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Background Triglyceride glucose (TyG) index was recently reported to be associated with an increased risk of the development and recurrence of cardiovascular events, and atherosclerosis is a main speculative mechanism. However, data on the relationship between TyG index and atherosclerosis, especially in the setting of ischemic stroke, is rare. We aimed to explore the association between TyG index and carotid atherosclerosis in patients with ischemic stroke. Methods A total of 1523 ischemic stroke patients with TyG index and carotid artery imaging data were enrolled in this analysis. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Carotid atherosclerosis was measured by common carotid artery intima-media thickness (cIMT), and abnormal cIMT was defined as a mean cIMT and maximum cIMT value ≥ 1 mm. Multivariable logistic regression models and restricted cubic spline models were used to assess the relationships between TyG index and abnormal cIMT. Risk reclassification and calibration of models with TyG index were analyzed. Results The multivariable-adjusted odds ratios (95% CIs) in quartile 4 versus quartile 1 of TyG index were 1.56 (1.06–2.28) for abnormal mean cIMT and 1.46 (1.02–2.08) for abnormal maximum cIMT, respectively. There were linear relationships between TyG index and abnormal mean cIMT ( P for linearity = 0.005) and abnormal maximum cIMT ( P for linearity = 0.027). In addition, the TyG index provided incremental predictive capacity beyond established risk factors, shown by an increase in net reclassification improvement and integrated discrimination improvement (all P  < 0.05). Conclusions A higher TyG index was associated with carotid atherosclerosis measured by cIMT in patients with ischemic stroke, suggesting that TyG could be a promising atherosclerotic marker.

Necroptosis contributes to ischemia-induced brain injury. Tumor necrosis factor (TNF) receptor associated factor 2 (TRAF2) has been reported to suppress necroptotic cell death under several pathological conditions. In this study, we investigated the role of TRAF2 in experimental stroke using a mouse middle cerebral artery occlusion (MCAO) model and in vitro cellular models. TRAF2 expression in the ischemic brain was assessed with western blot and real-time RT-PCR. Gene knockdown of TRAF2 by lentivirus was utilized to investigate the role of TRAF2 in stroke outcomes. The expression of TRAF2 was significantly induced in the ischemic brain at 24 h after reperfusion, and neurons and microglia were two of the cellular sources of TRAF2 induction. Striatal knockdown of TRAF2 increased infarction size, cell death, microglial activation and the expression of pro-inflammatory markers at 24 h after reperfusion. TRAF2 expression and necroptosis were induced in mouse primary microglia treated with conditioned medium collected from neurons subject to oxygen and glucose deprivation (OGD) and in TNFα-treated mouse hippocampal neuronal HT-22 cells in the presence of the pan-caspase inhibitor Z-VAD. In addition, TRAF2 knockdown exacerbated microglial cell death and neuronal cell death under these conditions. Moreover, pre-treatment with a specific necroptosis inhibitor necrostatin-1 (nec-1) suppressed the cell death exacerbated by TRAF2 knockdown in the brain following MCAO, indicating that TRAF2 impacted ischemic brain damage through necroptosis mechanism. Taken together, our results demonstrate that TRAF2 is a novel regulator of cerebral ischemic injury.

Background The risk factors for ischemic stroke in young people are complex, varied and closely related to prognosis. This study aims to analyze the risk factors for ischemic stroke in Chinese young people and to explore the main factors influencing the prognosis. Method A total of 444 patients aged 16 to 45 years with ischemic stroke admitted to Suzhou tertiary hospital from 2011 to 2019 were retrospectively analyzed. Risk factors were identified according to the IPSS definition of pediatric stroke and the TOAST classification. All patients were followed up, and the modified Rankin score was used to evaluate the prognosis. Logistic regression analysis was used to explore the influencing factors of poor prognosis. Results Among the patients, 12 risk factors were found according to the IPSS definition of pediatric stroke, and 5 types of stroke were found according to the TOAST classification. A total of 299 patients had a good prognosis. Anemia, venous sinus thrombosis, isolated large-vessel occlusion, and high baseline NIHSS score were significant risk factors. Conclusion The IPSS definition enables patients to be classified on the basis of more risk factors than other classification methods. The prognosis of ischemic stroke in young people is generally good in the 5 years following the event. Anemia, venous sinus thrombosis, isolated large-vessel occlusion and high baseline NIHSS score were associated with poor prognosis.

Background Migraine is an extremely prevalent and disabling primary neurological disease worldwide. Although multiple forms of patient education for migraine management have been employed in the past decades, the quality and reliability of headache-related online videos targeting migraine patients remained unclear, particularly those in China. Therefore, in this study, our research team aimed to explore the overall quality and credibility of online videos concerning patient education on migraine treatment in China Mainland. Methods A total of 182 online videos concerning migraine treatment were retrieved from four most popular Chinese language online video platforms, including Douyin, BiliBili, Haokan Video, and Xigua Video. Our research team collected the producer identity and basic information of these videos, and then used two major score instruments, i.e., the Global Quality Score (GQS) scale and the DISCERN questionnaire, to evaluate the quality and reliability of its content. Subsequently, overall descriptive analysis and detailed comparison among specific video platforms and producers were performed. Finally, using the Spearman correlation coefficient, we also explored the potential correlation between video general information and video quality and reliability. Results The overall quality and reliability of the migraine-related information provided by online videos were poor, yet those uploaded to Douyin were relatively more satisfactory. Among all study videos, 10 encouraged patients to keep a headache diary, 12 warned about the risk of medication overuse, and 32 emphasized the preventive treatment of chronic migraine. However, the treatment recommendations proposed by video creators were highly heterogenous, with the most frequently mentioned pharmacological, non-pharmacological, and traditional Chinese medicine measures being Triptans ( n  = 57, 31.3%), massage ( n  = 40, 22.0%), and acupuncture ( n  = 31, 17.0%), respectively. We also observed slight positive correlations between video quality and the numbers of likes and comments received. Conclusions The results of our research revealed that the quality and reliability of Chinese language online videos focused on patient education for migraine treatment were inadequate, suggesting that viewers should treat these contents with caution. However, the prospects for video-based patient education remain promising. Implementing appropriate strategies, such as strengthening regulations on health-related videos and instituting a review process conducted by medical professionals, may elevate the overall quality and trustworthiness of medical information shared through online video platforms.

Background Serum uric acid (UA) and the neutrophil-to-lymphocyte ratio (NLR) have been reported to be associated with outcomes in acute ischemic stroke (AIS). However, whether UA is related to the prognosis of AIS patients undergoing intravenous thrombolysis (IVT) remains inconclusive. We sought to explore the combined effect of UA and NLR on the prognosis of AIS treated with IVT. Methods A total of 555 AIS patients receiving IVT treatment were enrolled. Patients were categorized into four groups according to the levels of UA and NLR: LNNU (low NLR and normal UA), LNHU (low NLR and high UA), HNNU (high NLR and normal UA), and HNHU (high NLR and high UA). Multivariable logistic regression analysis was used to evaluate the value of serum UA level and NLR in predicting prognosis. The primary outcomes were major disability (modified Rankin scale (mRS) score 3–5) and death within 3 months. Results After multivariate adjustment, a high NLR (≥ 3.94) increased the risk of 3-month death or major disability (OR, 2.23; 95% CI, 1.42 to 3.55, p  < 0.001). However, there was no statistically significant association between a high UA level (≥ 313.00 µmol/L) and clinical outcome. HNHU was associated with a 5.09-fold increase in the risk of death (OR, 5.09; 95% CI, 1.31–19.83; P value = 0.019) and a 1.98-fold increase in the risk of major disability (OR, 1.98; 95% CI 1.07–3.68; P value = 0.030) in comparison to LNNU. Conclusions High serum UA levels combined with high NLR were independently associated with 3-month death and major disability in AIS patients after IVT.

Background Mechanical thrombectomy (MT) has been proven as an effective and safe therapy for patients with acute ischemic stroke from large vessel occlusion. However, there is still a controversial topic about post-procedural management including blood pressure (BP). Methods A total of 294 patients who received MT in Second Affiliated Hospital of Soochow University from April 2017 to September 2021 were included consecutively. The association of blood pressure parameters (BPV and hypotension time) with poor functional outcome was evaluated using logistic regression models. Meanwhile, the effects of BP parameters on mortality was analyzed using cox proportional hazards regression models. Furthermore, the corresponding multiplicative term was added to the above models to study the interaction between BP parameters and CS. Results Two hundred ninety four patients were included finally. The mean age was 65.5 years. At the 3-month follow-up, 187(61.5%) had poor functional outcome and 70(23.0%) died. Regardless of the CS, BP CV is positively associated with poor outcome. Hypotension time was negatively associated with poor outcome. We conducted a subgroup analysis according to CS. BPV was significantly associated with mortality at 3-month and displayed a trend toward poor outcome for patients with poor CS only. The interaction between SBP CV and CS with respect to mortality after adjusting for confounding factors was statistically significant ( P for interaction = 0.025) and the interaction between MAP CV and CS with respect to mortality after multivariate adjustment was also statistically significant ( P for interaction = 0.005). Conclusion In MT-treated stroke patients, higher BPV in the first 72 h is significantly associated with poor functional outcome and mortality at 3-month regardless of CS. This association was also found for hypotension time. Further analysis showed CS modified the association between BPV and clinical prognosis. BPV displayed a trend toward poor outcome for patients with poor CS.

White matter hyperintensity (WMH) and brain atrophy, as imaging marker of cerebral small-vessel diseases (CSVD), have a high prevalence and strong prognostic value in stroke. We aimed to explore the association between lymphocyte count, a maker of inflammation, and WMH and brain atrophy in patients with acute ischemic stroke (AIS). A total of 727 AIS patients with lymphocyte count and brain magnetic resonance imaging data were enrolled. Participants were divided into four groups according to the quartiles of baseline lymphocyte counts. WMH is frequently divided into periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH). WMH was defined as Fazekas scale score ≥ 3; PVH was defined as periventricular Fazekas scale ≥2; DWMH was defined as deep Fazekas scale ≥2. Brain atrophy was defined as global cortical atrophy score ≥ 1. Multivariable logistic regression models were used to assess the association between lymphocyte count and WMH and brain atrophy. Among 727 AIS, 517 (71.1%), 442 (60.8%), 459 (63.1%), 583 (80.2%) had WMH, PVH, DWMH and brain atrophy, respectively. After adjustment for potential covariates, the highest quartiles of lymphocyte counts were significantly associated with lower risk of WMH (adjusted odds ratio [aOR] 0.57, 95% confidence intervals [CI] 0.32-0.99), PVH (aOR 0.52, 95% CI 0.31-0.87), DWMH (aOR 0.53 95% CI 0.32-0.90) as well as brain atrophy (aOR 0.46, 95% CI 0.23-0.92) compared with the lowest quartiles of lymphocyte counts, respectively. Furthermore, a notable inverse association was observed between continuous lymphocyte counts and WMH, PVH, DWMH, and brain atrophy. Additionally, we found that the inverse association between baseline lymphocyte count and WMH was significant only in individuals with mild stroke. In patients with AIS, there was an independent and inverse association between the baseline lymphocyte count and both WMH and brain atrophy.

Background High white blood cell (WBC) count and high blood glucose level are risk factors for mortality and pneumonia after acute ischemic stroke (AIS). We investigated the combined effect of high WBC count and high blood glucose level on hospital admission and in-hospital mortality and pneumonia in acute AIS patients. Methods A total of 3124 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of WBC count and blood glucose: NWNG (normal WBC count and normal glucose), NWHG (normal WBC count and higher glucose), HWNG (higher WBC count and normal glucose), and HWHG (higher WBC count and higher glucose). Cox proportional hazard model and logistic regression model were used to estimate the combined effect of WBC count and blood glucose on all-cause in-hospital mortality and pneumonia in AIS patients. Results HWHG was associated with a 2.22-fold increase in the risk of in-hospital mortality in comparison to NWNG (adjusted hazard ratio [HR] 2.22; 95% confidence interval [CI], 1.21–4.07; P trend = 0.003). The risk of pneumonia was significantly higher in patients with HWHG compared to those with NWNG (adjusted odds ratio [OR] 2.61; 95% CI, 1.66–4.10; P trend < 0.001). The C-statistic for the combined WBC count and blood glucose was higher than WBC count or blood glucose alone for prediction of in-hospital mortality and pneumonia (all p  < 0.01). Conclusions High WBC count combined with high blood glucose level at admission was independently associated with in-hospital mortality and pneumonia in AIS patients. Moreover, the combination of WBC count and blood glucose level appeared to be a better predictor than WBC count or blood glucose alone.

Background and purposeControversy persists over the balance of benefits and harms of early intensive blood pressure (BP) lowering in thrombolysis-treated acute ischaemic stroke (AIS) patients. The BP-control arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) (n=2196) showed that compared with guideline-recommended management (systolic BP (SBP)<180 mm Hg), intensive BP lowering did not improve functional outcome despite reducing intracranial haemorrhage. We aimed to evaluate the relationship between the BP parameters and cerebral oedema in ENCHANTED BP-control arm participants.MethodsENCHANTED was an international, multicentre, open-label, blinded outcome assessed, randomised controlled trial in thrombolysed AIS patients. All baseline and follow-up brain images were centrally analysed using standardised techniques and planimetric software by expert readers blind to clinical details. The severity of cerebral oedema was measured on a 7-point scale that ranged from 0 (no oedema) to 6 (most severe oedema); the primary outcome of ‘severe cerebral oedema’ defined by scores 4–6.Results1477 (67.3%) participants (mean age 67.7 years, 39.6% female) with available cerebral oedema data were included. Patients with a larger magnitude of SBP reduction in 1 hour had a lower odds of severe cerebral oedema (adjusted OR 0.72 per 10 mm Hg, 95% CI 0.53 to 0.98; p=0.04), whereas those with greater SBP variability between 1 hour and 24 hours had a shift towards worse cerebral oedema (adjusted OR 1.27 per 10 mm Hg, 95% CI 1.01 to 1.60; p=0.04).ConclusionAlthough the effect size is modest, achieving rapid lowering of SBP within 1 hour and then maintaining stable SBP over 24 hours appears to be associated with less cerebral oedema in thrombolysis-treated AIS patients.Clinical trial registrationThe trial is registered at ClinicalTrials.gov (NCT01422616).

Background The extent to which healthy lifestyle factors influence recurrent cardiovascular events in obstructive sleep apnea (OSA) patients is uncertain. To evaluate the association between adherence to baseline healthy lifestyle and the risk of recurrent cardiovascular events in OSA patients. Methods Post hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) study involving participants with moderate-to-severe OSA and established cardiovascular disease (CVD) who were randomized to continuous positive airway pressure (CPAP) plus usual care or usual care alone. We assigned a score ranging from 0 to 4 for each participant, based on the number of criteria met for the baseline health lifestyle factors of non-smoking, moderate-to-vigorous physical activity, ideal waist/hip ratio, and low-to-moderate alcohol consumption. Results In total, 2659 OSA patients with established CVD were included. The adjusted hazard ratios for participants with ≥ 2 healthy lifestyle factors compared with none were 0.64 (95% confidence interval [CI] 0.50–0.84) for composite cardiovascular events, 0.46 (0.28–0.74) for stroke, 0.65 (0.45–0.96) for hospitalization for unstable angina, 0.35 (0.19–0.63) for all-cause mortality, and 0.36 (0.16–0.79) for CVD death during a mean follow-up of 3.7 years. Each increment in healthy lifestyle factor score was associated with reduced risk of composite and separate cardiovascular events. A trend was found showing greater CPAP treatment benefit in those with more baseline healthy lifestyle for myocardial infarction and all-cause mortality; however, it did not reach statistical significance. Conclusions Greater adherence to an overall baseline healthy lifestyle is significantly associated with a lower risk of recurrent composite cardiovascular events in OSA patients with established CVD.