Journal of Investigative Medicine最新文献

{"title":"Learning curve and embolisation strategy in single-stage surgery combined embolisation and microsurgery for brain arteriovenous malformations: results from a nationwide multicentre prospective registry study.","authors":"Tengfei Yu, Heze Han, Li Ma, Yang Zhao, Yukun Zhang, Youxiang Li, Shuo Wang, Yu Chen, Xiaolin Chen","doi":"10.1136/svn-2025-004051","DOIUrl":"https://doi.org/10.1136/svn-2025-004051","url":null,"abstract":"<p><strong>Objective: </strong>Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs. This study aimed to investigate the learning curve and embolisation strategy for single-stage surgery for AVMs.</p><p><strong>Methods: </strong>This prospective cohort study used data from the nationwide Multimodality Treatment for Brain Arteriovenous Malformations (MATCH) registry in China, conducted between August 2011 and December 2023. A total of 213 complex AVMs were divided into two groups. Group 1 included the first 25 patients. The 188 cases in group 2 included patients numbered 26-213. A case-crossover design was employed to evaluate the influence of complications, unfavourable outcomes and worsening modified Rankin Scale (mRS) score. Cumulative summation analysis was performed to assess the learning curve.</p><p><strong>Results: </strong>The rate of major complications decreased from 52.00% in group 1 to 34.57% in group 2 (p=0.089), while the rate of unfavourable outcomes decreased from 44.00% in group 1 to 18.62% in group 2 (p=0.004). The distribution of the three preoperative embolisation strategies was as follows: curative: 72.00% and 19.15%, palliative: 24.00% and 67.55%, and targeted: 4.00% and 13.30%, respectively (p<0.001). Multivariable regression analysis showed that surgeon experience was associated with a lower rate of unfavourable outcomes (p=0.022, OR=0.333). The mean follow-up duration was 49.90±20.54 months. The follow-up mRS score of 5-6 decreased from 9.09% in group 1 to 0.8% in group 2 (p=0.035).</p><p><strong>Conclusions: </strong>Performing single-stage combined surgery in 25 AVM cases is necessary to achieve reproducibility. Rates of major complications and unfavourable outcomes decreased significantly after the first 50 procedures. Palliative and targeted embolisation strategies are associated with a lower rate of unfavourable outcomes.</p><p><strong>Trial registration number: </strong>NCT04572568.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804598","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":"Stepwise improvement in intracerebral haematoma expansion prediction with advanced imaging: a comprehensive comparison of existing scores.","authors":"Umberto Pensato, Koji Tanaka, Chitapa Kaveeta, Johanna Ospel, MacKenzie Horn, David Rodriguez-Luna, Nishita Singh, Ankur Banerjee, Sanchea Wasyliw, Kennedy Horn, Amy Bobyn, Anneliese Neweduk, Wu Qiu, Mayank Goyal, Bijoy Menon, Andrew Demchuk","doi":"10.1136/svn-2024-003988","DOIUrl":"https://doi.org/10.1136/svn-2024-003988","url":null,"abstract":"<p><strong>Background: </strong>We aim to comprehensively assess and compare the predictive performance of haematoma expansion (HE) scores in a homogeneous cohort of acute intracerebral haemorrhage (ICH) patients.</p><p><strong>Methods: </strong>Existing scores for predicting HE in acute ICH patients were included and categorised by imaging modality: non-contrast CT (NCCT), single-phase CT angiography (sCTA) and multiphase CTA (mCTA). The predictive performance of the scores was evaluated with the c-statistic in a population of consecutive adult patients with acute ICH admitted to a tertiary care centre in Southern Alberta, Canada, between February 2012 and May 2020, investigated with a multimodal imaging protocol (NCCT, sCTA and mCTA). The primary outcome was HE (ICH volume growth ≥6 mL or ≥33%), and the secondary outcome was severe HE (ICH volume growth ≥12.5 mL or ≥66%). The DeLong test compared the best-performing scores from each imaging category.</p><p><strong>Results: </strong>16 HE scores were assessed (NCCT=8, sCTA=6 and mCTA=2) in 217 patients with a median age of 70 years (IQR=60-80), and 86 (39.6%) were females. 51 (23.5%) patients experienced HE and 35 (16.1%) had severe HE. The c-statistic for predicting HE ranged from 0.516 to 0.674 for NCCT-based scores, 0.627 to 0.725 for sCTA-based scores and 0.800 to 0.814 for mCTA-based score. The c-statistic for predicting severe HE ranged from 0.505 to 0.666 for NCCT scores, 0.651 to 0.740 for sCTA scores and 0.813 to 0.828 for mCTA scores. A statistically significant difference favouring mCTA over other imaging modalities in predicting both HE and severe HE was observed.</p><p><strong>Conclusions: </strong>Advanced imaging demonstrated a stepwise improvement in the predictive performance of HE scores. However, no existing score achieved excellent predictive performance (c-statistics ≥0.90) in our cohort, highlighting the need for further refinement.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804609","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":"Thrombus iodine-based perviousness is associated with recanalisation and functional outcomes in endovascular thrombectomy.","authors":"Chao Tian, Song Liu, Lejun Fu, Jingjing Guo, Chen Cao, Yu Sun, Tao Ren, Huiying Wang, Sifei Wang, Leilei Luo, Luotong Wang, Ming Wei, Shuang Xia, Song Jin, Tong Han, Nina Hao","doi":"10.1136/svn-2024-003661","DOIUrl":"10.1136/svn-2024-003661","url":null,"abstract":"<p><strong>Background: </strong>Dual-energy CT (DECT) provides several novel methods to assess thrombus perviousness. We aimed to evaluate whether the novel thrombus perviousness measured with DECT is associated with improved recanalisation and better functional outcomes in acute ischaemic stroke (AIS) patients with endovascular thrombectomy (EVT).</p><p><strong>Methods: </strong>108 AIS patients with middle cerebral artery occlusion who underwent DECT angiography on admission and received EVT treatment between April 2020 and September 2023 were retrospectively analysed. Thrombus attenuation increase (TAI) was evaluated on routine CT angiography and non-contrast CT, and DECT quantitative parameters of thrombus, including iodine concentration (IC) and normalised IC (NIC) were measured. Multivariable logistic regression analysis was used to evaluate the association of thrombus characteristics with arterial occlusive lesion scale and 90-day modified Rankin Scale.</p><p><strong>Results: </strong>NIC was significantly associated with successful recanalisation (OR 1.372 (95% CI 1.194 to 1.625); p<0.001) and good functional outcome (OR 1.252 (95% CI 1.114 to 1.446); p<0.001). NIC yielded higher performance, with area under curve (AUC) of 0.789 and 0.740, in the prediction of recanalisation and functional outcome than TAI (AUCs=0.635 and 0.592). Compared with low-level NIC thrombus, high-level NIC was associated with 11.4 and 15.4 times higher likelihood of successful recanalisation and good functional outcome. Moreover, NIC was a significant indicator to differentiate large artery atherosclerosis from cardioembolism stroke with high specificity and positive predictive value.</p><p><strong>Conclusions: </strong>Higher DECT-derived NIC is associated with increased odds of successful recanalisation and good functional outcome for EVT patients, and it yielded higher prediction performance than TAI.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505189","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":"Response to 'comments on the article 'sex differences in the epidemiology of spontaneous and traumatic cervical artery dissections''.","authors":"Elke Schipani, Zafer Keser","doi":"10.1136/svn-2025-004158","DOIUrl":"https://doi.org/10.1136/svn-2025-004158","url":null,"abstract":"","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732435","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":"Cerebrovascular cinematic rendering of multisystemic smooth muscle dysfunction syndrome.","authors":"Linggen Dong, Guanglei Li, Ming Lv","doi":"10.1136/svn-2024-003872","DOIUrl":"10.1136/svn-2024-003872","url":null,"abstract":"","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587716","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":"Rationale and Study Design to Assess the Efficacy and Safety of Minocycline in Patients with Moderate to Severe Acute Ischaemic Stroke (EMPHASIS).","authors":"Yao Lu, Ling Guan, Meiyang Zhang, Qianqian Yang, Baoshan Qiu, Dongyang Zhou, Yicong Wang, Yuesong Pan, Luyan Wang, Xuejiao Zhou, Hui Qu, Xiaoling Liao, Liping Liu, Xingquan Zhao, Philip M Bath, S Claiborne Johnston, Pierre Amarenco, Yongjun Wang, Yilong Wang","doi":"10.1136/svn-2024-003577","DOIUrl":"https://doi.org/10.1136/svn-2024-003577","url":null,"abstract":"<p><strong>Background: </strong>Inflammation and blood-brain barrier disruption may contribute to the pathogenesis of ischaemic stroke. Minocycline was shown to exert anti-inflammatory effects by attenuating microglial activation and protecting blood-brain barrier in preclinical studies. Previous small-scale clinical studies have suggested that minocycline may have a potential beneficial effect on prognosis in acute ischaemic stroke. However, the efficacy and safety of minocycline in patients with acute ischaemic stroke need to be further confirmed.</p><p><strong>Study aims: </strong>We designed the study, Efficacy and Safety of Minocycline in Patients with Moderate to Severe Acute Ischaemic Stroke (EMPHASIS), to evaluate the effect of minocycline in improving the functional outcome and the drug safety in patients with acute ischaemic stroke.</p><p><strong>Methods: </strong>The EMPHASIS study is a multicentre, randomised, double-blind, placebo-controlled trial aiming to recruit patients with acute ischaemic stroke. Patients who had ischaemic stroke within 72 hours of onset, a National Institutes of Health Stroke Scale score between 4 and 25 and Ia≤1 (moderate-to-severe) will be randomly allocated to either minocycline or placebo groups in a 1:1 ratio. Patients will receive minocycline (or placebo) with a loading dose of 200 mg, and subsequent 100 mg every 12 hours for 4 days. All patients will receive routine guideline-based treatment. The primary efficacy outcome is an excellent functional outcome assessed by the proportion of modified Rankin Scale score of 0-1 at 90±7 days. The main safety outcomes include the number of symptomatic intracranial haemorrhage at 24±2 hours and 6±1 days.</p><p><strong>Discussion: </strong>The EMPHASIS trial is the first phase III trial to investigate whether minocycline is effective and safe in improving functional outcome at 90 days in patients with moderate-to-severe acute ischaemic stroke. The data generated may provide valuable evidence of a potential anti-inflammation treatment for ischaemic stroke.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732407","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":"Influence of impaired renal function on the outcomes of patients with acute ischaemic stroke treated with intravenous tenecteplase and alteplase: a post hoc analysis of the TRACE-2 trial.","authors":"Yu Wu, Yuesong Pan, Mengxing Wang, Xia Meng, Yilong Wang, Shuya Li, Yongjun Wang, Yilun Zhou, Wanliang Du","doi":"10.1136/svn-2024-003726","DOIUrl":"https://doi.org/10.1136/svn-2024-003726","url":null,"abstract":"<p><strong>Objective: </strong>Limited evidence is available regarding the risk-benefit ratio of thrombolytic therapy in patients with stroke and renal impairment complications, particularly for the drug tenecteplase. Therefore, we examined the association of impaired renal function with the safety and efficacy of intravenous thrombolytic treatment (IVT) in patients with acute ischaemic stroke (AIS).</p><p><strong>Methods: </strong>A post hoc analysis of a randomised controlled trial (ClinicalTrials gov. NCT04797013) was conducted. Participants who received IVT with tenecteplase and alteplase (0.25 and 0.9 mg/kg, respectively) within 4.5 hours of symptoms onset were categorised based on their estimated glomerular filtration rate as follows: (1) ≥90 mL/min/1.73 m²,normal renal function; (2) 60-89 mL/min/1.73 m², mildly decreased renal function; and (3) <60 mL/min/1.73 m², moderately to severely decreased renal function. Patients stratified based on the normal renal function were used as the references. The primary efficacy and safety outcome were the percentage of patients achieving a modified Rankin Scale score of 0-1 at 90 days and the symptomatic intracranial haemorrhage (sICH) occurrence within 36 hours, respectively.</p><p><strong>Results: </strong>In intravenous tenecteplase-treated patients, mildly decreased renal function (OR 3.10; 95% CI: 1.41 to 6.78) and moderately to severely decreased renal function (OR: 8.03; 95% CI: 2.76 to 23.38) showed an association with a higher risk of all-cause mortality but not with sICH incidence compared with normal renal function. Among patients administered intravenous alteplase, those with a moderate-to-severe decrease in renal function exhibited an elevated risk of sICH (adjusted OR: 10.01; 95% CI: 1.61 to 62.15) and all-cause mortality (adjusted OR: 4.54; 95% CI: 1.48 to 13.91). Comparative treatment effects between tenecteplase and alteplase according to renal function grades showed no heterogeneity.</p><p><strong>Conclusions: </strong>A significant correlation was noted between kidney dysfunction and unfavourable outcomes in individuals with AIS who received treatment with either tenecteplase or alteplase.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659481","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":"MetS in the prediction of asymptomatic intracranial arterial stenosis: the potential mediating role of hsCRP.","authors":"Jie Liu, Yang Liu, Longyou Zhang, Wenbo Li, Ying Zhang, Yin Hong, Juan Li, Yun Yun Duan, Huaguang Zheng","doi":"10.1136/svn-2024-003779","DOIUrl":"https://doi.org/10.1136/svn-2024-003779","url":null,"abstract":"<p><strong>Background: </strong>We aimed to investigate the relationships between metabolic syndrome (MetS) and its severity score (Metsss) with asymptomatic intracranial arterial stenosis (aICAS) while also assessing the additional effect of high-sensitivity C reactive protein (hsCRP).</p><p><strong>Methods: </strong>This cross-sectional study included 2390 individuals who underwent health examinations at our centre from June 2019 to August 2023. Participants received physical examinations, laboratory tests and magnetic resonance angiography evaluations. MetS was defined by the modified acknowledged criteria and quantified by Metsss. Logistic regression, interaction analysis and mediation analysis were employed.</p><p><strong>Results: </strong>Among the 2390 participants, 135 (5.65%) had aICAS, and 726 (30.40%) had MetS. After adjusting for confounders, MetS was significantly associated with aICAS (OR: 1.68, 95% CI: 1.16 to 2.43, p=0.006). The prevalence of aICAS increased significantly from 3.6% to 8.6% as the number of MetS components increased. Higher quartiles of Metsss also significantly increased aICAS risk (P for trend <0.001). After multivariable adjustment, MetS (p=0.001) and elevated Metsss (p<0.001) were only associated with posterior circulation aICAS (vs anterior). Furthermore, participants with both MetS and elevated hsCRP levels had a greater risk for aICAS (OR: 2.32, 95% CI: 1.36 to 3.96, p=0.002). hsCRP mediated the association between MetS and alCAS in participants ≤65 years old.</p><p><strong>Conclusions: </strong>MetS and Metsss were independently associated with the risk of aICAS. The mediating effect of hsCRP on the relationship between MetS and aICAS appears to be age-dependent. These findings offer valuable insights into clinical decision making of aICAS and further improve the primary stroke prevention.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651579","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":"LRRC8A in endothelial cells contributes to the aberrant blood-brain barrier integrity in ischaemic stroke.","authors":"Yanfei Tian, Yan Wang, Yupeng Zhao, Chang Liu, Xiaoyu Zhang, Yan Zhang, Zhenghui Wu, Yue Kong, Bo Wang, Huaxing Zhang, Xiaona Du, Hailin Zhang, Huiran Zhang","doi":"10.1136/svn-2024-003675","DOIUrl":"https://doi.org/10.1136/svn-2024-003675","url":null,"abstract":"<p><strong>Background: </strong>The increased permeability of the blood-brain barrier (BBB) is a critical contributor to the high mortality following ischaemic stroke. However, the mechanisms regulating BBB integrity remain poorly understood. Leucine-rich repeat-containing 8A (LRRC8A) is a chloride channel critical for cellular volume homeostasis and plays a key role in regulating neuronal injury during ischaemia. However, its impact on BBB function is currently unclear.</p><p><strong>Methods: </strong>A transient middle cerebral artery occlusion model was established to investigate the impact of LRRC8A on BBB integrity. Laser speckle contrast imaging was used to monitor cortical blood flow. Primary mouse and human brain microvascular endothelial cells (m/hBMVECs) were subjected to oxygen-glucose deprivation (OGD) and re-oxygenation for varying durations. Patch-clamp recordings were performed to measure volume-regulated chloride currents. Immunostaining was conducted to evaluate protein expression. Cell permeability was evaluated with transwell assay.</p><p><strong>Results: </strong>LRRC8A deletion in endothelial cells ameliorates the infarct area and mitigates BBB leakage. Ischaemia dramatically upregulates the expression of LRRC8A in endothelial cells, concurrently downregulating tight junction proteins. OGD exposure augments the VRCC current mediated by LRRC8A in BMVECs. In contrast, inhibiting LRRC8A promotes the expression of ZO-1 and VE-cadherin, thereby preserving the integrity of endothelial cells. With-no-lysine kinase 1 (WNK1) inhibition contributes to LRRC8A-induced BBB damage post-ischaemic stroke. Eupatorin, a newly identified LRRC8A inhibitor, exerts neuroprotective effects against ischaemic stroke.</p><p><strong>Conclusions: </strong>LRRC8A in BMVECs plays a pivotal role in modulating BBB integrity, a process regulated by WNK1. As an LRRC8A inhibitor, Eupatorin holds the potential for ischaemic stroke therapy.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651578","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":"Analysis of prehospital delay in acute ischaemic stroke and its influencing factors: a multicentre prospective case registry study in China.","authors":"Ying Su, Wenwei Qi, Yanni Yu, Jiaqian Zhu, Xin Shi, Xiaohong Wu, Feng Chi, Runyu Xia, Limin Qin, Liming Cao, Yan Yang, Qin Liu, Xiaoxiang Peng, Guobing Huang, Jinyan Chen, Yidong Xue, Wenbiao Guan, Dan Gao, Bin Ye, Lijie Ren","doi":"10.1136/svn-2024-003535","DOIUrl":"10.1136/svn-2024-003535","url":null,"abstract":"<p><strong>Background: </strong>Prehospital delay in acute ischaemic stroke (AIS) remains prevalent in China. We aimed to assess the status of the onset-to-door time (ODT) in AIS and analyse its influencing factors.</p><p><strong>Methods: </strong>Data were collected from a prospective multicentre hospital-based registry (China National Cerebrovascular Disease Prevention and Control Project Management Special Database) of patients with AIS involving 21 hospitals across different economic and geographical regions in China in 2022. The Mann-Whitney U test or t-test was used for between-group comparisons. Factors influencing ODT ≤3 hours were analysed using a binary logistic regression model.</p><p><strong>Results: </strong>Of the included 12 484 patients (attended middle school or below, 69.2%), females had a higher illiteracy rate (13.1%) than males (4.8%); 94.8% were living with others at illness onset; 22.5% of patients/family members were aware of the stroke emergency map (SEM, but only 7.3% were transported by SEM; 76.8% lived within 20 km of the first visited hospital. Significant differences occurred in modes of arrival at hospitals among cities of different sizes (χ²=74.882, p<0.001). Being in a medium-sized (OR 0.65, 95% CI 0.50 to 0.86); large (OR 0.61, 95% CI 0.47 to 0.79) or extralarge city (OR 0.60, 95% CI 0.46 to 0.78); experiencing cardiogenic embolism (OR 0.65, 95% CI 0.50 to 0.86) or stroke of undetermined aetiology (OR 0.69, 95% CI 0.52 to 0.92); stroke onset between 18:00 and 23:59 (OR 0.71, 95% CI 0.60 to 0.85); distance <20 km from onset location to the hospital (OR 0.47, 95% CI 0.41 to 0.54); being transported by SEM (OR 0.31, 95% CI 0.26 to 0.36) and having initial National Institutes of Health Stroke Scale scores of 5-15 (OR 0.63, 95% CI 0.57 to 0.71) or 16-42 (OR 0.32, 95% CI 0.27 to 0.39) were independent factors favouring ODT ≤3 hours. Conversely, being transferred between hospitals during transportation (OR 3.31, 95% CI 2.66 to 4.14); experiencing wake-up stroke (OR 2.00, 95% CI 1.67 to 2.38); symptom-onset including dizziness (OR 1.28, 95% CI 1.10 to 1.47) and prestroke modified Rankin scale (mRS) score of 2-3 (OR 1.58, 95% CI 1.30 to 1.92) or 4-5 (OR 1.48, 95% CI 1.02 to 2.15) tended to indicate ODT >3 hours.</p><p><strong>Conclusions: </strong>Urban scale, stroke type, onset time, distance from initial location to the first hospital visit, transportation method, stroke symptoms, prestroke mRS score and stroke severity significantly influenced prehospital delay. Our findings can facilitate the development of targeted policies.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558315","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}