Residual inflammatory risk and vulnerable plaque in the carotid artery in patients with ischemic stroke.

Objective: Inflammation is a central driver of atherogenesis and eventual plaque rupture. This study aimed to evaluate the association between residual inflammatory risk (RIR) and vulnerable plaques in the carotid artery in patients with ischemic stroke. Methods: Patients with acute ischemic stroke were enrolled from January 2021 to July 2022. They were divided into four groups: RIR only (LDL-C <2.6 mmol/L and hsCRP ≥2 mg/L), residual cholesterol risk (RCR) only (LDL-C ≥2.6 mmol/L and hsCRP <2 mg/L), both risk or residual cholesterol and inflammatory risk (RCIR) (LDL-C ≥2.6 mmol/L and hsCRP ≥2 mg/L), and neither risk (LDL-C <2.6 mmol/L and hsCRP <2 mg/L). Vulnerable plaques were determined if it had a low attenuated plaque CT value of <35 Hounsfield Units (HU) and a remodeling index of >1.1, which indicated a positive remodeling. Results: Out of the 468 enrolled patients, 157 (33.5%) were detected to have vulnerable plaques. The proportion of patients with neither risk, RIR, RCR, and RCIR were 32.9%, 28.6%, 18.8%, and 19.7%, respectively. Patients with vulnerable plaques exhibited a higher prevalence of hyperlipidemia (P = 0.026), higher proportion of RIR (P = 0.015), a higher ratio of stroke subtypes of large artery atherosclerosis (P = 0.012), and high leukocyte counts (P < 0.001). The logistic regression analysis detected that RIR was associated with vulnerable plaques after adjusted for major confounding factors (OR 1.98, 95% CI 1.13-3.45, P = 0.016), especially in the large artery atherosclerosis subtype (OR 2.71, 95% CI 1.08-6.77, P = 0.034). Conclusions: In patients with ischemic stroke, RIR is associated with the vulnerability of carotid plaques, especially for those with the large artery atherosclerosis subtype. Therefore, further studies investigating the interventions to modulate inflammation in these patients may be warranted.

Serum amyloid A is a potential predictor of prognosis in acute ischemic stroke patients after intravenous thrombolysis.

Objectives: Inflammation shows a notable relationship to acute ischemic stroke's (AIS) occurrence and prognosis. However, existing research has confirmed that serum amyloid A (SAA) is an inflammatory biomarker. The aim of this paper was to investigate the association between SAA and the three-month clinical results of acute AIS patients after intravenous thrombolysis (IVT). Methods: The evaluation of AIS patients with complete medical records was carried out by prospectively investigating patients hospitalized in our department between January 2020 and February 2023. The SAA levels were examined with the use of an immunosorbent assay kit that shows a relationship with the enzyme (Invitrogen Corp). Patients were dichotomized into favorable (mRS score of 0, 1 or 2) and unfavorable (mRS score of 3, 4, 5, or 6) results with the use of the modified Rankin Scale (mRS). Results: A total of 405 AIS patients who were subjected to IVT therapy were prospectively covered. To be specific, 121 (29.88%) patients had an unfavorable prognosis during the follow-up for 3 months. On that basis, patients achieving unfavorable results gained notably greater SAA levels (39.77 (IQR 38.32-46.23) vs.31.23 (IQR 27.44-34.47), p < 0.001) during hospitalization in comparison to patients with a better result. In the analysis with multiple variates, SAA was adopted to achieve the independent prediction of the three-month unfavorable clinical results of acute AIS patients after IVT [OR:2.874 (95% CI, 1.764-4.321), p < 0.001]. When the fundamental confounding factors were regulated, the odds ratio (OR) of unfavorable prognosis after AIS patients undergoing IVT therapy was 4.127 (95% CI = 1.695-10.464, p = 0.032) for the maximum tertile of SAA in terms of the minimal tertile. With an AUC of 0.703 (95% CI, 0.649-0.757), SAA revealed a notably more effective discriminating capability in terms of CRP, NLR, EMR, and WBC. SAA as a predictor in terms of the prediction of three-month unfavorable results after AIS patients undergoing IVT therapy achieved specificity and sensitivity of 84.45% and 77.23%, as well as an optimal cut-off value (COV) of 37.39. Conclusion: SAA level that is up-regulated during hospitalization is capable of serving as an effective marker in terms of the prediction of unfavorable three-month results in AIS patients after IVT.

Serum Cystatin C is Associated with Depression After Intracerebral Hemorrhage.

Purpose: Cystatins are associated with neuronal degeneration and nervous system healing. Cystatin C (Cys C) has recently been linked to brain injury and immunological inflammation. This study aimed to determine the relationship between serum Cys C levels and depression following intracranial hemorrhage (ICH). Patients and Methods: Between September 2020 and December 2022, 337 patients with ICH were sequentially recruited and followed up for three months. The post-stroke depression (PSD) and non-PSD groups were separated based on the 17-item Hamilton Depression Rating Scale (HAMD). The PSD diagnosis was established based on the DSM-IV criteria. Cys-C levels were documented within twenty-four hours of admission. Results: Three months after ICH, 93 (27.6%) of 337 enrolled patients were diagnosed with depression. The Cys C levels were significantly higher in depressed patients than in nondepressed patients after ICH (1.32 vs 1.01; p<0.001). After adjusting for potential confounding variables, depression after ICH was associated with the highest quartile of Cys C levels (odds ratio (OR) = 3.195, 95% CI: 1.562-6.536; p=0.001). The receiver operating characteristic curve (ROC) curve predicted that the ideal cut-off for CysC levels as a predictor of depression after ICH would be 0.730, resulting in 84.5% sensitivity and 88.4% specificity, with an area under curve (AUC) of 0.880 (95% CI: 0.843-0.917; p< 0.0001). Conclusion: Increased CysC concentrations were independently related to depression three months after ICH, highlighting that CysC levels at admission may be a potential biomarker for predicting the onset of depression following ICH.

Predictors of Symptomatic Intracranial Hemorrhage after Endovascular Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

INTRODUCTION: This meta-analysis assessed the predictors of symptomatic intracranial hemorrhage (sICH) after endovascular thrombectomy (EVT) for patients with acute ischemic stroke. METHODS: PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science were searched for studies published from inception to February 16, 2021. We included studies that evaluated the predictors of sICH after EVT. The random-effect model or fixed-effect model was used to pool the estimates according to the heterogeneity. RESULTS: A total of 25 cohort studies, involving 15,324 patients, were included in this meta-analysis. The total incidence of sICH was 6.72 percent. Age (MD = 2.57, 95% CI: 1.53-3.61; p < 0.00001), higher initial NIHSS score (MD = 1.71, 95% CI: 1.35-2.08, p < 0.00001), higher initial systolic blood pressure (MD = 7.40, 95% CI: 5.11-9.69, p < 0.00001), diabetes mellitus (OR = 1.36, 95% CI: 1.10-1.69, p = 0.005), poor collaterals (OR = 3.26, 95% CI: 2.35-4.51; p < 0.0001), internal carotid artery occlusion (OR = 1.55, 95% CI: 1.26-1.90; p < 0.0001), longer procedure time (MD = 18.92, 95% CI: 11.49-26.35; p < 0.0001), and passes of retriever >3 (OR = 3.39, 95% CI: 2.45-4.71; p < 0.0001) were predictors of sICH, while modified thrombolysis in cerebral infarction score ≥2b (OR = 0.61, 95% CI: 0.46-0.79; p = 0.0002) was associated with a decreased risk of sICH. There were no significant differences in the female gender, initial serum glucose, initial ASPECT score, atrial fibrillation, oral anticoagulants, antiplatelet therapy, intravenous thrombolysis, general anesthesia, neutrophil-to-lymphocyte ratio, and emergent stenting. CONCLUSIONS: This study identified many predictors of sICH. Some of the results lack robust evidence given the limitations of the study. Therefore, larger cohort studies are needed to confirm these predictors.

Study on the intervention effect of SMG health management in patients with ischemic stroke.

INTRODUCTION: The aim of the study was to explore the clinical effect of brain and heart health managers combined with the "SMG" health management mode on nursing intervention in ischemic stroke patients. MATERIAL AND METHODS: A total of 187 ischemic stroke patients divided into 96 patients in the observation group and 91 patients in the control group with the random number table method. The control group conducted the routine care intervention, and the observation group used the brain and heart health managers combined with the "SMG" health management model for the nursing intervention. The control of stroke risk factors was explored by comparing blood pressure, blood glucose and blood lipid and other indicators between the two groups before and after treatment. RESULTS: Compared with that before the intervention, the Stroke Self-Efficacy Questionnaire (SSEQ) score of both the observation group and the control group were significantly higher ( p < 0.05), and the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores were all decreased ( p < 0.05). The proportion of patients with treatment adherence did not differ significantly before and after the intervention in the control group ( p > 0.05), and it increased significantly in the observation group after the intervention ( p < 0.05). The observation group had higher SSEQ score and lower HAMA, HAMD, NIHSS, and mRS scores after the intervention compared with the control group, with statistically significant differences. CONCLUSIONS: The combination of brain and heart health managers and "SMG" is more conducive to improving the selfefficacy of ischemic stroke patients, alleviating patient anxiety and depression, improving patient treatment compliance, controlling stroke risk factors, and promoting neurological function recovery.

Effect of Cluster Nursing on Recovery Effect and Hospitalization Time of Patients with Acute Cerebral Infarction After Thrombectomy.

Objective: To explore the effects of cluster nursing on self-care ability, length of hospital stay, complications and neurological function of patients with mechanical thrombectomy of large vessel occlusion in acute cerebral infarction. Methods: A total of 83 patients with acute cerebral infarction who underwent thrombolectomy in a tertiary hospital in Anhui Province from June 2019 to March 2021 were randomly divided into observation group and control group. The observation group was treated with cluster nursing intervention mode, and the control group was treated with routine nursing mode. Barthel index scores and National Institute of Health Stroke Scale (NIHSS) scores were compared between the two groups at admission and at 1 week, 1 month and 3 months of nursing intervention. The length of stay and incidence of complications were compared between the two groups. Results: There was no significant difference in baseline data, Barthel index and NIHSS score between the two groups at admission (P>0.05). The Barthel index at 1 week, 1 month and 3 months after operation in the observation group was significantly higher than that in the control group (P<0.05), while the NIHSS score, incidence of complications and length of hospital stay were significantly lower than those of the control group (P<0.05). Conclusion: Cluster nursing can improve the neurological function, improve the self-care ability, reduce the incidence of complications, shorten the hospitalization period, improve the prognosis and promote the recovery of patients with acute cerebral infarction thrombolysis.

Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion.

BACKGROUND: Data from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited. METHODS: We conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control). The primary outcome was good functional status, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]), at 90 days. Secondary outcomes included a modified Rankin scale score of 0 to 2, distribution across the modified Rankin scale score categories, and quality of life. Safety outcomes included symptomatic intracranial hemorrhage at 24 to 72 hours, 90-day mortality, and procedural complications. RESULTS: Of the 507 patients who underwent screening, 340 were in the intention-to-treat population, with 226 assigned to the thrombectomy group and 114 to the control group. Intravenous thrombolysis was used in 31% of the patients in the thrombectomy group and in 34% of those in the control group. Good functional status at 90 days occurred in 104 patients (46%) in the thrombectomy group and in 26 (23%) in the control group (adjusted rate ratio, 2.06; 95% confidence interval [CI], 1.46 to 2.91, P<0.001). Symptomatic intracranial hemorrhage occurred in 12 patients (5%) in the thrombectomy group and in none in the control group. Results for the secondary clinical and imaging outcomes were generally in the same direction as those for the primary outcome. Mortality at 90 days was 37% in the thrombectomy group and 55% in the control group (adjusted risk ratio, 0.66; 95% CI, 0.52 to 0.82). Procedural complications occurred in 14% of the patients in the thrombectomy group, including one death due to arterial perforation. CONCLUSIONS: In a trial involving Chinese patients with basilar-artery occlusion, approximately one third of whom received intravenous thrombolysis, endovascular thrombectomy within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical care but was associated with procedural complications and intracerebral hemorrhage. (Funded by the Program for Innovative Research Team of the First Affiliated Hospital of USTC and others; ATTENTION ClinicalTrials.gov number, NCT04751708.).

Progressive ataxia of cerebrotendinous xanthomatosis with a rare c.255+1G>T splice site mutation: A case report.

BACKGROUND: Cerebrotendinous xanthomatosis is an autosomal recessive disorder of lipid metabolism caused by the mutation of the CYP27A1 gene encoding sterol 27-hydroxylase, an essential enzyme for the conversion of cholesterol to chenodeoxycholic and cholic acids. Cerebrotendinous xanthomatosis is a rare neurological disease with a wide range of clinical symptoms that are easily misdiagnosed. CASE SUMMARY: Here we report the clinical, biochemical, and molecular characterization of a 33-year-old female patient with cerebrotendinous xanthomatosis. The patient developed ataxia and had the typical symptoms of juvenile cataracts, tendon xanthomata, and progressive nervous system dysfunction. Magnetic resonance imaging of the brain revealed bilateral dentate nucleus lesions and white matter abnormalities. This patient was misdiagnosed for 2 years resulting in severe neurological complications. After 2 years of chenodeoxycholic acid treatment, she still presented with ataxia and dysarthria. The pathogenic sites of CYP27A1 were identified as c.255+1G>T and c.1263+1G>T, which were both caused by shear denaturation. CONCLUSION: Cerebrotendinous xanthomatosis requires a multidisciplinary diagnosis that must be made early to avoid progressive neurological degeneration. c.1263+1G>T is a known mutation, but c.255+1G>T is a rare mutation site.

Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry.

BACKGROUND: The authors compare the effectiveness and safety of endovascular treatment (EVT) versus best medical management (BMM) in strokes attributable to acute basilar artery occlusion (BAO). METHODS: The present analysis was based on the ongoing, prospective, multicenter ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) trial registry in China. Our analytic sample comprised 2134 patients recruited at 48 sites between 2017 and 2021 and included 462 patients who received BMM and 1672 patients who received EVT. We performed an inversed probability of treatment weighting analysis. Qualifying patients had to present within 24 hours of estimated BAO. The primary clinical outcome was favorable functional outcome (modified Rankin Scale score, 0-3) at 90 days. We also performed a sensitivity analysis with the propensity score matching-based and the instrumental variable-based analysis. RESULTS: In our primary analysis using the inversed probability of treatment weighting-based analysis, there was a significantly higher rate of favorable outcome at 90 days among EVT patients compared with BMM-treated patients (adjusted relative risk, 1.42 [95% CI, 1.19-1.65]; absolute risk difference, 11.8% [95% CI, 6.9-16.7]). The mortality was significantly lower (adjusted relative risk, 0.78 [95% CI, 0.69-0.88]; absolute risk difference, -10.3% [95% CI, -15.8 to -4.9]) in patients undergoing EVT. Results were generally consistent across the secondary end points. Similar associations were seen in the propensity score matching-based and instrumental variable-based analysis. CONCLUSIONS: In this real-world study, EVT was associated with significantly better functional outcomes and survival at 90 days. Well-designed randomized studies comparing EVT with BMM in the acute BAO are needed. REGISTRATION: URL: www.chictr.org.cn; Unique identifier: ChiCTR2000041117.

Association of Versican Gene Polymorphisms with Intracranial Aneurysm Susceptibility in the Eastern Chinese Population.

OBJECTIVE: The proteoglycan versican (VCAN) plays an important role in extracellular matrix (ECM) assembly, and diminished maintenance of the ECM has been increasingly regarded as an important factor in the development of intracranial aneurysms (IAs). Previous studies have revealed that single-nucleotide polymorphisms (SNPs) of the VCAN gene are associated with susceptibility to IAs in European or Japanese populations. However, the association between IA susceptibility and VCAN SNPs in the Eastern Chinese population remains unclear. This study aimed to investigate the associations of the SNPs rs251124, rs2287926, and rs173686 with IA susceptibility in the Eastern Chinese population. METHODS: A total of 162 patients with IA and 182 controls were enrolled in this study. The study was conducted between January 2017 and December 2020. SNP genotyping for rs251124, rs2287926, and rs173686 was performed using Kompetitive Allele Specific PCR (KASP) after DNA extraction. The SNP data were analysed with CFX Manager Software version 3.1 (Bio-Rad). RESULTS: rs251124 and rs173686 were significantly associated with susceptibility to IA. The frequency of rs251124-TT in IA was higher than in controls (OR =1.26, 95% CI: 1.07-1.49; P<0.01), and its risk mainly came from the T allele. Furthermore, logistic regression analysis showed that the T/T genotype and T allele of rs251124 were independent risk factors for IA (OR=1.726, 95% CI: 1.136-2.263; P=0.011). Moreover, the G/G genotype and G allele of rs173686 were associated with increased IA susceptibility (OR=2.52, 95% CI: 1.261-5.037; P=0.009). CONCLUSION: The SNPs rs251124 and rs173686 were strongly associated with genetic susceptibility to IA in the Eastern Chinese population; however, no such association was found in the SNP rs2287926 of VCAN. Our findings suggest that the VCAN gene is an IA susceptible gene that should be further studied as a screening marker for IAs.

High Uric Acid Level Predicts Early Neurological Deterioration in Intracerebral Hemorrhage.

OBJECTIVE: Increased level of serum uric acid (UA) is often considered a risk factor for ischemic stroke. However, there are limited data on the association between UA and intracerebral hemorrhage (ICH). This study aimed to examine the connection between UA and early neurological deterioration (END) in patients with ICH. METHODS: This is a prospective observational study. Patients with ICH were enrolled from January 2017 to December 2020. END was diagnosed as the Canadian Stroke Scale (CSS) score decreased ≥1 points between admission and 48 hours. UA was measured at admission. Multivariable logistic regression analysis was performed to explore the relationship between serum UA and END. RESULTS: Of the 498 enrolled patients, 132 (26.5%) were developed with END. Patients with END had a significantly higher level of serum UA (332 vs 270 µmol/L, P < 0.001). Univariate logistic regression analysis indicated that patients with the highest quartile of UA level had an OR of 3.256 (95% CI: 1.849-5.734, P < 0.001) for END compared with those with the lowest quartile of UA level. After adjusting for major confounders, the highest UA quartile remained as an independent predictor for END (OR = 2.282, 95% CI: 1.112-4.685, P = 0.013). CONCLUSION: Higher serum UA level was independently associated with END in patients with ICH; therefore, intervention to lower UA level may be worth considering.

Elevated Neutrophil-to-Lymphocyte Ratio Predicts Depression After Intracerebral Hemorrhage.

PURPOSE: Inflammation plays a critical role in the development of depression after intracerebral hemorrhage (ICH), while neutrophil-to-lymphocyte ratio (NLR) has been identified as a novel comprehensive inflammatory indicator in recent years. The aim of this study was to examine the association between NLR and depression after ICH. PATIENTS AND METHODS: From January 2016 to December 2018, ICH patients were prospectively enrolled. NLR was measured at admission. Depression at 3 months after ICH was diagnosed according to the Hamilton Depression Scale (HAMD). RESULTS: Of the 372 enrolled patients, 107 (28.8%) were diagnosed with depression at 3 months after ICH. Patients with depression had a higher NLR (6.15 vs 3.55, P < 0.001). Logistic regression analysis detected that after adjusting for major confounders, NLR remained independently associated with depression after ICH (OR = 2.25, 95% CI: 1.45-3.49, P < 0.001). Moreover, NLR acted as the optimal variable for prediction, with the optimal predictive threshold of 4.53 in ROC analysis. CONCLUSION: Elevated NLR is associated with depression at 3 months after ICH, suggesting that NLR may be a significant biomarker to predict depression after ICH.

Clinical Study of Restless Leg Syndrome Accompanied by Psychological Symptoms Induced by High-Dose Treatment With Madopar.

Objectives: Some neurological disorders demonstrate indistinguishable psychological symptoms at an early stage, especially when accompanied by jitters similar to those in Parkinson's disease. During dopamine replacement therapy, some patients display restless leg syndrome (RLS)-like symptoms. Therefore, we aimed to analyze treatment strategies and the prognosis of RLS caused by high-dose Madopar. Methods: Nine patients who were misdiagnosed with Parkinson's disease, taking a high dose of Madopar, and showed symptoms of anxiety, depression, and somatization were recruited. Clinical data were collected, and strategies of treatment and prognosis were analyzed. Results: Seven patients demonstrated varying degrees of anxiety and depression, and the other two cases were misdiagnosed as Parkinson's disease. During Madopar treatment, patients gradually showed aggravated symptoms, including swelling, numbness, pain, and other sensory abnormalities in both lower extremities, which spread to both upper extremities in a few patients. Among the seven patients, symptoms of anxiety, depression, insomnia, and somatization significantly worsened during the observation period. The average time from taking Madopar to the appearance of RLS was 2.6 ± 0.6 months, the average time to clinical diagnosis was 18.17 ± 9.40 months, and the average dosage of Madopar was 1.44 ± 0.21 g per day. Gradually reducing the Madopar dosage and administering a small dose of long-acting dopamine preparation greatly alleviated the symptoms after 3 months. Conclusion: A high dose of Madopar can cause RLS-like symptoms accompanied by anxiety, depression, insomnia, and other mental health symptoms. These symptoms should be more closely monitored by clinicians.

An InP-based vortex beam emitter with monolithically integrated laser.

Semiconductor devices capable of generating a vortex beam with a specific orbital angular momentum (OAM) order are highly attractive for applications ranging from nanoparticle manipulation, imaging and microscopy to fiber and quantum communications. In this work, an electrically pumped integrated OAM emitter operating at telecom wavelengths is fabricated by monolithically integrating an optical vortex emitter with a distributed feedback laser on the same InGaAsP/InP epitaxial wafer. A single-step dry-etching process is adopted to complete the OAM emitter, equipped with specially designed top gratings. The vortex beam emitted by the integrated device is captured and its OAM mode purity characterized. The integrated OAM emitter eliminates the external laser required by silicon- or silicon-on-insulator-based OAM emitters, thus demonstrating great potential for applications in communication systems and the quantum domain.