Vascular Risk Research Articles

Neuroimaging Correlates of 3 Distinct Physical-Cognitive Phenotypes in Cognitively Normal Older Adults: The Gothenburg H70 Cohort Study.

Individuals aged 70 and older frequently experience an increased risk of deficits in both physical and cognitive functions. However, the natural progression and interrelationship of these deficits, as well as their neurologic correlates, remain unclear. We aimed to classify the data-driven physical-cognitive phenotypes and then investigate their associations with neuroimaging markers. This cross-sectional study included 70-year-old participants from the Gothenburg H70 Birth Cohort (2014-2016). Based on physical performance (grip strength, balance, walking speed, and chair stand) and cognitive measures (episodic memory, perceptual speed, executive function, verbal fluency, and visuospatial abilities), we applied latent class analysis to identify physical-cognitive phenotypes. Based on the brain MRI measurements, 3 groups of neuroimaging markers were involved-neurodegeneration, cerebral small vessel disease (cSVD), and microstructural white matter (WM) integrity. We performed multinomial logistic regressions to examine the differences between the physical-cognitive phenotypes. In total, 1,140 participants (female: 53.3%) without dementia and disability were included in the study, with 721 (female: 52.2%) undergoing MRI scans. Three physical-cognitive phenotypes were identified: an "optimal" group characterized by high performance in both physical and cognitive functions, an "intermediate" group showing a slight reduction in both domains, and a "physical deficit" group marked by a significant reduction in physical performance. Compared with the optimal group, the other 2 groups were more likely to present with vascular risk factors. The physical deficit group had higher odds of experiencing depression compared with the intermediate group (adjusted odds ratio [aOR] 2.9, 95% CI 1.4-5.9). Compared with the optimal group, the odds of presenting all 3 severe neuroimaging markers were higher in both the intermediate (aOR 3.4, 95% CI 1.5-7.9) and physical deficit (aOR 10.3, 95% CI 2.4-45.0) groups. This study highlights the variability in physical and cognitive performance among older adults and suggests that neuroimaging markers of neurodegeneration, cSVD, and microstructural WM integrity may account for these variations. Our findings indicate the potential for developing group-based strategies to prevent and manage age-related functional decline. Further research with larger sample sizes is needed to deepen our understanding of physical-cognitive decline patterns.

Association of Medial Temporal Lobe Cerebrovascular Reactivity and Memory Function in Older Adults With and Without Cognitive Impairment.

Cerebrovascular reactivity (CVR) represents the ability of cerebral blood vessels to regulate blood flow in response to vasoactive stimuli and is related to cognition in cerebrovascular and neurodegenerative conditions. However, few studies have examined CVR in the medial temporal lobe, known to be affected early in Alzheimer disease and to influence memory function. We aimed to examine whether medial temporal CVR is associated with memory function in older adults with and without mild cognitive impairment (MCI). In this observational study, independently living older adults free of dementia or stroke were recruited from the community and underwent brain MRI, neuropsychological assessment, and blood draw in an academic research setting. pCASL MRI quantified medial temporal lobe cerebral perfusion during CVR response to hypercapnia. Hypercapnia was induced by visually guided breathing exercises (15 seconds breath holds) during capnographic monitoring. MCI diagnosis and memory performance were assessed through comprehensive neuropsychological assessment. Aβ42/40 and pTau181 levels were quantified in blood plasma. Logistic and hierarchical linear regression examined medial temporal CVR in relation to MCI diagnosis and memory function. In a sample of 144 older adults (mean age = 69.6 years; SD = 7.4%; 34.7% male; mean education = 16.6 years, SD = 2.3), CVR to hypercapnia in the medial temporal lobe was attenuated in individuals with MCI after adjusting for age, sex, education, apolipoprotein ε4 carrier status, Aβ42/40 and pTau181 levels, and vascular risk factors (OR = 0.87, 95% CI [0.77-0.97], p = 0.013). Cerebrovascular reactivity to hypercapnia was associated with verbal memory performance for stories (B = 0.33, 95% CI [0.09-0.57], p = 0.009), a word list (B = 0.10, 95% CI [0.001-0.20], p = 0.048), and visual memory (B = 0.33, 95% CI [0.09-0.57], p = 0.008). Deficits in medial temporal CVR are observed in older adults with MCI and are related to worse memory function. Findings suggest that medial temporal cerebrovascular dysfunction is related to cognition and memory before the onset of dementia, independent of changes in Alzheimer pathophysiologic markers. Limitations of the study include the cross-sectional design. Future longitudinal studies are warranted to examine whether early cerebrovascular changes can predict progressive memory decline.

Effect of genetic and vascular risk factors on rates of cognitive decline in early-onset and late-onset Alzheimer's disease.

Although previous studies have shown that cognitive decline in Alzheimer's disease (AD) is associated with various risk factors, they primarily focused on late-onset AD (LOAD). We aim to evaluate the differential impact of risk factors on the cognitive decline between early-onset AD (EOAD, onset < 65 years) and LOAD (onset 65 years) and explore the longitudinal effect of Apolipoprotein E allele 4 (APOE ε4) on cortical atrophy in both cohorts. Using data from 212 EOAD and 1101 LOAD participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI), we conducted multivariable mixed-effect models to evaluate the impact of APOE ε4, education, hypertension, diabetes, dyslipidemia, and body mass index on cognitive performance. Preprocessed MRI data were utilized for longitudinal parametric mapping. APOE ε4 carriers in both groups showed significantly accelerated declines in language, verbal memory, executive function, and general cognition. By controlling other significant risk factors, APOE ε4 carriers showed faster declines in language and verbal memory in both groups. Females exhibited accelerated declines in Language and verbal memory in the EOAD and LOAD cohorts respectively. LOAD individuals with hypertension showed faster declines while overweight and obese participants displayed slower declines in both cohorts across all domains except visuospatial. Notably, APOE ε4 status was associated with longitudinal cortical atrophy in the LOAD cohort but not in the EOAD cohort. Known risk factors for AD were associated with cognitive decline in both EOAD and LOAD cohorts.

Some thoughts about the "Consensus statement on smoking and vascular risk" from the Spanish Autonomous Societies of Hypertension and Vascular Risk.

Smoking is a known preventable risk factor for vascular diseases. However, it is one of the most forgotten risks when we talk about its relationship with kidney disease. Following the publication of the "Consensus statement on smoking and vascular risk" promoted by the autonomous societies of hypertension and vascular risk of Spain, we consider that the nephrology community should be alerted about the deleterious effects of exposure to tobacco smoke and its consequences on renal damage. Something to take into account given the prevalence of smoking in our environment, approaching its prevention and treatment.

Real-world experience in the management of CML patients focused on tyrosine kinase inhibitors intolerance and health-related quality of life.

This study aimed to analyze the survival outcomes and adverse events (AEs) associated with the long-term use of tyrosine kinase inhibitors (TKIs) and to assess health-related quality of life (HRQoL) in patients with chronic myeloid leukemia (CML). Medical records of 345 patients with CML treated with at least one type of TKI were retrospectively reviewed. No significant differences in survival were observed based on the number of different TKIs the patients received (p = 0.301) or the sequence of TKIs used (p = 0.770). Among 182 patients treated with nilotinib, 25 experienced cardiovascular events (CVEs). After 10 years of nilotinib treatment, CVEs occurred in 55.2% of patients with ≥ 2 vascular risk factors. Pleural effusion was observed in 27 of 78 dasatinib-treated patients. In terms of HRQoL, patients treated with nilotinib generally reported higher satisfaction levels than did those treated with imatinib or dasatinib. When stratified by age or duration of TKI treatment, patients aged < 60 years or those with a treatment duration of ≥ 1 year exhibited better satisfaction levels. Survival outcomes were not affected by history of TKI treatment. Nilotinib is favorable for HRQoL but increases the risk of serious CVEs in patients with vascular risk factors.

Hypermethylation of PM20D1 Is Associated With Carotid Bifurcation Intima-Media Thickness in Dominican Republic Families.

Carotid intima-media thickness (IMT) is a measure of atherosclerosis and a predictor of vascular diseases. Traditional vascular risk factors and genetic variants do not completely explain the variation in carotid IMT. We sought to identify epigenetic factors that may contribute to the remaining carotid IMT variability. An epigenome-wide association study was performed in 61 Dominican families with 769 individuals. A cytosine nucleotide that precedes a guanine nucleotide methylation in blood-derived DNA was measured using the Human MethylationEPIC BeadChip. Linear mixed model analyses were performed regressing bifurcation carotid IMT (bIMT) on beta values for cytosine nucleotide that precedes a guanine nucleotide sites, adjusting for covariates, followed by differentially methylated region (DMR) analysis. One-sample Mendelian randomization analysis was conducted to investigate causal associations between DMRs and bIMT. Twenty-five DMRs were associated with bIMT (Sidak P <0.05), with the strongest DMR (Sidak P =2.45×10-17) overlapping with the promoter of PM20D1. All 11 cytosine nucleotides that precede a guanine nucleotide within the PM20D1 DMR were positively associated with bIMT (P=0.0007-0.00006). Methylation of the PM20D1 DMR was associated with cis variants, including rs823154 (β=0.26; P=1.1×10-121). As reported in GTEx (Genotype-Tissue Expression project), rs823154 is an expression quantitative trait locus for PM20D1 in multiple tissues, including the aorta (P=2.3×10-60) and blood (P=4.0×10-73), suggesting that hypermethylation of the PM20D1 DMR directs lower expression of the gene. Mendelian randomization analysis supported a causal role for PM20D1 DMR in bIMT (P=0.049). Our study and previous expression quantitative trait locus studies provide converging evidence that reduced PM20D1 expression via hypermethylation of the promoter is associated with increased atherosclerosis.

Multimorbid patients in visceral surgery-Upper gastrointestinal tract

The treatment of multimorbid patients in oncological surgery of the upper gastrointestinal tract requires adifferentiated consideration of every single risk factor in order to provide a holistic assessment. This article focuses on pre-existing diseases that are particularly relevant for elective esophageal and gastric surgery and have practical clinical consequences. In this way a differtiation is made between metabolic, vascular, cardiopulmonary and organ-specific risks. The aim of this work is to provide practical guidelines for complex and multimorbid cases. Given the multifactorial interrelationships, the importance of athorough preoperative evaluation and interdisciplinary management cannot be overemphasized.

Vascular risk factors and cerebrovascular pathologic changes on autopsy: The 90+ Study.

Cerebrovascular pathologic changes (CVPC) are prevalent and associated with dementia in those≥90 years. However, CVPC associations to traditional risk factors (hypertension, diabetes, and hyperlipidemia) are variable. We hypothesized that neither traditional risk factors nor related medications would be associated with CVPC presence. In autopsy volunteers from The 90+ Study, odds ratios (OR) of CVPC presence to self-reported vascular risk factors and cardiovascular medication classes were calculated using logistic regressions adjusted for age of death, sex, and education. In 267 participants (mean age at death 98(±3.5) years; 75% female), CVPC presence was not related to traditional risk factors. Lower odds of atherosclerosis with diuretics [OR 0.55] and lower odds of cerebral amyloid angiopathy (CAA) with B-blocker [OR 0.57] or vasodilator [OR 0.40] use were observed. Our findings suggest that vascular risk factors are not risk factors for CVPC at this age, medications have mitigated risks, or survival bias obscures associations. Cardiovascular risk factors are thought to contribute to cerebrovascular diseases. Risk factors were generally not associated with cerebrovascular changes. Lower odds of certain cerebrovascular changes were associated with antihypertensive use.

Trends in Ethnic Disparities in Stroke Care and Long-Term Outcomes

Reducing the burden of stroke is a public health priority. While higher stroke incidence among ethnic minority populations (defined in the context of this study as individuals who are not White) is well established, reports on ethnic inequalities in care or outcomes are conflicting and often limited to hospital-admitted patients and short-term outcomes. To investigate ethnic differences in stroke care and outcomes up to 5 years after stroke and describe temporal trends and contributory factors. This population-based cohort study enrolled participants from a geographically defined area of London, United Kingdom, with prospective follow-ups up to 5 years after stroke. Participants were adults with incident stroke in 1995 to 2021. Data were analyzed from May 2023 to October 2024. Self-reported ethnicity, categorized as Black African, Black Caribbean, White, or other (eg, Asian, other Black ethnicity, or multiple ethnicities). Outcomes of interest were stroke unit admission, thrombolysis rate, functional outcomes (measured using Barthel Index and Frenchay Activities Index), and survival. Among 7280 patients (mean [SD] age, 69.3 [15.2] years; 3787 [52.0%] male) included, 3628 (63.2% of 3-month survivors) had 3-month follow-up data and 1951 (60.8% of 5-year survivors) had 5-year follow-up data. By ethnicity, 861 participants (11.8%) were Black African, 1089 (15.0%) were Black Caribbean, 4738 participants (65.1%) were White, and 592 participants (8.1%) identified as other ethnicity. Black African and Black Caribbean participants were younger than White participants (mean [SD] age, 59 [14] years, 68 [15] years, and 72 [14] years, respectively), with higher rates of hypertension (629 participants [75.0%], 805 participants [75.6%], and 2801 participants [61.8%], respectively), diabetes (246 participants [29.3%], 427 participants [40.2%], and 750 participants [16.5%], respectively), and body mass index greater than 25 (372 participants [69.0%], 370 participants [61.3%], and 1094 participants [51.6%], respectively). Black African and Black Caribbean participants had higher stroke unit admission rates than White participants in 1995 to 2003 (66 participants [42.6%], 129 participants [42.0%], and 573 participants [29.5%], respectively) but not thereafter. Black Caribbean participants had persistently lower thrombolysis rates (adjusted odds ratio compared with White participants, 0.56 [95% CI, 0.40-0.80]) and later hospital arrivals (arrival >4 hours after stroke onset: 217 Black African participants [53.8%]; 251 Black Caribbean participants [60.0%]; 654 White participants [51.2%]; P = .02). Black African and Black Caribbean participants had better survival than White participants (Black African participants: adjusted hazard ratio, 0.64 [95% CI, 0.54-0.77]; Black Caribbean participants: adjusted hazard ratio, 0.83 [95% CI, 0.74-0.94]) but poorer functional outcomes up to 5 years after stroke, with no significant changes over time. This cohort study found major and persistent ethnic inequalities in stroke care and outcomes, and these disparities were not fully explained by sociodemographic or stroke-related factors or the high vascular risk factor prevalence in Black African and Black Caribbean participants. Drivers of poor functional outcomes require further research, but cardiovascular health-checks should be considered for Black African individuals at younger ages, and late hospital arrivals and low thrombolysis rates in Black Caribbean individuals might be amenable to tailored health campaigns.

Burden of vascular risk factors by age, sex, ethnicity and deprivation in young adults with and without newly diagnosed type 2 diabetes.

Do associations between age at diagnosis of type 2 diabetes and vascular risk factors vary by ethnicity and deprivation? Utilising the Clinical Practice Research Datalink, we matched 16-50-year-old individuals with newly diagnosed type 2 diabetes to ∼10 individuals without using sex, age and primary care practice. Differences in BMI, obesity, LDL-cholesterol, HbA1c, and hypertension between individuals with vs without type 2 diabetes across sex, age, ethnicity and deprivation quintiles were explored using generalised linear models. We included 108,061 individuals (45.6% women) with newly diagnosed type 2 diabetes and 829,946 controls. BMI, obesity, LDL-cholesterol, and hypertension were higher in individuals with vs without type 2 diabetes. Across both sexes, all ethnic groups and deprivation quintiles, these differences were larger with an earlier age, particularly for BMI and obesity. Association between age and HbA1c were variable across subgroups. Differences in BMI, obesity, and hypertension (individuals with vs without diabetes) were largest in White individuals and with less deprivation. The increased vascular risk phenotype associated with an earlier age of diagnosis of type 2 diabetes was consistent across ethnic and deprivation groups. Population-based strategies are needed to address the risk associated with early-onset type 2 diabetes, especially weight-management-based strategies.

Longitudinal associations between air pollution and incident dementia as mediated by MRI-measured brain volumes in the UK Biobank.

Although there is increasing evidence that environmental exposures are associated with the risk of neurodegenerative conditions, there is still limited mechanistic evidence evaluating potential mediators in human populations. UK Biobank is a large long-term study of 500,000 adults enrolled from 2006 to 2010 age 40-69years. ICD-10 classified reports of dementia cases up to 2022 (Alzheimer's disease, vascular dementia, dementia in other classified diseases, and unspecified dementia) were identified from health record linkage. Estimates of residential air pollution, traffic noise, and greenspace exposure have been modelled. Structural brain MRI was conducted from 2014 to 2022, with brain volumes relevant to dementia identified a priori. Associations between environmental exposures, brain volumes, and dementia cases (diagnosed post-MRI) were tested using linear and logistic regression and adjusted for age, sex, household income, ethnicity, education, smoking, and area-level deprivation. Mediation of exposure-outcome associations by plausible brain volumes (those associated with both environmental exposure and dementia outcomes) were modelled using the quasi-Bayesian Monte Carlo method (N=34,817-39,772). Small but significant mediating effects (2%-8% of relationships mediated) were observed between PM2.5abs exposure and dementia risk by reduced total brain volume, NOx and Alzheimer's disease risk by reduced peripheral cortical grey matter, PM2.5abs and vascular dementia risk by reduced peripheral cortical grey matter, PM2.5abs and other dementia risk by reduced total grey matter, and PM10 and other dementia risk by reduced total grey matter. Greenspace and noise were not associated with dementia outcomes in the subset of the cohort providing brain imaging data. This study adds to existing evidence of associations between environmental exposures and dementia outcomes. Our findings provide novel evidence that differences in brain volume may mediate these relationships. Future research is required to prove this mechanism and establish the other mechanisms through which exposure to air pollution might increase dementia risk.

Effect of glucagon-like peptide-1 receptor agonists on vascular risk factors among adults with type 2 diabetes and established atherosclerotic cardiovascular disease

Effect of glucagon-like peptide-1 receptor agonists on vascular risk factors among adults with type 2 diabetes and established atherosclerotic cardiovascular disease

Complex interactions and composite burden of risk factors in vascular cognitive impairment.

Vascular cognitive impairment (VCI) stresses the vascular contributions to cognitive decline, ranging from mild to major forms. Except for symptomatic treatment for relevant vascular diseases, the other recommended strategy is to intervene in key vascular risk factors (VRFs) as early as possible. A considerable amount of previous research delineated the association of a specific factor with dementia, involving each risk factor discussed in the present review. However, due to the heterogeneity and complexity of VCI, managing a single factor is insufficient to reduce its incidence and prevalence. Ongoing studies suggest differences in the impact of various combinations of risk factors on dementia. Here in this review, we aimed to provide an updated overview of clinical evidence and implications of complex interactions among various risk factors of VCI, including common VRFs and modifiable dementia-related risk factors. Understating the effect of comorbid risk factors on VCI and underlying mechanisms of them during VCI progression is essential for identifying high-risk population and developing preventive strategies. Furthermore, we summarized common composite risk scores and models used for risk evaluation and prediction of VCI, involving conventional risk scores, subclinical vascular composites, and novel risk models driven by intelligent algorithms. Lastly, we discussed potential gaps and research directions on searching specific clinical risk profiles, constructing effective risk scores, and implementing targeted risk interventions.

Associations of Traumatic Brain Injury and Hearing: Results From the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).

To examine associations of traumatic brain injury (TBI) with self-reported and clinical measures of hearing function. Four US communities. A total of 3176 Atherosclerosis Risk in Communities Study participants who attended the sixth study visit in 2016-2017, when hearing was assessed. Prospective cohort study. TBI occurring prior to the hearing assessment was defined using self-reported questions and "International Classification of Diseases-9th/10th Edition" (ICD-9/10) codes. Hearing function was assessed by self-reported questionnaires and clinically measured indices (audiometry [4-frequency pure tone average for each ear] and speech-in-noise testing). Linear, logistic, and multinomial logistic models adjusted for sociodemographics, vascular risk factors, and occupational noise exposure were used to examine associations. Participants were a mean age of 79years, 59% were female, 21% were of self-reported Black race, and 33% had a history of TBI (median time from first TBI to hearing assessment: 39years (25th-75th percentile=19-63years). Compared to participants without TBI, participants with prior TBI had higher age-adjusted prevalence of self-reported hearing loss (42.3% vs 35.3%), tinnitus (28.0% vs 23.8%), hearing aid use (23.4% vs 17.8%), pure tone average>40dB (30.6% vs 24.8%), and presence in the lowest quartile of speech-in-noise performance (27.6% vs 22.8%). With further adjustment, and particularly with adjustment for occupational noise exposure, associations with hearing measures were largely no longer statistically significant. In secondary analyses of associations of TBI frequency and severity with hearing function, results were similar to our main analyses, without evidence of dose-dependent associations. In this community-based cohort, prior TBI was associated with impaired hearing on both self-reported and clinically measured assessments, but these associations were attenuated after adjustment for occupational noise exposure. These results underscore the importance of the consideration of loud noise exposures, which may confound associations of TBI with hearing, in future studies.

Xixin Decoction May Treat VaD by Modulating the NPTX2/C1q/C3 Complement Pathway.

Vascular dementia (VaD) is a type of dementia that results from brain injury caused by cerebrovascular disease or vascular risk factors. Accumulating evidence from clinical studies hasfound that Xixindecoction can effectively improve the cognitive function of patients with VaDand improve their daily living ability. However, the pathogenesis of VaD is not fully understood, and the therapeutic mechanism of Xixindecoction is also unclear. The Morriswater maze, new object recognition, TEM observation, Golgi staining, Nissl staining, Western blotting and RT-qPCR were employed to explore the therapeutic mechanismofXixindecoction. The results showed decreased learning and cognitive abilities, hippocampal neuron damage, decreased NPTX2 protein expression, and increased expression of inflammatory factors such as C1q and C3 in the model group compared withthe control group. Furthermore, compared with the model group, the above symptoms were improved after administration ofXixindecoction, and the activity of the NPTX2/C1q/C3 complement pathway was altered. In conclusion, these results suggested that Xixindecoctionmight treat VaD by modulating the NPTX2/C1q/C3 complement pathway.

Neurological management of ischemic stroke in sickle cell disease- a case report with an updated review of the literature.

In children and adults with sickle-cell disease (SCD), acute ischemic stroke (AIS) associated with a vaso-occlusive crisis is a leading cause of physical and cognitive disability and death. However, neurological guidelines for acute management of AIS fail to directly address this issue. We here report a case of a man with severe cerebrovascular complications and illustrate the current evidence on the management of SCD-related AIS. A 46-year-old man suffering from SCD and poorly controlled diabetes was admitted to the emergency room complaining of the onset, more than 10h before, of headache, paresthesia, and right hemianopia. The brain Angio-CT study revealed bilateral occlusion of the internal carotids and the posterior cerebral arteries, with remarkable compensatory hypertrophy of other vessels. The laboratory exams confirmed severe anemia with high hemoglobin-S levels (50%) and severe dehydration. IV hydration was prompted, along with erythrocyte apheresis and antiplatelet therapy. The patient successfully underwent these treatments, and the neurological deficits significantly improved. Nonetheless, due to the time window, he could not be treated with intravenous thrombolysis (IVT). AIS is a time-sensitive condition. In SCD, vaso-occlusive phenomena are the leading cause of AIS, but "classical" vascular risk factors can also play a role. Since current guidelines on the acute management of SCD complications are mainly focused on the hematological- rather than neurological- aspects, it is not clear whether these patients should undergo IVT before or after fluid resuscitation and erythrocyte apheresis. Furthermore, the principles of secondary prophylaxis are still controversial and require further investigation.

The VIDIA BONE score as a patient- and fracture-related risk score for the occurrence of fracture sequelae in proximal humerus fractures

PurposeThe aim of the study was to determine preoperative patient- and fracture-related risk factors for estimating the risk of fracture sequelae after surgically treated proximal humerus fractures (PHF) using locking plate osteosynthesis. The purpose was to develop a fracture sequelae risk score as an additional tool to facilitate the treatment strategy for PHF.MethodsAll patients with PHF who underwent surgery with locking plate osteosynthesis were included. Inclusion criteria were complete preoperative parameters including general patient-specific information, preoperative radiographs and computed tomography (CT) scans. The patients were divided into 2 groups according to the occurrence of fracture sequelae (Group I: no fracture sequelae, Group II: fracture sequelae). Following risk factors for fracture sequelae were defined: Vascular supply interruption risk [V], Individual (female gender) [I], Diabetes [D], ISAR (Identification of Seniors at risk) [I], ASA (American Society of Anesthesiologists) score [A], Body mass index [B], Osteopenia [O], Nicotine abuse [N], Elderly > 65 [E]. The VIDIA BONE score contains 9 items. For each parameter of the VIDIA BONE score, a value between 1 and 3 was assigned based on the odds ratio (OR).ResultsThis comparative case series study included 112 patients, with 82 (73.2%) in Group I and 30 (26.8%) in Group II. All defined preoperative risk factors were associated with an increased risk of fracture sequelae (FS), with odds ratios (OR) ranging from 1.3 to 3.9, although not all parameters reached statistical significance. The maximum score was 24 points, categorized as follows: scores of 1 to 8 indicating low risk, 9 to 16 indicating moderate risk, and 17 to 24 indicating high risk of fracture sequelae following PHF. Patients with a VIDIA BONE score of 1 to 8 points demonstrated favorable postoperative outcomes, with FS observed in only 6% of cases. In contrast, 84% of patients with a score of 17 to 24 developed a FS. Additionally, 90% of all patients who developed FS had a VIDIA BONE score more than 9 points.ConclusionThe VIDIA BONE score appears to be a simple, reproducible, and valuable tool for supporting reliable treatment decisions. Locking plate osteosynthesis is an effective treatment option for patients with a low risk VIDIA BONE score. However, patients with a high risk VIDIA BONE score are more likely to experience FS and osteosynthesis failure.Level of evidenceIII.

Heart–brain microvascular MRI study: protocol for a multicentre, observational, cohort study in the UK assessing associations between small vessel disease of the heart and brain

IntroductionIschaemic heart disease (IHD) and cerebrovascular disease are leading causes of morbidity and mortality worldwide. Cerebral small vessel disease (CSVD) is a leading cause of dementia and stroke. While coronary...

The role of the neurovascular unit in vascular cognitive impairment: Current evidence and future perspectives.

Vascular cognitive impairment (VCI) is a progressive cognitive impairment caused by cerebrovascular disease or vascular risk factors. It is the second most common type of cognitive impairment after Alzheimer's disease. The pathogenesis of VCI is complex, and neurovascular unit destruction is one of its important mechanisms. The neurovascular unit (NVU) is responsible for combining blood flow with brain activity and includes endothelial cells, pericytes, astrocytes and many regulatory nerve terminals. The concept of an NVU emphasizes that interactions between different types of cells are essential for maintaining brain homeostasis. A stable NVU is the basis of normal brain function. Therefore, understanding the structure and function of the neurovascular unit and its role in VCI development is crucial for gaining insights into its pathogenesis. This article reviews the structure and function of the neurovascular unit and its contribution to VCI, providing valuable information for early diagnosis and prevention.

Outcomes of Symptomatic Intracranial Large Artery Stenoses: a Prospective Cohort Study from The Asian Registry of Intracranial Atherosclerosis (ARICAS).

Intracranial large artery atherosclerosis (ICAS) is a common cause of stroke in Asia. Prior epidemiological publications on ICAS have largely been single-country reports. This collaborative study involving several Asian countries aims to investigate the characteristics and outcomes of patients with stroke attributable to ICAS. This is an international, multicentre, observational, prospective cohort study of patients admitted with acute ischemic stroke secondary to ICAS to stroke centres in six Asian countries. Stroke due to ICAS was diagnosed when there was a >50% intracranial large artery stenosis ipslateral to a non-lacunar infarct, without significant ipsilateral extracranial stenosis, cardiac cause or other mechanism found for the stroke. Data was collected on patient demographics, vascular risk factors, stroke location and severity. Outcomes of interest were stroke recurrence and mortality at 12-month follow-up. A total of 356 patients were recruited. Mean age was 62.7  13.8 years, and 39.9% were females. Mean NIHSS on admission was 9 + 8, with majority of patients having mild (39.3%) or moderate (37.9%) strokes. Stroke recurrence was 6.7% (95%CI 4.4 - 9.9%) while mortality rate was 13.2% (95%CI 9.9 - 17.2%) within one year. The risk of stroke recurrence was associated with increasing age (odds ratio OR 1.04, 95% CI 1 - 1.06, p = 0.05) and hypertension (OR 3.23, 95%CI 1.09 - 9.61, p = 0.035). Mortality was associated with age (OR 1.05, 95%CI 1.01 - 1.08, p = 0.006) and NIHSS (OR 1.12, 95%CI 1.07 - 1.17, p <0.001). This multicenter Asian study demonstrates a high risk of stroke recurrence and mortality among patients with acute stroke due to ICAS. They are associated with age (both), as well as hypertension (for recurrence) and NIHSS (for mortality). Better treatment modalities are needed to reduce the frequency of adverse outcomes in symptomatic ICAS.