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Background: Poststroke cognitive impairment (PSCI) is a prevalent complication among stroke survivors. Although the systemic inflammatory response index (SIRI) has been shown to be a reliable predictor of a variety of inflammatory diseases, the association between the SIRI and PSCI is still unclear. Therefore, the purpose of this study was to investigate the relationship between SIRI and PSCI, and to design a nomogram to predict the risk of PSCI in acute ischemic stroke (AIS) patients., Methods: A total of 1342 patients with AIS were included in the study. Using the Mini-Mental State Examination scale, patients were separated into PSCI and non-PSCI groups within 2 weeks of stroke. Clinical data and SIRI values were compared between the groups. We developed the optimal nomogram for predicting PSCI using multivariate logistic regression. Finally, the nomogram was validated using the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA)., Results: In total, 690 (51.4%) patients were diagnosed with PSCI. After adjusting for potential confounders, the SIRI (OR = 1.226, OR: 1.095-1.373, p < .001) was shown to be an independent risk factor for PSCI in the logistic regression analysis. The nomogram based on patient gender, age, admission National Institutes of Health Stroke Scale scores, education, diabetes mellitus, and SIRI had good discriminative ability with an area under the curve (AUC) of 0.716. The calibration curve and Hosmer-Lemeshow test revealed excellent predictive accuracy for the nomogram. Finally, the DCA showed the good clinical utility of the model., Conclusion: Increased SIRI on admission is correlated with PSCI, and the nomogram built with SIRI as one of the predictors can help identify PSCI early., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background: Initiation of early antithrombotic therapy after acute ischemic stroke (AIS) is crucial. We aimed to investigate whether early antithrombotic therapy influences early neurological deterioration (END) in AIS patients with postinterventional cerebral hyperdensity (PCHD) immediately after mechanical thrombectomy (MT)., Methods: We retrospectively analyzed 108 consecutive anterior circulation AIS patients with PCHD immediately after MT. All patients were divided into END group and non-END group and END was defined as an increase of four points or more on the postinterventional National Institutes of Health Stroke Scale (NIHSS) score within the first 72 h after MT. Early antithrombotic therapy was defined as patients with PCHD who received antithrombotic therapy within 24 h after MT. Statistical analyses were performed to evaluate the association between early antithrombotic therapy and the risk of END., Results: Among 108 patients, 27 (25%) patients developed END. Multivariate regression analysis revealed that early use of antithrombotic therapy (OR = 0.229, 95%CI = 0.083-0.626, P = 0.004) was an independent protector of END and postinterventional low density shadow exceeding 1/3 of the vascular territory (OR = 4.000, 95%CI = 1.157-13.834, P = 0.029) was an independent risk factor for END., Conclusion: Antithrombotic therapy within 24 h after MT maybe associated with the reduced risk of END in anterior circulation AIS patients with PCHD., (© 2023. The Author(s).)

Background: Stroke is one of the leading causes of death worldwide, especially in developing countries. In China, there is an urgent need to educate people about stroke awareness and the importance of using emergency medical services (EMS) quickly after a stroke has occurred., Objective: We sought to explore the effects of the Stroke 1-2-0 Prehospital Stroke Education System based on the experience of a general practitioner team., Method: We prospectively enrolled 119 community general practitioners to be trained in the procedures advocated by the Stroke 1-2-0 Prehospital Stroke Education System. The training content included early detection of ischemic stroke, first aid for stroke, and intravenous thrombolysis; The effects of the training were later evaluated via a before-and-after comparison. The 119 enrolled physicians formed a Stroke 1-2-0 lecturer group and taught stroke knowledge to community residents. The group remained active for 6 months, during which the medical treatment data of stroke patients (i.e., stroke onset time, prehospital delay, whether an ambulance was called, and whether thrombolytic therapy was performed) in each of 5 jurisdictions were recorded for the month before (January 2021) and that after (August 2021) the 6-month community education program. Finally, the effects of the community education program were evaluated., Results: The participants' understanding of intravenous thrombolysis in the treatment of acute ischemic stroke improved significantly after the training as compared with their earlier understanding (96% vs. 78.99%; P < .001), and their understanding of the time window for intravenous thrombolysis increased from 26.05% before to 72% (P < .001) after the training. Most of the participants (90% vs. 67.23%; P < .001) said that they would immediately call the 120 emergency number of China's emergency phone system if they encountered individuals who appeared to be victims of acute stroke. A total of 82 stroke patients were seen before and 67 after the community education program. As for the use of the emergency call system, more patients with stroke activated that system after the program versus before (21.95% vs. 37.31%; P = .04). The 3-hour arrival rate after the program was nearly three times higher than that before the program (62.69% vs. 19.51%; P < .001). Also, regarding receiving thrombolysis after the occurrence of a stroke, the program triggered a substantial increase compared with the total earlier (19.4% vs. 6.1%; P = .013)., Conclusion: We found that the Stroke 1-2-0 Prehospital Stroke Education System significantly improved community residents' knowledge regarding stroke., (© 2023. The Author(s).)

Introduction. The intestinal flora has become a promising new target in acute ischaemic stroke (AIS), and small intestinal bacterial overgrowth (SIBO) is a common pathological condition of the intestinal flora. Recently, the lactose hydrogen-methane breath test has emerged as a non-invasive and economical method for the detection of SIBO in AIS patients. Exploring the prevalence of SIBO and its associated risk factors will provide a clinical basis for the association between intestinal flora and AIS. Hypothesis/Gap Statement. Given that the prevalence of SIBO and its risk factors in patients with AIS remain to be studied, there is a need to investigate them. Aim. This study aimed to investigate the prevalence and risk factors of SIBO in patients with AIS Methodology. Eighty patients tested for SIBO using the lactulose hydrogen-methane breath test were evaluated. Patients were divided into SIBO-positive and SIBO-negative groups according to the presence or absence of SIBO, respectively. The baseline characteristics and clinical biochemical indicators of the patients were compared between the two groups. The independent risk factors and predictive value of SIBO in AIS patients were determined using multivariate logistic regression and receiver operating characteristic (ROC) curve analyses. Results. Of the 80 consecutive patients with AIS, 23 (28.8 %) tested positive for SIBO. Triglyceride (TG) and homocysteine (Hcy) levels were identified as independent risk factors for SIBO in patients with AIS using multivariate logistic regression analysis ( P <0.005). ROC curve analysis showed that the area under the curve (AUC) of TG was 0.690 (95 % CI 0.577-0.789, P =0.002). The sensitivity, specificity and optimal cut-off values were 95.7 %, 35.1 % and 1.14 mmol l -1 , respectively. The AUC of Hcy was 0.676 (95 % CI 0.562-0.776, P =0.01). The sensitivity, specificity and optimal cut-off values were 73.9 %, 59.7 % and 14.1 µmol -1 , respectively. When TG and Hcy levels were combined, the AUC increased to 0.764 (95 % CI 0.656-0.852, P <0.001). The specificity and sensitivity were 61.4 and 82.6 %, respectively. This showed that the combined detection of TG and Hcy levels had a higher predictive value Conclusion. The prevalence of SIBO in patients with AIS was 28.8 %. TG and Hcy levels are independent risk factors for SIBO in patients with AIS. Both markers had good predictive value for the occurrence of SIBO. In the future, we should actively utilize these indicators to prevent intestinal flora imbalance and the occurrence of SIBO.

Evidence for effects of the dose of recombinant tissue plasminogen activator(rt-PA) in Asian populations is inconclusive. The standard dose may cause drug waste and increase economic burden in developing country. Therefore, we preliminarily describe the safety and efficacy of a new modified dose of rt-PA regimen(0.6 or 0.9 mg/kg, with a maximum dose of 50 mg) in real world settings. 265 consecutive patients with ischemic stroke were treated with intravenous(IV) rt-PA alone from all the 323 consecutive patients treated with reperfusion therapy between January 1, 2017 and March 31, 2020. Safety and Efficacy was assessed by early neurological improvement(ENI), early neurological deterioration(END), symptomatic intracranial hemorrhage(sICH) and 90-day outcome defined by modified Rankin scale(mRS). Subgroup analysis was conducted to draw comparisons between different dose groups ([0.5,0.6)mg/kg, [0.6,0.7)mg/kg, [0.7,0.8)mg/kg, [0.8,0.9]mg/kg). Among the 265 patients, 150(56.60%) had a favorable outcome at 3 months(3 M); Mortality occurred in 17(6.40%) in 3 M; sICH in 12(4.50%); ENI in 70(26.40%); END 2 in 29(10.90%) and END 4 in 18(6.80%). In subgroup analysis, there was a significant difference in sICH that more patients developed sICH in [0.8-0.9]mg/kg group(P = 0.044) in univariate analysis of different dose. After adjusting, there was no significant difference between 4 dosage groups. Significant differences were seen in gender, atrial fibrillation and baseline NIHSS in the multivariable model of favorable outcome at 3 M. Our study preliminarily shows a good safety and efficacy of our modified rt-PA regimen, indicating that this regimen should be worthy of further study especially in developing country to reduce the financial burden of patients and avoid drug waste., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and Purpose: Age and stroke severity as 2 independent predictors have been included in many well-known prediction models. However, whether the model consisting of the 2 variables derived from early arrival group could bring equal clinical benefit for those patients presented late was unclear. This study aimed to investigate the performance of this transformation., Methods: We enrolled ischemic stroke patients admitted to our stroke center within 3 days after symptom onset from January 1, 2018 to March 31, 2019.These patients were divided into 2 groups, early arrival group within 6 hours after onset and late arrival group between 6 hours and 3 days. Two multivariate logistic regression models were developed consisting of the variable age and stroke severity. The primary outcome was the unfavorable outcome which defined as modified Rankin Scale score of 3-6. The differences of the performance of the models were compared through 3 aspects (discrimination, calibration, and clinical utility)., Results: Five-hundred seventeen ischemic stroke patients were included in our study. There were 258 patients reached in our stroke center within 6 hours while 259 patients were not. The area under the curve were .78 (95% confidence interval .70-.87) for the model developed in the early arrival group and .82 (95% confidence interval .73-.90) for the model developed in the late arrival group respectively. The models calibrated well in the late arrival group. As for clinical utility, the net benefit of the model developed in the early group was only slightly lower than the model developed in the late arrival group., Conclusions: The prediction model consisting of the variable age and stroke severity derived from the early arrival group patients had the potential to be applied directly in the patients presented late., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The evidence for the association between white matter hyperintensity (WMH) severity and neurological deterioration (ND) in patients with single subcortical infarction (SSI) remains unclear and whether the association between them is modified by anterior circulation parent artery steno‐occlusion (PAS) is unknown. Herein, we aimed to prospectively investigate the internal relevance. Methods: In this prospective study, the severity of WMH and PAS were assessed in 288 consecutive patients with anterior circulation SSI arriving at our hospital, a tertiary teaching hospital affiliated with Fudan University, 24 h after onset from January 2017 to December 2018. The multivariable logistic regression model was used to estimate the association between WMH severity and the risk of ND within 7 days after stroke onset as well as the interactive effect between WMH severity and PAS on ND among patients with SSI. Results: PAS modified the association between WMH severity and ND among patients with SSI (pinteraction =.029). After multivariate adjustment, the odds ratios of moderate‐severe WMH associated with ND were 1.61 (95% CI, 0.50–5.19; ptrend =.428) for patients with PAS, and 0.37 (95% CI, 0.14–0.97; ptrend =.043) for those without PAS. Adding WMH severity to conventional risk factors improved risk prediction for ND in patients without PAS (net reclassification improvement: 48.2%, p =.005; integrated discrimination index: 2.5%, p =.004) but not in those with PAS. Conclusion: There was a modified effect of PAS on the association between WMH severity and ND within 7 days after stroke onset among patients with anterior circulation SSI, which deserves more research attention. WMH was negatively associated with ND in anterior circulation SSI patients without PAS. [ABSTRACT FROM AUTHOR]

Background and Purpose: To investigate the impact of the novel coronavirus disease 2019 (Covid-19) on the behavior of those seeking medical attention for community residents suspected of having had a transient ischemic attack (TIA) during the pandemic. Methods: This was a community-based cross-sectional study with residents living in two communities located in the suburb of Shanghai. A face-to-face interview was prospectively conducted from 20 May 2020 to 30 June 2020 between community physicians and the community residents. Suspected TIA that occurred during the pandemic was identified by symptoms recalled from the community residents. The behavior of seeking medical attention after the suspected TIA was investigated. Results: A total of 873 community residents (517 from the Wujing community and 356 from the Maqiao community) took part in face-to-face interviews. Among them, 143 (16.38%) suspected TIA cases were identified. Less than 20% of the community residents suspected of having a TIA went to the hospital during the Covid-19 pandemic. The most common reason for not seeking medical care during the pandemic was still that symptoms disappeared quickly (94.9%); however, the pandemic did have an impact on behavior. Fear of in-hospital infection (55.1%) and of complicated procedures involved in seeking medical attention during the pandemic (55.9%) made community residents hesitate to seek medical attention after the suspected TIA. Residents with a dual attack within 1 week or with aphasia or dysarthria were more likely to seek medical attention during the pandemic. Conclusion: Our study indicated that the Covid-19 pandemic negatively affected the behavior of those seeking medical attention among community residents with suspected TIA and this might explain part of the reduction in patients presenting with stroke or TIA observed from other reports. [ABSTRACT FROM AUTHOR]