Stroke最新文献

{"title":"Nursing's Role in Psychosocial Health Management After a Stroke Event: A Scientific Statement From the American Heart Association.","authors":"Patricia A Zrelak, Karen B Seagraves, Samir Belagaje, Wendy Dusenbury, James J García, Niloufar N Hadidi, Kiffon M Keigher, Mary Love, Gianluca Pucciarelli, Erica Schorr, Cesar Velasco","doi":"10.1161/STR.0000000000000471","DOIUrl":"10.1161/STR.0000000000000471","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke can have profound psychosocial health implications. These constructs are often overlooked and undertreated yet can be as devastating as the physical, functional, and cognitive consequences after stroke.</p><p><strong>Aim: </strong>This scientific statement aims to evaluate 5 important aspects of psychosocial health (depression, stress, anxiety, fatigue, and quality of life) after a stroke to provide a framework for related nursing care across the poststroke continuum.</p><p><strong>Methods: </strong>A narrative review of the literature published from 2018 to 2023 was conducted with databases such as PubMed/MEDLINE, ClinicalTrials.gov, PsychInfo/EBSCOHost, PsychArticles, CINHAL, and the Cochrane Library.</p><p><strong>Results: </strong>Findings reveal a gap in evidence-based nursing interventions for addressing poststroke psychosocial needs. Critical strategies for shaping therapeutic nursing care include enhanced screening with validated tools; educating stroke survivors, families, and staff on symptom recognition, prevention, and treatment; and ensuring appropriate pharmacological management and access to psychological and psychosocial interventions, including referrals to social services and other essential support systems. Care should be comprehensive and interdisciplinary. Nurse-led research can benefit from more inclusive inclusion, including individuals with recurrent strokes and preexisting psychosocial conditions, focusing on the impact of structural racism and care disparities and expanding evidence-based nursing interventions.</p><p><strong>Conclusions: </strong>Although there is limited high-level evidence on the nursing care for patients with suboptimal psychosocial health after stroke, nurses have a crucial role in addressing these needs. Enhanced screening, assessment, supportive services, and education are vital to ensure that patients receive the necessary treatment and care.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e281-e294"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Dependent Potentiation of the PERK Branch of UPR by GPR68 Offers Protection in Brain Ischemia.","authors":"Wenyan Sun, Virendra Tiwari, Grace Davis, Guokun Zhou, Sarun Jonchhe, Xiangming Zha","doi":"10.1161/STROKEAHA.124.048163","DOIUrl":"10.1161/STROKEAHA.124.048163","url":null,"abstract":"<p><strong>Background: </strong>In ischemia, acidosis occurs in/around injured tissue and parallels disease progression. Therefore, targeting an acid-sensitive receptor offers unique advantages in achieving the spatial and temporal specificity required for therapeutic interventions. We previously demonstrated that increased expression of GPR68 (G protein-coupled receptor 68), a proton-sensitive G protein-coupled receptor, mitigates ischemic brain injury. Here, we investigated the mechanism underlying GPR68-dependent protection.</p><p><strong>Methods: </strong>We performed biochemical and molecular analyses to examine poststroke signaling. We used in vitro brain slice cultures and in vivo mouse transient middle cerebral artery occlusion (tMCAO) models to investigate ischemia-induced injuries.</p><p><strong>Results: </strong>GPR68 deletion reduced PERK (protein kinase R-like ER kinase) expression in mouse brain. Compared with the wild-type mice, the GPR68-/- (knockout) mice exhibited a faster decline in eIF2α (eukaryotic initiation factor-2α) phosphorylation after tMCAO. Ogerin, a positive modulator of GPR68, stimulated eIF2α phosphorylation at 3 to 6 hours after tMCAO, primarily in the ipsilateral brain tissue. Consistent with the changes in eIF2α phosphorylation, Ogerin enhanced tMCAO-induced reduction in protein synthesis in ipsilateral brain tissue. In organotypic cortical slices, Ogerin reduced pH 6 and oxygen-glucose deprivation-induced neurotoxicity. Following tMCAO, intravenous delivery of Ogerin reduced brain infarction in wild-type but not knockout mice. Coapplication of a PERK inhibitor abolished Ogerin-induced protection. Delayed Ogerin delivery at 5 hours after tMCAO remained protective, and Ogerin has a similar protective effect in females. Correlated with these findings, tMCAO induced GPR68 expression at 6 hours, and Ogerin alters post-tMCAO proinflammatory/anti-inflammatory cytokine/chemokine expression profile.</p><p><strong>Conclusions: </strong>These data demonstrate that GPR68 potentiation leads to neuroprotection, at least in part, through enhancing PERK-eIF2α activation in ischemic tissue but has little impact on healthy tissue.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2510-2521"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Adjuvant Thrombolytic Therapies for Acute Ischemic Stroke Reperfusion.","authors":"Vignan Yogendrakumar, Sarah Vandelanotte, Eva A Mistry, Michael D Hill, Shelagh B Coutts, Raul G Nogueira, Thanh N Nguyen, Robert L Medcalf, Joseph P Broderick, Simon F De Meyer, Bruce C V Campbell","doi":"10.1161/STROKEAHA.124.045755","DOIUrl":"10.1161/STROKEAHA.124.045755","url":null,"abstract":"<p><p>Thrombolytic therapies for acute ischemic stroke are widely available but only result in recanalization early enough, to be therapeutically useful, in 10% to 30% of cases. This large gap in treatment effectiveness could be filled by novel therapies that can increase the effectiveness of thrombus clearance without significantly increasing the risk of harm. This focused update will describe the current state of emerging adjuvant treatments for acute ischemic stroke reperfusion. We focus on new treatments that are designed to (1) target different components that make up a stroke thrombus, (2) enhance endogenous fibrinolytic systems, (3) reduce stagnant blood flow, and (4) improve recanalization of distal thrombi and postendovascular thrombectomy.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2536-2546"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Stratified Genome-Wide Association Study in the Spanish Population Identifies a Novel Locus for Lacunar Stroke.","authors":"Jara Cárcel-Márquez, Elena Muiño, Cristina Gallego-Fabrega, Natalia Cullell, Miquel Lledós, Laia Llucià-Carol, Jesús M Martín-Campos, Tomás Sobrino, Francisco Campos, José Castillo, Marimar Freijo, Juan Francisco Arenillas, Victor Obach, José Álvarez-Sabín, Carlos A Molina, Marc Ribó, Jordi Jiménez-Conde, Jaume Roquer, Lucia Muñoz-Narbona, Elena Lopez-Cancio, Mònica Millán, Rosa Diaz-Navarro, Cristòfol Vives-Bauza, Gemma Serrano-Heras, Tomás Segura, Laura Ibañez, Laura Heitsch, Pilar Delgado, Rajat Dhar, Jerzy Krupinski, Luis Prats-Sánchez, Pol Camps-Renom, Marina Guasch, Garbiñe Ezcurra, Natalia Blay, Lauro Sumoy, Rafael de Cid, Joan Montaner, Carlos Cruchaga, Jin-Moo Lee, Joan Martí-Fàbregas, Israel Férnandez-Cadenas","doi":"10.1161/STROKEAHA.124.047833","DOIUrl":"10.1161/STROKEAHA.124.047833","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke (IS) represents a significant health burden globally, necessitating a better understanding of its genetic underpinnings to improve prevention and treatment strategies. Despite advances in IS genetics, studies focusing on the Spanish population and sex-stratified analyses are lacking.</p><p><strong>Methods: </strong>A case-control genome-wide association study was conducted with 9081 individuals (3493 IS cases and 5588 healthy controls). IS subtypes using Trial of ORG 10172 in Acute Stroke Treatment criteria were explored in a sex-stratified approach. Replication efforts involved the MEGASTROKE, GIGASTROKE, and the UK Biobank international cohorts. Post-genome-wide association study analysis included: in silico proteomic analysis, gene-based analysis, quantitative trait loci annotation, transcriptome-wide association analysis, and bioinformatic analysis using chromatin accessibility data.</p><p><strong>Results: </strong>Identified as associated with IS and its subtypes were 4 significant and independent loci. Replication confirmed 5p15.2 as a new locus associated with small-vessel occlusion stroke, with rs59970332-T as the lead variant (beta [SE], 0.13 [0.02]; <i>P</i>=4.34×10^-8). Functional analyses revealed <i>CTNND2</i> given proximity and its implication in pathways involved in vascular integrity and angiogenesis. Integration of Hi-C data identified additional potentially modulated genes, and in silico proteomic analysis suggested a distinctive blood proteome profile associated with the lead variant. Gene-set enrichment analyses highlighted pathways consistent with small-vessel disease pathogenesis. Gene-based associations with known stroke-related genes such as <i>F2</i> and <i>FGG</i> were also observed, reinforcing the relevance of our findings.</p><p><strong>Conclusions: </strong>We found <i>CTNND2</i> as a potential key molecule in small-vessel occlusion stroke risk, and predominantly in males. This study sheds light on the genetic architecture of IS in the Spanish population, providing novel insights into sex-specific associations and potential molecular mechanisms. Further research, including replication in larger cohorts, is essential for a comprehensive understanding of these findings and for their translation to clinical practice.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"55 10","pages":"2462-2471"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EEG Provides Insights Into Motor Control and Neuroplasticity During Stroke Recovery.","authors":"Célia Delcamp, Ramesh Srinivasan, Steven C Cramer","doi":"10.1161/STROKEAHA.124.048458","DOIUrl":"10.1161/STROKEAHA.124.048458","url":null,"abstract":"<p><p>In many branches of medicine, treatment is guided by measuring its effects on underlying physiology. In this regard, the efficacy of rehabilitation/recovery therapies could be enhanced if their administration was guided by measurements that directly capture treatment effects on neural function. Measures of brain function via EEG may be useful toward this goal and have advantages such as ease of bedside acquisition, safety, and low cost. This review synthetizes EEG studies during the subacute phase poststroke, when spontaneous recovery is maximal, and focuses on movement. Event-related measures reflect cortical activation and inhibition, while connectivity measures capture the function of cortical networks. Several EEG-based measures are related to motor outcomes poststroke and warrant further evaluation. Ultimately, they may be useful for clinical decision-making and clinical trial design in stroke neurorehabilitation.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2579-2583"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewer Experience Detecting and Judging Human Versus Artificial Intelligence Content: The <i>Stroke</i> Journal Essay Contest.","authors":"Gisele S Silva, Rohan Khera, Lee H Schwamm","doi":"10.1161/STROKEAHA.124.045012","DOIUrl":"10.1161/STROKEAHA.124.045012","url":null,"abstract":"<p><p>Artificial intelligence (AI) large language models (LLMs) now produce human-like general text and images. LLMs' ability to generate persuasive scientific essays that undergo evaluation under traditional peer review has not been systematically studied. To measure perceptions of quality and the nature of authorship, we conducted a competitive essay contest in 2024 with both human and AI participants. Human authors and 4 distinct LLMs generated essays on controversial topics in stroke care and outcomes research. A panel of <i>Stroke</i> Editorial Board members (mostly vascular neurologists), blinded to author identity and with varying levels of AI expertise, rated the essays for quality, persuasiveness, best in topic, and author type. Among 34 submissions (22 human and 12 LLM) scored by 38 reviewers, human and AI essays received mostly similar ratings, though AI essays were rated higher for composition quality. Author type was accurately identified only 50% of the time, with prior LLM experience associated with improved accuracy. In multivariable analyses adjusted for author attributes and essay quality, only persuasiveness was independently associated with odds of a reviewer assigning AI as author type (adjusted odds ratio, 1.53 [95% CI, 1.09-2.16]; <i>P</i>=0.01). In conclusion, a group of experienced editorial board members struggled to distinguish human versus AI authorship, with a bias against best in topic for essays judged to be AI generated. Scientific journals may benefit from educating reviewers on the types and uses of AI in scientific writing and developing thoughtful policies on the appropriate use of AI in authoring manuscripts.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2573-2578"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to Acute Dizziness/Vertigo in the Emergency Department: Selected Controversies Regarding Specialty Consultation.","authors":"Madeleine M Puissant, Susan Giampalmo, Charles R Wira, Joshua N Goldstein, David E Newman-Toker","doi":"10.1161/STROKEAHA.123.043406","DOIUrl":"10.1161/STROKEAHA.123.043406","url":null,"abstract":"<p><p>Acute dizziness and vertigo are common emergency department presentations (≈4% of annual visits) and sometimes, a life-threatening diagnosis like stroke is missed. Recent literature reviews the challenges in evaluation of these symptoms and offers guidelines for diagnostic approaches. Strong evidence indicates that when well-trained providers perform a high-quality bedside neurovestibular examination, accurate diagnosis of peripheral vestibular disorders and stroke increases. However, it is less clear who can and should be performing these assessments on a routine basis. This article offers a focused debate for and against routine specialty consultation for patients with acute dizziness or vertigo in the emergency department as well as a potential path forward utilizing new portable technologies to quantify eye movements.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2584-2588"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142295968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Psychosocial Health a Neglected Modifier of the Link Between Cerebral Small Vessel Disease and Dementia?","authors":"Sanjula D Singh, Jasper R Senff, Jose Rafael Romero","doi":"10.1161/STROKEAHA.124.048352","DOIUrl":"10.1161/STROKEAHA.124.048352","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2459-2461"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Stroke</i> Literature Synopsis (Clinical).","authors":"Emma Ball, Terence J Quinn","doi":"10.1161/STROKEAHA.124.048808","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048808","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"55 10","pages":"e271-e272"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"David G. Sherman Lecture: Improving Stroke Diagnosis and Treatment-A Journey Toward the End of Time.","authors":"Steven J Warach","doi":"10.1161/STROKEAHA.124.046919","DOIUrl":"10.1161/STROKEAHA.124.046919","url":null,"abstract":"<p><p>In the 2024 David G. Sherman Lecture, Steven J. Warach, illustrating with examples from his research, walks through the history of magnetic resonance imaging in acute stroke from the 1990s and early 2000s with the introduction, validation, and application of diffusion-weighted imaging, penumbral imaging (the diffusion-perfusion mismatch), and other imaging markers of the acute stroke pathology into routine clinical practice and stroke trials. The adaptation of diffusion-weighted imaging for clinical scanners in the acute hospital setting began a revolution in ischemic stroke diagnosis as the presence, location, and size of ischemic lesions could now be visualized at the earliest times after stroke onset when computed tomography and conventional magnetic resonance imaging still appeared normal. In combination with perfusion magnetic resonance imaging, diffusion-weighted imaging made imaging of the ischemic penumbra a practical reality for routine clinical use and feasible for integration as a selection tool into clinical trials. It was apparent from the initial use of diffusion-perfusion imaging in acute stroke that many patients had persistence of penumbra as late as 24 hours after stroke onset although the probability of penumbra decreased over time. The therapeutic time window for ischemic stroke selected by clinical and temporal criteria reflected the decreased proportion of patients with the therapeutic target over time rather than the absence of the penumbral target in all patients at later times. This work provided the empirical and conceptual framework for the shift toward selection and evaluation of patients for acute stroke therapies based on direct observation of the target pathology and away from the exclusive dependence on clinical and temporal surrogates to infer the presence of stroke therapeutic targets, a shift that has expanded the indications for acute reperfusion therapies over the last 10 years.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"55 10","pages":"2567-2572"},"PeriodicalIF":7.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}