Journal of Investigative Medicine最新文献

{"title":"Protective effects of melatonin on stroke in diabetic mice: central and peripheral inflammation modulation.","authors":"Cuiying Liu, Jiayi Guo, Longfei Guan, Junfa Li, Baohui Xu, Heng Zhao","doi":"10.1136/svn-2024-003442","DOIUrl":"https://doi.org/10.1136/svn-2024-003442","url":null,"abstract":"<p><strong>Background: </strong>Melatonin protects against ischaemic stroke in diabetic animal models, though the mechanisms involving brain and peripheral immune responses remain underexplored. We aimed to clarify how melatonin interacts with these immune responses to protect against stroke in diabetic mice.</p><p><strong>Methods: </strong>Type 1 diabetes mellitus (T1DM) was induced in mice using streptozotocin. RNA sequencing of brain tissue and peripheral blood mononuclear cells (PBMCs) was performed 24 hours poststroke. Inflammatory responses were evaluated 72 hours after ischaemia/reperfusion.</p><p><strong>Results: </strong>Melatonin reduced infarction and improved neurological function in T1DM mice. In the ischaemic brain, melatonin downregulated inflammatory factor expression, with bioinformatics identifying 62 differentially expressed genes (DEGs) related to inflammation and 11 associated with inflammasomes. Western blotting confirmed reductions in NLRP3, HMGB1 and Cleaved Caspase-1 expression. Flow cytometry showed reduced infiltration of CD8+T cells and neutrophils. Melatonin decreased IL-6, IL-1β and IL-4 levels. In PBMCs, RNA sequencing revealed 939 DEGs following melatonin treatment. Kyoto Encyclopaedia of Genes and Genomes analysis indicated that downregulated DEGs were involved in metabolic pathways, and upregulated DEGs were enriched in the Jak-STAT signalling pathway. GO analysis showed that downregulated DEGs were enriched in the cytosol, and upregulated DEGs related to macromolecule modification. Protein-protein interaction analysis revealed that melatonin affected 38 inflammation-associated genes linked to key cytokines (Il6, Il1b, Ifng, Il4). Flow cytometry indicated melatonin increased CD8+T cells, monocytes and neutrophils in the blood, suggesting a reversal of immunosuppression. Multiplex cytokine assays showed melatonin decreased IL-6 and IFN-γ levels.</p><p><strong>Conclusion: </strong>Poststroke melatonin therapy reduces ischaemic brain damage in T1DM mice by modulating central and peripheral inflammatory responses.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505186","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":"Updates on vascular dementia.","authors":"Sabrina Ng, Ava Hornblass, Parnian Habibi, Salman Ikramuddin, Jeffrey Chen, Wayne Feng, Dongming Cai","doi":"10.1136/svn-2025-004048","DOIUrl":"https://doi.org/10.1136/svn-2025-004048","url":null,"abstract":"<p><p>Vascular dementia (VaD) is the second leading cause of dementia after Alzheimer's disease (AD). In comparison to AD, there is a decline in the incidence of VaD due to recent improvements in cardiovascular risk factors. Brain hypoperfusion and hypoxia due to vascular pathologies have been postulated as the primary disease mechanism of VaD. However, other factors such as neuroinflammation may also contribute to the development of VaD. Non-modifiable and modifiable risk factors have been attributed to VaD. The clinical features overlapping between AD and VaD create significant challenges for physicians. Newly developed biomarkers may potentially help differentiate VaD from other forms of dementia. Unlike AD, there is no Food and Drug Administration-approved drug or device for treating VaD. Current treatment options mainly target symptoms rather than slowing the development or progression of VaD. There are ongoing research studies testing the efficacy of various therapeutic strategies for VaD. In this narrative review, we will summarise current findings on epidemiology, attributed risk factors and disease mechanisms, as well as emphasise the importance of optimising lifestyle modifications and comorbid condition management in preventing or slowing down the development of VaD. Finally, current therapies and ongoing research studies of novel therapeutic interventions such as stem-cell therapy and neuromodulation are highlighted.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505192","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":"Explainable models for predicting long-term outcomes in patients with spontaneous intracerebral haemorrhage: a retrospective cohort study.","authors":"Kai-Cheng Yang, Yu-Jia Jin, Li-Li Tang, Feng Gao, Lusha Tong","doi":"10.1136/svn-2024-003864","DOIUrl":"https://doi.org/10.1136/svn-2024-003864","url":null,"abstract":"<p><strong>Background and aim: </strong>Recently, long-term outcomes in patients with spontaneous intracerebral haemorrhage (sICH) have gained increasing attention besides acute-phase characteristics. Predictive models for long-term outcomes are valuable for risk stratification and treatment strategies. This study aimed to develop and validate an explainable model for predicting long-term recurrence and all-cause death in patients with ICH, using clinical and imaging markers of cerebral small vascular diseases from MRI.</p><p><strong>Method: </strong>We retrospectively analysed data from a prospectively collected large-scale cohort of patients with acute ICH admitted to the Neurology Department of The Second Affiliated Hospital of Zhejiang University between November 2016 and April 2023. After comprehensive variable selection using least absolute shrinkage and selection operator and stepwise Cox regression, we constructed Cox proportional hazards models to predict recurrence and all-cause death. Model performance was evaluated using the concordance index, integrated Brier score and time-dependent area under the curve. Global and local interpretability were assessed using variable importance calculated as SurvSHAP(t) and SurvLIME methods for the entire training set and individual patients, respectively.</p><p><strong>Results: </strong>A total of 842 eligible patients were included. Over a median follow-up of 36 months (IQR: 12-51), 86 patients (9.1%) died, and 62 patients (6.6%) experienced recurrence of ICH. The concordance indexes for the all-cause death and recurrence models were 0.841 (95% CI 0.767 to 0.913) and 0.759 (95% CI 0.651 to 0.867), respectively, with integrated Brier scores of 0.079 and 0.063. The interpretability maps highlighted age, aetiology of ICH and low haemoglobin as key predictors of long-term death, while cortical superficial siderosis and previous haemorrhage were crucial for predicting recurrence.</p><p><strong>Conclusions: </strong>This model demonstrates high predictive accuracy and emphasises the crucial factors in predicting long-term outcomes of patients with sICH.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505183","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":"Long-term outcome in a cohort of 36 patients with sacral dural arteriovenous fistulae after endovascular embolisation or microsurgery.","authors":"Yu Duan, Xuanfeng Qin, Qinyi Chen, Binbin Xu, Qinzhu An, Yujun Liao, Yuanyuan Hu, Gong Chen","doi":"10.1136/svn-2024-003463","DOIUrl":"https://doi.org/10.1136/svn-2024-003463","url":null,"abstract":"<p><strong>Objective: </strong>Sacral dural arteriovenous fistula (SDAVF) is a rare spinal vascular malformation and often misdiagnosed or even mistreated. This study delved into the clinical characteristics, vascular architecture and treatment results of SDAVF, with the goal of enhancing upcoming diagnostic and therapeutic methodologies.</p><p><strong>Methods: </strong>From March 2014 to March 2022, consecutive patients with SDAVF were retrospectively analysed. The data on demographics, symptom resolution, angioarchitectural features and postoperative course were studied. Spinal cord function was evaluated by modified Aminoff-Logue scale.</p><p><strong>Results: </strong>A total of 36 patients with 36 SDAVFs were enrolled, 12 of whom were misdiagnosed on their initial visit. The SDAVFs were located at S1 in 24 (66.7%), S2 in 10 (27.8%) and S3 in 2 (5.6%) cases, respectively. The primary feeding arteries included lateral sacral artery (LSA) of internal iliac artery (31/36, 86.1%), the branches of external iliac artery (2/36, 5.6%) and median artery (3/36, 8.3%), most of which are straight. Venae terminalisis is the sole drainage vein, flowing back into perimedullary venous network. Endovascular embolisation is the main therapy method for 30 cases, while the other 6 cases were treated with microsurgical fistulectomy. MRI tests showed that the abnormal vascular signals around the medulla disappeared, and the spinal cord oedema was alleviated in the majority of cases (32/36, 88.9%). Six patients, who all were treated by endovascular embolisation at first time, had residual or recurrent and two of them were performed by microsurgical fistulectomy again. All patients by microsurgical fistulectomy had no residual or recurrent during follow-up. According to the spinal cord functional assessment, the Aminoff-Logue score was significantly decreased (Z=-3.449, p=0.001) postoperatively.</p><p><strong>Conclusion: </strong>The misdiagnosis rate of SDAVF is very high. The most feeding artery of SDAVF came from the LSA, which was thicker and more straight, making it easier for microcatheters to reach the fistula site. So, endovascular embolism has become the first choice of treatment with minimal invasion, and safe and effective results.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415928","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":"Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy.","authors":"Alhuda Dabbagh, Janine Mielke, Katja S Mühlberg, Karl Titus Hoffmann, Dirk Lindner, Charlotte Huber, Dominik Michalski, Johann Otto Pelz","doi":"10.1136/svn-2024-003808","DOIUrl":"https://doi.org/10.1136/svn-2024-003808","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolic events (VTEs) like deep vein thrombosis or pulmonary embolism are frequent complications in (neuro) critical ill patients. Anticoagulation for VTE after space-occupying brain infarction is a therapeutic dilemma. The aim of this retrospective study was to investigate the frequency of clinically apparent VTE in patients with acute ischaemic stroke (AIS) due to large vessel occlusion (LVO), its treatment, and the rate of complications.</p><p><strong>Methods: </strong>Patients with first AIS due to LVO were assigned to one of the following groups: space-occupying brain infarction with (1) or without (2) decompressive craniectomy (DC), AIS comprising more than 2/3 (3) or less than 2/3 (4) of the middle cerebral artery territory. Clinically obtained parameters included risk factors for VTE, type of thromboprophylaxis, treatment of VTE and treatment-associated complications.</p><p><strong>Results: </strong>15 of 173 (8.7%) patients had a VTE, which was diagnosed 10.9 ± 7.2 days after admission. Patients with a space-occupying brain infarction and DC had significantly more VTE (n=11/63; 17.5%) than patients with a space-occupying brain infarction without DC (0/26; p =0.023) or patients without DC (4/110; 3.6%; p = 0.004). Younger age, DC and cumulative duration of central venous catheter were identified as risk factors for VTE. Only three patients had major bleeding events while being anticoagulated (one asymptomatic cerebral and two extracranial bleedings).</p><p><strong>Discussion: </strong>Patients with space-occupying brain infarction and DC hold a high risk for VTE. Despite extensive infarct size and DC, therapeutic anticoagulation required for VTE appeared to be safe regarding intracranial bleeding complications.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400521","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":"Phase II randomised, double-blind, placebo-controlled trial to assess the efficacy and safety of MLC1501 in patients with stroke: the MLC1501 study Assessing Efficacy in post-STrOke Subjects with mOtor deficits (MAESTOSO) study protocol.","authors":"Christopher P L H Chen, Romulo U Esagunde, Cyrus G Escabillas, John Harold Hiyadan, Joel M Advincula, Christian Oliver C Co, Maria Epifania V Collantes, Annabelle Y Lao, Yeow-Hoay Koh, Deidre Anne De Silva, Carol Huilian Tham, Johnny K Lokin, Narayanaswamy Venketasubramanian","doi":"10.1136/svn-2024-003750","DOIUrl":"https://doi.org/10.1136/svn-2024-003750","url":null,"abstract":"<p><strong>Background: </strong>MLC1501, consisting of four herbs, that is, <i>Radix Astragali</i>, <i>Radix Angelicae sinensis</i>, <i>Rhizoma Chuanxiong</i>, <i>Radix Polygalae</i>, has the same pharmacological properties as its precursors MLC601 and MLC901 which contain extracts of nine herbs and showed neuroprotective, anti-inflammatory and neurorestorative properties in non-clinical models, as well as clinical benefits in improving functional and neurological recovery after brain injuries.</p><p><strong>Aims: </strong>To determine the efficacy of MLC1501 on motor recovery as measured by Fugl-Meyer motor Assessment (FMA) total score at 24 weeks in patients with ischaemic stroke (IS).</p><p><strong>Design: </strong>A total of 300 patients aged >18 years, diagnosed with IS in the prior 2-10 days, with National Institute of Health Stroke Scale (NIHSS) total score of 8-18 and a combined score of ≥3 on NIHSS motor items 5A, 5B, 6A and/or 6B, will be randomised in a 1:1:1 ratio to receive oral placebo, MLC1501 low dose or MLC1501 high dose for 6 months. The study is governed by a Steering Committee. An independent Data Monitoring Committee oversees patient safety.</p><p><strong>Outcomes: </strong>The primary outcome is mean change from baseline in FMA total score at 24 weeks. Efficacy outcomes evaluated in person at baseline, 12 weeks and 24 weeks include the FMA (total, upper extremity and lower extremity motor scores), modified Rankin Scale (mRS), Patient-Reported Outcomes Measurement Information System-Global Health (PROMIS-10) and NIHSS. Additionally, telephone assessment at week 4 includes the simplified mRS and PROMIS-10.Safety will be evaluated by standard assessments and occurrence of adverse events over the duration of the study.</p><p><strong>Discussion: </strong>Interventions that enhance recovery beyond the acute period of stroke are needed. MLC1501 has a good safety profile as well as potential to be a treatment for recovery after brain injury. The results of this study will provide objective level B evidence on the efficacy of MLC1501 on long-term recovery and safety of 24 weeks of treatment among patients with IS.</p><p><strong>Trial registration number: </strong>NCT05289947.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366295","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":"Efficacy of butylphthalide in preventing cognitive decline in ischaemic stroke survivors: a 12-month prospective following-up study.","authors":"Qingqing Han, Xiyu Zhao, Yingzhe Shao, Fengtao Tan, Haotian Wen, Di Wang, Xiao Li, Yunfan Wang, Jun Tu, Lifeng Wang, Xianjia Ning, Jinghua Wang, Yan Li","doi":"10.1136/svn-2024-003611","DOIUrl":"https://doi.org/10.1136/svn-2024-003611","url":null,"abstract":"<p><strong>Background: </strong>Cognitive decline is a significant concern for stroke survivors, affecting their quality of life and increasing their burden on the healthcare system. DL-3-n-butylphthalide (butylphthalide) has shown efficacy in the short-term treatment of various cognitive impairments. This study evaluated the efficacy of butylphthalide in preventing cognitive decline over a 12-month period in patients with ischaemic stroke.</p><p><strong>Methods: </strong>This prospective following-up study involved patients newly diagnosed with ischaemic stroke between 1 month and 6 months after stroke onset and not in the acute phase. Patients were assigned to either the butylphthalide or control group. Cognitive function was assessed using the mini-mental state examination (MMSE) at baseline and at the 12-month follow-up. Statistical analyses included t-tests, χ² tests and multivariate regression analyses.</p><p><strong>Results: </strong>Butylphthalide was negatively associated with the MMSE D-value (β=-0.122; 95% CI -1.932 to -0.298; p=0.003) and the MMSE D-value percentage (β=-0.117; 95% CI -0.057 to -0.011; p=0.004). A multivariate analysis indicated that butylphthalide treatment was negatively associated with both changes in orientation and language score. Additionally, the incidence of cognitive decline was significantly lower in the butylphthalide group (OR, 0.612; p=0.020) than the control group. An age of ≥60 years and lower educational level were identified as risk factors for lower cognitive score and cognitive decline.</p><p><strong>Conclusion: </strong>This study demonstrated that butylphthalide is effective in preventing cognitive decline in patients with ischaemic stroke. These findings have significant implications for clinical practice, suggesting that butylphthalide could be incorporated into standard post-stroke care regimens to improve patient outcomes and reduce the healthcare burden. Additional multicentre double-blind trials are recommended to confirm these results in diverse populations.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042519","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":"Chinese stroke association guidelines on reperfusion therapy for acute ischaemic stroke 2024.","authors":"Yunyun Xiong, Shuya Li, Chunjuan Wang, Dapeng Sun, Zixiao Li, HongQiu Gu, Aoming Jin, Qiang Dong, Liping Liu, Zhongrong Miao, Yongjun Wang","doi":"10.1136/svn-2024-003977","DOIUrl":"https://doi.org/10.1136/svn-2024-003977","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a major global health challenge, with China experiencing a significant burden due to its high incidence and severe outcomes. Reperfusion therapies, such as intravenous thrombolysis and endovascular thrombectomy, have shown substantial benefits in improving early outcomes for ischaemic stroke. Recent clinical trials have validated the safety and efficacy of a broader range of thrombolytic agents and expanded the eligible patient populations for both intravenous thrombolysis and mechanical thrombectomy. This guideline aims to provide the latest evidence-based insights in the field of reperfusion therapy.</p><p><strong>Methods: </strong>The Chinese Stroke Association (CSA) established a writing group to develop updated guidelines on reperfusion therapy for acute ischaemic stroke. A comprehensive search of MEDLINE (via PubMed) was conducted up to 30 September 2024. Experts in the field of stroke engaged in extensive discussions, both online and offline, to evaluate the latest evidence. Each recommendation was graded using the CSA's class of recommendation and level of evidence in the Guideline Development Manual of the CSA.</p><p><strong>Results: </strong>This guideline, reviewed and approved by the CSA Guidelines Writing Group, outlines the criteria for patient selection for thrombolysis and thrombectomy and summarises the latest evidence on various thrombolytic drug options to support decision-making in reperfusion therapy. Additionally, the guideline includes green channel flow charts for intravenous thrombolysis and mechanical thrombectomy, designed to assist clinicians in optimising their clinical decisions.</p><p><strong>Conclusion: </strong>This guideline updates the latest advancements in the field of reperfusion therapy for acute ischaemic stroke. It is anticipated that future clinical research will further advance areas such as innovative thrombolytic agents, expanded indications for thrombolysis and mechanical thrombectomy.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014602","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":"Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial.","authors":"Xuewei Xie, Jing Jing, Anxin Wang, Qin Xu, Xingquan Zhao, Jinxi Lin, Pan Chen, Yong Jiang, Yilong Wang, Hao Li, Xia Meng, Yongjun Wang","doi":"10.1136/svn-2024-003293","DOIUrl":"https://doi.org/10.1136/svn-2024-003293","url":null,"abstract":"<p><strong>Background and purpose: </strong>Symptomatic internal carotid artery stenosis (sCAS) is an essential cause of transient ischaemic attack (TIA) or minor stroke. We aimed to evaluate whether the superiority of aspirin-ticagrelor over aspirin-clopidogrel varies between patients with sCAS or not.</p><p><strong>Methods: </strong>This was a post-hoc analysis of the High-Risk Patients with Acute Nondisabling Cerebrovascular Events-II (CHANCE-2) trial, all of which were <i>CYP2C19</i> loss-of-function alleles carriers. The primary exposures of interest were the treatment group and sCAS status. The primary efficacy endpoint was the new stroke assessed within 90 days.</p><p><strong>Results: </strong>A total of 5920 (92.3%) from 6412 were analysed, including 197 (3.3%) with sCAS and 5723 (96.7%) without sCAS. Stroke recurrence occurred in 13 (12.15%) and 11 (12.22%) patients with sCAS who received aspirin-ticagrelor and aspirin-clopidogrel, respectively (adjusted HR, 1.04; 95% CI, 0.46 to 2.36; p=0.930). Among patients without sCAS, there were 158 cases (5.52%) of new strokes in the aspirin-ticagrelor group and 222 cases (7.76%) in the aspirin-clopidogrel group (HR, 0.70; 95% CI, 0.57 to 0.86; p=0.0006). The treatment-by-sCAS subtype was not significant (p=0.405).</p><p><strong>Conclusions: </strong>Genotype-guided dual antiplatelet treatment with aspirin-ticagrelor may be beneficial for preventing recurrent strokes in patients without sCAS; however, it appears less effective in those with sCAS. No significant interaction was found between the treatment and sCAS subtypes.</p><p><strong>Trial registration number: </strong>NCT04078737.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957288","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":"Comments on the article 'Sex differences in the epidemiology of spontaneous and traumatic cervical artery dissections'.","authors":"Xiao-Mei Zhang, Gang Wang","doi":"10.1136/svn-2024-003904","DOIUrl":"https://doi.org/10.1136/svn-2024-003904","url":null,"abstract":"","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933201","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}