Stroke Association Research Articles

Abstract TP204: Discharge Statin Practices For Young Stroke Patients In A Stroke Clinical Network

Background: Despite the association of statin use and lowered recurrent stroke and mortality, some studies suggest young stroke patients do not receive the same intense targeted treatment medical therapies for secondary stroke prevention as older patients. Our specific objective was to determine if there were differences in statin medication discharge practices provided to young ischemic stroke patients within a Stroke Clinical Network. The Stroke Clinical Network consists of nine stroke centers located in rural, suburban and urban geographical regions. Methods: The GWTG registry was queried (FY 2017-2021) to identify ischemic stroke patients to determine statin discharge practices using the following criteria: sex, race, age groups ≥18-39 and ≥40-49, LDL levels < 100, 101-129 and > 130, diabetes, HTN, and smoking status. Chi squared tests of proportions were used to evaluate significant relationships between subgroups. Results: Among 1,294 young ischemic stroke patients: 53% (682/1294) were Black and 38% (493/1294) White; mean age 40.9 years (SD +/-7.21years). Men, blacks, patients older than 40 and diabetics were more likely to be discharged on a statin. There was a direct correlation between sex, race, age, LDL level and diabetes with statin discharge practices. There was no difference in statin discharge practices between smokers and nonsmokers. Conclusions: Opportunities to improve compliance with obtaining LDL levels upon admission and prescribing statins at discharge exist. Increasing statin administration in the young stroke patient population reflects best practice and will decrease mortality and morbidity.

Abstract TMP99: Genetics Of Stroke Of Undetermined Source: Overlap With Known Stroke Etiologies And Associations With Modifiable Risk Factors

Introduction: Stroke etiology remains unknown in 30% of cases, hindering secondary prevention efforts. We leveraged human genetic data in order to identify evidence of overlap between stroke of undetermined source and defined stroke etiologies as well as causal relationships with modifiable risk factors. Methods: We analyzed genome-wide data from 16,851 ischemic stroke cases and 32,473 controls from the NINDS Stroke Genetics Network with TOAST- and CCS-defined subtypes. Using genetic risk scores for large artery, cardioembolic, and small vessel stroke (LAS, CES, SVS) we assessed the degree of overlap with stroke of undetermined source and used pairwise GWAS to search for shared loci. We then applied Mendelian randomization (MR) to identify causal risk factors for stroke of undetermined source. Results: There was significant overlap between stroke of undetermined source and all defined stroke subtypes at a genome-wide and locus level (19 shared loci with LAS, 2 with CES, 5 with SVS). Shared loci pointed to altered gene expression in arterial tissue and blood and atherosclerosis-related mechanisms. Further, genetically predicted carotid intima media thickness was associated with stroke of undetermined source. While genetic liability to atrial fibrillation also showed a significant association, this was attenuated in analyses excluding cases with incomplete diagnostic workup. MR analyses showed significant associations in blood pressure, diabetes, waist-to-hip ratio, inflammatory pathways (IL-6 signaling, MCP-1 levels), and elevated factor XI levels with stroke of undetermined source (Figure). Conclusion: These analyses suggest that stroke of undetermined source shares genetic and modifiable risk factors with defined stroke subtypes. Together, they raise the hypothesis that refinement of current subtyping approaches can reduce the proportion of cases classified as undetermined and optimize secondary prevention strategies.

Abstract TMP36: Improve Patient Outcomes In A Specialized Neurological Emergency Department

Improved Patient Outcomes In A Specialized Neurological Emergency Department Introduction: Stroke is now the fifth leading cause of death in the U.S., but remains the leading cause of long term disability. Target: Stroke helps hospitals achieve improved stroke outcomes through reduced door-to-needle times for eligible stroke patients. Phase III of the American Heart Association/American Stroke Association initiative set more aggressive targets for timely treatment with IV alteplase. To achieve rapid treatment times and better patient outcomes, we created a neurologic emergency department (Neuro ED). Neuro ED hours are staffed by emergency physicians with specialized neuroscience training and administer IV alteplase independently, compared to the traditional ED (TED) where emergency providers consult neurology. Methods: This is a retrospective observational study from 2019-2021 comparing outcomes of acute ischemic stroke patients who received IV alteplase following implementation of the Neuro ED compared to a TED. The following metrics were calculated for each patient: Door to Needle times (DTN), door to CT times (DTCT), and pre and post National Institute of Health Stroke Scale (NIHSS) Results: 74 patients were treated in the Neuro ED and 45 patients were treated in the TED. Average DTN times in the Neuro ED were 27 minutes compared to 65 minutes in the TED. Patients treated in the Neuro ED achieved DTN times of 45 min or less 87% of cases, while only 24% of the time in the TED. Patients treated in the Neuro ED achieved DTN times of 30 min or less 65% of cases, with only 4% of cases in the TED. Average DTCT times in the Neuro ED were 8 minutes faster than the TED. No differences in admission NIHSS were found with an average of 8.75, but a significant improvement was found in discharge NIHSS. Average discharge NIHSS was 3.8 for Neuro ED stroke patients compared with 5.6 for TED patients (p<0.001). Conclusion: Implementation of a Neuro ED led to swift management and improved symptoms for stroke patients. A dedicated Neuro ED is highly effective in improving DTN times, DTCT times, and overall stroke outcomes.

Abstract TP122: Comparison Of Pharmacologic And Physical Venous Thromboembolism Prophylaxis: A Single Center Descriptive Analysis

Introduction: Recent American Heart Association/American Stroke Association guidelines suggest that physical venous thromboembolism (VTE) prophylaxis modalities are effective at preventing VTE events. Objective: To compare the incidence of VTE events among AIS patients receiving either pharmacologic prophylaxis or physical prophylaxis during hospitalization. Methods: Single center data was retrospectively analyzed among AIS patients who developed DVT or PE during their hospitalization. Patients were selected from January 1, 2016 - December 31, 2020. Inclusion criteria included age 18 and above, AIS patients, diagnosis of acute or chronic VTE events, and exclusive use of physical or pharmacologic VTE prophylaxis modality. We excluded patients who received combined SCD and pharmacologic prophylaxis during hospitalization. Results: Of 5104 patients diagnosed with AIS, 40 patients (0.8%) developed VTE events during their hospitalization. Of these, 29/40 (73%) received pharmacologic VTE prophylaxis and 11/40 (27%) received physical VTE prophylaxis. Of the 3488 patients receiving pharmacologic VTE prophylaxis, 29 (0.8%) developed VTE. Of the 1616 that received physical VTE prophylaxis, 11 (0.7%) developed VTE. Conclusions: Our single center study observed higher rates of VTE events among AIS patients receiving pharmacologic VTE prophylaxis in comparison to physical VTE prophylaxis.

Abstract TMP88: Development Of An Interprofessional Pediatric Stroke Program Across A Fourteen Hospital Healthcare System In Southern California

Background: An annual estimate of 1.0 to 2.0 in every 100,000 children are affected by stroke. The American Stroke Association (ASA) recommends the development of education programs to expand provider knowledge and establish systems to facilitate efficient pediatric stroke care. We embarked on establishing a regionwide, multidisciplinary pediatric stroke program consistent with the ASA goals of prompt recognition and management of stroke in pediatric patients across the organization’s 14 hospitals. Methods: In February 2020, we established a workgroup consisting of a stroke neurologist, pediatric physicians, stroke coordinators, clinical nurse specialists, nurse educators, clinical informaticists, and clinical nurses. The objectives were to standardize the pediatric stroke algorithms for the inpatient, emergency, and ambulatory settings; identify documentation tools specific for pediatric stroke; and develop education modules. The primary goal was immediate specialty consultation and transfer of pediatric stroke patients to the appropriate level of care. Nursing flowsheets were enhanced to include the Pediatric NIH Stroke Scale. The pediatric stroke education was designed as a multimodal program tailored for each professional role and work area. Education was implemented utilizing strategic methods to initiate (interactive online modules), reinforce (huddles, skills day), and sustain (annual updates) knowledge on pediatric stroke recognition, escalation, and management. Results: The organization’s pediatric stroke algorithms, documentation tools, and online modules raised awareness on this low-volume, high-risk pediatric condition. It is anticipated that referrals to the regional telestroke and the comprehensive stroke center will increase, resulting in timely treatment and better outcomes. Conclusion: Development of a regionwide pediatric stroke program requires the support and commitment from leadership and clinical stakeholders. Next steps for the organization’s pediatric stroke workgroup will include establishment of quality metrics relevant to pediatric stroke, including timeliness of subspeciality assessment and transfers, and initiation of emergent interventions.

Abstract TP179: Candidate Genes For Small Vessel Ischemic Stroke: A Gwas Pilot Study

Background: The genetic basis of small vessel stroke (SVS) is poorly understood. Few genetic loci have been identified that may provide insights into SVS pathogenesis. We sought to identify genetic associations with incident SVS. Methods: A GWAS analysis was performed on a prospective cohort of patients enrolled in the American Stroke Association- Bugher Small Vessel Intracranial Disease Whole Genome Association Study which included patients from 4 hospitals in North Carolina recruited between December 2007-August 2012. Patients with SVS in the prior 2 years confirmed clinically and on neuroimaging were compared to a control group who had no previous history of stroke. A logistic regression model with SVS as the outcome and single nucleotide polymorphisms (SNPs) as the main predictor was performed and adjusted for baseline demographics and clinical characteristics, including age, race/ethnicity, sex, tobacco use, history of hypertension, diabetes, hyperlipidemia, atrial fibrillation, history of stroke/TIA, and principal components. Because of the relatively small sample size, SNPs with p-values <1E-4 were considered significant. Results: The cohort included 139 patients who had SVS and 64 controls. Among this cohort, 50% were men and 38% African-American. The mean age of the study group was 63-years. Sixteen SNPs in 9 genes met the statistical cutoff for association with SVS. These were involved in extracellular matrix integrity (CHD23, CLDN14, SPTBN1), neuronal differentiation (DSCAML1), cholesterol transport (GRAMD1B), transcriptional regulation (JARID2, LINC02111, LINC01993) and voltage-gated potassium channel (KCND2). Conclusion: In this pilot GWAS study, several loci variations were associated with SVS. Although this study is hypothesis generating, previous studies have also shown an association of SVS with genes involved in extracellular matrix integrity. In addition, we found it interesting that SNPs in both CLDN14 and CDH23 genes, which have been linked to non-syndromic sensorineural deafness, are also more common in SVS. Some forms of sensorineural deafness have been associated with cognitive impairment and stroke, and if a genetic association is confirmed, it would suggest a common pathophysiology may link the two conditions.

Abstract WMP33: Longitudinal Use Of The American Stroke Association Time Tracker Tool To Reduce Door To Needle And Door To Device Times In Stroke

Introduction: The faster IV Alteplase and mechanical thrombectomy is initiated in acute ischemic stroke, the better the outcome. Delays can significantly impact times to treatment. A mechanism to communicate time targets to code stroke teams can play an important role in providing knowledge about time sensitive metrics. The utilization of the ASA Stroke Time Tracker tool was created to improve communication in a timely manner to stroke teams providing acute treatment. The emphasis is on the education of time targets to improve door to treatment times. Hypothesis: To explore whether the use of the American Stroke Association Time Tracker tool as a communication instrument is associated with improved DTN and DTD times in both direct and transfer patients. Methods: In March 2020 the application of the ASA time tracker tool was introduced. A retrospective review revealed that DTN times improved from 58.7% to 71.6 % for those receiving t-PA within 45 minutes or less during the period the tool was in use. To explore whether timely feedback using the Time Tracker tool was associated with improved DTD times, mechanical thrombectomy data including DTD was collected and communicated to stroke care teams in April 2021. Compilation of time sensitive metrics in the evaluation of DTN times continued through Q2 2021. A retrospective analysis was conducted. Results: For those who received IV Alteplase, the percentage of patients treated within 30 minutes continued to improve, 21.1% (Q3 2020) vs. 35.7% (Q2 2021). The percentage of patients treated within 45 minutes also improved from 71.8% (Q3 2020) to 80.0% (Q2 2021). In patients who received endovascular therapy during Quarter 3 2020, 56.1% met the advanced therapy AHA Elite Plus criteria of DTD within 60 minutes (transfer patients) OR within 90 minutes (direct admit). This improved to 73.1% patients in Quarter 2 2021, during the use of the tool. Conclusions: There is an association between use of the ASA Time Tracker tool and improved DTN and DTD times. Further study should include continued use of the tool to confirm an association between direct communication with Code Stroke teams and improved treatment times.

Stroke survivors\u2019 preferences regarding study participation in rehabilitation research

BackgroundTo pursue high quality research, successful participant recruitment is essential, but recruitment rates are often low. This is specifically true in target populations with impairments, for instance, among stroke survivors. Previous studies focusing on recruitment have mainly relied on information from professionals, and there is therefore a need to contribute with new methodological insights to how potential rehabilitation research participants describe their interest and preferences to participate in research. The purpose of this study was to generate knowledge about stroke survivors’ interest in participating in rehabilitation research, reasons for being interested or not, and preferred forms and foci of rehabilitation interventions. An additional aim was to describe preferences regarding survey administration modes and processes for recruitment to studies.MethodThis cross-sectional study recruited Swedish residents who had sustained a stroke, initially by using advertisement on the National Stroke Association’s website, flyers posted at local occupational and physical therapy offices and at local stroke/senior organization meetings. Secondly, participants were recruited through a local stroke register. The survey, administered either in a paper form returned by postal mail; online or as a phone interview with 128 stroke survivors.ResultsMost of the participants were interested in participating in rehabilitation research, particularly younger persons (p = 0.001) and those closer to stroke onset (p = 0.047). Contribution to research, possibility to try new rehabilitation interventions and meeting others in the same situation were reasons that attracted an interest to participate. Other important aspects were related to motivation, individual needs, as well as how skilled the people who provided the intervention were. Participants preferred group-based programs, and programs focusing on regaining lost functions were highly requested. A majority wanted to be contacted through postal mail (70%) and most of them (90%) used the paper form to respond to the survey.ConclusionsA range of personal and external aspects, including challenges related to digitized administration modes, should be considered to achieve high participation rates in rehabilitation research targeting stroke survivors. The importance of addressing individual needs and prerequisites in an individualized manner should not be underestimated and might be a useful strategy to recruitment success.

Association of atrial 18F-fluorodeoxyglucose uptake and prior ischemic stroke in non-atrial fibrillation patients

BackgroundAtrial cardiomyopathy has gained increasing attention in the field of ischemic stroke due to its prothrombotic substrate. Timely identification of high-risk individuals without atrial fibrillation (AF) is essential in secondary prevention. We sought to explore the feasibility of atrial 18F-fluorodeoxyglucose (FDG) imaging in detecting diseased atrial substrate and in identifying ischemic stroke in a non-AF population. Methods1444 non-AF inpatients were initially identified. Among them, 196 patients had enhanced atrial FDG uptake, while 392 patients without atrial activity were selected as controls. Atrial activity, the history of ischemic stroke, and atrial cardiomyopathy were analyzed. ResultsPatients with atrial cardiomyopathy had a higher prevalence of enhanced atrial activity (47.1% vs 26.0%, P < .001), and patients with increased atrial activity had a higher prevalence of a prior history of ischemic stroke (12.2% vs 3.3%, P < .001). Multivariate regression analysis demonstrated that atrial activity was independently related to ischemic stroke after adjustment for risk factors (OR 4.02, 95% CI 1.97–8.19, P < .001) and atrial cardiomyopathy (OR 3.63, 95% CI 1.51–8.74, P = .004). ConclusionsThis study identified an association between atrial FDG activity and a history of ischemic stroke and atrial cardiomyopathy in non-AF individuals. Further longitudinal study is warranted to demonstrate their causal relationship.

Association of Brachial Ankle Pulse Wave Velocity With New Onset Stroke in Hypertensive Patients Aged Less Than 65 With Normal Fasting Glucose Among Chinese Community-Based Population.

BackgroundPrevious studies have shown an association of stroke and brachial ankle pulse wave velocity (baPWV). However, due to limitations on total population size and small numbers of stroke cases, lack of power has prevented further detection among subgroups such as age and laboratory testing.MethodsA total of 19217 participants including 660 incident stroke patients were pooled in the present study. Participants were divided to 2 groups, aged less than 65 years [56.0 (50.0, 61.0)] and aged 65 years or more [70.0 (67.0, 74.0)].ResultsAfter adjustment for demographic, anthropometric, and laboratory parameters, the incident stroke was positively associated to baPWV in the group aged less than 65 years (OR, 1.16; 95% CI, 1.05–1.28), but not in the older group aged 65 or more. When baPWV was assigned as quartiles, a significant, increased risk of new-onset stroke was found in quartiles 3-4 compared with quartile 1. In addition, the predictive value of baPWV for incident stroke was modified by fasting glucose in participants aged less than 65 years (P-interaction = 0.010). An increase in baPWV was strongly, positively associated to new-onset stroke in the subgroup of normal fasting glucose (< 5.6 mmol/L) (OR, 1.34; 95% CI, 1.15 - 1.57), but no effect was seen in the impaired fasting glucose (5.6-7.0 mmol/L) or diabetic fasting glucose (> 7.0 mmol/L) subgroups.ConclusionsIncreased baPWV was significantly associated with new-onset stroke in a hypertensive population aged less than 65 years. Particularly, it is of great importance to monitor baPWV for predicting incident stroke in “relatively healthy” hypertensive patients, i.e. aged less than 65 years with normal fasting glucose.

Altered triglyceride glucose index and fasted serum triglyceride high-density lipoprotein cholesterol ratio predict incidence of cardiovascular disease in the Mashhad cohort study.

The triglyceride glucose (TyG) index and triglyceride/high lipoprotein density cholesterol (TG/HDL-C) are two important risk markers to evaluate the insulin resistance and cardiovascular diseases (CVDs). To assess the association between TG/HDL-C and TyG index and CVDs. The Mashhad stroke and heart association disorder cohort study started in 2010 and has been continued until 2020. During 6-year follow-up of 9704 participants, 235 events including 118 acute coronary syndrome (ACS), 83 chronic coronary syndrome, 27 myocardial infarction, and 27 cardiac death were confirmed. SPSS software (version 21) was used for statistical analysis and figures were drawn by GraphPad Prism 6 software. The prevalence of ACS and cardiac death were higher in the fourth quartile of serum TG/HDL-C (>4.43) and higher prevalence of ACS was considered in subjects classified in the fourth quartile of TyG index (>8.98). A high TyG index was associated with an increased risk of ACS and cardiac death [1.362 (95% confidence interval [CI]: [1.013-1.831]) and 2.3 (95% CI: [1.247-4.241])] respectively; based on Cox regression analysis elevated TyG and TG/HDL-C increased the chance of CVD by [1.634 (95% CI: 1.304-2.047) and 1.068 (95% CI: 1.031-1.105)], respectively. Our results strongly showed that TyG index and TG/HDL-C are independent risk factors for incident CVD, suggesting that TyG index and TG/HDL-C may be as an important unique biomarker for predicting CVD outcomes and progression.

A practice game changer: Impact of tenecteplase for acute ischemic stroke in a multicenter quality improvement project.

Tenecteplase is a thrombolytic that is more fibrin specific, has a longer half-life, and is easier to administer than alteplase for acute ischemic stroke (AIS). This article outlines the pharmacy experience and perspective on implementation of tenecteplase as the treatment of choice for AIS. Tenecteplase has been of increasing interest for AIS and is currently being studied in several clinical trials. Although it is not indicated by the Food and Drug Administration for AIS, several published studies and an update to stroke guidelines from the American Heart Association and American Stroke Association support its use in this setting. In January 2021, Cedars-Sinai Health System made the decision to add tenecteplase to the formulary for AIS in addition to keeping alteplase for patients who met the criterion of being outside the 4.5-hour window following stroke onset. Along with the added benefits of having tenecteplase on formulary come challenges of managing multiple thrombolytics for the same indication. Identifying key stakeholders and creating an interdisciplinary team are critical to ensure safe transitions. Institutions can safely transition from alteplase to tenecteplase as a thrombolytic of choice for AIS.

Analysis of Stroke Care Among 2019-2020 National Emergency Medical Services Information System Encounters

ObjectivesEmergency Medicine Service (EMS) providers play a pivotal role in early identification and initiation of treatment for stroke. The objective of this study is to characterize nationwide EMS practices for suspected stroke and assess for gender-based differences in compliance with American Stroke Association (ASA) guidelines. Materials and MethodsUsing the 2019-2020 National Emergency Medical Services Information System (NEMSIS) Datasets, we identified encounters with an EMS designated primary impression of stroke. We characterized patient characteristics and EMS practices and assessed compliance with eight metrics for “guideline-concordant” care. Multivariable logistic regression modeled the association between gender and the primary outcome (guideline-concordant care), adjusted for age, EMS level of service, EMS geographical region, region type (i.e. urban or rural), and year. ResultsOf 693,177 encounters with a primary impression of stroke, overall compliance with each performance metric ranged from 18% (providing supplemental oxygen when the pulse oximetry is less than 94%) to 76% (less than 90sec from incoming call to EMS dispatch). 2,382 (0.39%) encounters were fully guideline-concordant. Women were significantly less likely than men to receive guideline-concordant care (adjusted OR 0.82, 95% CI 0.75-0.89; 0.36% women, 0.43% men with guideline-concordant care). ConclusionsA minority of patients received prehospital stroke care that was documented to be compliant with ASA guidelines. Women were less likely to receive fully guideline-compliant care compared to men, after controlling for confounders, although the difference was small and of uncertain climical importance. Further studies are needed to evaluate the underlying reasons for this disparity, its impact on patient outcomes, and to identify potential targeted interventions to improve prehospital stroke care.

Association between blood coagulability and migraine

BackgroundAn association between migraine and stroke has been suggested for a long period, although conclusive evidence has not been reported. Several theories about hypercoagulability have been proposed for the association of ischemic stroke and migraine especially migraine with aura. This study aimed to assess blood coagulability in patients with migraine.ResultsMean serum levels of protein S and anti-thrombin III were significantly lower in migraine patients compared to control subjects. Migraine patients showed abnormal MRI findings in the form of white matter hyper-intense lesions and ischemic foci compared to healthy controls. A significant negative correlation was detected between serum protein C level and intensity of migraine headache. Also, a significant correlation was found between deficient serum protein S and abnormal findings in brain MRI. Serum protein C deficiency is an independent predictor for migraine intensity grade.ConclusionsThere is an association between migraine and hypercoagulability, which may indicate increased risk of cerebral ischemic events in migraine patients and suggest adding prophylactic therapy to the management strategies of such patients.

Moderating effect of ppar-γ on the association of c-reactive protein and ischemic stroke in patients younger than 60.

The aim of this study was to evaluate the moderating effect of peroxisome proliferator activated receptor-γ (PPAR-γ) gene variants on the association of serum C-reactive protein level (CRP) and ischemic stroke (IS). A total of 114 patients with IS and 135 healthy controls were included. After adjustment for age, sex, total cholesterol, LDL and HDL cholesterol, triglycerides, hypertension, smoking, body mass index and previous therapy with antihypertensive and/or statins, PPAR-γ had statistically significant moderating effect on association of serum CRP level and IS in patients younger than 60. In participants with PPAR CG or GG genotype level of CRP and IS were not statistically significantly associated (OR = 1.00; 95% CI 0.90-1.10; p = 0.933), but in participants with PPAR CC genotype, the association of serum CRP level and IS was significant (OR = 1.67; 95% CI 1.21-2.31; p = 0.002). In patients with PPAR CC genotype the association of serum CRP level and IS was significant.

Big Data and AI Utilization in Stroke Care

In recent years, over 5 million stroke cases in the United States and Europe have been registered in the American Heart Association/American Stroke Association's Get with the Guideline Stroke database. In the United States and Europe, studies on the extent to which standard treatment is provided for each disease(process indicators)are increasingly being conducted. In this paper, we discuss examples of the use of big data in neurosurgical diseases and its application and future prospects, while focusing on the contents of the presentation conducted at the 2021 Annual Meeting of the Japanese Neurosurgical Association.

Impact of Multimedia Campaigns on Recognition and Response to Stroke

Background: Timely recognition of stroke symptoms and appropriate emergency response offers those who experience stroke an increased chance of physical and psychosocial recovery. International research suggests there is a lack of knowledge amongst the general population of the signs and symptoms of stroke, this may impact on seeking treatment. Public awareness campaigns are designed to educate the public on how to recognise and respond to symptoms of stroke Aim: To investigate recognition and response to stroke and associated factors. Design: A cross-sectional study was designed, a researcher developed questionnaire sought information related to previous experience of stroke, knowledge of risk factors, recognition of stroke symptoms, awareness of treatment available and the ability to identify what the letters of the FAST acronym represent. The Stroke Action Test (STAT)41 was used to investigate how participants would respond to specific symptoms of stroke. Sample: A convenient sample (n=243) which included older people attending an outpatients’ clinic in a large teaching hospital were included. A mixed method of data collection of online and paper version was used. Findings: Results identified that 41% of participants recognised all six stroke symptoms as defined by the American Heart and Stroke Association. The symptom most frequently recognised by participants was numbness of the face, arm and leg (97%). The mean STAT score for participants was 9 which indicated that most participants would respond appropriately, by contacting the emerging services, to 9 out of a total of 21 items describing stroke in the STAT. Multivariate analysis identified that having previously had a stroke and knowledge of risk factors for stroke were significantly associated with recognition of stroke symptoms. Participants were most likely to respond to items which described classic stroke symptoms such as limb weakness and difficulty speaking. Conclusion Awareness of treatment available for stroke is a predictor of appropriate response to stroke. Future stroke awareness campaigns should include information on the availability, benefits and timelines for treatment of stroke to help individuals who experience stroke overcome delays in their response to the recognition of stroke symptoms.

Perspective on the relationship between microbiota dysbiosis and neuroinflammation: probiotics as a treatment option.

Perspective on the relationship between microbiota dysbiosis and neuroinflammation: probiotics as a treatment option.

Metabolic abnormalities, rather than body mass index, associated with increased risk of recurrent stroke in hospitalized stroke patients: a cross-sectional study.

Metabolic abnormalities and body mass index (BMI) are apparent risk factors for recurrent stroke. For the prevention of recurrent stroke, which one is more important remains uncertain. This study aimed to compare metabolic phenotypes and BMI as indicators of recurrent stroke in Chinese hospitalized stroke patients. In this cross-sectional population-based study, 856 hospitalized stroke patients from the First People's Hospital of Changzhou, the Third Affiliated Hospital of Soochow University, were enrolled. We implemented the standardized questionnaire and biochemical measurements to collect participants' data. Recurrent stroke was defined as new-onset stroke in patients with a definite history of previous stroke. Metabolic phenotypes were categorized based on the Adult Treatment Panel III criteria. Obesity was defined as BMI ≥25 kg/m2. Multivariate logistic regression analyses were used for the association of recurrent stroke with metabolic abnormalities and BMI. Among the hospitalized stroke patients, the prevalence of recurrent stroke was 22.4%. Metabolic abnormalities, rather than BMI, were significantly associated with recurrent stroke. Compared with metabolically healthy patients, metabolically unhealthy patients had a 72% [odds ratio (OR) =1.72, 95% confidence interval (CI): 1.10-2.68] increased risk of recurrent stroke, regardless of BMI and other confounding factors. No statistical association between BMI and recurrent stroke was found. Furthermore, metabolic status significantly improved the risk prediction of recurrent stroke when combined with conventional risk factors (net reclassification index 17.6%, P=0.0047; integrated discrimination improvement 0.7%, P=0.014), whereas BMI did not. Recurrent stroke is likely associated with metabolic abnormalities rather than BMI. For the secondary prevention of stroke, controlling metabolic abnormalities is more crucial than controlling BMI in stroke patients. The longitudinal study and intervention study are warranted in the further.

Consider the Source: Noise-Stroke Association Varies by Transportation Type.

Consider the Source: Noise-Stroke Association Varies by Transportation Type.