The co-occurrence of rheumatoid arthritis (RA) and cerebral infarction is highly prevalent in clinical practice. While integrated traditional Chinese medicine (TCM) and Western medicine offers unique advantages in treatment, the objective indicators associated with TCM syndromes in this specific patient population remain unclear, hindering precise syndrome differentiation. This study, utilizing a screened cohort from 920 hospitalized patients with RA and cerebral infarction, aimed to address this research gap. Based on strict inclusion, exclusion, and elimination criteria, 142 patients were selected from the initial 920. The distribution of TCM syndromes and their associated influencing factors were analyzed using the Kolmogorov-Smirnov test, Brown-Forsythe ANOVA, the chi-square test, as well as both binary and multinomial logistic regression (employed complementarily to overcome the sample size limitations of less common syndromes). First, among the quantitative indicators, only hemoglobin (Hb) level showed significant differences between groups. The Hb level in the wind-cold obstruction syndrome was significantly higher than that in the dampness-heat obstruction syndrome (P = .007) and the phlegm-stasis obstruction syndrome (P = .029). Second, glucose-6-phosphate isomerase, anti-keratin antibody, and anti-cyclic citrullinated peptide IgG were significantly associated with TCM syndromes (P < .05). Specifically, they were identified as independent risk factors for dampness-heat obstruction syndrome (OR = 2.611, 2.218), while also serving as independent protective factors for liver-kidney deficiency syndrome relative to phlegm-stasis obstruction syndrome (OR = 0.294, 0.350). Within the studied population from East China, glucose-6-phosphate isomerase, anti-keratin antibody, anti-cyclic citrullinated peptide IgG, and Hb show associations with TCM syndrome differentiation in patients with RA complicated by cerebral infarction, particularly for the dominant damp-heat obstruction syndrome. The rigorous screening process enhances the reliability of the conclusions for the major syndromes studied, providing a preliminary evidence-based foundation for objective syndrome differentiation in this specific clinical context. Further multi-center studies with larger samples, especially of rare syndrome types, are needed to validate and generalize these findings.

Post hoc analyses of clinical trials have characterized dupilumab's adverse effects, yet the real-world impact in chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma is not well described. This study aims to characterize the risks of lymphoma, cardiovascular events, eosinophilia, joint pain, inflammatory arthritis, and sleep apnea in dupilumab-treated CRSwNP and/or asthma patients compared to those not taking dupilumab, and to other biologics. This retrospective cohort study used TriNetX, a de-identified database containing over 100 million patient records. Demographics and adverse effects associated with immunotherapy use were collected. We identified 21,249 dupilumab-treated CRSwNP and/or asthma patients. After matching for demographics, comorbid conditions, and medication use, dupilumab was associated with a lower risk of acute myocardial infarction (RR 0.538, 95% CI 0.435-0.665), pulmonary embolism (RR 0.639, 95% CI 0.500-0.817), cerebral infarction (RR 0.716, 95% CI 0.580-0.884), venous thrombosis (RR 0.625, 95% CI 0.511-0.763), cardiovascular disease (RR 0.733, 95% CI 0.678-0.791), and sleep apnea (RR 0.891, 95% CI 0.818-0.970), with a higher risk of eosinophilia (RR 3.157, 95% CI 2.606-3.826), versus no biologic. Dupilumab was associated with a similar risk of lymphoma and musculoskeletal outcomes. Compared to omalizumab and mepolizumab, dupilumab showed a more favorable musculoskeletal and cardiovascular profile, while it demonstrated a largely similar profile to tezepelumab. Despite eosinophilia, dupilumab was associated with decreased risk of major cardiovascular, thromboembolic, and sleep apnea outcomes in CRSwNP and asthma. These findings suggest dupilumab may confer protection against adverse outcomes beyond respiratory symptom control.

Randomized trials showed that endovascular thrombectomy (EVT) did not improve outcomes in medium vessel occlusion (MeVO) stroke compared with usual care. We investigated whether patients randomized to EVT who achieved near-complete/complete reperfusion had improved clinical outcomes compared with patients randomized to usual care. Post-hoc analysis of ESCAPE-MeVO, which randomized patients with MeVO stroke to undergo EVT in addition to usual care or usual care only. Reperfusion grade in EVT patients was assessed with the MeVO expanded Thrombolysis in Cerebral Infarction (meTICI) score. Regression analyses were used to compare clinical outcomes between EVT patients with near-complete/complete (meTICI 2c-3) reperfusion and usual care patients, and the association between reperfusion grade and clinical outcomes in EVT patients. Overall, 253 of 255 (99.2%) patients randomized to EVT had final meTICI scores, of whom 133 (52.2%) achieved meTICI 2c-3 reperfusion. Infarct volumes were lower in EVT meTICI 2c-3 patients than in usual care patients, but there were no significant differences between EVT meTICI 2c-3 and usual care patients for 90-day modified Rankin Scale (mRS) score (adjusted common OR 1.17, 95% CI 0.79 to 1.75). Higher final meTICI scores were associated with improved 90-day mRS and lower infarct volumes in EVT patients. Although higher reperfusion grade was associated with smaller infarct volumes, there was no statistically significant difference in 90-day mRS between patients achieving meTICI 2c-3 and those receiving usual care.

Background Acute cerebral infarction (ACI) comorbid with rapid eye movement-related obstructive sleep apnea (REM-OSA) worsens prognosis, but gender-specific differences in outcomes and their underlying mechanisms remain understudied, and this gap limits the development of personalized interventions for female patients. Objective To analyze gender differences in prognosis among ACI patients with REM-OSA and identify contributing factors, providing evidence for improving outcomes. Methods A retrospective analysis of acute cerebral infarction (ACI) patients with REM-related obstructive sleep apnea (REM-OSA) admitted to the Department of Neurology, Affiliated Hospital of Yangzhou University, from February 2023 to February 2025. The study included 140 patients (71 females, 69 males) with ACI and REM-OSA, who underwent all-night polysomnographic monitoring. The data collected included: (1) baseline clinical characteristics; (2) laboratory indicators; (3) subjective sleep assessments, including sleep quality, daytime sleepiness, and emotional state; (4) objective sleep monitoring data (video polysomnography during the night); (5) prognostic indicators, including the Modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Results Female patients had significantly higher discharge NIHSS scores ( p = 0.011) and 3-month mRS scores ( p = 0.008). Multivariate regression analysis showed that the lowest nadir of oxyhemoglobin saturation (SpO₂) ( β = −0.325, p = 0.006) and neutrophil count ( β = 0.258, p = 0.019) were independent prognostic predictors for poor outcomes in female patients. Conclusion Female ACI patients with REM-OSA have poorer prognosis, likely linked to severe REM hypoxia and inflammation. Gender-specific REM-OSA screening and interventions are warranted.

Setting benchmark for ischemic stroke treated endovascularly: A systematic review and meta-analysis.

Integrated Structural Analysis of Trunk Function Assessment After Stroke- New Evaluation Model Based on Multiscale Factor Analysis and Rasch Analysis.

Malignant middle cerebral artery infarction is associated with high mortality and severe disability despite decompressive craniectomy. The thalamus plays a central role in arousal and sensorimotor integration and may be vulnerable to early compression from cerebral mass effect. This study evaluates whether preoperative ipsilateral thalamic volume reduction predicts functional outcomes following decompressive craniectomy. This retrospective cohort study included 41 adult patients with malignant middle cerebral artery infarction who underwent decompressive craniectomy between April 2017 and September 2022. Preoperative computed tomography scans were analysed for infarct volume, midline shift, herniation markers, and percentage ipsilateral thalamic volume reduction. Functional outcomes were assessed at discharge and 90 days using the Full Outline of UnResponsiveness score, National Institutes of Health Stroke Scale, modified Rankin Scale, Barthel Index, and Disability Rating Scale. Logistic regression and receiver operating characteristic analyses were performed. Mean ipsilateral thalamic volume reduction was 15.1%. Each 1% increase in thalamic volume loss independently increased the odds of poor functional outcome, defined as modified Rankin Scale scores of 5-6, at discharge and 90 days. Greater thalamic distortion was associated with higher National Institutes of Health Stroke Scale scores. Receiver operating characteristic analysis demonstrated good discrimination, with optimal thresholds of 14% at discharge and 19% at 90 days. Increased thalamic compression was associated with postoperative infections and longer hospital stays. Preoperative ipsilateral thalamic volume reduction is a strong imaging biomarker for predicting outcomes after decompressive craniectomy in malignant middle cerebral artery infarction.

Randomized trials have not shown a clear benefit of endovascular therapy (EVT) for medium vessel occlusion (MeVO) strokes. We aimed to identify subgroups in which successful recanalization provides meaningful clinical benefit. We retrospectively analyzed prospectively recorded consecutive patients with MeVO stroke treated with EVT at two comprehensive stroke centers. Successful recanalization was defined as expanded Thrombolysis in Cerebral Infarction (eTICI) 2b-3. The treatment effect was calculated as the difference in 90-day functional independence (modified Rankin Scale score 0-2) between recanalized and non-recanalized patients. Predicted infarct core on admission was calculated on non-contrast CT using AI-based software (AI-ICV; Methinks AI) and on CT perfusion (cerebral blood flow (CBF) <30%; IschemiaView). The hypoperfused volume (Tmax >6 s) was also obtained and the perfusion mismatch ratio was calculated (Tmax >6 s - CBF <30%)/Tmax >6 s). The treatment effect was analyzed in the overall cohort and after applying enrichment strategies based on clinical and imaging variables. Optimal cutoffs were identified by maximizing the added treatment effect while retaining ≥40% of the cohort. Among 232 EVT-treated patients (mean age 76.1±12.3 years; median (IQR) National Institutes of Health Stroke Scale (NIHSS) score 9 (6-14)), the recanalization rate was 84.9%. The overall treatment effect was +33.3% (recanalized 53.3% vs non-recanalized 20.0%). Enrichment strategies increased the treatment effect: age ≤80 years (+13.8%), AI-ICV ≤9 mL (+9.9%), and NIHSS score ≥10 (+6.7%). Combining age, NIHSS, and AI-ICV criteria increased the treatment effect to 61.9% for an added value of +33.6%. In MeVO stroke, the benefit of successful recanalization is substantial and can be further enhanced through pragmatic enrichment using readily available clinical and imaging variables, supporting refined patient selection and future trial design focused on enriched subgroups.

The mechanism of electroacupuncture treatment for post-stroke spasticity: A systematic review and Meta-analysis.

Acute ischemic stroke due to large-vessel or medium-vessel occlusion is often treated with aspiration thrombectomy. Delivery-assist catheters (DAsCs) are a new class of tapered support catheters designed to facilitate navigation of large-bore aspiration catheters through tortuous anatomy. To perform a meta-analysis to evaluate the procedural efficacy and safety of DAsC-assisted aspiration thrombectomy. A PRISMA-guided systematic review identified studies using DAsCs during aspiration thrombectomy for large- or medium-vessel occlusions. We extracted data on successful reperfusion; first pass effect (FPE), defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b (FPE≥2b) and mTICI≥2c (FPE≥2); use of adjunctive devices; and symptomatic intracranial hemorrhage (sICH). Pooled event rates with 95% CIs were calculated using a random-effects meta-analysis of proportions. 14 studies were identified with 720 patients. Pooled successful reperfusion was 95% (95% CI 91 to 97%) for final mTICI ≥2b and 71% (95% CI 59% to 81%) for final mTICI ≥2c. FPE ≥2c was achieved in 51% (95% CI 43% to 59%) of cases, while FPE ≥2b was 65% (95% CI 54% to 75%). Adjunctive rescue devices were used in 23% (95% CI 17% to 30%) of procedures. Puncture-to-recanalization time was 26.1 min on average. The rate of sICH was 1% (95% CI 0% to 3%), and 44% (95% CI 39% to 50%) of patients had a 90-day modified Rankin Scale score of 0-2. In pooled analysis, DAsC-assisted aspiration thrombectomy demonstrated high first pass efficacy and low hemorrhagic rates across single-arm studies. This meta-analysis supports DAsCs as a safe adjunct to aspiration thrombectomy. Prospective comparative studies are warranted to evaluate technical performance and safety relative to standard aspiration techniques.

The optimal anesthetic approach for intracranial stenting in acute stroke remains unclear. We compared outcomes of patients under general anesthesia (GA) versus local anesthesia or conscious sedation. The RESISTANT registry is amulticenter observational study on acute intracranial stenting during thrombectomy. Patients treated between January 2016 and June 2023 were included and stratified into GA and local anestesia/conscious sedation groups. The primary outcome was an adjusted shift analysis of the modified Rankin Scale (mRS) at 90days. Secondary outcomes included mRS 0-2 at 90days and final modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3scores. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Adjusted ordinal and logistic regression with mixed-effects models were performed. Of 876 patients, 445 (50.8%) received GA. Median age was 67years [59-77]; 567 (64.8%) were men. No differences were found in 90-day mRS (adjusted common OR = 1.256 [0.887-1.780], p = 0.199). Rates of functional independence (39.0% vs 44.5%; aOR = 0.956 [0.606-1.507], p = 0.846), mTICI2c/3 (68.9% vs 68.7%; aOR = 0.941 [0.602-1.471], p = 0.790), and sICH (8.0% vs 8.6%; aOR = 0.769 [0.374-1.584], p = 0.477) were comparable. In-hospital (23.0% vs 12.0%; aOR = 2.39 [1.35-4.22], p = 0.003) and 90-day mortality (33.3% vs 21.1%; aOR = 2.017 [1.227-3.315], p = 0.006) were higher in the GA group. In patients undergoing intracranial stenting during thrombectomy, anesthesia modality was not associated with better outcomes. GA was linked to higher mortality, likely due to indication bias.

Targeting the interaction between the C-terminal domain of the GluA2 subunit of AMPA receptors and BRAG2 presents a highly promising therapeutic approach for acute ischemic stroke. The membrane-permeable peptide Tat-GluA2-3Y has shown potential by competitively binding to BRAG2 to inhibit GluA2 endocytosis; however, its clinical application is limited due to poor stability in vivo. To address this limitation, we developed stapled peptides based on GluA2-3Y, leading to the identification of the lead compound P3LC7LC-P, which exhibits high-affinity binding to BRAG2. Functionally, P3LC7LC-P offers strong neuroprotection in two injury models: oxygen-glucose deprivation-induced and glutamate-induced neurotoxicity. Notably, P3LC7LC-P significantly improved plasma stability compared to Tat-GluA2-3Y, with a half-life exceeding 372.7 min. In the transient middle cerebral artery occlusion (tMCAO) model, P3LC7LC-P reduced cerebral infarction areas to 21.00% at a dose of 8 mg/kg. These findings highlight P3LC7LC-P as a promising candidate for the development of novel therapies for ischemic stroke.

Several observational studies have supported the use of conscious sedation (CS) for endovascular thrombectomy in patients with acute ischemic stroke and associated general anesthesia (GA) with poor functional outcomes. Recently, few randomized controlled trials have shown no difference in the functional outcomes between GA and CS. The aim of this paper is to compare the outcomes of GA versus CS in patients with acute ischemic stroke undergoing mechanical thrombectomy in the MOST (Multi-arm Optimization of Stroke Thrombolysis) trial. Patients who underwent mechanical thrombectomy for acute ischemic stroke under GA or CS in the MOST trial were included. The primary outcome of interest was the utility weighted modified Rankin Scale (mRS) score at 90 days after stroke. The secondary outcomes were mRS score ≤1, ≤2 at 90 days, 90-day mRS score, thrombolysis in cerebral infarction 2B or better, 24-hour National Institutes of Health Stroke Scale score, 24-hour change in National Institutes of Health Stroke Scale score, and 90-day mortality. A total of 219 patients underwent mechanical thrombectomy with 101 patients receiving GA and 118 patients receiving CS. Our analysis showed that GA was associated with a lower average utility weighted mRS score at 90 days compared with CS (P≤0.02). Similarly, GA was associated with higher odds of worse outcomes on 90-day mRS 0 to 2 (P<0.001), 90-day mRS median score (P<0.001), a higher 24-hour National Institutes of Health Stroke Scale score (P<0.001), and a lower change in baseline 24-hour National Institutes of Health Stroke Scale score (P<0.001). A sensitivity analysis of patients with anterior stroke alone also favored better neurologic outcomes in the CS group compared with the GA group. In patients undergoing endovascular thrombectomy in the MOST trial, GA was associated with poorer functional outcomes compared with CS.

To evaluate prevalence, clinical predictors, brain lesions and cognitive test scores of high-risk carotid plaque features-namely intraplaque haemorrhage (IPH), lipid-rich necrotic core (LRNC), and plaque ulceration-in patients with asymptomatic, intermediate-degree carotid artery stenosis. The Carotid Artery Multi-modality imaging Prognostic (CAMP) study is a prospective, observational cohort study enrolling patients with 40-60% asymptomatic carotid artery stenosis assessed by Doppler ultrasound. The present study is a cross-sectional analysis of baseline data. High-risk plaque characteristics were evaluated with multimodal vascular imaging, including computed tomography and magnetic resonance angiography, while brain magnetic resonance imaging and neurocognitive testing assessed covert brain infarcts, cerebral small vessel disease, and cognitive functions. Among 155 patients (mean age: 72 years, 27% female, 29% with chronic coronary syndromes), at least one high-risk plaque feature (LRNC, IPH, or ulcer) was present in 51% of cases. IPH and LRNC were present in 23% for both, and ulceration in 38%. Patients with high-risk plaque features had higher high-sensitivity cardiac troponin T and 3-vessel coronary artery disease. Non-lacunar brain infarcts [cortical and large (>15 mm) subcortical brain infarcts] and markers of small vessel disease (lacunar infarcts or white matter hyperintensities) were observed in 11% and 71% of patients, respectively. In univariate analysis, homolateral IPH, LRNC, and ≥50% carotid stenosis were associated with non-lacunar brain infarcts. In multivariable models adjusted for cardiovascular risk factors and carotid stenosis, both IPH and LRNC remained significantly associated with non-lacunar brain infarcts. When high-risk plaque features (LRNC and/or IPH) and ≥50% stenosis were included in the same model, only high-risk plaque features remained significantly associated with non-lacunar brain infarcts. Low visuospatial and nonverbal memory test scores were common, with a tendency towards poorer performance in patients with high-risk features, although the differences were not statistically significant. High-risk plaque features are frequent in patients with asymptomatic intermediate carotid disease and are associated with non-lacunar covert brain infarcts. Cognitive impairment was common in the cohort, although not associated with high-risk carotid plaque. These findings support the use of a comprehensive plaque characterization beyond stenosis grading for cerebrovascular risk assessment in such patients.

Systemic sclerosis (SSc) is a rare autoimmune disease with high mortality, often due to cardiopulmonary complications. Hydroxychloroquine (HCQ), commonly used in other rheumatic diseases, has immunomodulatory and potentially cardioprotective effects, but its role in SSc remains unclear. This study aimed to evaluate the association between HCQ use and the risk of mortality, ischemic heart disease (IHD), and pulmonary hypertension (PH) in a large real-world SSc cohort. This retrospective cohort study utilized de-identified electronic medical records from the TriNetX Research network. Adults with an SSc diagnosis (ICD-10-CM: M34) were divided into HCQ users and non-users. After 1:1 propensity score matching for demographics, comorbidities and medications, outcomes including mortality, PH, acute myocardial infarction (MI), cerebral infarction, conduction heart disease, and myocarditis were assessed over 5 years. Risk ratios (RR) and Kaplan-Meier hazard ratios were calculated. Out of 17 395 HCQ users and 58 576 non-users, 15 485 propensity score matched pairs were analyzed. Over 5 years, HCQ users showed higher PH (RR 1.124, 95% CI, 1.052-1.200, p < 0.001) but lower mortality (RR 0.719, 95% CI, 0.674-0.767, p < 0.001), indicating potential survival benefits. No significant differences were observed for IHD, MI, cerebral infarction, conduction disorders, or myocarditis. Our research indicated that although patients on HCQ had a higher prevalence of PH, they exhibited lower mortality rates, suggesting a possible survival benefit. Further prospective studies are needed to explore these findings and clarify HCQ's role in SSC management.

Indications, Timing, and Outcome of Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction: A Swedish Multicenter Study.

Tongqiao Huoxue Decoction modulates glycolysis and activates the BDNF-TrkB pathway by lactate to protect PC12 cells from OGD-induced injury.

ZFP36 attenuates neuronal apoptosis and pyroptosis through inhibiting TXNIP/NLRP3 pathway in hypoxic-ischemic brain damage.

Stroke impairments can lead to various complications, including hemiplegia, sensory loss, dyspraxia, and hemianopsia. It is estimated that 16% to 84% of stroke patients experience Hemiplegic Shoulder Pain (HSP). In the present case, a 38-year-old man who had a left middle cerebral artery infarct two years prior showed good recovery of voluntary movement but continued to struggle with low self-esteem, psychological distress, mild weakness, and spasticity. He also experienced a dull ache in his right shoulder. To address these issues, a structured Cognitive Behavioural Therapy (CBT) programme was implemented. The programme consisted of 30-minute sessions held five days a week for four weeks and included three phases: educating the patient about stroke and CBT principles, focussing on cognitive restructuring and behavioural strategies, and consolidating skills learned. Depression, anxiety, and stress levels were measured using the Depression Anxiety Stress Scale (DASS) at baseline, after the intervention, and at a six-month follow-up. Significant reductions in psychological distress were noted after the CBT sessions, with sustained improvements observed at follow-up. The CBT programme was effective in addressing biopsychosocial factors and successfully reduced HSP in this patient with a chronic left Middle Cerebral Artery (MCA) infarct.

To compare the clinical outcomes among various infarct patterns and to investigate the associations between the morphological parameters of contralateral middle cerebral artery (cMCA) M1 segment and infarct patterns in ischemic stroke attributed to large vessel occlusion (LVO) in M1 segment caused by intracranial atherosclerotic disease (ICAD). Patients with stroke attributed to M1-ICAD-LVO were enrolled. The infarct patterns were categorized into artery-to-artery embolism (AAE), large infarct, borderzone infarct (BZI), and perforating artery infarction (PAI). The morphological parameters of cMCA-M1 segment included proximal and distal diameter, arc, and chord length. The tortuosity index of cMCA-M1 segment was calculated by (arc length/chord length-1)×100%. A total of 171 participants were enrolled. Compared to AAE, the risk of poor outcome increased in BZI (odds ratio [OR]=5.51, 95% confidence interval [CI]=1.71-17.78, p=0.004) and large infarct (OR=10.92, 95% CI=2.01-59.27, p=0.006) and was comparable in PAI. The tortuosity index (OR=2.85, 95% CI=1.13-7.18, p=0.026) and arc length (OR=2.47, 95% CI=1.02-5.97, p=0.045) significantly increased in BZI than other three patterns. Participants other than BZI were categorized into large infarct (n=32) and non-large-infarct (n=46) groups, and the proximal diameter (OR=0.22, 95% CI=0.07-0.72, p=0.012), arc length (OR=0.88, 95% CI=0.78-0.98, p=0.018), and chord length (OR=0.87, 95% CI=0.77-0.995, p=0.042) were associated with large infarct. For patients with M1-ICAD-LVO, large infarct and BZI had poorer outcomes than PAI and AAE. The cMCA-M1 segment with elevated tortuosity and arc length was associated with BZI, whereas a thin and short M1 segment was correlated with large infarct in patients with a less tortuous cMCA trunk.