Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Association between life’s crucial 9 and stroke: results from the NHANES 2005–2018","authors":"Xiaodong Chen ,&nbsp;Yifan Xu ,&nbsp;Chao Wang ,&nbsp;Wencong Guo ,&nbsp;Yancheng Song ,&nbsp;Bing Chen","doi":"10.1016/j.jstrokecerebrovasdis.2025.108462","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108462","url":null,"abstract":"<div><h3>Background</h3><div>Life’s Crucial 9 (LC9) is a composite cardiovascular health score comprising nine modifiable factors. This study examines the relationship between LC9 scores and stroke prevalence in US adults.</div></div><div><h3>Methods</h3><div>This study conducted a cross-sectional analysis of National Health and Nutrition Examination Survey data from 2005 to 2018. To facilitate analysis, LC9 values were separated into four quartiles. The relationship between LC9 scores and the prevalence of stroke was evaluated using subgroup analysis, restricted cubic spline (RCS) modeling, and weighted multivariable logistic regression.</div></div><div><h3>Results</h3><div>Among 19 207 participants with an average LC9 score of 70.70 ± 0.22, the overall stroke prevalence was 2.87 %. Each one-point increase in LC9 score was associated with a 4.7 % reduction in stroke odds (95 % CI 0.943–0.963; <em>p</em> &lt; 0.001). Compared with the lowest LC9 quartile (Q1), individuals in the highest quartile (Q4) had a 72.6 % lower stroke prevalence (95 % CI 0.169–0.446; <em>p</em> &lt; 0.001). Stratified analyses and interaction assessments indicated that the inverse association remained consistent across age, sex, BMI, diabetes, and hypertension categories, with no significant interactions observed. Furthermore, curve fitting analysis identified a linear correlation between LC9 scores and the risk of stroke.</div></div><div><h3>Conclusions</h3><div>Our findings indicated that higher LC9 scores were associated with a reduced likelihood of stroke. Preserving a favorable LC9 score may serve as a potential strategy for stroke prevention. To substantiate these observations and establish clinically applicable LC9 thresholds, additional large-scale prospective studies with prolonged follow-up are needed.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108462"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precipitation, EMS use, and time to presentation of Acute Ischemic stroke in the get with the guidelines-stroke registry","authors":"Marisa Berner MA ,&nbsp;Mathew Reeves BVSc PhD ,&nbsp;George S. Usmanov PhD ,&nbsp;Kevin N. Sheth MD ,&nbsp;Amar Dhand MD DPhil","doi":"10.1016/j.jstrokecerebrovasdis.2025.108460","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108460","url":null,"abstract":"<div><h3>Background</h3><div>Delayed presentation to the hospital is a barrier for delivering acute stroke treatments. The effects of weather on delay are unstudied. We examined the relationship between precipitation and time to arrival nationwide.</div></div><div><h3>Methods</h3><div>We studied patients with acute ischemic stroke who presented at a Get With the Guidelines®-Stroke hospital from 2010-2019. The exposure variable was total daily precipitation on the day of presentation, obtained from the National Oceanic and Atmospheric Administration, and categorized as none (0 inches/day), mild (&gt;0-1 inch/day), and major (&gt;1 inch/day). The primary outcome was time to hospital arrival after stroke (in minutes). We conducted multivariate regression analysis, including analysis of interaction between precipitation level and EMS usage.</div></div><div><h3>Results</h3><div>In ∼2.7 million patients, 50.7% were female and 38.6% were ≥75 years old. Median time to hospital arrival was 212 minutes in no precipitation, 219 minutes in mild precipitation, and 223 minutes in major precipitation. In adjusted analyses, compared to no precipitation, mild precipitation was associated with 4.63 minutes of delay [95% CI: (2.77, 6.49)]. Major precipitation was associated with 7.69 minutes of delay [95% CI: (2.86, 12.52)]. EMS usage improved arrival time overall, and there was an interaction with mild precipitation (-6.09 minutes [95% CI: (-9.79 to -2.39)]). However, there was no interaction with major precipitation (-2.72 minutes [95% CI: (-12.38 to 6.93)]).</div></div><div><h3>Conclusion</h3><div>Precipitation was associated with delayed presentation to the hospital in acute stroke. Increased frequency of extreme weather calls for developing EMS strategies and infrastructure to support climate-ready stroke systems of care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108460"},"PeriodicalIF":1.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Theory-based self-management to improve blood pressure control in stroke survivors: a systematic review and meta-analysis","authors":"Anchalee Ngamvitroj RN, PhD ,&nbsp;Sararin Pitthayapong RN, Dr.PH ,&nbsp;Teerapon Dhippayom PharmD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108455","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108455","url":null,"abstract":"<div><h3>Background</h3><div>Blood pressure (BP) control is essential in post-stroke management; however, comprehensive evidence on the benefits of self-management interventions in this population remains limited.</div></div><div><h3>Purpose</h3><div>To determine the effectiveness of self-management interventions on BP control in stroke survivors using a meta-analysis approach.</div></div><div><h3>Method</h3><div>We searched PubMed, EMBASE, CINAHL, CENTRAL, and ProQuest Dissertation &amp; Theses Global from their inception to January 2025. Randomized controlled trials investigating the effects of self-management on BP in post-stroke patients were included. We used the Cochrane Risk of Bias version 2 (RoB 2) to evaluate the quality of RCTs. The effect estimates for systolic BP (SBP) and diastolic BP (DBP) were calculated using mean differences (MDs) with their 95 % confidence interval (95 %CI) under a random-effects model.</div></div><div><h3>Result</h3><div>Out of 2,708 records identified, 18 trials (5,435 participants) were included. All studies showed some concerns about the risk of bias. A greater reduction in both SBP and DBP was observed in the self-management group compared to control groups (MD -4.87; 95 %CI:6.82 to -2.92; I²=81 % and MD -1.34; 95 %CI:2.56 to -0.13; I²=65 %, respectively). The reduction in SBP appeared greater in trials lasting ≤ 6 months (MD -7.99; 95 %CI:12.41 to -3.58; I²= 64 %) compared with those over 6 months (MD -3.93; 95 %CI:6.99 to -0.87; I²=87 %).</div></div><div><h3>Conclusions</h3><div>Self-management interventions were effective in BP control for stroke survivors. However, the effectiveness of the intervention faded over time. Future investigations are crucial to solidify the role of self-management in secondary stroke prevention.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108455"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung function as a modifiable risk factor for Ischemic Stroke: Evidence from the UK biobank","authors":"Zihong Bai ,&nbsp;Qingcui Huang ,&nbsp;Xinya Li ,&nbsp;Yitong Ling ,&nbsp;Panwen Wu ,&nbsp;Xiaxuan Huang ,&nbsp;Shanyuan Tan ,&nbsp;Jun Lyu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108457","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108457","url":null,"abstract":"<div><h3>Background</h3><div>Ischemic stroke remains a leading cause of disability and mortality worldwide, with pulmonary function emerging as a potential modifiable risk factor.</div></div><div><h3>Methods</h3><div>This study utilizes data from the UK Biobank to explore the association between peak expiratory flow (PEF), a simple and cost-effective marker of lung function, and ischemic stroke risk. A total of 307,827 participants were followed for a median of 13.8 years, with Cox regression models employed to examine the relationship between PEF and ischemic stroke incidence. Restricted cubic splines and mediation analysis were also used to investigate potential nonlinear relationships and the mediating role of inflammatory biomarkers, respectively.</div></div><div><h3>Results</h3><div>The results demonstrate that individuals with higher PEF levels exhibit a significantly reduced risk of ischemic stroke, with a 6.7 % and 10.4 % lower risk in the second and third tertiles of PEF, respectively, compared to the first tertile.Stratified analyses revealed a significant inverse association between PEF and stroke risk in former smokers (HR = 0.93, 95 %CI:0.88–0.98), with a non-significant trend in current smokers (HR = 0.92, 95 %CI:0.84–1.01). Subgroup analysis revealed heterogeneity by age, gender, hypertension, and diabetes status, highlighting differential effects. Mediation analysis suggested that inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio, partially mediate the association between lung function and stroke risk.</div></div><div><h3>Conclusion</h3><div>This study underscores the importance of monitoring lung function, particularly at the community level, as a preventive measure against ischemic stroke. Given the aging global population, early detection and management of declining lung function could play a crucial role in reducing stroke-related morbidity and mortality.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108457"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent visual deficits in minor ischemic stroke","authors":"Humza Qureshi BA ,&nbsp;Raj G. Saraiya BS ,&nbsp;Manisha Koneru MD, MS ,&nbsp;Karandeep S. Bhatti MD ,&nbsp;Manurag Khullar BS ,&nbsp;Michael J. Dubinski BS ,&nbsp;Mary Penckofer MD ,&nbsp;Jane Khalife MD, MS ,&nbsp;Hermann C. Schumacher MD ,&nbsp;Khalid A. Hanafy MD, PhD ,&nbsp;Courtney Curran MD ,&nbsp;James E. Siegler MD ,&nbsp;Olga R. Thon MD ,&nbsp;Jesse M. Thon MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108458","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108458","url":null,"abstract":"<div><h3>Background</h3><div>Compared to more severe presentations, minor ischemic stroke (MIS) remains poorly characterized regarding predictors of long-term outcomes. Particularly there is a need to assess the impact of persistent visual deficits on functional disability in this population. This study aims to compare functional outcomes of MIS between patients with persistent visual deficits (PeVD) and patients without PeVD.</div></div><div><h3>Methods</h3><div>This retrospective single-center cohort study included adult acute ischemic stroke patients who presented to a comprehensive stroke center from 2019 to 2023. MIS was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≤5 on admission and at 24 hours. PeVD was defined as a nonzero visual field NIHSS subscore at 24 hours. The primary outcome was the 90-day modified Rankin Scale (mRS) score.</div></div><div><h3>Results</h3><div>Among 1041 MIS patients, 108 (10.4%) had PeVD. Both median presenting (PeVD+: 2 [IQR 1-4] v. PeVD-: 1 [IQR 0-3], p&lt;0.001) and 24-hour NIHSS (PeVD+: 2 [IQR 1-3] v. PeVD-: 1 [IQR 0-2], p&lt;0.001) were higher in patients with PeVD than those without PeVD. At 90 days, patients with PeVD had higher mortality rate (14.3% vs. 7.8%, p=0.04) and mRS scores (p=0.003). After multivariable regression and sensitivity analyses, 24-hour NIHSS was associated with worse 90-day functional outcomes (p&lt;0.001) while PeVD was not (p=0.21).</div></div><div><h3>Conclusion</h3><div>This study suggests a minority of MIS patients have PeVD, which is associated with stroke severity but not with 90-day functional outcomes. Future studies should evaluate alternative and impactful functional outcome measures not captured by mRS in MIS patients with PeVD.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108458"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with osteoporosis: Treatment with zoledronic acid instead of alendronic acid is associated with a higher risk of ischemic stroke - A real-world global study","authors":"Sien-Yu Ko MD ,&nbsp;Jun-Fu Lin MSc ,&nbsp;Ching-Heng Lin Ph.D ,&nbsp;Yuan-Yang Cheng Ph.D","doi":"10.1016/j.jstrokecerebrovasdis.2025.108456","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108456","url":null,"abstract":"<div><h3>Aims</h3><div>We aimed to determine whether prolonged use of bisphosphonates increases the risk of ischemic stroke in the general population and in individuals with pre-existing cardiovascular conditions.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study adhering to the STROBE checklist. We assessed ischemic stroke incidence following alendronic or zoledronic acid treatment in 1,905,808 patients aged ≥55 years with osteoporosis using TriNetX data from January 1, 2002, to December 31, 2022. Patients were stratified by age and gender, and propensity score matching was used to minimize confounding. Analyses focused on the general population and subgroups with pre-existing atrial fibrillation or atherosclerosis. Hazard ratios were calculated at 5, 10, and 15 years post-index date, using alendronic acid users as the reference (HR = 1). The Kaplan–Meier analysis was used to estimate event-free survival over time.</div></div><div><h3>Results</h3><div>Zoledronic acid was associated with an increased ischemic stroke risk at 5, 10, and 15 years of follow-up compared to alendronic acid in the general population, in women, and in patients without pre-existing atrial fibrillation or aortic atherosclerosis. The Kaplan–Meier analysis of stroke-free survival at 15 years showed 85.9 % in the zoledronic acid group and 89.9 % in the alendronic acid group, with a hazard ratio of 1.22 (95 % confidence interval, 1.11–1.34).</div></div><div><h3>Conclusions</h3><div>Zoledronic acid was associated with an increased ischemic stroke risk compared to alendronic acid in the general population, in women, and in patients without pre-existing atrial fibrillation or aortic atherosclerosis. Therefore, we recommend long-term follow-up and strict management of stroke risk factors in these relatively vulnerable populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108456"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does sex matter in neurons’ response to hypoxic stress?","authors":"Eva J.H.F. Voogd ,&nbsp;Marloes R. Levers ,&nbsp;Jeannette Hofmeijer ,&nbsp;Monica Frega ,&nbsp;Michel J.A.M. van Putten","doi":"10.1016/j.jstrokecerebrovasdis.2025.108444","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108444","url":null,"abstract":"<div><h3>Background:</h3><div>Stroke exhibits significant sex differences in incidence, response to treatment, and outcome. Preclinical studies suggest that hormones, particularly estrogens, are key to differential sensitivity, as female neurons demonstrate enhanced resilience compared to males in both in vivo and in vitro models. This study investigates whether these sex-specific differences in neuronal vulnerability extend to the ischemic penumbra and explores the effects of estrogens under such conditions.</div></div><div><h3>Methods:</h3><div>Primary cortical neuronal networks were generated from male and female newborn Wistar rats and cultured on micro-electrode arrays or glass coverslips. Male and female networks were subjected to hypoxic conditions, followed by a recovery phase, with or without exogenous estrogen treatment. Electrophysiological activity, including spikes and bursts, was monitored and analyzed. Apoptosis was assessed through immunocytochemistry, focusing on caspase-dependent and apoptosis-inducing factor (AIF)-dependent pathways.</div></div><div><h3>Results:</h3><div>Under hypoxia, male and female networks showed similar reductions in firing and burst rates with longer burst durations. Exogenous estrogen altered these dynamics, leading to increased burst rates and shorter burst durations for both sexes. During recovery, two-way ANOVA suggested higher burst rates in estrogen-treated networks and sex differences in burst duration at 24h, but these effects were not confirmed by non-parametric analysis. Immunocytochemistry revealed that estrogen significantly reduced caspase-dependent apoptosis, but not AIF-dependent apoptosis. Mean firing rates and overall network viability did not differ between groups, indicating no clear long-term survival benefit.</div></div><div><h3>Conclusion:</h3><div>In our model of the ischemic penumbra, exogenous estrogen modulated neuronal network activity, with sex-dependent differences evident under normoxic but not hypoxic or recovery conditions. These effects reflect context-dependent responsiveness rather than intrinsic sex differences, and provide no evidence for enhanced neuronal survival after hypoxia.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108444"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood-based MMP-9 for the early differentiation of acute ischemic stroke: a systematic review and meta-analysis","authors":"Jan Emmerich ,&nbsp;Aditya Chanpura ,&nbsp;Tyler Lu ,&nbsp;Alison Baird ,&nbsp;Frank Barone ,&nbsp;Deborah Gustafson ,&nbsp;Timo Siepmann ,&nbsp;Hagen Huttner ,&nbsp;Kristian Barlinn","doi":"10.1016/j.jstrokecerebrovasdis.2025.108454","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108454","url":null,"abstract":"<div><h3>Background</h3><div>Early differentiation between acute ischemic stroke (AIS) and stroke mimics remains challenging in emergency setting. Molecular biomarkers such as matrix metalloproteinase-9 (MMP-9) may aid in improving diagnostic accuracy.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted according to PRISMA guidelines across PubMed, EMBASE, Cochrane Library, and Web of Science. Studies assessing MMP-9 concentrations within 24 hours of symptom onset in AIS patients versus stroke mimics or healthy/matched controls ≥18 years were included. Random-effects meta-analyses were used to estimate pooled mean differences (MD) in MMP-9 levels between groups. Heterogeneity was assessed using I² and Cochran’s Q.</div></div><div><h3>Results</h3><div>Twenty-seven studies were included, with 16 (2,661 AIS patients, 1,283 all controls) meeting criteria for meta-analysis. Mean MMP-9 concentrations were significantly higher in AIS patients compared to all controls combined (MD: 93.9 ng/mL; 95%CI: 25.0-162.8; p=0.01, I²=96%, Cochran's Q: p&lt;0.001). Subgroup analyses confirmed elevated levels in AIS patients versus healthy/matched controls (MD: 110.6 ng/mL; 95%CI:13.8-207.4; p=0.029) and versus stroke mimics (MD: 66.61 ng/mL; 95%CI: -6.2-139.4; p=0.01). Heterogeneity remained consistently high across comparisons (I² ≥ 95%; p&lt;0.05).</div></div><div><h3>Conclusion</h3><div>MMP-9 levels appear significantly elevated in AIS patients compared to both stroke mimics and healthy controls/matched controls, supporting its potential as a diagnostic biomarker in the acute setting. However, substantial inter-study heterogeneity limits generalizability, and standardized studies are needed to validate their clinical applicability. (PROSPERO: CRD42024611953)</div></div><div><h3>Funding</h3><div>We acknowledge support from the German Research Foundation, the Medical Faculty Carl Gustav Carus, and the SLUB, as well as the Open Access Publication Funds of the TU Dresden. The funding bodies had no impact on any aspect of the study or the content of the manuscript.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108454"},"PeriodicalIF":1.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of ischemic stroke in safety-net hospitals","authors":"Michelle Zhan BA ,&nbsp;Shumei Man MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108453","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108453","url":null,"abstract":"<div><h3>Background</h3><div>Safety-net hospitals (SNHs) often face financial limitations and resource shortages compared to their counterparts. We hypothesized that patients with ischemic stroke treated at SNHs would have inferior outcomes compared to non-SNHs.</div></div><div><h3>Methods</h3><div>This retrospective study used the National Inpatient Sample Database to study patients who were ≥18 years old and hospitalized for acute ischemic stroke from 2016 to 2019. The characteristics and outcomes of the patients with or without safety-net features treated at SNHs vs non-SNHs were compared. A composite adverse outcome was also generated to include in-hospital mortality, acute respiratory failure, tracheostomy, and sepsis.</div></div><div><h3>Results</h3><div>We identified a weighted total of 1,823,985 patients, including 448,965 treated at SNHs and 1,375,020 at non-SNHs. The patients treated at SNHs were associated with higher in-hospital mortality (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.09-1.19) and composite adverse outcome (aOR 1.18, 95% CI 1.14-1.21), and longer hospital length of stay (5.6±7.7 vs 4.5±5.4 days, p&lt;0.001). Patients without safety-net features who were cared for at SNHs had higher in-hospital mortality (aOR 1.14, 95% CI 1.09-1.19), and composite adverse outcomes (aOR 1.19, 95% CI 1.15-1.23) compared to those treated at non-SNHs.</div></div><div><h3>Discussion</h3><div>Patients treated for ischemic stroke at SNHs have higher in-hospital mortality and an increased risk for adverse outcomes. Such a pattern was observed for patients without safety-net features but not patients with safety-net features. These findings support changes in resource allocation and efforts to improve the care of ischemic stroke in SNHs.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108453"},"PeriodicalIF":1.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury to repair: Functions of microglia and monocyte-derived cells in ischemic stroke","authors":"Ryan Martynowicz BS ,&nbsp;David P. Sullivan PhD ,&nbsp;Ayush Batra MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108422","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108422","url":null,"abstract":"<div><h3>Introduction</h3><div>Microglia, the central nervous system’s resident immune cells, play a complex role in acute ischemic stroke (AIS), contributing to both neuroprotection and secondary neurologic injury. After ischemic injury, microglia activate and adopt a diverse range of phenotypes, from extremes of pro-inflammatory to anti-inflammatory microglia. Coinciding with microglial activation, AIS triggers infiltration of monocytes, which transform into monocyte-derived cells (MdCs) within the ischemic microenvironment. MdCs display many overlapping characteristics with microglia, complicating their identification and role in recovery.</div></div><div><h3>Methods</h3><div>This narrative review synthesizes current basic and translational research examining the heterogeneity and interplay of microglia and MdCs in response to AIS. Relevant literature was identified through a comprehensive search of the PubMed database, inclusive of studies published through June 2025.</div></div><div><h3>Results and Conclusions</h3><div>Anti-inflammatory microglial phenotypes promote neuronal survival, phagocytosis of necrotic debris, and blood-brain barrier repair. Pro-inflammatory microglial phenotypes, conversely, exacerbate injury through excitotoxicity, cytokine release, and vascular disruption. Initially, MdCs adopt a neuroprotective, reparative microglia-like role by phagocytizing debris and supporting repair but later shift to a pro-inflammatory phenotype, driving secondary damage. The dynamic interaction between microglia and MdCs is crucial for stroke recovery, with microglia and MdCs initially aiding in tissue repair and angiogenesis while subsequently amplifying secondary injury through pro-inflammatory phenotypes. Although various biomarkers have been proposed to differentiate microglia from MdCs and predict stroke outcomes, none have been clinically validated. Further studies are needed to identify reliable biomarkers for these distinct cell types and develop strategies to minimize secondary injury without impairing recovery after stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108422"},"PeriodicalIF":1.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}