Yuping Tang

The clinical significance and contribution of the lipid profile in atherosclerosis are well established. However, further investigation is needed in stroke patients, particularly regarding apolipoprotein B100 (ApoB100), a novel non-traditional lipid component in the lipid profile. To explore lipid parameters and their impact on stroke outcomes in patients with and without thrombolysis. We prospectively enrolled patients with acute ischemic stroke (AIS) at a single center, including those who did and did not receive thrombolysis. Participants were stratified into improvement (favorable outcome at 2 weeks) and non-improvement groups. Demographic, laboratory, imaging, and clinical scale data were compared between groups. Random forest analyses were used to evaluate the predictive value and importance of individual lipid measures: triglycerides, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), ApoB100, and lipoprotein(a), which better describe the internal characteristics of the profile. Complete data were available for 262 AIS patients, 165 of whom received thrombolysis. Plasma ApoB100 levels were significantly lower in the thrombolysis group (p < 0.001) and decreased ApoB100 levels were independently associated with 2-week stroke improvement (p = 0.009, OR = 0.89, 95% CI: 0.84–0.93). Random-forest feature-importance plots revealed that HDL and ApoB100 (each contributing > 15%) were the strongest lipid predictors of a favorable outcome, outperforming the other lipid variables. We found that thrombolysis is associated with ApoB100 decrease and a decrease in ApoB100 can predict the 2-week functional improvement in stroke. HDL and ApoB100 emerge as more important determinants of favorable AIS outcomes in this machine-learning analysis. These findings warrant external validation in multi-center trials. ChiCTR1800018315, 11/09/2018.

Ischemic stroke is a major health concern, particularly in patients with type 2 diabetes mellitus (T2DM), who are at elevated risk. This study aimed to evaluate the prognostic impact of glibenclamide pretreatment on patients with acute ischemic stroke and T2DM. A total of 122 patients with acute ischemic stroke and T2DM were retrospectively analyzed. Based on medication history, patients were categorized into the glibenclamide group (group 1, n = 54) and the control group (group 2, n = 68). Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional status was evaluated with the Barthel Index (BI) and modified Rankin Scale (mRS). Patients were followed for 3 months. At admission, group 1 demonstrated significantly better neurological function (lower NIHSS) and higher BI scores compared to group 2 (P < 0.05). At 3 months, mortality was 1.9% in group 1 and 5.9% in group 2, though this difference was not statistically significant (χ² = 0.430, P = 0.512). Adverse events occurred in 7.4% and 10.3% of patients in groups 1 and 2, respectively (P > 0.05), with no drug-related deaths or serious safety concerns. The incidence of hemorrhagic transformation also showed no significant difference (P > 0.05). However, group 1 showed significantly better functional outcomes at 3 months, with higher BI scores and lower mRS scores (P < 0.05), suggesting improved independence and neurological recovery. Glibenclamide pretreatment in patients with acute ischemic stroke and T2DM may confer clinical benefits by reducing stroke severity and enhancing post-stroke functional outcomes, without increasing adverse events.

Cerebral venous sinus thrombosis (CVST) is typically associated with a prothrombotic state of the blood, with its causative factors varying widely. Prior research has not reported the simultaneous occurrence of CVST and dural arteriovenous fistulas (DAVFs) as potentially resulting from genetic mutations. In this case report, we introduce a unique occurrence wherein a patient with a heterozygous mutation of the low-density lipoprotein receptor (LDLR) gene presented with CVST in conjunction with DAVFs. Presentation: A male patient, aged 51, sought treatment at our facility due to a consistent decline in cognitive functions accompanied by recurrent headaches. Comprehensive evaluations were administered, including neurological examinations, laboratory tests, magnetic resonance imaging, digital subtraction angiography, and whole exome sequencing. Digital subtraction angiography identified DAVFs in the patient’s right sigmoid sinus and an occlusion within the left transverse sinus. The whole exome sequencing of blood samples pinpointed a heterozygous mutation in the LDLR gene (NM_000527:exon12:c.C1747T:p.H583Y). Following the confirmed diagnosis of CVST and DAVFs, the patient underwent anticoagulant therapy combined with endovascular procedures — these comprised embolization of the arteriovenous fistula in the right sigmoid sinus and balloon dilation with stent implantation in the left transverse sinus. A six-month follow-up indicated a significant abatement in the patient’s symptoms. This report marks the first documented case of an LDLR gene mutation that could be associated with the onset of CVST and DAVFs. The mutation in the LDLR gene might foster a prothrombotic environment, facilitating the gradual emergence of CVST and the subsequent genesis of DAVFs.

Objectives: Insomnia was associated with cerebral structural changes and Alzheimer’s disease. However, associations among cerebral perfusion, insomnia with cerebral small vessel disease (CSVD), and cognitive performance were little investigated.Methods: This cross-sectional study included 89 patients with CSVDs and white matter hyperintensities (WMHs). They were dichotomized into the normal sleep and poor sleep group, according to Pittsburgh sleep quality index (PSQI). Baseline characteristics, cognitive performance, and cerebral blood flow (CBF) were measured and compared between the two groups. The association or correlation between cerebral perfusion, cognition, and insomnia was analyzed using binary logistic regression.Results: Our study found that declined MoCA score (P = .0317) was more prevalent in those with poor sleep. There was a statistical difference in the recall (P = .0342) of MMSE, the delayed recall (P = .0289) of MoCA between the two groups. Logistic regression analysis showed educational background (P < .001) and insomnia severity index (ISI) score (P = .039) were independently correlated with MoCA scores. Arterial spin labeling demonstrated that left hippocampal gray matter perfusion was significantly reduced (P = .0384) in the group with poor sleep. And, negative correlation was found between left hippocampal perfusion and PSQI scores.Conclusions: In the patients with CSVDs, insomnia severity was associated with cognitive decline. Left hippocampal gray matter perfusion was correlated with PSQI scores in CSVDs.

Background and Purpose: Cerebral small vessel damages and large artery atherosclerotic (LAA) stroke share many risk factors, such as inflammation, but little attention has been paid to the relationship between cerebral small vessel damages with inflammation in predicting large artery atherosclerotic stroke outcomes. Methods: We consecutively enrolled participants with LAA stroke and collected their baseline and follow-up data, especially the imaging markers of cerebral small vessel disease and C reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) levels. The primary outcomes were LAA stroke outcomes at 3-month and 1-year, the secondary outcomes poststroke hemorrhagic transformation, infarction recurrence, and mortality. Results: 864 participants were included to the final analysis. We found that only cerebral microbleed (CMB) with numbers greater than 5 can predict 3-month (p < 0.001) and 1-year (p < 0.01) outcomes in LAA stroke, furthermore when CMB is more than 5 plus NLR or CRP more than 3, the prediction in primary outcomes is significant (all p < 0.05), but not in secondary outcomes. Conclusions: Our multi-centered cohort study suggests that CMB counts > 5 were not associated with the prognosis of LAA stroke, and CMB counts > 5 with high levels of inflammation (NLR or CRP > 3) were associated with a poor prognosis of LAA stroke.

Background: Arterial calcification in the aortic arch, carotid bifurcation, or siphon on computed tomography was associated with cardiovascular disease. The association between arterial calcification prevalence and progression of branch atheromatous disease (BAD) in intracranial artery atherosclerosis was little investigated. Methods: This study included 310 patients with ischemic stroke from one stroke center. Patients were divided into BAD (110) and non-BAD groups (200). Baseline characteristics, lipids, and arterial calcification were measured. The primary outcome was the prevalence of arterial calcification in BAD progression, and the secondary outcome was the prevalence of calcification in arterial stenosis. The association or correlation among calcification prevalence, lipid markers, and BAD progression was analyzed using logistic regression, receiver operating characteristic curve, and linear regression. Results: Our study found that carotid siphon calcification on computed angiography was more prevalent ( P =0.01) in patients with BAD and also more prevalent ( P P =0.01). Furthermore, a strong linear correlation between oxidized lipid and calcification density was found (beta=−0.73, P =0.0048) in patients with BAD, a subtype (B-type) of intracranial arterial atherosclerotic disease. Conclusions: We found that carotid siphon calcification was associated with BAD and its computed tomography values could predict the symptomatic progression in patients with intracranial arterial atherosclerotic disease and BAD, indicating the important role of carotid calcification in B-type intracranial arterial atherosclerotic disease. Registration: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR1800018315

Background: Minimally invasive surgery for intracerebral hemorrhage (ICH) has been evaluated in clinical trials. Although meta-analyses on this topic have been performed in the past, recent trials have added important information to the results of the comparison. However, little work has been done to compare the effect of MIS and conventional treatment on patient prognosis, especially mortality.Methods: PubMed, EMBASE, Web of Science, Ovid, China National Knowledge Infrastructure, and ClinicalTrials.gov were searched on May 1, 2021, for randomized controlled trials of MIS for spontaneous ICH. The primary outcome was defined as death at follow-up, while the secondary outcome was defined as death in different comparisons between MIS and craniotomy (CT) or medication (Me).Results: The initial search yielded 12 high-quality randomized controlled trials involving 2,100 patients. We analyzed the odds ratios (ORs) for MIS compared with conventional treatment, including Me and conventional CT. The OR and confidence intervals (CIs) of the primary and secondary outcomes were 0.62 (0.45–0.85) for MIS vs. conventional treatment. We also conducted subgroup analyses and found that the ORs and CIs for MIS compared with that of conventional treatment in the short-term follow-up were 0.58 (0.42–0.80), and, in the long-term follow-up, was 0.67 (0.46–0.98); and found that ORs were 0.68 (0.48–0.98) for MIS vs. CT and 0.57 (0.41–0.79) for MIS vs. Me.Conclusions: This meta-analysis demonstrates that certain patients with ICH benefit in short- and long-term follow-up from MIS over other treatments, including open surgery and conventional Me.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/.

The current treatment spontaneous intracerebral hemorrhage (sICH) is limited. To determine the optimal time window for minimally invasive surgery in patients with sICH. sICH patients with a hematom...