Supported transitional care applied to stroke survivors: A meta-analysis.

BACKGROUND: This meta-analysis aims to assess the outcomes of supported intervention transitional care compared to traditional care for stroke survivors. MATERIAL AND METHODS: A systematic literature review was accomplished and 4,437 stroke patients were recruited for the current study; 2,211 of them were treated with transitional care and 2,226 with traditional care. The inclusion criteria of the current study recruited only randomized clinical trials up until November 2023. A random analysis model was used to analyze the continuous and dichotomous models. RESULTS: Supported intervention transitional care (early supported discharge) for stroke survivors showed a significant (p = 0.002) impact regarding the functional status of patients as expressed by the Barthel index (mean difference (MD) = 0.57, 95% confidence interval (95% CI): 0.20-0.94, I² = 93.72%). On the other hand, there were no considerable (p > 0.05) differences regarding other outcomes such as activities of daily living, the Caregiver Strain Index (CSI), the modified Rankin scale (mRS), and mortality (MD = 0.29, 95% CI: -0.12-0.69, I² = 94.5%; MD = -0.13, 95% CI: -0.40-0.14, I² = 68.65%; MD = -0.13, 95% CI: -0.49-0.23, I² = 83.33%; and MD = -0.19, 95% CI: -0.58-0.17, I² = 0%; respectively). CONCLUSION: Supported transitional care allowed stroke survivors to succeed in enhancing their functional status outcomes compared with controls, while there was no significant impact regarding mortality rate. Further investigations and multicenter studies are required to enhance the evidence.

Hepcidin depending on astrocytic NEO1 ameliorates blood-brain barrier dysfunction after subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) significantly compromises the blood-brain barrier (BBB) and impairs patient recovery. This study elucidates the critical role of astrocytic Neogenin-1 (NEO1) in BBB integrity post-SAH and examines the regulatory effects of hepcidin on endothelial cell (EC) function amid NEO1-mediated disruptions in iron homeostasis. Proteomic analyses of cerebrospinal fluid (CSF) from SAH patients revealed a substantial decrease in NEO1 expression, identifying it as a key factor in BBB integrity. 111 CSF proteins were significantly reduced in early SAH stages (days 1-3), with NEO1 among the most significantly altered. This dysregulation was linked to poorer patient outcomes, as indicated by a negative correlation between NEO1 levels and Modified Rankin Scale scores six months post-SAH (R = -0.4743, P < 0.0001). Experimental models further highlighted the importance of NEO1: SAH model and NEO1GFAP-Cre mice exhibited exacerbated EC dysfunction and increased BBB permeability, evidenced by significant Evans Blue retention and dextran leakage in the parietal cortex, effects that were mitigated by hepcidin administration. Our findings highlight the complex interplay between astrocytic signaling and endothelial function in SAH pathophysiology. The loss of astrocytic NEO1 led to increased EC proliferation and altered BBB structure, as confirmed by transmission electron microscopy and immunostaining for PECAM-1, indicating heightened blood vessel density in the affected cortex. Hepcidin treatment effectively reversed the EC dysfunction and BBB disruption in both NEO1-cKO mice and the SAH model, highlighting its potential as a therapeutic agent to enhance recovery and improve prognosis following SAH.

Comparison of Pipeline embolization device versus Tubridge embolization device in unruptured intracranial aneurysms: a multicenter, propensity score matched study.

BACKGROUND: Flow diverter devices (FDs) are increasingly used for treating unruptured intracranial aneurysms (UIAs), but limited studies compared different FDs. OBJECTIVE: To conduct a propensity score matched analysis comparing the Pipeline embolization device (PED) and Tubridge embolization device (TED) for UIAs. METHODS: Patients with UIAs treated with either PED or TED between July 2016 and July 2022 were included. Propensity score matching was performed to adjust for age, sex, comorbidities, smoking, drinking, aneurysm size, morphology, neck, location, parent artery diameter, adjunctive coiling, and angiographic follow-up duration. Perioperative complications and clinical and angiographic outcomes were compared after matching. RESULTS: 735 patients treated by PED and 290 patients treated by TED were enrolled. Compared with the PED group, patients in the TED group had a greater number of women and patients with ischemia, a smaller proportion of vertebrobasilar and non-saccular aneurysms, a smaller size and neck, and fewer adjunctive coils and overlapping stents, but a larger parent artery diameter and lumen disparities. After adjusting for these differences, 275 pairs were matched. No differences were found in perioperative complications (4.4% vs 2.5%, P=0.350), in-stent stenosis (16.0% vs 15.6%, P>0.999), or favorable prognosis (98.9% vs 98.5%, P>0.999). However, PED showed a trend towards better complete occlusion over a median 8-month angiographic follow-up (81.8% vs 75.3%, P=0.077). CONCLUSION: Compared with PED, TED provides a comparable rate of perioperative and short-term outcomes. Nevertheless, a better occlusion status in the PED group needs to be further verified over a longer follow-up period.