Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Association between secondhand smoke exposure, maternal smoking during pregnancy, and stroke incidence in nonsmokers","authors":"Yi-Ping Huang ,&nbsp;Wei-Dong Fan ,&nbsp;Ying Feng ,&nbsp;Daniel Nyarko Hukportie ,&nbsp;Cui-Yi Jin ,&nbsp;Fu-Rong Li","doi":"10.1016/j.jstrokecerebrovasdis.2025.108379","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108379","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the independent and combined associations of secondhand smoke (SHS) exposure and maternal smoking during pregnancy with the risk of total stroke and its subtypes, including ischemic and hemorrhagic stroke, among nonsmokers.</div></div><div><h3>Objectives</h3><div>To investigate the independent and combined associations of SHS exposure and maternal smoking during pregnancy with stroke risk in nonsmokers.</div></div><div><h3>Methods</h3><div>A prospective analysis was conducted using 336,640 nonsmoking participants from a nationwide cohort, free from pre-existing cardiovascular disease. SHS exposure was categorized based on hours per week (0, &gt;0–4, &gt;4), and maternal smoking was assessed via participant recall. Outcomes included total stroke, ischemic stroke, and hemorrhagic stroke, identified through hospital records. Cox regression models adjusted for demographic, behavioral, and clinical covariates were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Over a median follow-up of 11.8 years, 5,051 participants experienced strokes. SHS exposure &gt;4 hours/week was associated with increased incident stroke risk (HR 1.34, 95 % CI 1.18–1.52) compared to no exposure. Maternal smoking was associated with a 7 % increase in total stroke risk (HR 1.07, 95 % CI 1.02–1.14). Combined exposure to SHS &gt;4 hours/week and maternal smoking conferred the highest stroke risk (HR 1.57, 95 % CI 1.29–1.90). Subgroup and sensitivity analyses confirmed these findings.</div></div><div><h3>Conclusions</h3><div>SHS exposure and maternal smoking was independently and jointly associated with higher stroke risk, underscoring the need for robust tobacco control policies to mitigate these exposures and their public health impact.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108379"},"PeriodicalIF":2.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328461","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":"Sex differences in etiologies, risk factors, and outcomes among young adult patients with acute ischemic stroke","authors":"Ekta G. Shah DO, MS ,&nbsp;Manish Bhojwani MD, MPH ,&nbsp;Kelly Chang MD ,&nbsp;Deepa Dongarwar BS ,&nbsp;Nicole R. Gonzales MD ,&nbsp;Erica Jones MD ,&nbsp;Audrey Sarah Cohen MS ,&nbsp;Anjail Z. Sharrief MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2025.108380","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108380","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of ischemic stroke is increasing among young adults. Several studies have demonstrated sex differences in risk and outcomes; however, findings are inconsistent. We sought to evaluate sex differences in stroke risk factors, etiology, and disposition in a diverse cohort of patients admitted to a comprehensive stroke center for evaluation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients 18-45 years admitted between January 1, 2015 and September 30, 2021 with an acute ischemic stroke. Patient demographics, risk factors, and disposition were extracted from our institutional inpatient stroke registry and inpatient electronic medical record. Stroke etiology was assigned based on record review. Bivariate analyses were conducted between sex and demographic variables, risk factors, stroke etiology, and disposition.</div></div><div><h3>Results</h3><div>Among 785 patients included, 48.9% (n=384) were female and 51.1% (n=401) were male. Female patients had a higher proportion of prior strokes, cardiac/pulmonary shunts, autoimmune disorders, history of migraine headaches, and exogenous hormone use with a higher proportion of ischemic strokes of other etiologies. Male patients had a higher proportion of lower left ventricular ejection fraction, atrial fibrillation, substance use, and obstructive sleep apnea with a higher proportion of ischemic strokes due to small vessel occlusions and cardioembolic sources. There was a comparable proportion of traditional risk factors and strokes secondary to large artery atherosclerosis between the sexes. No sex differences were seen among functional outcomes at discharge; however, female patients had a lower inpatient mortality rate and lower odds of being discharged to skilled nursing facilities/long-term acute care hospitals/acute care facilities compared to male patients.</div></div><div><h3>Conclusions</h3><div>This study supports the known sex differences in stroke risk factors, etiology, and outcomes for ischemic stroke in young patients, showing the relationship also remains applicable in a large, diverse population. Strategies to address these differences could improve stroke classification and stroke prevention efforts, improving outcomes in this age group.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108380"},"PeriodicalIF":2.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307160","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":"Communicating the ethical, legal, and social issues in neurobiobanking and stroke genomic research in Africa: Project intervention tools development and evaluation procedures","authors":"Babatunde R. Ojebuyi PhD ,&nbsp;Ibukun Afolami PhD ,&nbsp;Muyiwa Adigun PhD ,&nbsp;Arti Singh MD ,&nbsp;Carolyn Jenkins DrPH ,&nbsp;Michelle Nichols PhD, RN ,&nbsp;Kolawole Wahab MD, FMCP ,&nbsp;Abiodun Bello MD ,&nbsp;Fred S. Sarfo MBChB, PhD ,&nbsp;Lukman F. Owolabi MD, FMCP ,&nbsp;Rabiu Musbahu MD ,&nbsp;Reginald Obiako MD, FWACP ,&nbsp;Albert Akpalu MBChB, FWACP ,&nbsp;Mayowa Ogunronbi MPH ,&nbsp;Olorunyomi Olorunsogbon MPH ,&nbsp;Benedict Calys-Tagoe MD ,&nbsp;Deborah Adesina RN ,&nbsp;Nathaniel Coleman MPH ,&nbsp;Abdullateef G. Sule MD ,&nbsp;Aliyu Mande HND ,&nbsp;Rufus Akinyemi MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108378","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108378","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Issues concerning appropriate Community Engagement (CE) and communication of research outcomes with stakeholders have received the attention of scholars in different sub-fields of clinical research. However, given its novel nature, especially in Sub-Saharan Africa, CE addressing the ethical, legal, and social implications (ELSI) of neurobiobanking and stroke genomic research has not received much scholarly attention. Therefore, this study was designed as a pioneering effort to report the procedures for developing and evaluating intervention tools for the CE component of the African Neurobiobank for Precision Stroke Medicine ELSI Project.</div></div><div><h3>Methods</h3><div>A community-based participatory research design was adopted. The intervention tools we developed include <em>general advocacy, educative, and training videos focusing on neurobiobanking, stroke genomics and precision stroke medicine in Africa; infographics; and a policy brief.</em> An adapted Doak and Doak’s Suitability Assessment Measure (SAM), the Agency for Healthcare Research and Quality (AHRQ) Patient Education Materials Assessment Tool (PEMAT), and semi-structured interview questions based on Willis’ Cognitive Interviewing Techniques were used to evaluate the suitability, actionability, understandability and cultural appropriateness of the tools.</div></div><div><h3>Results</h3><div>PEMAT mean percentage scores of 71.4 % for actionability and 82.4 % for understandability, and a SAM suitability score of 67.9 % were reported for the videos. Identified weaknesses captured in seven thematic areas after assessment analysis by experts and community members guided the final refinement of the tools.</div></div><div><h3>Conclusion</h3><div>The overall reviewers’ reports and evaluation scores indicate that the intervention tools are generally suitable for community deployment in sub-Saharan Africa. Clinical researchers must partner with key stakeholders, define policy objectives and desired behaviour change, and develop appropriate persuasive communication strategies and tools for community engagement.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108378"},"PeriodicalIF":2.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311201","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":"Sex differences on cerebrovascular complications in hospitalized COVID-19 patients: a meta-analysis","authors":"Bradley Ong MD ,&nbsp;Lea Elora Conda MD, MBA ,&nbsp;Tereynz Paul Mendoza MS ,&nbsp;Adrian V. Hernandez MD, PhD ,&nbsp;Sung-Min Cho DO, MHS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108377","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108377","url":null,"abstract":"<div><h3>Background</h3><div>Although pre-pandemic data suggest a higher stroke incidence in females, recent evidence suggests COVID-19-related strokes disproportionately affect males. Prior studies often analyzed stroke as a composite outcome without stratifying by biologically distinct subtypes. This systematic review and meta-analysis evaluated sex differences in the risk of ischemic and hemorrhagic stroke among hospitalized patients with COVID-19.</div></div><div><h3>Methods</h3><div>We searched MEDLINE and six additional databases from inception to December 2024. We included observational studies enrolling adults (≥18 years) with active COVID-19 infection, hospitalized, and reporting sex-stratified stroke outcomes. Pooled risk ratios (RRs) for each stroke subtype were calculated using random-effects models. We defined RR as the ratio of the cumulative incidence of type of stroke in males over the cumulative incidence of the same type of stroke in females.</div></div><div><h3>Results</h3><div>Seventeen studies comprising 135,481 hospitalized COVID-19 patients (mean age 63.3 years; 48.7% male) met inclusion criteria. Stroke occurred in 1,509 patients (1.1%), with ischemic stroke accounting for 53.9% of cases, unspecified stroke for 30.1%, and hemorrhagic stroke for 16.1%. Males accounted for a greater proportion of stroke cases across all subtypes: 63.1% of ischemic, 69.0% of hemorrhagic, and 59.0% of unspecified strokes. The estimated prevalence of ischemic stroke was 17% in males (95% CI, 15%–20%) versus 9% in females (95% CI, 7%–11%), and hemorrhagic stroke occurred in 4% of males (95% CI, 2%–6%) versus 1% of females (95% CI, 0%–2%). Unspecified stroke occurred in 2% of both sexes (95% CI, 0%–3%). Pooled risk estimates showed that males had a significantly higher risk of any stroke (RR = 1.25; 95% CI,1.05-1.50), driven by an elevated risk of hemorrhagic stroke (RR = 1.64; 95% CI, 1.06-2.54). The increased risk of ischemic stroke in males did not reach statistical significance (RR = 1.18; 95% CI, 0.97–1.44).</div></div><div><h3>Conclusions</h3><div>This is the first meta-analysis to stratify stroke risk by sex and stroke subtype in hospitalized COVID-19 patients. Males were at significantly higher risk for hemorrhagic stroke, suggesting possible sex-specific vulnerability that warrants further studies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108377"},"PeriodicalIF":2.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298062","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":"Identification of neurological text markers associated with risk of stroke","authors":"Anoop Mayampurath PhD ,&nbsp;Avery Rosado BS ,&nbsp;Elida Romo BS ,&nbsp;Philip Silberman MA ,&nbsp;Jay Patel BS ,&nbsp;Samantha Jankowski BS ,&nbsp;Matthew Maas MD, MS ,&nbsp;Jane L. Holl MD, MPH ,&nbsp;Ava L. Liberman MD ,&nbsp;Shyam Prabhakaran MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108376","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108376","url":null,"abstract":"<div><h3>Background</h3><div>Delayed or missed stroke diagnosis is associated with poor outcomes. We utilized natural language processing of notes from non-neurological emergency department (ED) encounters to identify text phrases indicating stroke presentations that are associated with stroke hospitalization 30 days after ED discharge.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of stroke (case) and gastroenteritis (matched-control) patients at two academic medical centers who had an ED encounter 30 days before index admission diagnosis. Medical concepts were extracted from the ED encounter notes. Statistical analysis was used to detect neurological text markers indicating stroke signs and symptoms using data from one hospital (discovery cohort) and validated in the second (validation cohort). We further compared the coefficients and the predictive performance of an elastic net model of both cohorts.</div></div><div><h3>Results</h3><div>We detected 58 medical concepts with a statistically significant positive association with stroke cases in the discovery cohort of 987 patients (51 % stroke). Expert review was used to combine these medical concepts into 11 text markers indicative of stroke presentations (e.g., coordination, language). Markers demonstrated external validity in terms of positive association when analyzed in the validation cohort of 433 patients (24 % stroke). Elastic net models derived at each center demonstrated equivalence in coefficient magnitudes and predictive performance, demonstrating generalizability.</div></div><div><h3>Conclusion</h3><div>We detected and validated neurologic text markers characteristic of stroke signs and symptoms at an ED encounter 30 days before the stroke diagnosis. The presence of these markers could be used to prompt additional neurologic evaluation to prevent delayed stroke diagnosis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108376"},"PeriodicalIF":2.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279256","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 carotid endarterectomy in symptomatic octogenarian patients","authors":"Marcello Lodato ,&nbsp;Rodolfo Pini ,&nbsp;Gianluca Faggioli ,&nbsp;Cristina Rocchi ,&nbsp;Enrico Gallitto ,&nbsp;Andrea Vacirca ,&nbsp;Mauro Gargiulo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108375","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108375","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Carotid endarterectomy (CEA) is the standard treatment for symptomatic carotid artery stenosis (ipsilateral cerebral ischemic symptoms in the last 3months - SCS) in patients suitable for open surgery. Given the increasing age of the general population, this treatment is performed in octogenarian patients with increasing frequency. However, this population was not included in the historical randomized controlled trials and there is a lack of available data on perioperative complications, specifically the severity of possible postoperative stroke. The aim of this study is to report the outcomes of CEA for SCS in octogenarians and to evaluate the characteristics of postoperative stroke, in comparison to non-octogenarians.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This is a retrospective analysis of patients treated with CEA from 2012 to 2023 for SCS. Patients were divided according to their age in non-octogenarian (&lt;80year-old) and octogenarian (≥80 year-old) and compared according to type of preoperative symptoms and timing of intervention. The primary endpoints of this study were to analyze the postoperative stroke and death rate and to assess the severity of postoperative stroke in octogenarian and non-octogenarian patients using the National Institute of Health Institute of Stroke Scale (NIHSS) classification. Follow-up was performed with yearly clinical visit.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 664 symptomatic patients were treated by CEA, 157(24 %) were octogenarian (mean age 84 ± 4) and had similar preoperative characteristics of non-octogenarian except for the distribution of preoperative neurological type of symptoms: transient ischemic attack (TIA) 51 %vs42 %,&lt;em&gt;P&lt;/em&gt; = .05, amaurosis fugax (AF) 14 %vs5 %,&lt;em&gt;P&lt;/em&gt; = .001; stroke 36 %vs53 %,&lt;em&gt;P&lt;/em&gt; = .01. The timing between symptoms and surgery was similar between the octogenarian and non-octogenarian patients 10 ± 8vs8 ± 7 days(&lt;em&gt;P&lt;/em&gt; = .22). The overall postoperative rate of stroke and death was 3.1 %, similar between octogenarian and non-octogenarian: 3.7 %vs.3.1 %,&lt;em&gt;P&lt;/em&gt; = .39. The type of preoperative symptoms did not affect the outcome between older and younger patients: TIA 3.4 %vs.3.3 %,&lt;em&gt;P&lt;/em&gt; = .63; AF 0 %vs0 %,&lt;em&gt;P&lt;/em&gt; = .1.0 and stroke 3.5 %vs.3.3 %,&lt;em&gt;P&lt;/em&gt; = 1.0. In octogenarian patients stroke and death rate was similar independently on the timing of CEA performance: 3.9 %, if performed within 48h, 3.7 % between 2days and 14 days and 3.4 % after 2 weeks, &lt;em&gt;P&lt;/em&gt; = .72. Postoperative stroke rate was similar in the two groups: 15(2.9 %) in non-octogenarians and 5(3 %) in octogenarian patients (&lt;em&gt;P&lt;/em&gt; = .1); but moderate/severe stroke (NIHSS ≥ 5) was more frequent in octogenarian patients: 2 % vs 0.4 %, &lt;em&gt;P&lt;/em&gt; = .05 The mean follow-up was 68±14 months and at 5-year the ipsilateral stroke free survival was 97.6 % ± 4 % with no differences between octogenarian and non-octogenarian: 95.2 % ± 6 %vs98.1 % ± 3 ","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108375"},"PeriodicalIF":2.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279257","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":"Trends and Disparities in In-Hospital Mortality Among Ischemic Stroke Patients During the COVID-19 Era: A Nationwide Study (2016–2022)","authors":"Mian Urfy MD ,&nbsp;Mariam Tariq Mir MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108367","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108367","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The COVID-19 pandemic disrupted stroke systems of care, but its impact on in-hospital mortality and disparities among ischemic stroke patients remains unclear. We examined nationwide trends in stroke mortality before and during the COVID-19 era, with a focus on demographic and socioeconomic disparities.</div></div><div><h3>Methods</h3><div>We used the National Inpatient Sample (2016–2022) to identify adult hospitalizations with a primary diagnosis of ischemic stroke. Crude in-hospital mortality rates were calculated annually and stratified by sex, age group, race/ethnicity, and insurance status. Multivariable logistic regression was used to estimate adjusted odds of in-hospital mortality, controlling for year, age, sex, race/ethnicity, payer, and comorbidities.</div></div><div><h3>Results</h3><div>Among 950,518 ischemic stroke admissions, in-hospital mortality rose from 6.32% in 2019 to 8.24% in 2021—a 30% relative increase during the COVID-19 era. Mortality was highest among patients aged ≥85 years (11.1%), males (7.2%), and those with self-pay status (OR 2.33 vs. Medicare). Crude mortality increased most among Hispanic (+36.1%), American Indian/Alaska Native (+35.5%), and Black patients (+26.7%). After adjustment, the odds of in-hospital death remained significantly elevated in 2020 (OR 1.05), 2021 (OR 1.17), and 2022 (OR 1.09) compared to 2016. Regional disparities were also observed, with the greatest adjusted mortality increases in the Northeast and West. Race-stratified models confirmed disproportionately higher pandemic-era mortality among minority groups</div></div><div><h3>Conclusion</h3><div>In-hospital stroke mortality rose significantly during the COVID-19 era, with disproportionately greater increases among racial and ethnic minority groups and socioeconomically vulnerable patients. These findings underscore the need for equity-focused interventions in stroke systems of care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108367"},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278077","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":"Continuous temperature monitoring in patients with spontaneous intracerebral hemorrhage: insights into temperature patterns and variability","authors":"Kornelia Laichinger MD ,&nbsp;Annerose Mengel MD ,&nbsp;Maria-Ioanna Stefanou MD ,&nbsp;Sophia Kindzierski MD ,&nbsp;Constanze Single MD ,&nbsp;Lena S. Geiger MD ,&nbsp;Till-Karsten Hauser MD ,&nbsp;Ulf Ziemann MD ,&nbsp;Markus Krumbholz MD ,&nbsp;Katharina Feil MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108366","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108366","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous intracerebral hemorrhage (ICH) is frequently associated with autonomic nervous system dysfunction, potentially leading to temperature dysregulations.</div></div><div><h3>Methods</h3><div>This retrospective study analysis temperature and variability indices standard deviation (SD), coefficient of variation (CV) and successive variability (SV) continuously monitored over the first 96 hours post-admission in 261 ICH patients. Functional outcomes included the modified Rankin Scale (mRS) at discharge and 90-day follow-up.</div></div><div><h3>Results</h3><div>Elevated temperature occurred in 69 patients (26.4 %) and was associated with higher admission National Institutes of Health Stroke Scale (NIHSS) scores (<em>p</em> = 0.003), early hematoma expansion (<em>p</em> = 0.012), longer ICU stays (<em>p</em> &lt; 0.001), and worse functional outcomes at discharge (<em>p</em> = 0.039) and follow-up (<em>p</em> = 0.045). Patients with elevated temperature exhibited greater SD variability, while SV remained similar. Subgroups with intraventricular (<em>p</em> = 0.033), or larger hemorrhages (<em>p</em> = 0.019) were predisposed to elevated temperature and higher SD variability. Logistic regression revealed that younger age, lower premorbid mRS, and lower NIHSS at admission were significant predictors of good 90-day outcomes (e.g., OR 0.352, CI 0.226–0.548, <em>p</em> &lt; 0.001 for premorbid mRS). Intraventricular hemorrhage significantly reduced the likelihood of recovery (OR 0.289, CI 0.123–0.682, <em>p</em> = 0.005 for 0–24 h). Elevated temperature showed a trend toward worse outcomes (OR 2.445, 95 %CI 0.994–6.011, <em>p</em> = 0.051), and increased temperature variability (SD) was independently associated with poor outcomes in the first 24 hours (OR 0.090, CI 0.009–0.956, <em>p</em> = 0.046).</div></div><div><h3>Conclusions</h3><div>Elevated temperature and early temperature variability within the first 24 hours are associated with worse functional outcomes in ICH patients, highlighting the importance of targeted thermoregulation strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108366"},"PeriodicalIF":2.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261645","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":"The relationship between flavonols intake and stroke in the elderly: a cross-sectional study from NHANES (2007-2010 and 2017-2018)","authors":"Xuehua Cheng ,&nbsp;Ting Peng ,&nbsp;Li Han","doi":"10.1016/j.jstrokecerebrovasdis.2025.108373","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108373","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Stroke is a common fatal and disabling disease in the elderly. We investigated the correlation and potential benefits of dietary intake of flavonoid compounds and their subclasses in elderly stroke patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) for the cycles 2007-2010 and 2017-2018. Dietary flavonoids intake was calculated based on food frequency questionnaires (FFQ) through a 24-hour dietary recall. To explore the relationship between flavonoids intake and their subclasses with stroke prevalence, we employed multivariable logistic regression models, adjusting for relevant covariates. Restricted cubic splines (RCS) and generalized additive models (GAMs) were applied to explore potential nonlinear relationships between flavonols subclasses and stroke prevalence. Multivariable logistic regression models were conducted both for the overall population and stratified by flavonols subclasses intake. Additionally, we utilized Bayesian kernel machine regression (BKMR) to evaluate the overall effect of flavonols intake levels on stroke status, accounting for potential interaction and correlation between subclasses. Given the high correlation among flavonols subclasses, we incorporated a hierarchical variable selection approach using a Markov Chain Monte Carlo (MCMC) algorithm. Finally, we analyzed the XGBoost model by applying SHAP (SHapley Additive exPlanations) values to assess the specific contribution of different flavonoids intake to stroke.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Including 3,806 elderly stroke patients, the study revealed an inverse relationship between dietary flavonoids and their subclasses and stroke prevalence. After adjusting for potential confounders, it was found that higher quartiles of flavonols intake were associated with lower stroke prevalence. Specifically, with each unit increase in flavonols (Q4) intake, the odds of stroke in the elderly decreased by 61 % (OR=0.390, 95 % CI [0.209-0.728]; &lt;em&gt;P&lt;/em&gt; = 0.005). Similar results were observed for the subclasses of flavonols. Subgroup analyses indicated that age and poverty index ratio (PIR) were effect modifiers in the relationship between flavonols intake and stroke. We further examined the intake levels of dietary flavonols subclasses such as isorhamnetin, kaempferol, myricetin, and quercetin and their association with stroke status stratified by population characteristics. In addition to age and PIR, hyperlipidemia and body mass index (BMI) were found to be the most common significant influencing factors in the relationship between flavonols subclasses and stroke prevalence. Furthermore, RCS revealed a “U”-shaped nonlinear relationship between flavonols, including their quercetin and kaempferol subclasses, and stroke, whereas the relationship between stroke and myricetin was linear. Our study also assessed the overall impact of dietary flavonols subcla","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108373"},"PeriodicalIF":2.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254995","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":"Association between plain water intake and stroke among American adults: National health and nutrition examination survey 1999-2020","authors":"Yahui Pan ,&nbsp;Yanzhen Sun ,&nbsp;Xiaohua Pan ,&nbsp;Yongchao Yin ,&nbsp;Qianqian Liu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108372","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108372","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a leading cause of disability and mortality. While plain water intake has been linked to stroke-related risk factors—including hypertension, diabetes, and obesity—its direct relationship with stroke remains unclear. This study aimed to evaluate the association between plain water intake and stroke.</div></div><div><h3>Methods</h3><div>We analyzed data from adults aged over 20 years who participated in the National Health and Nutrition Examination Survey between 1999 and 2020. Information on stroke status, plain water intake, and other relevant variables was collected. We used weighted logistic regression models, restricted cubic spline analysis, stratified analysis with interaction testing, threshold effect analysis, and sensitivity analyses to evaluate the association.</div></div><div><h3>Results</h3><div>A total of 29,489 participants were included, of whom 1,268 (3.18 %) reported having been diagnosed with stroke. Significant differences in stroke prevalence and participant characteristics were observed across quartiles of water intake (<em>P</em> &lt; 0.001). Multivariable regression indicated a negative association between plain water intake and stroke risk in all adjusted models. The relationship followed an l-shaped curve, with an inflection point at approximately 1,382.86 mL/day (non-linearity, <em>P</em> = 0.005). For those consuming ≤1,382.86 mL/day, the odds ratio for stroke was 0.97 (95 % CI: 0.93 – 0.99, <em>P</em> = 0.03). Subgroup, interaction, and sensitivity analyses supported the stability of the results.</div></div><div><h3>Conclusion</h3><div>The association between plain water intake and stroke among U.S. adults follows an L-shaped curve, with an inflection point near 1,382.86 mL/day. Further research is warranted to investigate the mechanisms underlying this association.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108372"},"PeriodicalIF":2.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259887","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}