Journal of Investigative Medicine最新文献

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Predictors of malignant swelling in space-occupying cerebellar infarction. 占位性小脑梗塞恶性肿胀的预测因素
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-29 DOI: 10.1136/svn-2024-003360
Enayatullah Baki, Lea Baumgart, Victoria Kehl, Felix Hess, Andreas Wolfgang Wolff, Arthur Wagner, Moritz Roman Hernandez Petzsche, Tobias Boeckh-Behrens, Bernhard Hemmer, Bernhard Meyer, Jens Gempt, Silke Wunderlich
{"title":"Predictors of malignant swelling in space-occupying cerebellar infarction.","authors":"Enayatullah Baki, Lea Baumgart, Victoria Kehl, Felix Hess, Andreas Wolfgang Wolff, Arthur Wagner, Moritz Roman Hernandez Petzsche, Tobias Boeckh-Behrens, Bernhard Hemmer, Bernhard Meyer, Jens Gempt, Silke Wunderlich","doi":"10.1136/svn-2024-003360","DOIUrl":"https://doi.org/10.1136/svn-2024-003360","url":null,"abstract":"<p><strong>Background: </strong>Malignant swelling is a fatal complication that can occur abruptly in space-occupying cerebellar infarction. We aimed to establish markers that predict malignant swelling in cerebellar infarction.</p><p><strong>Methods: </strong>We retrospectively analysed data of stroke patients who were treated in our hospital between 2014 and 2020. Malignant swelling was defined as a mass effect in the posterior cranial fossa, accompanied by a decrease in consciousness due to compression of the brainstem and/or the development of obstructive hydrocephalus. Statistical analyses were performed on multiple variables to identify predictors of malignant swelling.</p><p><strong>Results: </strong>Among 7284 stroke patients, we identified 487 patients with an infarct in the cerebellum. 93 patients were suitable for analysis having space-occupying cerebellar infarction. 33 of 93 (35.5%) patients developed malignant swelling.Multivariable analysis revealed infarct volume as the main predictor being independently associated with the development of malignant swelling with a cut-off infarct volume of 38 cm<sup>3</sup> being associated with a swelling rate of >50% (OR 32.0, p<0.001).Higher NIHSS (National Institutes of Health Stroke Scale) score on admission (median NIHSS 12 vs 4, OR 1.078; p=0.008) and the presence of additional brainstem infarction (51.5% vs 16.7%, OR 5.312; p=0.013) were associated with the development of malignant swelling in univariate analyses.13 of 33 (39.4%) cases of malignant swellings occurred after more than 3 days.</p><p><strong>Conclusions: </strong>Infarct volume was the key significant predictor of malignant swelling in space-occupying cerebellar infarction. With many cases of malignant swelling occurring after more than 72 hours, we advocate prolonged neurological monitoring.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113761","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}
引用次数: 0
Why non-human primates are needed in stroke preclinical research. 为什么中风临床前研究需要非人灵长类动物?
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-28 DOI: 10.1136/svn-2024-003504
Xiya Long, Jinsheng Zeng
{"title":"Why non-human primates are needed in stroke preclinical research.","authors":"Xiya Long, Jinsheng Zeng","doi":"10.1136/svn-2024-003504","DOIUrl":"https://doi.org/10.1136/svn-2024-003504","url":null,"abstract":"<p><p>Numerous seemingly promising cerebroprotectants previously validated in rodents almost all have failed in stroke clinical trials. The failure of clinical translation strikes an essential need to employ more ideal animal models in stroke research. Compared with the most commonly used rodent models of stroke, non-human primates (NHPs) are far more comparable to humans regarding brain anatomy, functionality and pathological features. The aim of this perspective was to summarise the advantages of NHPs stroke models over rodents, discuss the current limitations of NHPs models, and cast an outlook on the future development of NHPs in stroke preclinical research.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113762","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}
引用次数: 0
Surgical timing and long-term outcomes in patients with severe haemorrhagic spinal cord cavernous malformations. 严重出血性脊髓海绵状畸形患者的手术时机和长期结果。
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002745
An Tian, Ziwei Cui, Jian Ren, Yeqing Ren, Ming Ye, Guilin Li, Chuan He, Xiaoyu Li, Gao Zeng, Peng Hu, Yongjie Ma, Jiaxing Yu, Jingwei Li, Lisong Bian, Fan Yang, Qianwen Li, Feng Ling, Tao Hong, Liyong Sun, Hongqi Zhang
{"title":"Surgical timing and long-term outcomes in patients with severe haemorrhagic spinal cord cavernous malformations.","authors":"An Tian, Ziwei Cui, Jian Ren, Yeqing Ren, Ming Ye, Guilin Li, Chuan He, Xiaoyu Li, Gao Zeng, Peng Hu, Yongjie Ma, Jiaxing Yu, Jingwei Li, Lisong Bian, Fan Yang, Qianwen Li, Feng Ling, Tao Hong, Liyong Sun, Hongqi Zhang","doi":"10.1136/svn-2023-002745","DOIUrl":"10.1136/svn-2023-002745","url":null,"abstract":"<p><strong>Background: </strong>Surgical resection of the lesions remains the main treatment method for most symptomatic spinal cord cavernous malformations (SCCMs) to eliminate the occupation and associated subsequent lifelong haemorrhagic risk. However, the timing of surgical intervention remains controversial, especially for patients in the acute stage after severe haemorrhage.</p><p><strong>Methods: </strong>Patients diagnosed with SCCMs who were surgically treated between January 2002 and December 2021 were selected and retrospectively reviewed. The Modified McCormick Scale (MMS) was used to evaluate neurological and disability status. All medical information was reviewed, and all patients were followed up for at least 6 months.</p><p><strong>Results: </strong>A total of 279 patients were ultimately included. With regard to long-term outcomes, 110 (39.4%) patients improved, 159 (57.0%) remained unchanged and 10 (3.6%) worsened. For patients with an MMS score of 2-5 on admission, in univariate and multivariate analyses, a ≤6 weeks period between onset and surgery (adjusted OR 3.211, 95% CI 1.504 to 6.856, p=0.003) was a significant predictor of improved MMS. Among 69 patients who first presented with severe haemorrhage, undergoing surgery within 6 weeks of the onset of severe haemorrhage (adjusted OR 4.901, 95% CI 1.126 to 21.325, p=0.034) was significantly associated with improvement of MMS score.</p><p><strong>Conclusion: </strong>Surgical timing can influence the long-term outcome of SCCMs. For patients with symptomatic SCCMs, especially those with severe haemorrhage, early surgical intervention within 6 weeks can provide more benefit.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72211460","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}
引用次数: 0
Reperfusion and cytoprotective agents are a mutually beneficial pair in ischaemic stroke therapy: an overview of pathophysiology, pharmacological targets and candidate drugs focusing on excitotoxicity and free radical. 再灌注和细胞保护剂是缺血性中风治疗中互惠互利的一对:病理生理学、药理学靶点和候选药物综述,重点关注兴奋性毒性和自由基。
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002671
Xiumei Xu, Mingyu Chen, Dongya Zhu
{"title":"Reperfusion and cytoprotective agents are a mutually beneficial pair in ischaemic stroke therapy: an overview of pathophysiology, pharmacological targets and candidate drugs focusing on excitotoxicity and free radical.","authors":"Xiumei Xu, Mingyu Chen, Dongya Zhu","doi":"10.1136/svn-2023-002671","DOIUrl":"10.1136/svn-2023-002671","url":null,"abstract":"<p><p>Stroke is the second-leading cause of death and the leading cause of disability in much of the world. In particular, China faces the greatest challenge from stroke, since the population is aged quickly. In decades of clinical trials, no neuroprotectant has had reproducible efficacy on primary clinical end points, because reperfusion is probably a necessity for neuroprotection to be clinically beneficial. Fortunately, the success of thrombolysis and endovascular thrombectomy has taken us into a reperfusion era of acute ischaemic stroke (AIS) therapy. Brain cytoprotective agents can prevent detrimental effects of ischaemia, and therefore 'freeze' ischaemic penumbra before reperfusion, extend the time window for reperfusion therapy. Because reperfusion often leads to reperfusion injury, including haemorrhagic transformation, brain oedema, infarct progression and neurological worsening, cytoprotective agents will enhance the efficacy and safety of reperfusion therapy by preventing or reducing reperfusion injuries. Therefore, reperfusion and cytoprotective agents are a mutually beneficial pair in AIS therapy. In this review, we outline critical pathophysiological events causing cell death within the penumbra after ischaemia or ischaemia/reperfusion in the acute phase of AIS, focusing on excitotoxicity and free radicals. We discuss key pharmacological targets for cytoprotective therapy and evaluate the recent advances of cytoprotective agents going through clinical trials, highlighting multitarget cytoprotective agents that intervene at multiple levels of the ischaemic and reperfusion cascade.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216801","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}
引用次数: 0
Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage. 脑小血管疾病改变了脑出血微创手术后的结果。
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002463
Yunke Li, Sung-Min Cho, Radhika Avadhani, Hassan Ali, Yi Hao, Santosh B Murthy, Joshua N Goldstein, Fan Xia, Xin Hu, Natalie L Ullman, Issam Awad, Daniel Hanley, Wendy C Ziai
{"title":"Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage.","authors":"Yunke Li, Sung-Min Cho, Radhika Avadhani, Hassan Ali, Yi Hao, Santosh B Murthy, Joshua N Goldstein, Fan Xia, Xin Hu, Natalie L Ullman, Issam Awad, Daniel Hanley, Wendy C Ziai","doi":"10.1136/svn-2023-002463","DOIUrl":"10.1136/svn-2023-002463","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS) for spontaneous supratentorial intracerebral haemorrhage (ICH) is controversial but may be beneficial if end-of-treatment (EOT) haematoma volume is reduced to ≤15 mL. We explored whether MRI findings of cerebral small vessel disease (CSVD) modify the effect of MIS on long-term outcomes.</p><p><strong>Methods: </strong>Prespecified blinded subgroup analysis of 288 subjects with qualified imaging sequences from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation (MISTIE) trial. We tested for heterogeneity in the effects of MIS and MIS+EOT volume ≤15 mL on the trial's primary outcome of good versus poor function at 1 year by the presence of single CSVD features and CSVD scores using multivariable models.</p><p><strong>Results: </strong>Of 499 patients enrolled in MISTIE III, 288 patients had MRI, 149 (51.7%) randomised to MIS and 139 (48.3%) to standard medical care (SMC). Median (IQR) ICH volume was 42 (30-53) mL. In the full MRI cohort, there was no statistically significant heterogeneity in the effects of MIS versus SMC on 1-year outcomes by any specific CSVD feature or by CSVD scores (all P<sub>interaction</sub> >0.05). In 94 MIS patients with EOT ICH volume ≤15 mL, significant reduction in odds of poor outcome was found with cerebral amyloid angiopathy score <2 (OR, 0.14 (0.05-0.42); P<sub>interaction</sub>=0.006), absence of lacunes (OR, 0.37 (0.18-0.80); P<sub>interaction</sub>=0.02) and absence of severe white matter hyperintensities (WMHs) (OR, 0.22 (0.08-0.58); P<sub>interaction</sub>=0.03).</p><p><strong>Conclusions: </strong>Following successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe WMHs. CSVD features may have utility for prognostication and patient selection in clinical trials of MIS.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72211457","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}
引用次数: 0
Src inhibition rescues FUNDC1-mediated neuronal mitophagy in ischaemic stroke. Src抑制挽救缺血性中风中FUNDC1介导的神经元线粒体自噬。
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002606
Tianchi Tang, Li-Bin Hu, Chao Ding, Zhihua Zhang, Ning Wang, Tingting Wang, Hang Zhou, Siqi Xia, Linfeng Fan, Xiong-Jie Fu, Feng Yan, Xiangnan Zhang, Gao Chen, Jianru Li
{"title":"Src inhibition rescues FUNDC1-mediated neuronal mitophagy in ischaemic stroke.","authors":"Tianchi Tang, Li-Bin Hu, Chao Ding, Zhihua Zhang, Ning Wang, Tingting Wang, Hang Zhou, Siqi Xia, Linfeng Fan, Xiong-Jie Fu, Feng Yan, Xiangnan Zhang, Gao Chen, Jianru Li","doi":"10.1136/svn-2023-002606","DOIUrl":"10.1136/svn-2023-002606","url":null,"abstract":"<p><strong>Background: </strong>Ischaemic stroke triggers neuronal mitophagy, while the involvement of mitophagy receptors in ischaemia/reperfusion (I/R) injury-induced neuronal mitophagy remain not fully elucidated. Here, we aimed to investigate the involvement of mitophagy receptor FUN14 domain-containing 1 (FUNDC1) and its modulation in neuronal mitophagy induced by I/R injury.</p><p><strong>Methods: </strong>Wild-type and FUNDC1 knockout mice were generated to establish models of neuronal I/R injury, including transient middle cerebral artery occlusion (tMCAO) in vivo and oxygen glucose deprivation/reperfusion in vitro. Stroke outcomes of mice with two genotypes were assessed. Neuronal mitophagy was analysed both in vivo and in vitro. Activities of FUNDC1 and its regulator Src were evaluated. The impact of Src on FUNDC1-mediated mitophagy was assessed through administration of Src antagonist PP1.</p><p><strong>Results: </strong>To our surprise, FUNDC1 knockout mice subjected to tMCAO showed stroke outcomes comparable to those of their wild-type littermates. Although neuronal mitophagy could be activated by I/R injury, FUNDC1 deletion did not disrupt neuronal mitophagy. Transient activation of FUNDC1, represented by dephosphorylation of Tyr18, was detected in the early stages (within 3 hours) of neuronal I/R injury; however, phosphorylated Tyr18 reappeared and even surpassed baseline levels in later stages (after 6 hours), accompanied by a decrease in FUNDC1-light chain 3 interactions. Spontaneous inactivation of FUNDC1 was associated with Src activation, represented by phosphorylation of Tyr416, which changed in parallel with the level of phosphorylated FUNDC1 (Tyr18) during neuronal I/R injury. Finally, FUNDC1-mediated mitophagy in neurons under I/R conditions can be rescued by pharmacological inhibition of Src.</p><p><strong>Conclusions: </strong>FUNDC1 is inactivated by Src during the later stage (after 6 hours) of neuronal I/R injury, and rescue of FUNDC1-mediated mitophagy may serve as a potential therapeutic strategy for treating ischaemic stroke.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152568","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}
引用次数: 0
One-year direct and indirect costs of ischaemic stroke in China. 中国缺血性脑卒中一年的直接和间接费用。
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002296
Wei Lv, Anxin Wang, Qianyi Wang, Ruimin Wang, Qin Xu, Shuqing Wu, Yi Han, Yong Jiang, Jinxi Lin, Jing Jing, Hao Li, Yongjun Wang, Xia Meng
{"title":"One-year direct and indirect costs of ischaemic stroke in China.","authors":"Wei Lv, Anxin Wang, Qianyi Wang, Ruimin Wang, Qin Xu, Shuqing Wu, Yi Han, Yong Jiang, Jinxi Lin, Jing Jing, Hao Li, Yongjun Wang, Xia Meng","doi":"10.1136/svn-2023-002296","DOIUrl":"10.1136/svn-2023-002296","url":null,"abstract":"<p><strong>Background: </strong>This is the first real-world study to estimate the direct costs and indirect costs of first-ever ischaemic stroke with 1-year follow-up in China, based on a nationally representative sample.</p><p><strong>Methods: </strong>Patients were chosen from 20 geographically diverse sites from the nationally representative database China National Stroke Registry-III (CNSR-III). The inclusion criteria were surviving patients who were hospitalised with first-ever ischaemic stroke from February 2017 to February 2018 (the index event); aged 18-80 during the index event; no history of other stroke types. The primary endpoints were direct medical costs, direct non-medical costs, indirect costs and total cost (ie, the sum of all cost components). Patient characteristics and clinical data were extracted from CNSR-III. Stroke-related in-hospital direct medical costs were collected from hospital electronic medical records. The patient survey collected data related to out-of-hospital direct medical costs, direct non-medical costs and indirect costs. The secondary objective was to explore clinical factors associated with cost outcomes through univariate analysis and multiple regression.</p><p><strong>Results: </strong>The study enrolled 520 patients. The total cost was 57 567.48 CNY, with 26 612.67 CNY direct medical costs, 2 787.56 CNY direct non-medical costs and 28 167.25 CNY indirect costs. Univariate analysis showed that longer lengths of stay during the index event, higher National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were associated with higher costs in all categories. Conversely, EuroQol 5 Dimension utility scores were associated with decreased costs except direct non-medical costs. Multiple regressions showed that higher admission NIHSS scores were independently associated with higher direct medical costs, indirect costs and total cost. Higher 3-month utilities were associated with lower total cost.</p><p><strong>Conclusion: </strong>This real-world study showed substantial 1-year economic burden following first-ever ischaemic stroke in China, and that indirect costs are a non-negligible driver of costs.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153687","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}
引用次数: 0
Combined effect of cortical superficial siderosis and cerebral microbleed on short-term and long-term outcomes after intracerebral haemorrhage. 皮质浅表含铁血黄素沉着症和脑微出血对脑出血后短期和长期结果的联合影响。
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002439
Yujia Jin, Yu-Hui Huang, Yu-Ping Chen, Yao-Dan Zhang, Jiawen Li, Kai-Cheng Yang, Xianghua Ye, Lu-Hang Jin, Jian Wu, Chang-Zheng Yuan, Feng Gao, Lu-Sha Tong
{"title":"Combined effect of cortical superficial siderosis and cerebral microbleed on short-term and long-term outcomes after intracerebral haemorrhage.","authors":"Yujia Jin, Yu-Hui Huang, Yu-Ping Chen, Yao-Dan Zhang, Jiawen Li, Kai-Cheng Yang, Xianghua Ye, Lu-Hang Jin, Jian Wu, Chang-Zheng Yuan, Feng Gao, Lu-Sha Tong","doi":"10.1136/svn-2023-002439","DOIUrl":"10.1136/svn-2023-002439","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cortical superficial siderosis (cSS) and cerebral microbleed (CMB) have distinct effects on intracerebral haemorrhage (ICH). We aim to investigate the combined effect of cSS and CMB on outcomes after ICH.</p><p><strong>Methods: </strong>Based on a single-centre stroke registry database, patients with spontaneous ICH who had CT scan within 48 hours after ictus and MRI subsequently were identified. Eligible patients were divided into four groups (cSS-CMB-, cSS-CMB+, cSS+CMB-, cSS+CMB+) according to cSS and CMB on susceptibility-weighted image of MRI. Primary outcomes were haematoma volume on admission and unfavourable outcome defined as modified Rankin Scale scores ≥3 at 3 months. Secondary outcomes were all-cause death, recurrence of stroke and ICH during follow-up (median follow-up 2.0 years, IQR 1.0-3.0 years).</p><p><strong>Results: </strong>A total of 673 patients were identified from 1044 patients with spontaneous ICH. 131 (19.5%) had cSS and 468 (69.5%) had CMB. Patients with cSS+CMB+ had the highest rate of poor outcome at 3 months, as well as all-cause death, recurrent stroke and ICH during follow-up. In cSS- patients, CMB was associated with smaller haematoma (β -0.13; 95% CI -0.22 to -0.03; p=0.009), but it still increased risks of recurrent ICH (OR 4.6; 95% CI 1.3 to 15.6; p=0.015) and stroke (OR 2.0; 95% CI 1.0 to 4.0; p=0.049). These effects of CMB became unremarkable in the context of cSS+.</p><p><strong>Conclusions: </strong>Patients with different combinations of cSS and CMB have distinct patterns of short-term and long-term outcomes. Although CMB is related to restrained haematoma, it does not improve long-term outcomes.</p><p><strong>Trial registration number: </strong>NCT04803292.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72211459","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}
引用次数: 0
Longitudinal associations of cardiovascular health and vascular events with incident dementia. 心血管健康和血管事件与痴呆事件的纵向关联。
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002665
Ya-Nan Ou, Kevin Kuo, Liu Yang, Ya-Ru Zhang, Shu-Yi Huang, Shi-Dong Chen, Yue-Ting Deng, Yu Guo, Rui-Qi Zhang, Bang-Sheng Wu, Lan Tan, Qiang Dong, Jian-Feng Feng, Wei Cheng, Jin-Tai Yu
{"title":"Longitudinal associations of cardiovascular health and vascular events with incident dementia.","authors":"Ya-Nan Ou, Kevin Kuo, Liu Yang, Ya-Ru Zhang, Shu-Yi Huang, Shi-Dong Chen, Yue-Ting Deng, Yu Guo, Rui-Qi Zhang, Bang-Sheng Wu, Lan Tan, Qiang Dong, Jian-Feng Feng, Wei Cheng, Jin-Tai Yu","doi":"10.1136/svn-2023-002665","DOIUrl":"10.1136/svn-2023-002665","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence supporting cardiovascular diseases could increase the risk of dementia remains fragmented. A comprehensive study to illuminate the distinctive associations across different dementia types is still lacking. This study is sought to: (1) determine the clinical validity of Framingham General Cardiovascular Risk Score (FGCRS) for dementia assessment and (2) examine the associations between cardiovascular diseases and the risk of dementia.</p><p><strong>Methods: </strong>A total of 432 079 dementia-free individuals at baseline from UK Biobank were included. Multivariable Cox proportional hazard models were used to investigate the prospective associations for FGCRS and a series of cardiovascular diseases with all-cause dementia (ACD) and its major components, Alzheimer's disease (AD) and vascular dementia (VaD).</p><p><strong>Results: </strong>During a median follow-up of 110.1 months, 4711 individuals were diagnosed with dementia. FGCRS was associated with increased risks across the dementia spectrum. In stratification analysis, high-risk groups have demonstrated the greatest dementia burdens, particularly to VaD. Over 74 traits, 9 adverse associations, such as chronic ischaemic heart disease (ACD: HR=1.354; AD: HR=1.269; VaD: HR=1.768), atrioventricular block (ACD: HR=1.562; AD: HR=1.556; VaD: HR=2.069), heart failure (ACD: HR=1.639; AD: HR=1.543; VaD: HR=2.141) and hypotension (ACD: HR=2.912; AD: HR=2.361; VaD: HR=3.315) were observed. Several distinctions were also found, with atrial fibrillation, cerebral infarction, and haemorrhage only associated with greater risks of ACD and VaD.</p><p><strong>Discussion: </strong>By identifying distinctive associations between cardiovascular diseases and dementia, this study has established a comprehensive 'mapping' that may untangle the long-standing discrepancy. FGCRS has demonstrated its predictivity beyond cardiovascular diseases burdens, suggesting potential opportunities for implantation.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216800","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}
引用次数: 0
Advanced rehabilitation in ischaemic stroke research. 缺血性中风研究中的高级康复。
IF 2.6 1区 医学
Journal of Investigative Medicine Pub Date : 2024-08-27 DOI: 10.1136/svn-2022-002285
Jixian Wang, Yongfang Li, Lin Qi, Muyassar Mamtilahun, Chang Liu, Ze Liu, Rubing Shi, Shengju Wu, Guo-Yuan Yang
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引用次数: 0
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