Qilin Ma

Background: Type 2 diabetes has been shown to reduce the risk of migraine, whereas insulin resistance (IR) is often elevated in migraineurs. The triglyceride glucose index (TyG) serves as a reliable surrogate marker of IR, which has been hypothesized to be associated with migraine pathophysiology. This study aimed to examine the relationship between TyG index scores and incidence as well as the severity of migraines through both cohort and cross-sectional analyses. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), we evaluated migraine incidence between 2015 and 2020. TyG index values were calculated using the following formula: ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The impact of TyG index scores on the incidence of migraines was assessed using a multivariate-adjusted Cox regression model. The cross-sectional study included 161 patients with migraines in Xiamen, China. The relationship between TyG index scores and different migraine characteristics was examined using multivariable and ordered logistic regression models with further subgroup analysis by migraine course. Results: Among the cohort participants, 1001 new migraine cases were identified during follow-up, with no significant relationship found between TyG index scores and migraine incidence (hazard ratio = 1.024 (0.916, 1.145), p = 0.677 > 0.05). The cross-sectional study showed that migraine-related disability was significantly lower among patients in the second, third and fourth quartiles of TyG index scores compared to the first quartile (odds ratio = 0.402 (0.163, 0.973), 0.322 (0.128, 0.789) and 0.301 (0.119, 0.736), respectively; ptrend = 0.009). A similar trend was observed in patients with migraine history of less than ten years. Conclusions: Integrating the results of both cohort and cross-sectional studies, this study suggests that IR may play a protective role in the early stages of migraine. Further research into the relevant underlying mechanisms could aid in identifying new therapeutic targets for migraine management.

Introduction The incidence of cancer-associated ischaemic stroke (IS) is increasingly prevalent. This study aimed to assess the levels of enlarged perivascular spaces in basal ganglion (BG-EPVS) in cancer-associated patients who had a stroke compared with the control group, and to investigate the diagnostic utility of BG-EPVS in the context of cancer-associated stroke. Method A matched case–control study was conducted in Xiamen, China. A total of 184 IS patients (cancer vs control=1:1) were recruited. The severity of BG-EPVS was graded using high-resolution MRI. Patients’ gender, age, clinical risk factors, other imaging changes and laboratory findings information at admission were collected. Logistic regression models were constructed and subgroup analysis by cancer treatment. Result Overall, 65.22% of the 184 subjects were male, with a mean (SD) age of 68.83±10.52 years. BG-EPVS had a significant influence on cancer-associated stroke (OR=1.85 (95% CI 1.29, 2.71), p=0.001) after adjusting for gender, age, clinical risk factors, other imaging changes and laboratory findings. The area under the curve of the diagnosis model that combined BG-EPVS and other factors was 0.848 (95% CI 0.787, 0.896), significantly higher than the other three models. Subgroup analysis suggested a heightened association between BG-EPVS and cancer-associated stroke within the cancer treatment group. Conclusion In conclusion, this is the first study to assess the diagnosis values of BG-EPVS on cancer-associated stroke and helps us understand the pathogenesis of cancer-associated stroke. Our findings demonstrate the effectiveness of BG-EPVS in diagnosing IS patients who may carry underlying cancer.

Background/aims The reciprocal promotion of cancer and stroke occurs due to changes in shared risk factors, such as metabolic pathways and molecular targets, creating a “vicious cycle.” Cancer plays a direct or indirect role in the pathogenesis of ischemic stroke (IS), along with the reactive medical approach used in the treatment and clinical management of IS patients, resulting in clinical challenges associated with occult cancer in these patients. The lack of reliable and simple tools hinders the effectiveness of the predictive, preventive, and personalized medicine (PPPM/3PM) approach. Therefore, we conducted a multicenter study that focused on multiparametric analysis to facilitate early diagnosis of occult cancer and personalized treatment for stroke associated with cancer. Methods Admission routine clinical examination indicators of IS patients were retrospectively collated from the electronic medical records. The training dataset comprised 136 IS patients with concurrent cancer, matched at a 1:1 ratio with a control group. The risk of occult cancer in IS patients was assessed through logistic regression and five alternative machine-learning models. Subsequently, select the model with the highest predictive efficacy to create a nomogram, which is a quantitative tool for predicting diagnosis in clinical practice. Internal validation employed a ten-fold cross-validation, while external validation involved 239 IS patients from six centers. Validation encompassed receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and comparison with models from prior research. Results The ultimate prediction model was based on logistic regression and incorporated the following variables: regions of ischemic lesions, multiple vascular territories, hypertension, D-dimer, fibrinogen (FIB), and hemoglobin (Hb). The area under the ROC curve (AUC) for the nomogram was 0.871 in the training dataset and 0.834 in the external test dataset. Both calibration curves and DCA underscored the nomogram’s strong performance. Conclusions The nomogram enables early occult cancer diagnosis in hospitalized IS patients and helps to accurately identify the cause of IS, while the promotion of IS stratification makes personalized treatment feasible. The online nomogram based on routine clinical examination indicators of IS patients offered a cost-effective platform for secondary care in the framework of PPPM.

Purpose: Serum neurofilament light chain (sNfL) can reflect nerve damage. Whether migraine can cause neurological damage remain unclear. This study assesses sNfL levels in migraine patients and explores whether there is nerve damage in migraine. Methods: A case–control study was conducted in Xiamen, China. A total of 138 migraine patients and 70 healthy controls were recruited. sNfL (pg/mL) was measured on the single-molecule array platform. Univariate, Pearson correlation and linear regression analysis were used to assess the relationship between migraine and sNfL levels, with further subgroup analysis by migraine characteristics. Results: Overall, 85.10% of the 208 subjects were female, with a median age of 36 years. sNfL levels were higher in the migraine group than in the control group (4.85 (3.49, 6.62) vs. 4.11 (3.22, 5.59)), but the difference was not significant (P = 0.133). The two groups showed an almost consistent trend in which sNfL levels increased significantly with age. Subgroup analysis showed a significant increase in sNfL levels in patients with a migraine course ≥ 10 years (β = 0.693 (0.168, 1.220), P = 0.010). Regression analysis results show that age and migraine course are independent risk factors for elevated sNfL levels, and there is an interaction between the two factors. Patients aged < 45 years and with a migraine course ≥ 10 years have significantly increased sNfL levels. Conclusions: This is the first study to evaluate sNfL levels in migraine patients. The sNfL levels significantly increased in patients with a migraine course ≥ 10 years. More attention to nerve damage in young patients with a long course of migraine is required.

Ischemic stroke is the most common neurological disease. Previous researches have proven that ischemic lesion topography in specific brain structural regions and vascular territories are critical for outcome prediction and personalized treatment plan making. Compared to traditional two-dimensional visualization, computerized three-dimensional visualization provides more complete and interactive information regarding the ischemic lesion topography. In this paper, we propose a fast-processing pipeline for three-dimensional visualization of ischemic lesion topography. The pipeline is able to achieve in average 80.3% similarity with the traditional pipeline in terms of dice score while greatly shorten the processing time.

Studies have shown that addictive behavior is associated with many brain regions, such as the insula, globus pallidus, amygdala, nucleus accumbens, and midbrain dopamine system, but only a few studies have explored the role of the dorsal striatum in addictive behavior. In June 2020, we started contacting 608 patients who were hospitalized between January 2017 and December 2019, and we recruited 11 smoking addicts with dorsal striatum damage and 20 controls with brain damage that did not involve the dorsal striatum (the damaged areas included the frontal lobe, temporal lobe, parietal lobe, brain stem, thalamus, internal capsule, and so on). All study participants had brain damage due to acute cerebral infarction. Disruption of smoking addiction was found to be significantly associated with the dorsal striatum (Phi = 0.794770, P = 0.000015). Our findings suggested that patients in the dorsal striatum group were more likely to discontinue smoking than those in the non-dorsal striatum group. The characteristics of this interruption is that smoking can be quit more easily and quickly without recurrence and that the impulse to smoke is reduced. These results suggest that the dorsal striatum is a key area for addiction to smoking.

White matter lesions known as leukoaraiosis (LA) are cerebral white matter hyperintensities observed in elderly individuals. Currently, no reliable molecular biomarkers are available for monitoring their progression over time. To identify biomarkers for the onset and progression of LA, we analyzed whole blood-based, microRNA expression profiles of leukoaraiosis, validated those exhibiting significant microRNA changes in clinical subjects by means of quantitative real-time polymerase chain reactions and determined the function of miRNA in cell lines by means of microRNA mimic transfection assays. A total of seven microRNAs were found to be significantly down-regulated in leukoaraiosis. Among the microRNAs, hsa-miR-1972 was downregulated during the early onset phase of leukoaraiosis, as confirmed in independent patients, and it was found to target leukoaraiosis-dependent BAIAP3, decreasing its expression in 293T cell lines. Functional enrichment analysis revealed that significantly dysregulated miRNAs-mRNAs changes associated with the onset of leukoaraiosis were involved in neurogenesis, neuronal development, and differentiation. Taken together, the study identified a set of candidate microRNA biomarkers that may usefully monitor the onset and progression of leukoaraiosis. Given the enrichment of leukoaraiosis-associated microRNAs and mRNAs in neuron part and membrane system, BAIAP3 could potentially represent a novel target of hsa-miR-1972 in leukoaraiosis through which microRNAs are involved in the pathogenesis of white matter lesions.