASA mitigates neuronal injury following IS and HT, positioning it as a promising candidate for treating these conditions.

Ischemic stroke is one of the leading causes of death and disability. Dual transcranial direct current stimulation (dual-tDCS) is a promising intervention to treat ischemic stroke, but its efficacy and underlying mechanism remain to be verified. Cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway has recently emerged as a key mediator in cerebral injury. However, little is known about the effect of cGAS-STING on neuronal damage in ischemic stroke, and it remains to be studied whether the cGAS-STING pathway is involved in tDCS intervention for ischemic stroke. Therefore, we aimed to investigate whether dual-tDCS can alleviate ischemic brain injury in a rat model of ischemic stroke and if so, whether via cGAS-STING pathway. Middle cerebral artery occlusion (MCAO) was employed to induce a rat model of ischemic stroke. Male SD rats weighing 250-280 g were randomly assigned to the Sham, MCAO, Dual-tDCS, Dual-tDCS + RU.521, and Dual-tDCS + 2'3'-cGAMP groups, with 10 rats in each group completing the experiment. Behavioral, morphological, MRI, and molecular biological methods were performed. We found that the cGAS-STING pathway was activated and expressed in neurons after MCAO. Dual-tDCS improved motor function and infarct volume, inhibited neuronal apoptosis, promoted the expression of neurotrophins (BDNF and NGF), CD31, and VEGF, and suppressed inflammation reaction after MCAO via the cGAS-STING pathway. Taken together, dual-tDCS may improve MCAO-induced brain injury and promote the recovery of motor function, resulting from the inhibition of neuronal apoptosis and inflammation reaction, as well as promotion of the expression of nerve plasticity- and angiogenesis-related proteins, via cGAS-STING pathway.

Parkinson disease (PD) is highly heterogeneous in response to antiparkinsonian drugs. We herein aimed to identify PD subtypes based on dopamine responsiveness in three key motor signs (resting tremor, rigidity, and bradykinesia).

The acute levodopa challenge test was performed. Improvement rates in resting tremor, rigidity, and bradykinesia were calculated. A total of 228 PD patients were included for further analysis. Subtypes were determined by k-means clustering based on the improvement rates.

Four subtypes were identified: rt-r-b, moderate improvement in resting tremor, rigidity, and bradykinesia; RT-r-b, marked improvement in resting tremor but moderate improvement in rigidity and bradykinesia; RT-R-B, marked improvement in resting tremor, rigidity, and bradykinesia; rt-R-B, moderate improvement in resting tremor but marked improvement in rigidity and bradykinesia. These subtypes also differed in other motor and nonmotor symptoms.

Our study reveals four distinct subtypes in PD patients based on dopamine responsiveness. Our findings provide a novel insight into understanding PD heterogeneity and facilitate precision treatment.

D-dimer, lipoprotein (a) (Lp(a)), and high-sensitivity C-reactive protein (hs-CRP) are known predictors of vascular events; however, their impact on the stroke prognosis is unclear. This study used data from the Third China National Stroke Registry (CNSR-III) to assess their combined effect on functional disability and mortality after acute ischemic stroke (AIS).

In total, 9,450 adult patients with AIS were enrolled between August 2015 and March 2018. Patients were categorized based on a cutoff value for D-dimer, Lp(a), and hs-CRP in the plasma. Adverse outcomes included poor functional outcomes (modified Rankin Scale (mRS score ≥ 3)) and one- year all-cause mortality. Logistic and multivariate Cox regression analyses were performed to investigate the relationship between individual and combined biomarkers and adverse outcomes.

Patients with elevated levels of all three biomarkers had the highest odds of functional disability (OR adjusted: 2.01; 95% CI (1.47-2.74); P＜0.001) and mortality (HR adjusted: 2.93; 95% CI (1.55-5.33); P＜0.001). The combined biomarkers improved the predictive accuracy for disability (C-statistic 0.80 vs.0.79, P＜0.001) and mortality (C-statistic 0.79 vs.0.78, P=0.01).

Elevated D-dimer, Lp(a), and hs-CRP levels together increase the risk of functional disability and mortality one-year post-AIS more than any single biomarker.

Metals and nonmetals in drinking water could potentially influence cardiovascular health. The relationship between poor-quality drinking water, major adverse cardiovascular events (MACE), and diet is not well studied.

The aim of this study was to determine whether long-term exposure to metals (copper, manganese, aluminum, zinc, and cadmium) and nonmetals (selenium, sulfate, and nitrate-nitrogen) in drinking water was associated with MACE outcomes, and whether the dietary patterns could modify the association between long-term exposure to low-quality drinking water and MACE.

Data from a prospective population-based cohort from Yinzhou District, Ningbo (follow-up between 2016 and 2022) were linked to Yinzhou Health Information System. MACE endpoints included acute myocardial infarction (AMI), heart failure, stroke, angina, and cardiovascular death. Effect modification of the associations between exposure and MACE by dietary factors was determined.

In the final cohort of 24,212 participants, 57 had an AMI; 886 developed heart failure; 733 had a stroke; 23 had angina; and 134 had a cardiovascular death. An increased risk of: 1) AMI was seen with exposure to copper, aluminum, cadmium, and selenium; 2) stroke with exposure to zinc, copper, and selenium; 3) angina with exposure to zinc and copper; and 4) cardiovascular death with exposure to zinc and aluminum in drinking water. Consuming fish, white meat, and grain products attenuated MACE outcomes induced by metals and nonmetals in drinking water.

In this study, long-term exposure to higher metallic and nonmetallic elements in drinking water was associated with an increased risk of MACE. Specific dietary patterns modified the associations. Further studies are needed in this area.

The efficacy and safety of different antiplatelet in minor strokes or transient ischemic attacks (TIAs) remains controversial.

We searched PubMed, Embase, Web of Science and the Cochrane Library to identify all eligible articles until 12 September 2024. Efficacy outcomes were all-cause mortality, excellent outcome, functional independence and recurrent stroke. Safety outcomes were any types of bleeding and intracerebral hemorrhage (ICH). The associations were calculated for the overall data by using the odds ratios (ORs).

12 high-quality studies with 10 RCTs and 2 Non-RCTs were included, involving 61,281 patients with minor strokes or TIAs. Ticagrelor + Aspirin was significantly more effective than Clopidogrel + Aspirin in preventing post-stroke neurological dysfunctions (mRS 0-1), recurrent stroke and major vascular events for up to 90 days. But Ticagrelor + Aspirin is associated with an increased risk of any bleeding and mild bleeding at 90 days, and there is no significant difference in other bleeding risks. The risk of any bleeding in Dipyridamole + Aspirin is not significantly different from that in Aspirin, and is even significantly lower than in Ticagrelor. Compared with other dual antiplatelet therapies (DAPTs), Dipyridamole + Aspirin had no significant difference in the risk of all-cause mortality and major vascular events during follow-up.

For minor strokes or TIAs with a low bleeding risk or CYP2C19 loss-of-function alleles, Ticagrelor + Aspirin may be a better choice than Clopidogrel + Aspirin. Due to limited studies, the superiority of Dipyridamole + Aspirin is still difficult to conclude, and further high-quality studies are needed to verify the benefits of Dipyridamole + Aspirin in minor stroke or TIAs.

https://www.crd.york.ac.uk/prospero/, identifier CRD42024537462.

Ischemic stroke (IS) is a common cardiovascular disease (CVD). Insulin-like growth factor 2 (IGF2), circZNF609, and circPUM1 are involved in metabolic regulation, vascular health, neuroprotection, and inflammation modulation and are relevant to IS mechanisms. This study investigated the effects of plasma exosomal expression of circZNF609, circPUM1, and IGF2 on IS.

The expression of circZNF609, circPUM1, and IGF2 mRNA in exosomes was detected in 145 patients with IS and 290 controls using real-time qPCR in a cross-sectional study. Q1-Q4 represents the quartile groups based on the target gene expression levels.

There was no significant difference in the expression levels of circZNF609 and circPUM1 in the plasma exosomes between the IS and control groups (P > 0.05). However, a nonlinear relationship between the expression levels of circZNF609 in the IS group (P < 0.05). Exosomal IGF2 mRNA expression in the IS group was significantly lower than that in the control group (P = 0.043). The multifactorial adjusted results showed that in the case-control study of IS, circZNF609 in plasma exosomes was associated with a reduced risk of disease in group Q2 (adjusted OR: 0.565; P = 0.035) compared to that in group Q1, the low-expression group. In plasma exosomes, circZNF609 expression in group Q4 was associated with a reduced risk of disease in group Q1 (adjusted OR: 0.654; P = 0.004) compared to that in group Q1 (low expression). Plasma exosomes with IGF2 showed a reduced risk in the Q4 group with high IGF2 expression compared to that in the Q1 group with low IGF2 expression (adjusted OR: 0.543; P = 0.042).

This study suggests that the low expression of circZNF609, circPUM1, and IGF2 in peripheral blood plasma exosomes could pose a potential risk for IS and serve as biomarkers for clinical treatment.

To evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for prognosis spontaneous intracerebral hemorrhage (ICH) patients.

PubMed, EMBASE, Cochrane Library, Web of Science were used for screening literature on NLR predicting ICH prognosis from database up to January 2024. Case-control or cohort studies that provided statistical analysis data on NLR predicting ICH prognosis were included. Data were combined using odds ratio (OR) and standard mean differences (SMD) for categorical variables and continuous variables, respectively. Meta-analysis, subgroup analyses, and sensitivity analyses were performed by Review Manager 5.4 and Stata 15.0.

Meta-analysis of 21 studies with a total of 7,176 patients confirmed that NLR has a significant predictive value for mortality (SMD: 0.80, 95% CI: 0.58-1.02; OR: 1.10, 95% CI: 1.04-1.17) and neurological function outcomes (SMD: 0.66, 95% CI: 0.50-0.81; OR: 1.29, 95% CI: 1.17-1.41). NLR also significantly predicted the occurrence of stroke-associated pneumonia (SAP) (SMD: 0.54, 95% CI: 0.21-0.87). Subgroup analysis suggested that NLR had good predictive value for mortality in ICH patients aged ≥60 years, with hematoma volume > 15 mL, and NLR cut-off >7.5, and for neurological function in ICH patients, Asian patients, and those with NLR cut-off >7.5. The stability of the results was confirmed by sensitivity analysis.

NLR can significantly predict mortality, neurological function outcomes, and SAP occurrence in ICH patients. NLR cut-off >7.5 has good predictive value for both mortality and neurological function in ICH patients. Considering the limitations of this study, such as small sample size and potential heterogeneity, prospective studies with larger sample sizes are needed to confirm the findings of this article.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024544506.

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.

Stroke is the second leading cause of death globally. Oxidative stress plays a critical role in the development of stroke. The Oxidative Balance Score (OBS) is a tool used to assess the combined impact of diet and lifestyle on the body's antioxidant capacity. The study included stroke survivors from the National Health and Nutrition Examination Survey (1999-2018), with a total of 1,781 participants and a median follow-up duration of 6.5 years, during which 786 participants (39.59%) died. The relationship between OBS and all-cause mortality was assessed using the Cox proportional hazards model. The results indicated that individuals in higher OBS quartiles had lower mortality rates. Specifically, patients in the fourth quartile had a 41% reduced risk of all-cause mortality compared to those in the first quartile (HR = 0.59, 95% CI = 0.42-0.84, p = 0.003). Restricted cubic spline analysis revealed a linear inverse relationship between OBS and all-cause mortality. Subgroup analysis further demonstrated that the inverse association persisted across various population subgroups. Overall, our study suggests that higher levels of OBS can reduce the risk of all-cause mortality in stroke survivors and provides new evidence for their diet and lifestyle.