Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Survey on neurological monitoring practices and clinician perspectives in acute stroke care","authors":"Alison McLoughlin ,&nbsp;Caroline Watkins ,&nbsp;Philippa Olive ,&nbsp;Christopher Price ,&nbsp;Catherine Elizabeth Lightbody","doi":"10.1016/j.jstrokecerebrovasdis.2025.108247","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108247","url":null,"abstract":"<div><h3>Aims</h3><div>To examine current practice and views regarding neurological assessment and monitoring across stroke services in the United Kingdom.</div></div><div><h3>Methods</h3><div>A cross-sectional survey of UK secondary care stroke services was conducted between December 2019 and September 2021.</div></div><div><h3>Results</h3><div>The response rate was 80 % (<em>n</em> = 125/156 services). Glasgow Coma Scale was the most frequently used routine neurological assessment (96 %). Variation in frequency, duration and response to monitoring was evident across all stroke types. Medical escalation was the most frequent response to neurological deterioration (99 %). Respondents acknowledged the importance of neurological monitoring, inadequacies of common tools, and supported further work to improve assessments and response protocols.</div></div><div><h3>Conclusion</h3><div>The extent of variation in clinical practice of neurological assessment and monitoring across the UK was unknown. Variation was found to be greater than anticipated. There is a need, and desire for, stroke type scenario-specific monitoring and standardised response guidance in acute stoke care. Introducing standardised care in this area would strengthen clinical protocols and could remove unwarranted variation in patient care ultimately improving outcomes.</div></div><div><h3>Funding</h3><div>Alison McLoughlin, Doctoral Research Fellow DRF-2018-11-ST2-074 was funded by the National Institute for Health and Care Research (NIHR) for this research. Some of the authors are funded by the NIHR Applied Research Collaboration North West Coast. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108247"},"PeriodicalIF":2.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the strengths and limitations of structured modified rankin scale validation studies – A systematic review","authors":"Shuait Nair BSFS,&nbsp;Jordyn Hurly BS,&nbsp;Deanna Saylor MD MHS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108242","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108242","url":null,"abstract":"<div><h3>Background</h3><div>Variations in performance of structured modified Rankin Scale (mRS) questionnaires in people with stroke within different cultural and language settings have not been systematically assessed. We systematically reviewed all studies of structured mRS questionnaires compared to in-person unstructured mRS evaluation scores.</div></div><div><h3>Methods</h3><div>We searched PubMed and Web of Science for studies that evaluated structured mRS questionnaires against in-person unstructured mRS evaluations among people with stroke. Studies were analyzed for country of investigation, mRS self-assessment modality, care setting (inpatient vs outpatient), concordance between structured and unstructured mRS scores, and risk of bias.</div></div><div><h3>Results</h3><div>We identified 13 structured mRS questionnaire validation studies across all continents except Africa. The telephone mRS questionnaire was most commonly used. Average time between unstructured and structured assessments was 14 days. The weighted kappa agreement between structured and in-person unstructured scores ranged from moderate to very good (K<em>_w</em> range: 0.56-0.90), though unweighted kappa scores were significantly lower (K range: 0.27-0.68). Discrepancies between structured and in-person unstructured scores tended to result from patients at the scale extremes. Patients with good mRS outcomes (mRS ≤2) tended to rate themselves better on structured questionnaires than their clinicians rated them on unstructured evaluations while those with poor outcomes (mRS ≥3) tended to rate themselves worse than their clinicians. Major limitations across studies included sampling bias in inpatient settings, time delays between in-person unstructured and structured mRS assessments, and differences in the formatting of unstructured mRS assessments.</div></div><div><h3>Conclusion</h3><div>While structured mRS questionnaire validation studies have generally displayed good agreement with in-person unstructured outcomes, significant discrepancies exist for patients with very poor and very good outcomes. Future studies should limit time between mRS assessments and better understand reasons for differences in structured and unstructured assessments. Further, data on validity of structured mRS tools are lacking from much of the world, especially Africa.</div></div><div><h3>Primary Funding</h3><div>1K01TW011771-01A1 (Saylor)</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108242"},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct oral anticoagulants compared to aspirin for embolic stroke of undetermined source: A comprehensive meta-analysis","authors":"Natalia Arturo M.D. ,&nbsp;Aishwarya Koppanatham M.B.B.S. ,&nbsp;Paweł Chochoł M.D. ,&nbsp;Aisha Rizwan Ahmed M.B.B.S. ,&nbsp;Andrei V. Alexandrov MD ,&nbsp;Thomas C. Varkey M.D, M.B.A, M.Ed","doi":"10.1016/j.jstrokecerebrovasdis.2025.108256","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108256","url":null,"abstract":"<div><h3>Background</h3><div>The use of anticoagulation for stroke prevention in embolic stroke of undetermined source (ESUS) is hypothesized to be beneficial over conventional antiplatelet use. However, randomized controlled trials (RCTs) have not found clear benefits, even when assessing cardioembolic <em>enriching</em> features. This study aimed to perform a meta-analysis exploring the efficacy and safety of direct oral anticoagulants (DOACs) following ESUS.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, and Cochrane Central were systematically searched for studies comparing DOACs versus aspirin after ESUS. The primary outcome was stroke recurrence, and the safety outcome was major bleeding. A random-effects model was used for the analyses. Statistical analysis was performed using Review Manager Web 8.0.0 (RevMan Web).</div></div><div><h3>Results</h3><div>14,582 patients were included from 9 studies, of which 4 were RCTs. 7,341 (50.3 %) received DOACs as secondary prevention. For stroke recurrence, there was noted non-statistically significant trends towards benefit for DOACs (OR 0.93; 95 % CI 0.81–1.06; <em>p</em> = 0.29; I² = 34 %). No differences were found for major bleeding (HR 1.57; 95 % CI 0.86–2.86; <em>p</em> = 0.15; I² = 63 %). Among the atrial cardiomyopathy subgroup, no benefit was observed (OR 0.88; 95 % CI 0.50–1.55; <em>p</em> = 0.67; I² = 39 %).</div></div><div><h3>Conclusion</h3><div>There is insufficient evidence to recommend the use of DOACs over aspirin following ESUS for the prevention of stroke recurrence. Nevertheless, the fears of increased bleed risks were also not seen. Further efforts should be directed towards identifying potential embolic sources and the population that benefit from OAC.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108256"},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality indicators of stroke care in Colombia based on the RES-Q registry","authors":"Hernán Bayona ,&nbsp;Pablo Amaya ,&nbsp;José Luis Bustos ,&nbsp;Liliana M Giraldo-Tapias ,&nbsp;Andrés Betancourt ,&nbsp;Catalina Vallejo ,&nbsp;Julián Rivillas ,&nbsp;Natalia Llanos-Leyton ,&nbsp;Katherine Mantilla ,&nbsp;Tony Fabián Álvarez ,&nbsp;Carlos Martinez ,&nbsp;Jaime Eduardo Rodriguez Orozco ,&nbsp;Claudio Jimenez ,&nbsp;Javier Torres ,&nbsp;Carolina Isaza ,&nbsp;Juliana Coral ,&nbsp;H. Mauricio Patiño-Rodriguez ,&nbsp;Hugo Macareno ,&nbsp;Daniel Mantilla ,&nbsp;Ángel Basilio Corredor-Quintero ,&nbsp;Mario Muñoz-Collazos","doi":"10.1016/j.jstrokecerebrovasdis.2025.108249","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108249","url":null,"abstract":"<div><h3>Objectives</h3><div>This study seeks to outline the epidemiological patterns and quality of care indicators of ischemic stroke in Colombia. It serves as a pioneering effort, offering crucial national-level insights to inform evidence-based stroke policies in Colombia.</div></div><div><h3>Materials and Methods</h3><div>Using data from the Registry of Stroke Care-Quality (RES-Q) spanning the years 2017 to 2021, a multicenter descriptive study was conducted in Colombia. A survival analysis using Kaplan-Meier curves was planned for the time from symptom onset to hospital arrival, hospital stay and mortality, stratified by pre-established geographic regions.</div></div><div><h3>Results</h3><div>A total of 7,963 patients were included in 4 geographic regions: Amazon, Andean, Caribbean and Pacific. The main data provider was the Andean region with 6,402 patients (80.3 %). 49 % were women. The median age was 72 years (IQR 61-81). The NIHSS scale was a median of 7 IQR (3-15). 14.5 % (994) received intravenous thrombolysis therapy. The door to needle time was 53 min IQR (36-70). 53 % were hospitalized in a standard bed, 41 % in intensive care/stroke unit. 33.4 % patients had a Rankin score at discharge between 0-2.</div></div><div><h3>Conclusion</h3><div>First study conducted using RES-Q data at the national level in Colombia. A reduction of door-to-needle times by at least 50 % compared to historical levels is evident. Low reperfusion rates persist. Secondary prevention measures are needed with the implementation of national stroke policies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108249"},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female Sex is associated with reduced thrombolytic administration in an Australian Stroke Cohort: A multicentre retrospective cohort study","authors":"Rudy Goh ,&nbsp;Felix Ng ,&nbsp;Jim Jannes ,&nbsp;Timothy Kleinig ,&nbsp;Annabel Sorby-Adams ,&nbsp;Britt Suann ,&nbsp;Stephen Bacchi","doi":"10.1016/j.jstrokecerebrovasdis.2025.108255","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108255","url":null,"abstract":"<div><h3>Background</h3><div>Female patients with AIS may not receive thrombolytic equitably.</div></div><div><h3>Aims</h3><div>We examined whether there were sex differences in the likelihood of receiving thrombolytic in South Australian AIS patients.</div></div><div><h3>Methods</h3><div>In a retrospective cohort study, consecutive patients admitted to metropolitan stroke units within South Australia between January 2019 to December 2023 with AIS without contraindication to thrombolytic were included. Multivariable logistic regression was used to determine the relevance of demographic, clinical, imaging and service delivery parameters associated with intravenous thrombolytic non-administration.</div></div><div><h3>Results</h3><div>A total of 3484 patients were included (1519 (43.59 %) female), of whom 744 (21.35%), including 304 (20.01%) females and 440 (22.39%) males received intravenous thrombolytic. A trend towards thrombolytic non-administration was observed in females during univariate analysis (OR 1.15, 95% CI 0.98-1.36, <em>p=</em>0.09). Female sex was associated with reduced odds of receiving thrombolytic in multivariate analysis (aOR 1.38, 95% CI 1.09-1.59). Other major factors associated with not receiving thrombolysis included lack of code stroke activation (OR 20.43, 95% CI 9.19-58.09), symptom onset-to-door time above 4.5 hours (OR 5.89, 95% CI 3.90-9.28), ‘wake up’ stroke (OR 3.72, 95% CI 2.90-4.82), in hospital stroke (OR 3.13, 95% CI 1.48-7.47), NIHSS below 5 (OR 2.61, 95% CI 2.05-3.33) and CT perfusion not performed (OR 2.58, 95% CI 1.76-3.87. Mediation analysis demonstrated a significant partial mediation effect of female sex on thrombolytic non-administration via CT perfusion imaging non-performance.</div></div><div><h3>Conclusion</h3><div>This study identified female sex was associated with a reduced likelihood of receiving thrombolytic in AIS. Further studies to determine the reason for these disparities are required.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108255"},"PeriodicalIF":2.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143304026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suboptimal medication possession ratio is associated with recurrent ischemic stroke in a veteran population","authors":"Kyle C. Kern MD MS ,&nbsp;Alexander Crossley MPH ,&nbsp;Naomi Wu PharmD ,&nbsp;Katherine T. Mun MD ,&nbsp;Sunita Dergalust PharmD ,&nbsp;Jason D. Hinman MD PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108257","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108257","url":null,"abstract":"<div><h3>Objectives</h3><div>Recurrent stroke results in higher disability and mortality but might be mitigated through interventions that improve medication adherence. The medication possession ratio (MPR) is an objective proxy for adherence that may provide an individualized risk assessment for recurrent stroke.</div></div><div><h3>Methods</h3><div>This is a retrospective, longitudinal cohort study of patients with recent ischemic stroke or TIA referred to a Veterans Affairs vascular neurology outpatient clinic between 2010 and 2016. We calculated average MPR quartile for four medication classes used for secondary stroke prevention by reviewing pharmacy and medical records following an incident cerebral ischemic event. Traditional stroke risk factors were quantified using the Framingham Stroke Risk Profile (FSRP) score. We hypothesized that lower average MPR would relate to higher recurrent stroke risk more than FSRP or stroke etiological classification.</div></div><div><h3>Results</h3><div>For 255 patients with stroke or TIA, 57 (22.4 %) patients had recurrent stroke during a median follow-up period of 5.0 years (IQR 2.0). Compared to optimal average MPR, each quartile lower average MPR was associated with higher cumulative incidence of recurrent stroke (subhazard ratio 1.63, 95 %CI: 1.24 to 2.14, p&lt;0.001) while accounting for the competing risk of death and covarying for FSRP. Neither FSRP nor stroke etiology were associated with recurrent stroke. However, higher baseline systolic blood pressure starting at 132 mm Hg was independently associated with stroke recurrence.</div></div><div><h3>Conclusions</h3><div>MPR is an effective proxy measurement to assess risk of recurrent stroke. Systems-based and individualized interventions to improve medication adherence are needed to reduce recurrent stroke rates in VA populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108257"},"PeriodicalIF":2.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint association of physical activity and night sleep duration with the risk of atherosclerotic cardiovascular disease","authors":"Yuxin Yang MM ,&nbsp;Lu Guo MPH ,&nbsp;Man Li MM ,&nbsp;Zhiqiang Li MM ,&nbsp;Yao Xiao MM ,&nbsp;Yue Wang MM ,&nbsp;Yuanyuan Li MM ,&nbsp;Jiawen Deng MM ,&nbsp;Shouling Wu MD ,&nbsp;Hong Zhang MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108258","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108258","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the joint association of physical activity (PA) and sleep duration with the risk of atherosclerotic cardiovascular disease (ASCVD).</div></div><div><h3>Methods</h3><div>A total of 111,714 participants who participated in health examinations were enrolled from the Kailuan Study between June 2006 and December 2009. Sleep duration was divided into three groups (short, healthy, and long). PA was categorized into physically inactive and physically active. Restricted cubic splines were used to analyze the associations of PA and sleep duration with ASCVD. Cox proportional hazards models were conducted to investigate the effects of PA and sleep duration on ASCVD risk, with their cross-product interaction terms tested on both multiplicative and additive scales.</div></div><div><h3>Results</h3><div>During 13.05 ± 3.16 years of follow-up, 10,408 participants developed ASCVD. Restricted cubic spline analysis revealed a nonlinear dose-response relationship between sleep duration and ASCVD risk among physically inactive participants (<em>P</em>_nonlinear &lt;0.05). Both additive and multiplicative interactions between physical activity and sleep duration were observed in their effects on ASCVD risk (<em>P</em>_interaction &lt; 0.05). Compared with participants who had healthy sleep duration and were physically active, those with unhealthy sleep duration and physical inactivity exhibited a significantly higher risk of ASCVD [short sleep duration: HR (95 %CI) = 1.19 (1.09, 1.30); long sleep duration: HR (95 % CI) = 1.10 (0.90, 1.34)]. However, physically active participants in both the short and long sleep duration groups exhibited a reduced risk of ASCVD.</div></div><div><h3>Conclusions</h3><div>Engaging in sufficient PA can reduce the risk of ASCVD in individuals with short sleep duration. Therefore, simultaneously maintaining healthy sleep duration and engaging in PA may effectively prevent ASCVD.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108258"},"PeriodicalIF":2.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mendelian randomization assessing causal relationship between fibrinogen levels and ischemic stroke","authors":"Gie Ken-Dror PhD ,&nbsp;Tanya Khanna BSc ,&nbsp;Emily Hills BSc ,&nbsp;Louise Lepert BSc ,&nbsp;Sana Mughal BSc ,&nbsp;Thang Sieu Han PhD ,&nbsp;Pankaj Sharma MD, PhD, FRCP","doi":"10.1016/j.jstrokecerebrovasdis.2024.108199","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108199","url":null,"abstract":"<div><h3>Objective</h3><div>High fibrinogen levels are associated with an increased risk of ischaemic stroke (IS). We used mendelian randomisation (MR) to explore a potential causal relationship.</div></div><div><h3>Materials and Methods</h3><div>Data for assessing the relationship between gene variant, disease and biological levels needed for a MR approach was collected using a meta-analytical approach. Inverse-variance weighted (IVW) approach was used for the main analyses and alternative approach for sensitivity analyses. The relationship between fibrinogen levels and IS was assessed using Odds Ratio (OR), while mean difference (g/L) was used for the relationship between SNP (rs1800790) and fibrinogen levels.</div></div><div><h3>Results</h3><div>The variant <em>FGB</em> rs1800790 SNP was interrogated as an instrumental variable of fibrinogen levels. A meta-analysis with 24 studies (12 case-control and 12 cohort studies, totalling 20,902 cases and 76,510 controls was conducted. Homozygotes (AG) of rs1800790 have 0.14g/L (95%CI: 0.08-0.19, <em>P</em>&lt;0.001) and minor allele (AA) have 0.18g/L (95%CI: 0.01-0.35, <em>P</em>=0.037) higher levels of plasma fibrinogen concentration compared with homozygous for the major allele (GG). The risk of IS was significantly increased in 1-g/L (OR=1.83, 95%CI: 0.92-3.62, <em>P</em>=0.084), or 1-SD of fibrinogen levels (OR=1.39, 95%CI: 1.03-1.87, <em>P</em>=0.030), or above median levels (OR=1.22, 95%CI: 1.02-1.46, <em>P</em>=0.029) or categorical levels tertiles (OR=1.50, 95%CI: 1.26-1.79, <em>P</em>&lt;0.001). Each 1-g/L increase in fibrinogen levels was causally associated with a higher risk of ischemic stroke (OR=2.28, 95%CI: 1.53–3.03, <em>P</em>&lt;0.001) in the Mendelian randomisation analysis.</div></div><div><h3>Conclusions</h3><div>Elevated fibrinogen levels are a causative risk factor for ischaemic stroke with each 1g/L increase doubling its risk.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108199"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet related gene IQGAP1 contributes to the onset and abnormal immune landscape of ischemic stroke patients","authors":"Youle Su ,&nbsp;Bo Chao ,&nbsp;Junhao Ren ,&nbsp;Lian Shuang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108194","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108194","url":null,"abstract":"<div><h3>Introduction</h3><div>Ischemic stroke (IS) is a complex illness resulting from a combination of numerous environmental and genetic risk factors. Recent reports have shed light on the vital role that platelets play in the pathophysiology of IS. Here, we aimed to explore the potential platelet-related genes in IS and investigate the effect of platelet-related genes in the immune microenvironment of IS.</div></div><div><h3>Methods</h3><div>The data of IS were retrieved from the Gene Expression Omnibus database. Firstly, we screened the platelet-related genes that were correlated with the onset of IS using differential expression analysis, enrichment analyses, and protein-protein interaction (PPI) network. Moreover, we analyzed the clinical value and functional information of platelet-related genes in IS. Finally, we explored the correlation between platelet-related genes and immune cells’ infiltration.</div></div><div><h3>Results</h3><div>Ten platelet-related genes that were correlated with the onset of IS were identified, among which <em>IQGAP1</em> was located at the core of the PPI network. <em>IQGAP1</em> was found to be expressed in the normal brain tissue and its expression was significantly elevated in IS samples. The area under the curve (AUC) values for <em>IQGAP1</em> in both the GSE16561 and GSE58294 datasets were close to 1. <em>IQGAP1</em> knockdown might increase OGD/R‑induced HT22 cell viability. Additionally, FoxO signaling pathway, NOD-like receptor signaling pathway, Phagosome and Platelet activation pathways were significantly activated in IS patients with high <em>IQGAP1</em> expression compared to those with low IQGAP1 expression. The IS patients in the <em>IQGAP1</em>^high and <em>IQGAP1</em>^low groups showed dramatically different proportions of immune cells and immune-related functions, and the <em>IQGAP1</em> expression was correlated with the immune cell’ infiltration in IS.</div></div><div><h3>Conclusions</h3><div>In this study, we identified the <em>IQGAP1</em> might serve as a potential diagnostic marker for IS, and the <em>IQGAP1</em> expression was very relevant in determining the immune cell’ infiltration in IS patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108194"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of stroke-associated hospital-acquired pneumonia: Machine learning approach","authors":"Ahmad A. Abujaber RN, MBA, PhD ,&nbsp;Said Yaseen MBBS ,&nbsp;Abdulqadir J. Nashwan RN, MSc, PhD(c) ,&nbsp;Naveed Akhtar MD, PhD ,&nbsp;Yahia Imam MBBS, MD, FRCP Edin, FEBN, MSc. Clinical Neurology, MSc. Stroke Medicine, FESO, FAAN","doi":"10.1016/j.jstrokecerebrovasdis.2024.108200","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108200","url":null,"abstract":"<div><h3>Background</h3><div>Stroke-associated Hospital Acquired Pneumonia (HAP) significantly impacts patient outcomes. This study explores the utility of machine learning models in predicting HAP in stroke patients, leveraging national registry data and SHapley Additive exPlanations (SHAP) analysis to identify key predictive factors.</div></div><div><h3>Methods</h3><div>We collected data from a national stroke registry covering January 2014 to July 2022, including 9,840 patients diagnosed with ischemic and hemorrhagic strokes. Five machine learning models were trained and evaluated: XGBoost, Random Forest, Support Vector Machine (SVM), Logistic Regression, and Artificial Neural Network (ANN). Performance was assessed using accuracy, precision, recall, F1-score, AUC, log loss, and Brier score. SHAP analysis was conducted to interpret model outputs.</div></div><div><h3>Results</h3><div>The ANN model demonstrated superior performance, with an F1-score of 0.86 and an AUC of 0.94. SHAP analysis identified key predictors: stroke severity, admission location, Glasgow Coma score (GCS), systolic and diastolic blood pressure at admission, ethnicity, stroke type, mode of arrival, and age. Patients with higher stroke severity, dysphagia, and those arriving by ambulance were at increased risk for HAP.</div></div><div><h3>Conclusion</h3><div>This study enhances our understanding of early predictive factors for HAP in stroke patients and underlines the potential of machine learning to improve clinical decision-making and personalized care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108200"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}