Integrative multi-omics analysis identifies coronin 1C as a potential mediator linking circadian rhythm disruption to neuroimmune dysregulation in ischemic stroke.

Recent randomized trials reported no overall functional benefit of endovascular treatment (EVT) for distal medium-vessel occlusion (DMVO) and did not identify consistent effect modifiers to guide patient selection. Consequently, the role of EVT-particularly for M2 occlusions-remains controversial. We investigated whether baseline clinical severity modifies the association between successful recanalization and 90-day outcome in patients with M2 occlusion. Multicenter retrospective cohort study at 2 tertiary stroke centers including consecutive adults with acute ischemic stroke due to M2 occlusion (January 2015-January 2023) triaged by multimodal CT and treated with EVT. The primary end point was functional independence (modified Rankin Scale [mRS] ≤ 2) at 90 days. Secondary end points included symptomatic intracerebral hemorrhage (sICH), mRS 0-1, and penumbra salvage volume (PSV). The primary analysis used multivariable logistic regression with baseline National Institutes of Health Stroke Scale (NIHSS) modeled linearly and an NIHSS×recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b) interaction term. Johnson-Neyman probing and inverse probability weighting (IPW) were applied; a supplementary restricted cubic spline analysis was performed to explore potential nonlinearity. Among 147 patients, 85 (58%) achieved successful recanalization. The mean age was 74 years (SD 13), and 47% were female. Higher baseline NIHSS (adjusted odds ratio [aOR] 0.83 per point, 95% CI 0.73-0.94) and older age (aOR 0.96 per year, 95% CI 0.94-0.99) were associated with lower odds of functional independence. NIHSS significantly modified the association between recanalization and outcome (interaction p = 0.03). The magnitude of the association between successful recanalization and functional independence was larger at higher NIHSS. Model-based estimates suggested a descriptive crossover around NIHSS 10, whereas statistical evidence of benefit emerged only at higher NIHSS values. Successful recanalization was associated with greater PSV (+33 mL, p = 0.01). In the PSV interaction model, onset-to-imaging time differed by recanalization status (p < 0.01): time was positively associated with PSV in the mTICI ≤2a group, but near zero in mTICI ≥2b. IPW analyses were concordant. sICH occurred in 8.2% vs 4.8% (p = 0.42). In M2 occlusions, the magnitude of the association between successful recanalization and functional independence was larger at higher NIHSS and not reliably demonstrable at lower NIHSS. These findings support a severity-informed, individualized EVT approach while remaining hypothesis-generating rather than prescriptive for specific NIHSS thresholds. Major limitations include the retrospective observational design and potential residual confounding.

Atrial fibrillation/flutter at presentation is associated with worse functional outcome in acute ischemic stroke patients treated with thrombolytic therapy: A multicenter retrospective cohort study.

Blood pressure variability (BPV) has emerged as a prognostic hemodynamic marker in acute ischemic stroke (AIS), with observational studies consistently associating early systolic fluctuations with infarct progression, neurological deterioration, hemorrhagic transformation, and worse functional outcomes. Whether BPV directly mediates injury or primarily reflects underlying stroke severity and physiological instability remains uncertain. Biologically plausible mechanisms exist in the context of impaired cerebral autoregulation, where systemic pressure fluctuations may translate into cerebral perfusion instability, particularly in the ischemic penumbra and during reperfusion. Despite consistent associations, clinical interpretation of BPV is limited by substantial heterogeneity in measurement methods, monitoring frequency, and analytic approaches. Most studies derive BPV from intermittently sampled oscillometric measurements, which may miss rapid fluctuations and are susceptible to artifacts. BPV is also strongly influenced by stroke severity, treatment intensity, and hemodynamic interventions, raising the possibility that observed variability reflects disease burden rather than an independent injury mechanism. This review summarizes evidence linking BPV to outcomes in AIS, examines methodological variability in its measurement, and highlights limitations restricting its translation into standardized monitoring or therapeutic strategies. BPV should be interpreted as a prognostic marker of disease severity rather than a confirmed causal mediator of injury, and its role as a modifiable treatment target remains unestablished. The HOPE randomized trial provided the first evidence that a reperfusion-guided, individualized systolic BP strategy may improve functional outcomes after endovascular thrombectomy (EVT), though findings require confirmation in larger trials.

Inhibition of endothelial ALOX12 mitigates cerebral ischemia-reperfusion injury by suppressing 12-HETE.

Acute haemorrhagic strokes are most common in people with hypertension, which causes high morbidity and mortality in Bangladesh. In this study, we investigated that whether serum potassium level is associated with risk of haemorrhagic strokes in hypertensive patients or not. We conducted a cross-sectional descriptive study that was carried out in the Department of Medicine and Neurology of Mymensingh Medical College Hospital, Mymensingh from December 2019 to May 2020. Total 100 patients (Mean age: 59.5±15 years, 58% male and 42% female) of hypertension with acute haemorrhagic stroke were enrolled in this study considering inclusion (both sex, CT scan proven stroke) and exclusion criteria (patients with congestive cardiac failure, conn's syndrome and kidney diseases). Our results showed that significant number of patients (34.0%) had potassium imbalance, with hypokalaemia (k+ <3.5) present in 31.0% study patients and hyperkalaemia (k+ >5) found in 3.0% patients. The present study also revealed that majority of patients having potassium imbalance had lower ICH score. From these findings we can conclude that hypokalemia may be responsible for subsequent increase in hemorrahagic stroke incidents in hypertensive patients. However, association between severity of acute hemorrahagic stroke and potassium imbalance was found not significant.

In-hospital stroke is associated with delayed recognition and worse outcomes compared with community-onset stroke. Contemporary national data in the mechanical thrombectomy (MT) era are limited. We performed a retrospective cohort study of adult ischemic stroke admissions in the Get With The Guidelines-Stroke registry from January 2016 to December 2023 (the MT era). In-hospital stroke was compared with community-onset stroke as the primary analysis. A secondary descriptive analysis comparing in-hospital patients with stroke from January 2006 to April 2012 and January 2016 to December 2023 was also performed. Primary outcomes were in-hospital mortality, discharge home, and independent ambulation at discharge. Multivariable logistic regression with generalized estimating equations accounted for within-hospital clustering and adjusted for demographics, vascular risk factors/comorbidities, and hospital characteristics. Temporal trends in MT use were assessed with the Cochran-Armitage trend test. Among 4 996 392 ischemic stroke admissions from 2016 to 2023, 191 355 (3.8%) were in-hospital, and 4 805 037 (96.2%) were community onset. In-hospital patients presented with greater severity (National Institutes of Health Stroke Scale score >20: 14.5% versus 7.9%; National Institutes of Health Stroke Scale score, 0-4: 43.3% versus 60.4%) had worse outcomes including higher in-hospital mortality (adjusted odds ratio, 2.27 [95% CI, 2.18-2.36]; P<0.001), lower likelihood of discharge home (adjusted odds ratio, 0.46 [95% CI, 0.45-0.48]; P<0.001), and lower independent ambulation at discharge (adjusted odds ratio, 0.52 [95% CI, 0.50-0.53]; P<0.001). Recognition-to-computed tomography time was longer for in-hospital (median 51 [interquartile range, 16-269] versus 18 [10-39] minutes; P<0.001). MT rates increased significantly from 2016 to 2023 in both in-hospital and community-onset patients (4.47%-9.54% and 2.35%-5.55%, respectively; P<0.001). Quality metrics and outcomes significantly improved in the MT era, independent of treatment modality. In patients with in-hospital stroke, MT rates increased over time, and improvements in quality metrics were observed regardless of treatment modality. A higher level of stroke severity and worse outcomes persists.

Atrial fibrillation as an independent predictor of early epileptic seizures after acute ischemic stroke.

Disparities in interfacility transfer of patients with acute ischemic stroke have been identified at the regional level, but a national analysis has not been conducted. This study aims to evaluate patient-level trends and disparities in transfer rates based on sex, race, ethnicity, and insurance status using the Get With The Guidelines-Stroke registry. The Get With The Guidelines-Stroke registry was used to identify patients admitted with acute ischemic stroke between January 2016 and December 2021. We examined patient transfer rate by race/ethnicity groups and by patient insurance status. Odds of transferring out among each demographic group were calculated using a multivariable generalized linear mixed-effect model accounting for patient- and hospital-level confounders. Models were stratified by sex to test for any potential interaction between sex and race/ethnicity or insurance status. Among 776 556 patients transferred out of 1333 sites, Hispanic and Black patients had lower odds of being transferred compared with non-Hispanic White patients among both men and women after adjustment for stroke severity and hospital characteristics (odds ratio [OR], 0.79 [95% CI, 0.74-0.84] for Hispanic women; OR, 0.88 [95% CI, 0.83-0.93] for Hispanic men; OR, 0.80 [95% CI, 0.76-0.83] for Black women; and OR, 0.84 [95% CI, 0.81-0.88] for Black men). Differences in transfer frequency were also noted based on insurance status. In the unadjusted model and model adjusted for stroke severity, patients of all non-Medicare payment groups had higher odds of being transferred out compared with Medicare patients. However, after also adjusting for hospital characteristics, patients with Medicaid had a lower frequency of transfer compared with patients with Medicare among men and women (OR, 0.75 [95% CI, 0.71-0.78] for women with Medicaid; OR, 0.78 [95% CI, 0.75-0.82] for men with Medicaid). In this large, nationwide cohort of patients with acute ischemic stroke, Black and Hispanic patients were less likely to be transferred than non-Hispanic White patients, and patients with Medicaid were less likely to be transferred than patients with Medicare. Further work is needed to understand the contributors to this disparity and the impact on access to high-quality stroke care.

This study aimed to determine the prognostic value of baseline serum cardiac biomarkers measured at emergency department admission in patients with acute ischemic stroke undergoing reperfusion therapy. This retrospective cohort study evaluated data from 433 AIS patients treated with intravenous thrombolysis (IVT), mechanical thrombectomy (MT), or combined therapy. Serum lactate dehydrogenase, creatine kinase, plasma N-terminal pro-brain natriuretic peptide, and high-sensitivity cardiac troponin T levels were analyzed. Stroke severity, functional outcomes, hemorrhagic transformation, and mortality were assessed. Continuous variables were evaluated using the Shapiro-Wilk test, Kruskal-Wallis ANOVA, and post-hoc pairwise comparisons. Diagnostic efficacy was calculated using ROC-AUC and the Youden Index. Independent risk factors were identified via Multivariate Logistic Regression analysis. High-sensitivity cTnT predicted functional prognosis at both discharge and 3 months, whereas LDH predicted outcomes exclusively at 3 months. Elevated CK and LDH levels correlated significantly with stroke etiology. An hs-cTnT value > 10.5 pg/mL independently increased the risk of poor discharge prognosis (OR: 1.725, p < 0.05). In multivariate logistic regression, age, baseline NIHSS, and hs-cTnT were independent risk factors for poor discharge outcomes. For 3-month mRS scores, the optimal prognostic cut-off values were > 200 U/L for LDH (p = 0.003) and >10.5 pg/mL for hs-cTnT (p = 0.007). In the final multivariate model, baseline NIHSS, stroke etiology, LDH (>200 U/L, OR: 1.845, p < 0.05), and hs-cTnT (>10.5 pg/mL, OR: 1.685, p < 0.05) emerged as independent risk factors for a poor 3-month prognosis. Integrating admission cardiac biomarkers into clinical evaluation scores significantly enhances risk stratification and predictive accuracy in acute ischemic stroke management.

Multimodal computed tomography angiography and perfusion (CTA/CTP) is increasingly used in the emergency department (ED) evaluation of acute ischemic stroke (AIS) but may delay thrombolysis. We examined whether the sequencing of multimodal CTA/CTP relative to thrombolytic administration affects door-to-needle (DTN) time. We conducted a retrospective cohort study of adult patients with AIS treated with intravenous alteplase at a tertiary, academically affiliated ED that is part of a certified Comprehensive Stroke Center between January 1, 2012, and August 1, 2023. All patients underwent an initial noncontrast CT (NCCT), followed by either a contrast-first workflow (i.e. CTA/CTP) or were given alteplase before proceeding to contrast administration. The primary outcome was DTN time, analyzed using univariate methods and multivariable quantile regression adjusting for stroke severity, pre-alteplase antihypertensive use, thrombectomy (as a correlate for large-vessel occlusion), primary language, and bedside ED pharmacist presence. Among 1,382 AIS encounters, 167 patients met inclusion criteria; 148 underwent CTA/CTP before alteplase and 19 received alteplase before contrast administration. Median DTN time was significantly shorter in the alteplase-first group (20 minutes [interquartile range (IQR), 15-26]) compared with the CTA/CTP-first group (44 minutes [IQR, 32-56]; P<0.001). After adjustment, alteplase-first administration remained independently associated with faster DTN time (-25 minutes; 95% CI, -34 to -16). Higher stroke severity and ED pharmacist presence were also associated with shorter DTN, whereas pre-alteplase antihypertensives, primary language, and thrombectomy were not. A contrast-first strategy incorporating multimodal CTA/CTP before alteplase administration was associated with approximately twofold longer DTN times. These findings suggest that obtaining CTA/CTP before thrombolytic administration may substantially prolong DTN times. Larger studies are needed to confirm the magnitude of this association and to identify patient populations most likely to benefit from alternative imaging workflows.

Obesity has been associated with increased incidence and severity of various cardiovascular risk factors, as well as an elevated risk of stroke. However, the evidence of its effect on outcomes in stroke patients has been equivocal. Previous studies have documented the obesity paradox in stroke, characterized by a negative correlation between BMI and stroke mortality. To address the limitations of relying solely on BMI in previous investigations, notably the documented obesity paradox linking BMI to stroke mortality, our study incorporates additional obesity metrics beyond BMI. We aimed to comprehensively evaluate the relationship between obesity and stroke outcomes, thereby providing a more holistic understanding of their association. The present study included 502,128 participants from the UK Biobank database. Cox proportional hazard models were performed to determine the associations of indicators, including BMI, WC, WHR, WHtR and BFP with the incidence and mortality of stroke. Increased BMI was associated with elevated stroke incidence and mortality, with the lowest risk observed in the BMI range of 18-24 kg/m². Both lower BMI (17≤BMI<18.5 kg/m²) and higher BMI (BMI≥25 kg/m²) were linked to higher incidence and mortality of stroke. In contrast, other obesity-related indicators (WC, WHR, WHtR and BFP) exhibited more pronounced linear relationships with the incidence of stroke, all-cause mortality in the total population, stroke mortality in the total population and all-cause mortality in stroke patients. However, no significant differences were found in stroke-specific mortality among underweight, normal weight, overweight and obese groups in stroke patients across various obesity indicators, suggesting no obvious association between obesity and stroke-specific mortality in stroke patients under the current definitions and adjustments in this study. Notably, stroke severity, acute care, and complications were not available in the analysis, and residual confounding from these unmeasured factors cannot be ruled out. Furthermore, our analyses on the relationships between several obesity subtypes with different metabolic health statuses and stroke incidence and mortality revealed that, regardless of normal weight or not, individuals with metabolic abnormalities had significantly higher incidence and mortality of stroke compared to those with normal metabolism. This highlights the importance of metabolic status in the onset and prognosis of stroke. Our findings demonstrate that stroke-specific mortality in stroke patients was not associated with obesity severity when assessed using multiple obesity indicators including BMI, WC, WHR, WHtR and BFP. This is inconsistent with previous observations of the obesity paradox. Meanwhile, the observation that individuals with metabolic abnormalities exhibit significantly higher stroke incidence and mortality compared to those with normal metabolism further confirms the adverse impact of metabolic disturbances on stroke risk and prognosis, underscoring the pivotal role of metabolic health in stroke management.

Stroke is often followed by vascular cognitive impairment and vascular dementia, the most feared complications of stroke. However, understanding of post-stroke cognitive impairment remains limited. Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. Patients with haemorrhagic or ischaemic stroke, or transient ischaemic attack, were recruited within six weeks of stroke from hospitals across the UK. Consent was obtained from patients with capacity or from relatives/friends in those without capacity. The primary outcome is dementia rate and its severity at two years assessed using a 7-level ordinal cognition outcome. Final dementia rate will be compared in those with mild stroke/TIA (worst NIHSS <=7) versus severe stroke (NIHSS >7). Secondary outcomes will include cognitive impairment, function, mood and quality of life, and predictors of cognitive impairment at one and two years. Data are shown as number (%), median [interquartile range, IQR] or mean (standard deviation, SD). We recruited 2441 patients from 50 hospitals. Of these, 2432 (99.6%) had a qualifying event of stroke or TIA. The mean age was 68.2 years (SD 13.5), females 979 (40.3%), ethnic minority 170 (7.0%), NIHSS <=7 1962 (80.7%), onset to recruitment 5 days [IQR 3-13] and diagnosis ICH 192 (7.9%), ischaemic stroke 2097 (86.2%), TIA 143 (5.9%). The distribution of cognition at baseline (within 6 weeks of onset) was: normal 1300 (53.5%), minor neurocognitive disorder-single domain 351 (14.4%), minor neurocognitive disorder-multi domain 263 (10.8%), major neurocognitive disorder-mild 387 (15.9%), major neurocognitive disorder-moderate 108 (4.4%) and major neurocognitive disorder-severe 23 (0.1%). Participants with more severe stroke were recruited later (8 [IQR 3-17] vs 5 [2-11] days, p<0.001), less likely to have capacity (86.3% vs 96.8%, p<0.001) and more likely to have had an intracerebral haemorrhage (12.0% vs 6.8%, p<0.001). We provide baseline data with the statistical analysis plan in the appendix. The data highlight the substantial under-appreciated cognitive burden of stroke, even in the first few days and weeks after onset.

Although previous evidence generally agreed on the short-term dual antiplatelet therapy (DAPT) for mild stroke or transient ischaemic attack (TIA), there is no consensus on the optimal threshold for stroke severity and initiation timing of DAPT. We conducted an updated meta-analysis of randomised controlled trials to evaluate early DAPT versus single therapy in mild stroke or TIA. We systematically reviewed double-blind and randomised controlled trials up to October 2024 evaluating DAPT versus monotherapy for acute mild, non-cardioembolic ischaemic stroke (National Institute of Health Stroke Scale; NIHSS≤5) or TIA within 72 hours of ictus. Random effects models generated risk ratio (RR) with 95% CIs for outcomes including stroke, composite vascular events, ischaemic stroke, major bleeding, haemorrhagic stroke and all-cause mortality. Pooled data from five trials (n=27 559) demonstrated that DAPT versus monotherapy lowered the risk of stroke recurrence (RR, 0.77; 95% CI 0.70 to 0.83), composite vascular events (RR, 0.75; 95% CI 0.68 to 0.83) and ischaemic stroke (RR, 0.74; 95% CI 0.68 to 0.81). However, DAPT increased the risk of major bleeding (RR, 2.19; 95% CI 1.38 to 3.49) and haemorrhagic stroke (RR, 2.08; 95% CI 1.13 to 3.82), with no significant increase in the risk of all-cause mortality (RR, 1.28; 95% CI 0.95 to 1.71). For acute mild stroke (NIHSS ≤5) or patients with TIA within 72 hours of ictus, early DAPT initiation demonstrates net clinical benefit through reducing ischaemic events, despite an increase in bleeding complications, without affecting mortality.

Hemorrhagic stroke (HS), including non-traumatic intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), accounts for approximately 30% of all stroke cases and over 40% of stroke-related deaths. With high mortality and disability rates, HS imposes a heavy global health burden. As a core metabolic disorder, insulin resistance (IR) has been proven to be associated with all-cause mortality (ACM) in patients with ischemic stroke in previous studies. Nevertheless, its prognostic value remains unclear in critically ill HS patients admitted to the intensive care unit (ICU). Given the markedly higher mortality and morbidity of HS compared with ischemic stroke, it is essential to explore this association. This study aimed to investigate the correlations between multiple surrogate markers of insulin resistance and all-cause mortality among critically ill HS patients in the ICU setting. Data were extracted from the public eICU-CRD database. Patients with severe HS were identified based on the International Classification of Diseases (ICD)-9/10 diagnostic codes. A total of 1538 ICU-admitted patients with severe HS were enrolled and stratified according to quartiles of various IR surrogate markers. The primary endpoint was in-hospital mortality. Cox regression analysis, Kaplan-Meier survival curves, restricted cubic splines (RCS) and receiver operating characteristic (ROC) curves were adopted for statistical analyses. Among the 1538 enrolled patients, males accounted for 54.6%, and the overall in-hospital all-cause mortality was 26.59%. Multivariate Cox regression analyses revealed that all IR surrogate markers were significantly correlated with all-cause mortality in severe HS patients. SPISE was negatively correlated with all-cause mortality, while other indicators showed positive correlations. Restricted cubic spline analyses demonstrated non-linear relationships between TyG, SPISE, TG_HDL, METS_IR, TyG_BMI, TyG_RC and mortality. No significant effect modification was observed in interaction analyses. ROC curve analysis indicated that TyG exhibited the highest predictive accuracy. In conclusion, insulin resistance surrogate markers were significantly associated with all-cause mortality in critically ill HS patients. Despite their weak-to-moderate discriminative performance, these indices may serve as auxiliary prognostic references for risk stratification. Clinical application of these indicators is expected to optimize therapeutic strategies and disease progression management. Furthermore, this study enriches current evidence regarding the association between insulin resistance surrogate markers and hemorrhagic stroke, and clarifies their roles in predicting mortality across different stroke subtypes.

PM2.5 exposure exacerbates cerebral infarction via HPG axis downregulation and pituitary lipid metabolism dysregulation in mice.

Estimated pulse wave velocity (ePWV), an easy to calculate proxy of carotid to femoral PWV (cfPWV), can be derived from 24-hour blood pressure monitoring (24h-BPM). Its role in acute ischemic stroke (AIS) has not previously been investigated in large multinational datasets. A pooled individual patient data analysis from 13 cohorts across seven countries was conducted, including 2,933 AIS patients who underwent 24h-BPM during the hyperacute to subacute phase. ePWV was calculated using a validated equation. Associations with clinical characteristics, stroke severity, etiologic subtypes, and outcomes were assessed with logistic regression. The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) >2. Patients with higher ePWV presented with more severe strokes (median NIHSS 7 vs. 3, P < .001) and had poorer outcomes both at 90 days (63.7% vs. 23.7%, P < .001) and discharge (61.9% vs 29.1%, P < .001). ePWV was associated with poor outcome at 90 days (aOR: 1.24, 95% CI: 1.05-1.45) and discharge (aOR: 1.26, 95% CI: 1.12-1.42), per 1 m/s increase in ePWV, after adjustment for conventional risk factors and stroke severity. In patients ≤50 years, ePWV was highest in those with small vessel disease (SVD), who also had more cardiovascular risk factors than other stroke subtypes. ePWV derived from 24h-BPM is a simple, widely applicable measure of vascular aging that is associated with functional outcome after AIS. The higher ePWV observed in young patients with SVD underscores a potential early arteriosclerotic burden in this subgroup.

Medicare's New Technology Add-On Payment (NTAP) incentivizes the adoption of innovative technologies. We examined factors associated with the use of NTAP-billed artificial intelligence (AI) software for detecting large vessel occlusion (LVO) in acute ischemic stroke (AIS) patients requiring thrombolytic treatment. Using nationally representative Medicare 5% Research Identifiable Files, inpatient AIS episodes billed under diagnosis-related groups (DRGs) 61-63 from October 2020 to December 2023 (NTAP period) were analyzed. AI use was identified via NTAP ICD-10 code 4A03X5D. Stroke severity and access to care were assessed using validated scales and the Area Deprivation Index. Associations between NTAP-billed AI use and patient, clinical, and facility characteristics were evaluated using chi-square tests. Odds of NTAP-billed AI use at the AIS inpatient visit level were evaluated with logistic regression models employing random effects to account for facility-level clustering. Among 2,116 AIS episodes across 1,076 facilities, NTAP-billed AI use among inpatient AIS episodes requiring thrombolytic treatment increased annually, peaking at 21% in 2022. NTAP-billed AI use was most common in episodes with CT imaging, at comprehensive stroke centers, and in facilities with ≥1000 beds. No disparities in NTAP-billed AI use were observed across patient demographics or stroke severity measures. In adjusted logistic regression models, odds of NTAP-billed AI use were highest in 2022 (OR 6.0, 95% CI 2.7-13.3), among beneficiaries in the Stroke Belt (OR 2.0, 95% CI 1.3-3.0), and at comprehensive stroke centers (OR 1.5, 95% CI 1.1-2.0). NTAP-billed AI adoption for LVO detection in AIS episodes requiring thrombolytic treatment increased from 2020 to 2022 and appeared to be driven by institutional factors, suggesting facility characteristics, rather than patient factors and stroke severity, may influence NTAP-billed AI use, potentially contributing to geographic variability in stroke care.

Stroke is associated with a high burden of sarcopenia, which may be related to poorer functional outcomes and quality of life (QoL). To estimate the prevalence of sarcopenia among stroke inpatients, identify factors associated with stroke-related sarcopenia, and examine the association between stroke-related sarcopenia and sarcopenia-specific QoL. Sarcopenia was evaluated according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Demographic and clinical data were collected. Nutritional status, dysphagia, activities of daily living (ADLs), and stroke severity were assessed using the Nutritional Risk Screening 2002 (NRS-2002), Water Swallow Test (WST), Barthel Index (BI), and National Institutes of Health Stroke Scale (NIHSS), respectively. QoL was assessed using the Sarcopenia and Quality of Life questionnaire (SarQoL). The prevalence of sarcopenia among stroke inpatients was 50.8%. Binary logistic regression analysis showed that age, limb dysfunction, dysphagia status, BI score, and NRS-2002 score were independently associated with sarcopenia, whereas regular exercise was associated with lower odds of sarcopenia. The total SarQoL score was 57.06 ± 17.583 in patients with sarcopenia and 66.72 ± 19.201 in patients without sarcopenia. Significant differences were observed between patients with and without sarcopenia in physical and mental health, locomotion, body composition, functionality, ADLs, fears, and the total SarQoL score. This study demonstrated a high prevalence of sarcopenia among stroke inpatients and identified several factors independently associated with sarcopenia. Sarcopenia was also associated with poorer sarcopenia-specific QoL.

This reflection explores the experience of aphasia following a severe stroke and the subsequent loss of a professional identity as a practicing psychologist. Through the process of relearning language, reading, and writing fiction, the author reflects on questions of identity, recovery, and the unfinished nature of medicine, psychology, and human lives. Memories of the author's father, a rural country physician, provide a framework for understanding that healing is not about completing another person's story, but participating in it. Writing serves not as an endpoint but as a continuing process of meaning-making, listening, and beginning again.