Zefeng Tan

Background: Neuroprotective therapies are frequently used for acute ischemic stroke in China. We examined associations of neurologists’ self-rated familiarity, perceived importance, and benefit expectations with reported prescribing frequency. Methods: A hospital-based quota survey recruited attending-level or senior neurologists involved in acute ischemic stroke care across mainland China from May 27 to July 16, 2025. High-frequency use was defined as prescribing neuroprotective therapy to at least 60% of patients. High familiarity and importance were ratings of 4 or 5 on 5-level scales; consistently high benefit expectations required ratings of 4 or 5 in all 4 scenarios. Modified Poisson generalized estimating equations estimated adjusted prevalence ratios (PRs) with hospital-clustered robust standard errors. Results: Among 1982 neurologists from 251 hospitals, 1007 (50.8%) were men and 1745 (88.0%) practiced in tertiary hospitals. High-frequency use was reported by 1596 respondents (80.5%), high familiarity by 1006 (50.8%), and consistently high benefit expectations by 1290 (65.1%). Lower familiarity with high-frequency use was reported by 743 respondents (37.5%). High familiarity (adjusted PR, 1.053; 95% CI, 1.007–1.102), high perceived importance (adjusted PR, 1.294; 95% CI, 1.148–1.458), and consistently high benefit expectations (adjusted PR, 1.198; 95% CI, 1.131–1.269) were associated with high-frequency use after adjustment for demographic and professional characteristics. Conclusions: Frequent self-reported neuroprotective prescribing coexisted with lower self-rated familiarity in a substantial subgroup. Familiarity, perceived importance, and benefit expectations were associated with prescribing frequency. These cross-sectional, class-level measures cannot establish prescribing appropriateness or causality. Studies linking drug-specific observed prescribing to indications and patient outcomes are needed.

Background: Acute ischaemic stroke often leads to significant disability and mortality. Secondary brain injury caused by post-stroke immune and inflammatory responses worsens outcomes. Aim: To assess the efficacy and safety of low-frequency deep transcranial magnetic stimulation (LF-dTMS), delivered with an H4 coil to target the insular and prefrontal cortex, and its potential effects on neuroimmune activity and recovery. Design: This randomised, multicentre, open-label, parallel-group trial with blinded outcome assessment evaluates early LF-dTMS at 1 Hz using the H4 coil in adults with anterior-circulation acute ischaemic stroke treated within 48 hours of onset. Participants are randomly assigned in a 1:1 ratio to receive either standard care plus LF-dTMS or standard care alone. Active LF-dTMS is delivered as two sessions per day, 1200 pulses per session, for three consecutive days. Study outcomes: The primary efficacy outcome is the growth in infarct volume from baseline to day 3, measured by diffusion-weighted MRI. The primary safety outcome is symptomatic intracranial haemorrhage within 3 days of treatment. Secondary outcomes include the modified Rankin Scale and serious adverse events at 90 days. Exploratory analyses in a predefined subgroup will involve dynamic plasma proteomics and single-cell RNA sequencing of peripheral mononuclear cells to understand immune responses (days 0, 3, 7), as well as resting-state functional MRI to evaluate the effects of neuromodulation on brain network connectivity. Summary: This study will evaluate the feasibility, safety and preliminary efficacy of early LF-dTMS in acute stroke. It will provide proof-of-concept data on whether modulating post-stroke inflammation and neuroplasticity can improve outcomes. The findings will inform the design of a large definitive trial. Trial registration number: NCT06064734 .

Background: COL4As, a group of six homologous genes that encode the type IV collagen α chains (α1-α6), have been identified as the main components of the collagen network in brain basement membranes. The distribution and generation changes of type IV collagen have been reported during glioma progression, but its underlying function of COL4As in glioma was still unclear.Methods: Based on the data of TCGA glioma cohort, we analyzed the correlation of COL4A family genes with the clinical characteristics and prognosis of glioma patients. By performing correlation and functional enrichment analysis, the interaction network of COL4As and their related genes in glioma were constructed to demonstrate the functional differences between COL4A members. By further screening the COL4As downstream factors, we sorted out the COL4As coregulated gene that could be the independent prognostic factor for glioma.Results: We found the high expressions in COL4A1 and COL4A2 were positively related to a worse prognosis of glioma patient, while, in COL4A3 and COL4A4 were predicted to a better prognosis. However, none of COL4As could function as an independent prognostic factor for glioma. HMGA2 is a coregulatory target of COL4A members through the COL4As-H19/HOTRAI-miR148a/miR222-HMGA2 axis. By being involved in the infiltration of Th2 cells and macrophages, HMGA2 could serve as an independent prognostic biomarker for glioma.Conclusion: In summary, our study revealed a potential common target of COL4A members HMGA2, which could serve as a novel prognostic factor for the diagnosis and therapy of glioma.

Objective: This study aims to investigate the relationship between treatment delay and poor prognosis in acute myelitis of Neuromyelitis Optica Spectrum Disorder (NMOSD). Additionally, we seek to explore the related factors that contribute to poor prognosis, with the intention of providing more precise clinical guidance.Methods: We retrospectively analyzed the acute myelitis attacks of NMOSD patients who were continuously followed up or referred to our hospital from January 2018 to September 2022. We further calculated the proportion of clinical score improvement: (acute‐follow‐up)/(acute‐baseline); poor prognosis was assigned to 0%–33% improvement. The relationship between treatment delay and poor prognosis was evaluated with clustered Receiver Operating Characteristic (ROC) analysis. A Generalized linear mixed model was used to analyze the related factors.Results: This study included a total of 144 episodes of myelitis attacks, of which 21.5% (31/144) resulted in poor prognosis. Based on the results of the clustered ROC analysis, it has been determined that treatment delay holds significant predictive value for poor prognosis (p = 0.001), with the optimal cut‐off point being 15 days. The generalized linear mixed model revealed that factors contributing to poor prognosis in NMOSD myelitis include age (OR, 1.041; CI, 1.013–1.071; p = 0.004) and treatment delay (OR, 1.034; CI, 1.014–1.054; p = 0.001).Conclusion: Our results confirm the treatment delay and age as predictors of poor prognosis in acute myelitis of NMOSD.

Background: Intracranial atherosclerotic stenosis is a leading cause of ischemic stroke and recurrent events due to plaque instability. High‐resolution magnetic resonance imaging identifies plaque enhancement as a key marker of instability. This study evaluated the efficacy of combined high‐intensity statins and proprotein convertase subtilisin/kexin type 9 inhibitors in plaque stabilization. Methods: In this prospective, single‐arm study, patients with acute stroke and intracranial atherosclerotic stroke in the M1 segment of the middle cerebral artery or basilar artery were enrolled. After 24 weeks of intensive statin and evolocumab therapy, high‐resolution magnetic resonance imaging assessments of intracranial vessels were conducted at baseline and follow‐up. The primary end point was the change in stenosis degree; secondary end points included changes in plaque enhancement (contrast ratio) and plaque burden. Results: Thirty‐six patients (median age, 58 years) participated. After therapy, stenosis decreased from 75.9% (interquartile range, 69.5%–84.8%) to 65.3% (interquartile range, 53.8%–75.0%; P P 2 [interquartile range, 0.59–1.72 mm ² ] to 2.08 mm ² [interquartile range, 1.00–3.10 mm ² ]; P <0.001). No significant changes were observed in wall area, wall area index, or remodeling index. A notable correlation between the decrease in low‐density lipoprotein cholesterol/apolipoprotein B ratio and reduction in contrast volume was observed. Conclusions: Combining proprotein convertase subtilisin/kexin type 9 inhibitors with high‐intensity statins may improve plaque stability and reduce lumen stenosis in patients with intracranial atherosclerotic stenosis. Larger randomized controlled trials are needed to confirm these findings. Registration: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2200058029.

Background and Purpose: Single Small Subcortical Infarction (SSSI) is a subtype of ischemic stroke with unique pathophysiology, often leading to poor outcomes. This study investigates the association between admission hematocrit (HCT) levels and the risk of progressive stroke in SSSI patients. Methods: We conducted a retrospective cohort study using data from the China National Stroke Registry III, including 2,457 SSSI patients. Progressive stroke was defined as an increase in the NIHSS score by ≥2 points during hospitalization. Logistic regression models assessed the association between HCT levels and progressive stroke risk. Results: Among 2,457 SSSI patients, 135 (5.50%) experienced progressive stroke. Higher HCT levels were independently associated with a lower risk of progressive stroke (adjusted OR 0.983, 95% CI 0.973-0.994, P = 0.002), with a potential dose-response relationship. The protective effect was more pronounced in patients with severe sensory deficits (P for interaction = 0.013) and younger age (<65 years) (P for interaction = 0.037). Lower HCT levels were also independently associated with increased mortality risk within 3 months after stroke (adjusted OR 0.937, 95% CI 0.892-0.984, P < 0.001). Conclusions: Higher admission HCT levels are associated with a lower risk of progressive stroke in SSSI patients, particularly those with severe sensory deficits and younger age. Lower HCT levels may also increase early mortality risk. These findings highlight the importance of monitoring and optimizing HCT levels in SSSI management. Further research should explore the underlying mechanisms and therapeutic implications.

JOURNAL/nrgr/04.03/01300535-202405000-00048/inline-graphic1/v/2023-09-28T063346Z/r/image-tiff Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations. However, the ability of retinal vasculature changes, specifically focusing on retinal vessel diameter, to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively. While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events, they have not incorporated this information into a predictive model. Therefore, this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke. Additionally, we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors. We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University. All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years. We found that, after adjusting for related risk factors, patients with acute ischemic stroke with mean arteriolar diameter within 0.5–1.0 disc diameters of the disc margin (MAD_0.5–1.0DD) of ≥ 74.14 μm and mean venular diameter within 0.5–1.0 disc diameters of the disc margin (MVD_0.5–1.0DD) of ≥ 83.91 μm tended to experience recurrent cerebrovascular events. We established three multivariate Cox proportional hazard regression models: model 1 included traditional risk factors, model 2 added MAD_0.5–1.0DD to model 1, and model 3 added MVD_0.5–1.0DD to model 1. Model 3 had the greatest potential to predict subsequent cerebrovascular events, followed by model 2, and finally model 1. These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke, and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.