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Background: This study aimed to investigate the factors associated with the time that community-dwelling stroke survivors spent walking. Methods: We analyzed the cross-sectional data of 1534 community-dwelling stroke survivors from the Korean National Health and Nutrition Examination Survey. Complex-sample logistic regression analyses were performed to determine the factors associated with insufficient walking time (<90 min/wk). The mean time spent walking was examined according to age, sex, resistance exercise level, and self-reported disability using complex-sample general linear models. Results: Women (odds ratio [OR] 1.5; 95% confidence interval [CI], 1.0–2.3), current smokers (OR 1.7; 95% CI, 1.1–2.8), insufficient resistance exercise (OR 2.3; 95% CI, 1.5–3.5), and those with rural residences (OR 1.4; 95% CI, 1.0–1.9) were independently associated with insufficient walking time. The mean time spent walking was significantly lower in older adults aged ≥65 years than in young adults aged <65 years (200.0 ± 42.0 min/wk vs 287.2 ± 36.6 min/wk, P =.002), in women than in men (200.9 ± 44.9 vs 286.2 ± 37.7 min/wk, P =.027), and in individuals engaging in insufficient resistance exercise compared with those engaging in sufficient resistance exercise (203.2 ± 36.2 vs 283.9 ± 43.0 min/wk, P =.008). The mean walking time did not vary according to the presence of self-reported disabilities. Conclusions: Environmental and personal factors are associated with insufficient walking time in community-dwelling stroke survivors. [ABSTRACT FROM AUTHOR]

Objective: Advancements in neuroimaging technologies have significantly deepened our understanding of the neural physiopathology associated with stroke. Nevertheless, the majority of studies ignored the characteristics of dynamic changes in brain networks. The relationship between dynamic changes in brain networks and the severity of motor dysfunction after stroke needs further investigation. From the perspective of multilayer network module reconstruction, we aimed to explore the dynamic reorganization of the brain and its relationship with motor function in subcortical stroke patients. Methods: We recruited 35 healthy individuals and 50 stroke patients with unilateral limb motor dysfunction (further divided into mild-moderate group and severe group). Using dynamic multilayer network modularity analysis, we investigated changes in the dynamic modular reconfiguration of brain networks. Additionally, we assessed longitudinal clinical scale changes in stroke patients. Correlation and regression analyses were employed to explore the relationship between characteristic dynamic indicators and impairment and recovery of motor function, respectively. Results: We observed increased temporal flexibility in the Default Mode Network (DMN) and decreased recruitment of module reconfiguration in the Attention Network (AN), Sensorimotor Network (SMN), and DMN after stroke. We also observed reduced module loyalty following stroke. Additionally, correlation analysis showed that hyper-flexibility of the DMN was associated with better lower limb motor function performance in stroke patients with mild-to-moderate impairment. Regression analysis indicated that increased flexibility within the DMN and decreased recruitment coefficient within the AN may predict good lower limb function prognosis in patients with mild to moderate motor impairment. Conclusions: Our study revealed more frequent modular reconfiguration and hyperactive interaction of brain networks after stroke. Notably, dynamic modular remodeling was closely related to the impairment and recovery of motor function. Understanding the temporal module reconfiguration patterns in multilayer networks after stroke can provide valuable information for more targeted treatments. [ABSTRACT FROM AUTHOR]

Respective changes in neurovascular coupling (NVC) and glymphatic function have been reported in post-stroke depression (PSD). Recent studies have found a link between NVC and waste clearance by the glymphatic system, which has not been illustrated in PSD. We prospectively recruited ninety-six stroke patients and forty-four healthy controls (HC), with fifty-nine patients undergoing a second MRI scan. NVC metrics were investigated by exploring Pearson correlation coefficients and ratios between cerebral blood flow (CBF) and BOLD-derived quantitative maps (ALFF, fALFF, REHO maps). Diffusion tensor imaging along the perivascular (DTI-ALPS) index was used to reflect glymphatic function. We first analyzed the altered NVC metrics in stroke patients relative to the HC group. Then, we explored the relationship between NVC metrics, ALPS index and depressive symptoms at baseline and during the follow-up period through correlation and mediation analyses. Stroke patients exhibited significantly lower global CBF-fALFF coupling and ALPS index. At the regional level, abnormal NVC alterations in brain regions involved in cognition, emotion, and sensorimotor function in PSD. Baseline analyses showed that ALPS index exhibited positive associations with both global and local NVC and abnormal regional NVC may contribute to generation of PSD by reducing glymphatic function (β = −0.075, p < 0.05, CI = [−0.169 to −0.012]). Longitudinal analyses similarly showed that ALPS index changes were positively associated with changes in NVC and mediated improvements in depressive symptoms. Our findings suggest that NVC abnormalities leading to impaired glymphatic system function may be a potential neurobiological mechanism of PSD. • Stroke patients exhibit abnormal global and local neurovascular coupling (NVC) which is linked with depressive symptom. • Stroke patients show glymphatic dysfunction which is associated with depressive symptoms. • NVC abnormalities after stroke may contribute to depressive symptoms by reducing glymphatic function. • Recovery of NVC is consistent with recovery of glymphatic function after stroke. • Glymphatic function improvement mediates the link between the recovery of NVC and the amelioration of depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Stroke remains a leading cause of disability globally and movement impairment is the most common complication in stroke patients. Resting-state electroencephalography (EEG) microstate analysis is a non-invasive approach of whole-brain imaging based on the spatiotemporal pattern of the entire cerebral cortex. The present study aims to investigate microstate alterations in stroke patients. Methods: Resting-state EEG data collected from 24 stroke patients and 19 healthy controls matched by age and gender were subjected to microstate analysis. For four classic microstates labeled as class A, B, C and D, their temporal characteristics (duration, occurrence and coverage) and transition probabilities (TP) were extracted and compared between the two groups. Furthermore, we explored their correlations with clinical outcomes including the Fugl-Meyer assessment (FMA) and the action research arm test (ARAT) scores in stroke patients. Finally, we analyzed the relationship between the temporal characteristics and spectral power in frequency bands. False discovery rate (FDR) method was applied for correction of multiple comparisons. Results: Microstate analysis revealed that the stroke group had lower occurrence of microstate A which was regarded as the sensorimotor network (SMN) compared with the control group (p = 0.003, adjusted p = 0.036, t = -2.959). The TP from microstate A to microstate D had a significant positive correlation with the Fugl-Meyer assessment of lower extremity (FMA-LE) scores (p = 0.049, r = 0.406), but this finding did not survive FDR adjustment (adjusted p = 0.432). Additionally, the occurrence and the coverage of microstate B were negatively correlated with the power of delta band in the stroke group, which did not pass adjustment (p = 0.033, adjusted p = 0.790, r = -0.436; p = 0.026, adjusted p = 0.790, r = -0.454, respectively). Conclusions: Our results confirm the abnormal temporal dynamics of brain activity in stroke patients. The study provides further electrophysiological evidence for understanding the mechanism of brain motor functional reorganization after stroke. [ABSTRACT FROM AUTHOR]

Purpose: Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. Methods: An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. Results: Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. Conclusion: Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance. IMPLICATIONS FOR REHABILITATION: Exercise-based telerehabilitation for individuals with stroke can be delivered safely when clinicians are trained, and social support and program resources are available. Exercise-based telerehabilitation may be viable and accessible for men and women with stroke to extend the opportunity for rehabilitation services within the first year post-event. Synchronously delivered telerehabilitation programs using user-friendly videoconference software is recommended for optimal participant satisfaction. [ABSTRACT FROM AUTHOR]

Defining Moments is a podcast that extends the reach of articles published in Health Communication into public acoustic realms. In this essay, we locate Defining Moments in the broader realm of podcasting and highlight its inception, production, distribution, and impact through available data analytics. We approach podcasting as a relational experience in which meaning-making extends beyond any audio text to include reactions, interactions, and actions. Across three seasons and thirty-five episodes, the podcast has created space for scholars to translate research for general audiences and reflect on defining moments of their personal and professional lives, often situated in adverse experiences or unjust social contexts. Common to all episodes are stories of retrospective sensemaking in the service of prospective change. [ABSTRACT FROM AUTHOR]

Introduction: Restorative Brain–Computer Interfaces (BCIs) provide an alternative non-muscular channel for stroke patients lacking volitional movement by enhancing sensorimotor rhythm modulation through motor imagery (MI). MI practice can be augmented with embodied feedback via virtual reality (VR). However, the clinical impact of embodied VR-BCI training remains under-explored. Methods: This study examines the effects of embodied VR-BCI training on brain activity patterns (measured through EEG and fMRI) and clinical outcomes (assessed by the Fugl–Meyer Assessment, FMA) in four chronic stroke patients. Over a 3-week MI-BCI intervention, patients performed a bimanual rowing task (NeuRow) in VR. EEG data were used to extract Event-related desynchronization (ERD) and lateralization indices, while fMRI data focused on the primary motor (M1) and supplementary motor (SMA) regions of interest. Results: Results indicated that all patients significantly induced ERD power, though the affected side exhibited reduced ERD compared to baseline during contralateral MI. Post-intervention, significant ERD differences from both hemispheres were observed, with decreased ERD correlating with no clinical improvement. Patients showing decreased ERD lateralization had no FMA score improvement. Activity within ipsilesional M1 and SMA correlated with FMA scores. Conclusions: The findings suggest a relationship between brain activity and clinical outcomes, highlighting that increased ERD lateralization is associated with clinical improvement. [ABSTRACT FROM AUTHOR]

Cognitive impairment is common early after stroke but trajectories over the long term are variable. Some stroke survivors make a full recovery, while others retain a stable impairment or decline. This study explored the perceived advantages and disadvantages of discussing potential cognitive trajectories with stroke survivors and their family members. Stroke survivors at least six-months post-stroke were purposively sampled from an existing pool of research volunteers recruited originally for the OCS-Recovery study. They were invited, alongside a family member, to participate in a semi-structured interview. Interviews were audio recorded, transcribed, and analyzed using reflexive thematic analysis. Twenty-six stroke survivors and eleven family members participated. We identified one overarching theme and three related subthemes. The overarching theme was: One size does not fit all. The subthemes were: (1) Hearing about potential cognitive trajectories helps to develop realistic expectations; (2) Discussions about cognitive trajectories may be motivating; (3) Cognitive decline and post-stroke dementia discussions may be anxiety-provoking and depressing. Healthcare professionals should adopt a person-centred approach to sharing information about post-stroke cognitive trajectories. Discussions should be tailored to individual needs and preferences, with dementia-related topics in particular addressed with the utmost selectivity and sensitivity. [ABSTRACT FROM AUTHOR]

Background: Impairment of trunk control is a common problem after stroke, and trunk impairment may affect many functions such as breathing, speech, limb movements and transfers. Objective: The present study was aimed to investigate the effect of trunk control on sitting balance and upper extremity functions in individuals with subacute stroke. Methods: A total of 30 patients with subacute stroke (14 female, 16 male) were included in this study. The mean age of the included patients was 59.80 ± 13.22 years, and the mean disease duration was 2.90 ± 1.38 months. Trunk Impairment Scale (TIS), Trunk Control Test (TCT), Function in Sitting Test (FIST), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Brunnstrom Recovery Stages of Arm (BRS-A) and Brunnstrom Recovery Stages of Hand (BRS-H) were performed to the patients. Results: The results of our study showed that there was a strong positive correlation was found between TIS and FIST (r = 0.765, p < 0.001). There was also a positive moderate correlation between TCT and FIST, FMA-UE, BRS-A and BRS-H (r = 0.67, r = 0.49, r = 0.49, r = 0.44; p < 0.05; respectively). There was a positive moderate correlation between TIS and FMA-UE, BRS-A and BRS-H (r = 0.67, r = 0.65 and r = 0.58; p < 0.005; respectively). Conclusion: In conclusion, trunk control has been shown to be a factor associated with sitting balance and upper extremity function in patients with subacute stroke. [ABSTRACT FROM AUTHOR]

Background: Left ventricular assist device (LVAD) malposition has been linked to hemocompatibility‐related adverse events (HRAEs). This study aimed to identify preoperative anatomical landmarks and postoperative pump position, associated with HRAEs during LVAD support. Methods: Pre‐ and postoperative chest X‐ray measures (≤14 days pre‐implantation, first postoperative standing, 6, 12, 18, and 24 months post‐implantation) were analyzed for their association with HRAEs over 24 months in 33 HeartMate 3 (HM3) patients (15.2% female, age 66 (9.5) years). Results: HM3 patients with any HRAE showed significantly lower preoperative distances between left ventricle and thoracic outline (dLVT) (25.3 ± 10.2 mm vs. 40.3 ± 15.5 mm, p = 0.004). A ROC‐derived cutoff dLVT ≤ 29.2 mm provided 85.7% sensitivity and 72.2% specificity predicting any HRAE during HM3 support (76.2% (>29.2 mm) vs. 16.7% (≤29.2 mm) freedom from HRAE, p < 0.001) and significant differences in cardiothoracic ratio (0.58 ± 0.04 vs. 0.62 ± 0.04, p = 0.045). Postoperative X‐rays indicated lower pump depths in patients with ischemic strokes (9.1 ± 16.2 mm vs. 38.0 ± 18.5 mm, p = 0.007), reduced freedom from any neurological event (pump depth ≤ 28.7 mm: 45.5% vs. 94.1%, p = 0.004), and a significant correlation between pump depth and inflow cannula angle (r = 0.66, p < 0.001). Longitudinal changes were observed in heart‐pump width (F(4,60) = 5.61, p < 0.001). Conclusion: Preoperative X‐ray markers are associated with postoperative HRAE occurrence. Applying this knowledge in clinical practice may enhance risk stratification, guide therapy optimization, and improve HM3 recipient management. [ABSTRACT FROM AUTHOR]

Background and purpose: Ambulance trials assessing interventions in suspected stroke patients will recruit patients with currently active symptoms that will resolve into transient ischaemic attack (TIA). The safety and efficacy of glyceryl trinitrate (GTN) in the pre‐specified subgroup of patients with TIA in the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial 2 (RIGHT‐2) was assessed. Methods: RIGHT‐2 was a pre‐hospital‐initiated multicentre randomized sham‐controlled blinded‐endpoint trial that randomized patients with presumed ultra‐acute stroke within 4 h of symptom onset to transdermal GTN or sham. Final diagnosis was determined by site investigators. The primary outcome was a shift in modified Rankin Scale (mRS) scores at 90 days analysed using ordinal logistic regression reported as adjusted common odds ratio with 95% confidence intervals (CIs). Secondary outcomes included death or dependence (mRS >2). Results: In all, 109 of 1149 (9.5%) patients had a final diagnosis of TIA (GTN 57, sham 52) with mean age 73 (SD 13) years, 19 (17.4%) had pre‐morbid mRS >2, and onset to randomization was 80 min (interquartile range 49, 105). GTN lowered blood pressure by 7.4/5.2 mmHg compared with sham by hospital arrival. At day 90, GTN had no effect on shift in mRS scores (common odds ratio for increased dependence 1.47, 95% CI 0.70–3.11) but was associated with increased death or dependence (mRS >2): GTN 29 (51.8%) versus sham 23 (46.9%), odds ratio 3.86 (95% CI 1.09–13.59). Conclusions: Pre‐hospital ultra‐acute transdermal GTN did not improve overall functional outcome in patients with investigator‐diagnosed TIA compared with sham treatment. [ABSTRACT FROM AUTHOR]

Background and purpose: Elevated serum lipoprotein(a) (Lp[a]) levels have been linked to an increased incidence of stroke. This systematic review and meta‐analysis aimed to evaluate the impact of serum Lp(a) on the functional outcomes of patients with ischemic stroke (IS). Methods: We conducted a comprehensive search of the MEDLINE, Web of Science, Embase, Wanfang, and China National Knowledge Infrastructure databases to identify relevant cohort studies. A random effects model was utilized to synthesize the data, accounting for study heterogeneity. Results: The analysis included 11 cohort studies comprising 11,958 patients with IS. Pooled results indicated that high baseline Lp(a) levels were associated with an increased risk of poor functional outcomes during follow‐up (odds ratio [OR] = 2.13, 95% confidence interval = 1.67–2.71, p < 0.001, I2 = 62%). Subgroup analyses revealed that the relationship between high Lp(a) levels and the risk of poor functional outcomes was more pronounced at discharge (OR = 3.25), 3 months (OR = 2.02), and 6 months (OR = 2.11) poststroke, compared to 12 months (OR = 1.25, p for subgroup difference < 0.001). Furthermore, the association was attenuated yet remained significant in studies adjusting for low‐density lipoprotein cholesterol (LDL‐C) compared to those that did not adjust for LDL‐C (OR = 1.69 vs. 2.63, p for subgroup difference = 0.03). Conclusions: High serum Lp(a) levels at baseline are significantly associated with poor functional outcomes in patients with IS. [ABSTRACT FROM AUTHOR]

Background and purpose: Considering the reliance of serum uric acid (SUA) levels on renal clearance function, its role in stroke outcomes remains controversial. This study investigated the association of renal function–normalized SUA (SUA to serum creatinine ratio, SUA/SCr), a novel renal function index, with the 1‐year outcomes in patients with acute ischemic stroke (AIS). Methods: This is a prospective, multicenter observational study. Renal function–normalized SUA levels were determined by calculating the ratio of SUA to SCr. One‐year outcomes included stroke recurrence, all‐cause mortality, and poor prognosis. Multivariable Cox regression analyses and restriction cubic splines for curve fitting were used to evaluate SUA/SCr's association with 1‐year stroke outcomes. Results: Among 2294 enrolled patients, after adjustment for potential confounders, multivariable Cox regression analyses showed that each one‐unit increase in SUA/SCr corresponded to a 19% decrease in 1‐year stroke recurrence in patients with AIS. SUA/SCr was analyzed as a continuous variable and categorized into quartiles (Q1–Q4). Compared with the Q1 reference group, Q2, Q3, and Q4 showed significantly lower 1‐year stroke recurrence risks. The trend test indicated significant differences in the 1‐year stroke recurrence trend from Q1 to Q4. In these patients, SUA/SCr did not show a significant association with poor prognosis or all‐cause mortality. Curve fitting revealed SUA/SCr had a negative but nonlinear association with 1‐year stroke recurrence. Conclusions: In patients with AIS, low SUA/SCr may be an independent risk factor for 1‐year stroke recurrence. Changes in SUA/SCr had no significant impact on 1‐year poor prognosis and all‐cause mortality. [ABSTRACT FROM AUTHOR]

Background and purpose: Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance. Methods: A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke. After data extraction, experts rated the recommendations on dimensions of applicability, that is, actionability, feasibility and validity, on a 9‐point Likert scale. Agreement was defined as a score of ≥8 by ≥80% of the experts. Results: Eighteen articles were identified and 48 recommendations were ultimately extracted. Papers were included only if they described the whole acute care process for patients with ischaemic stroke. Data extraction and analysis revealed variation in terms of both content and comprehensiveness of this description. Experts reached agreement on 34 of 48 (70.8%) recommendations in the dimension actionability, for 16 (33.3%) in feasibility and for 15 (31.3%) in validity. Agreement on all three dimensions was reached for seven (14.6%) recommendations: use of a stroke unit, exclusion of intracerebral haemorrhage as differential diagnosis, administration of intravenous thrombolysis, performance of electrocardiography/cardiac evaluation, non‐invasive vascular examination, deep venous thrombosis prophylaxis and administration of statins if needed. Discussion and conclusion: Substantial variation in agreement was revealed on the three dimensions of the applicability of recommendations. This overview can guide stroke physicians in improving the care process and removing barriers where implementation may be hampered by validity and feasibility. [ABSTRACT FROM AUTHOR]

Objective: This pilot study aims to evaluate the combined impact of peripheral nerve mobilization (PNM) and virtual reality (VR) game-based gait training on gait parameters in chronic anterior cerebral artery (ACA) stroke patients. Methods: Eight chronic ACA stroke patients were randomized into experimental (PNM + VR) and control (conventional exercises) groups. Interventions were conducted for 45 min per session, five times a week, over 4 weeks. Gait parameters were measured using the OpenPose-based Markerless Gait Analysis System. Results: Both groups showed significant improvements in post-intervention measurements. The control group exhibited a mean increase in gait speed from 0.46 m/s to 0.62 m/s (p < 0.001), while the intervention group showed improvements from 0.41 m/s to 0.54 m/s (p < 0.001). Between-group analyses revealed significant differences in gait parameters post-intervention (p < 0.05). Conclusion: PNM and VR game-based gait training emerge as effective interventions for enhancing gait parameters in ACA stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Teleneurocritical care (TNCC) provides virtual care for hospitals who do not have continuous neurointensivist coverage. It is not known if TNCC is cost effective nor which variables impact the total billed charges per patient encounter. We characterize cost, defined by charge characteristics of TNCC compared to in-person neurocritical care (NCC), for patients with acute ischemic or hemorrhagic stroke requiring ICU care. Methods: We performed a retrospective review from 2018 to 2021 of prospectively collected multinstitutional databases from a large, integrated, not-for-profit health system with an in-person NCC and spoke TNCC sites. The primary outcome was the total billable charge per TNCC patient with acute ischemic or hemorrhagic stroke compared to in-person NCC. Secondary outcomes were functional outcome, transfer rate, and length of stay (LOS). Results: A total of 1779 patients met inclusion criteria, 1062 at the hub in-person NCC hospital and 717 at spoke TNCC hospitals. Total billed patient charges of TNCC were similar to in-person NCC (median 104% of the cost per in-person NCC patient, 95% CI: 99%–108%). From 2018 to 2021, the charge difference between TNCC and NCC was not different (r 2 = 0.71, p = 0.16). Both age and length stay were independently predictive of charges: for every year older the charge increased by US $6.3, and every day greater LOS the charge increased by $2084.3 (p < 0.001, both). TNCC transfer rates were low, and TNCC had shorter LOS and greater favorable functional outcome. Discussion: TNCC was associated with similar patient financial charges as compared to in-person NCC. Standardization of care and the integrated hub-spoke value-focused operational procedures of TNCC may be applicable to other healthcare systems, however, further prospective study is needed. [ABSTRACT FROM AUTHOR]

Previous studies have shown that intravenous normal saline (NS) may be associated with the incidence of acute kidney injury (AKI). This study aimed to evaluate the association between the volume of NS infusion and AKI in heat stroke (HS) patients. This multicenter retrospective cohort study included 138 patients with HS. The primary outcome was the incidence of AKI. Secondary outcomes included the need for continuous renal replacement therapy (CRRT), admission to the intensive care unit (ICU), length of stay in the ICU and hospital, and in-hospital mortality. Multivariate regression models, random forest imputation, and genetic and propensity score matching were used to explore the relationship between NS infusion and outcomes. The mean volume of NS infusion in the emergency department (ED) was 3.02 ± 1.45 L. During hospitalization, 33 patients (23.91%) suffered from AKI. In the multivariate model, as a continuous variable (per 1 L), the volume of NS infusion was associated with the incidence of AKI (OR, 2.51; 95% CI, 1.43–4.40; p =.001), admission to the ICU (OR, 3.46; 95% CI 1.58–7.54; p =.002), and length of stay in the ICU (β, 1.00 days; 95% CI, 0.44–1.56; p <.001) and hospital (β, 1.41 days; 95% CI, 0.37–2.45; p =.008). These relationships also existed in the forest imputation cohort and matching cohort. There were no differences in the use of CRRT or in-hospital mortality. The volume of NS infusion was associated with a significant increase in the incidence of AKI, admission to the ICU, and length of stay in the ICU and hospital among patients with HS. [ABSTRACT FROM AUTHOR]

Background: Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. Methods: This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. Results: Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. Conclusion: We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke. [ABSTRACT FROM AUTHOR]

Background: Research findings on skeletal muscle degeneration in post-stroke sarcopenic obesity are limited. Thus, this study aimed to investigate the association between post-stroke sarcopenic obesity and quantitative and qualitative changes in skeletal muscles. Methods: This was a cross-sectional study conducted on patients with stroke admitted to the convalescent rehabilitation ward. For skeletal muscle assessment, an ultrasound system was used to measure quadriceps muscle thickness and echo intensity (QMT and QEI) on the paretic and non-paretic sides. Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Multiple regression analysis was performed to determine the relationships between sarcopenic obesity and QMT and QEI. Results: A total of 130 patients with stroke were included in this study (mean age: 69.4 ± 12.7 years). The prevalence of sarcopenic obesity was 23.1%. The multiple regression analysis showed that sarcopenic obesity was significantly negatively associated with QMT on both the paretic and non-paretic sides (paretic side: β = −0.28, p < 0.001; non-paretic side: β = −0.37, p < 0.001) and significantly positively associated with QEI (paretic side β = 0.21, p = 0.034; non-paretic side: β = 0.20, p = 0.029). Conclusions: Post-stroke sarcopenic obesity was independently associated with quantitative and qualitative changes in skeletal muscles on both the paretic and non-paretic sides. [ABSTRACT FROM AUTHOR]

Background: Drop foot is common post-stroke, elevating fall risks and mobility limitations. It is caused by weakness and lack of control of the tibialis anterior muscle (TA), for which various rehabilitation treatments are used. A reliable objective estimate of changes in TA muscle morphology and composition can enhance treatment optimization. Objectives: We aimed to ascertain 3D freehand ultrasound (3DfUS) reliability in measuring TA muscle volume, length, and echo intensity in stroke patients and healthy controls and its validity by comparing these features across legs, between patients and controls, and between clinical subgroups (i.e. patients with and without ankle contracture, spastic muscle overactivity, and foot dorsiflexor paresis). Methods: We included 9 stroke patients and 9 healthy controls to define reliability and 26 stroke patients and 28 healthy controls to define validity. For reliability, data were collected and processed by 2 different operators and processors. For inter- and intra-rater reliability, intra-class correlation coefficient (ICC) and standard error of measurement (SEM) were used. For validity, Wilcoxon-Signed-Ranked and Mann-Whitney U tests were used for comparisons between groups and subgroups. Results: All measurements showed good to excellent inter- and intra-rater reliability (ICC: 0.816 to 0.997, SEM: 0.5% to 7.8%). Comparison analyses revealed no differences in muscle features among legs, groups, or subgroups. Conclusion: While the 3DfUS is a reliable method to define TA morphology and composition, its clinical validity needs further investigation into factors influencing muscle property changes across various age groups and post-stroke time points. MeSH terms: Stroke; Skeletal muscle morphology; muscle composition; 3D freehand ultrasonography, Anterior Tibial Muscle [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors. Methods: A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522). Result: A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy. Conclusions: This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors. Ethics approval: PROSPERO registration (CRD42023412522) [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to make the Turkish cultural adaptation of the the Stroke Activity Scale (SAS). Method: This study was designed as a methodological research. The psychometric properties of the SAS scale were evaluated by validity and reliability analyses. Results: The average age of 84 stroke patients (mean ± SD) was 59.52 ± 14.03 years. Kaiser-Meyer-Olkin (0.816) and Bartlett's Test of Sphericity (χ2 = 288.968, df = 10, p < 0.001) showed that the data set can be factored. A one-factor structure was obtained with Principal Component Analysis (PCA). The factor loads of the items obtained with PCA and Confirmatory Factor Analysis (CFA) were found to be statistically significant. The obtained chi-square statistics (χ2 = 2.227, p = 0.694), normalized chi-square/freedom (χ2/sd) value (0 ≤ 0.557 ≤ 2) and other goodness of fit indices showed good compliance. The positive highly significant correlation (r = 0.846, p < 0.001) between the SAS and Rivermead Mobility Index (RMI) scales confirmed the Concurrent validity. Cronbach's alpha (0.864) value showed high reliability and Intraclass Correlation Coefficient (ICC) value (0.983, p < 0.001) showed excellent agreement. Conclusions: In this study, which was conducted for the Turkish adaptation of the SAS scale, the 5-item and 1-factor structure was evaluated as a valid and reliable scale for evaluating the balance abilities of stroke patients living in Turkey. [ABSTRACT FROM AUTHOR]

Background: Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear. Objectives: This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. Methods: The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods. Results: The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05). Conclusions: The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: An increasing number of individuals with stroke are having difficulties in returning to work, having a significant impact on both individuals and society. The aims of this meta-analysis were to summarize the interventions to support the return to work (RTW) for individuals with stroke and to quantitatively evaluate the efficacy of each type of intervention. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched until 26 June 2023, and the list of references of the initially included articles was also searched. Two researchers independently performed the search, screening, selection, and data extraction. The primary outcome was RTW rate (the RTW rate was defined as the proportion of individuals who returned to work in each group (intervention and control) at the endpoint). Pooled risk ratio (RR) was estimated using a random-effects model with 95% confidence intervals (CIs). Results: A total of 13 studies representing 4,282 individuals with stroke were included in our study. Results showed that physiological interventions could improve the RTW rate of individuals with stroke (RR: 1.19, 95% CI: 1.01 to 1.42, I2 = 72%). And receiving intravenous thrombolytic therapy was beneficial in promoting the RTW in individuals with stroke. Subgroup analysis and meta-regression analysis showed that the individuals' functional status during hospitalization was the only source of heterogeneity. Psychological interventions had little or no effect on the RTW rate of individuals with stroke (RR: 1.20, 95% CI: 0.58 to 2.51, I2 = 30%). Work-related interventions had little or no effect on the RTW rate of the individuals with stroke (RR:1.36,95%CI: 0.99 to 1.88, I2 = 73%). The subgroup analysis showed that country, age, and follow-up method were the sources of heterogeneity. Conclusion: Physiological intervention promoted the RTW of individuals with stroke. But, the effect of psychological and work-related interventions in promoting the RTW of individuals with stroke was not significant. We anticipate that these findings may inform the design of future interventions. For future research, we recommend that more high-quality randomized controlled trials be conducted to further promote the RTW of individuals with stroke. Systematic Review Registration: PROSPERO Registration Number, CRD42023443668. [ABSTRACT FROM AUTHOR]

Objectives: Tenecteplase, a modified variant of alteplase with greater fibrin specificity and longer plasma half-life, may have better efficacy and safety than alteplase in patients with acute ischemic stroke (AIS). We aimed to compare the benefits and risks of tenecteplase versus alteplase in the treatment of AIS. Methods: Electronic databases were searched up to 10 February 2023 for randomized controlled trials evaluating the effect of tenecteplase versus alteplase in the treatment of AIS. The primary outcome was functional outcome at 90 days, and secondary outcomes including the symptomatic intracranial haemorrhage (SICH), and major neurological improvement. Subgroup analysis was performed based on the different dosage of tenecteplase. Results: Ten studies with a total of 5123 patients were analysed in this meta-analysis. Overall, no significant difference between tenecteplase and alteplase was observed for functional outcome at 90 days (excellent: OR 1.08, 95%CI 0.93-1.26, I² = 26%; good: OR 1.04, 95%CI 0.83-1.30, I² = 56%; poor: OR 0.95, 95%CI 0.75-1.21, I² = 31%), SICH (OR 1.12, 95%CI 0.79-1.59, I² = 0%), and early major neurological improvement (OR 1.26, 95%CI 0.80-1.96, I² = 65%). The subgroup analysis suggested that the 0.25 mg/kg dose of tenecteplase had potentially greater efficacy and lower symptomatic intracerebral haemorrhage risk compared with 0.25mg/kg dose tenecteplase. Conclusions: Among AIS patients, there was no significant difference on clinical outcomes between tenecteplase and alteplase. Subgroup analysis demonstrated that 0.25mg/kg doses of tenecteplase were more beneficial than 0.4 mg/kg doses of tenecteplase. Further studies are required to identify the optimal dosage of tenecteplase. [ABSTRACT FROM AUTHOR]

Background: The benefit of oral anticoagulation in atrial fibrillation (AF) is well established for patients at elevated stroke risk, but less clear for those at intermediate risk. We investigated whether analysis of electrocardiogram (ECG) derived fibrillatory waves (F-waves) could help identify patients at risk for stroke and systemic embolism (SSE). Methods: The Finnish Cardioversion (FinCV) study included patients not on permanent anticoagulation therapy who underwent cardioversion for an acute AF episode. We identified 739 individuals with a valid ECG and complete follow-up data. The maximum amplitudes of the F-waves in leads II and V1 were manually measured from the pre-procedure ECG. Patients were categorized into fine and coarse F-wave groups. The optimal lead and amplitude threshold for grouping were found in an events per person-years analysis. SSE were identified from the patient medical records until either anticoagulation was prescribed, AF was deemed chronic, the patient had deceased, or the end of follow-up. Results: Overall 37 (5.0%) patients suffered SSE during the median follow-up time of 5.4years (1.9-10.8). Measured from lead V1 the SSE rates per 100 person-years were 1.5 and 0.7 in fine and coarse F-wave groups, respectively. Fine F-waves were observed in 112 (15.2%). Baseline characteristics were similar between the groups. Fine F-wave predicted SSE in a competing risk analysis (SHR 2.34, 95%CI 1.12-4.87, p=.023). Analyses from lead II did not provide significant results. Conclusion: Electrocardiographic F-wave amplitude may provide additional information on stroke risk in patients with paroxysmal AF and borderline indications or contraindications for anticoagulation. [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusions Physical activity (PA) is associated with lower risk of stroke and better functional outcome. However, low levels of PA after stroke are prevalent. The aim was to identify predictors of PA change after first‐time ischaemic stroke and to develop prediction models to predict change in PA.Pre‐stroke and 6 months post‐stroke PA were quantified with the Physical Activity Scale for the Elderly (PASE). Considered predictors were clinical data and demographics including data on socioeconomic status (SES). PASE change was analysed using mixed models of repeated measures. Elastic net regression models were used to predict decrease from higher PASE quartile to the lowest and increase from lowest to higher.A total of 523 first‐time ischaemic stroke patients were included. Median (interquartile range, IQR) age was 69 years (IQR 59, 77), 181 (35%) were female and median National Institutes of Health Stroke Scale score was 3 (IQR 2, 5). Overall PASE score did not change, but 20% of patients decreased to the lowest PASE quartile whereas 48% from the lowest quartile increased to a higher. Prediction performance measured by area under the receiver operating curve was 0.679 for PA decrease and 0.619 for increase. SES factors were the most consistent predictors.Half of the least active patients increased PA level after stroke whereas a fifth decreased with SES being the most consistent predictor. Despite comprehensive data, the prediction models only performed modestly. Efforts to optimize PA should include all stroke survivors to increase PA for least active patients and to prevent PA decrease. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Objectives Methods Results Conclusion Recent studies have demonstrated that early rhythm control for first‐line treatment of atrial fibrillation (AF) improved cardiovascular outcomes. However, there is limited data regarding the long‐term outcome of patients who failed antiarrhythmic drugs and who refuse radiofrequency catheter ablation (RFCA).Patients with AF who were refractory to antiarrhythmic drugs and had refused further rhythm control attempts via RFCA were retrospectively identified and propensity‐score (PS) matched with those who had been treated with RFCA. The primary outcome of interest was all‐cause mortality or ischemic stroke.A total of 169 patients who refused rhythm control with RFCA and PS matched 169 patients who had been treated with RFCA were included for analysis. During a mean follow‐up of 4.3 (2.3;6.9) years, maintenance of sinus rhythm was more achieved in RFCA group (7 [4.1%] in Refuse group vs. 133 [78.7%] in RFCA group, p < 0.001). The incidence of ischemic stroke was significantly higher in patients who refused RFCA compared with patients who underwent RFCA (2.96 per 100 person‐years in the Refused group vs. 0.74 per 100 person‐years in the RFCA group, log‐rank p < 0.001), but all‐cause mortality was not significantly different (log‐rank p = 0.8). Refusal of attempted rhythm control via RFCA was an independent risk factor for ischemic stroke on multivariate Cox analysis (hazard ratio [HR] 3.2; 95% confidence interval [CI] 1.2–8.53, p = 0.02).In patients with antiarrhythmic drug‐refractory AF, the risk of stroke was significantly higher in patients who refused rhythm control via RFCA compared with that of those treated with RFCA. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Data Sources Design Methods Results Conclusion Impact Protocol Registration Reporting To integrate experiences and perceptions about stroke survivors during the transition from hospital‐to‐home care.Seven databases, including PubMed, Embase, Cochrane Library, Ovid, Web of Science, EBSCO and MEDLINE, were searched comprehensively from inception to March 2024, including qualitative studies published in English.A qualitative systematic review.The search followed the Preferred Reporting Items report for Systematic Reviews and Meta‐analysis (PRISMA 2020). The included research quality was assessed according to the Critical Appraisal Skills Programme (CASP). Meta‐aggregation was used to develop analytical themes. Confidence in the Evidence from the Reviews of Qualitative Research (GRADE‐CERQual) framework was applied to the findings.Fifteen qualitative studies were included, from which 54 findings were extracted. Similar findings were summarised into eight categories, resulting in four synthesised findings: Joy and sadness intertwined, Destruction of sense of self and life, External support and internal motivation, and Emotional longings and practical needs.Stroke can lead to devastating changes in survivors' sense of self and physically. Through external support from family members and healthcare professionals, as well as internal motivation to cope positively, stroke survivors positively accept and adapt to life. Meanwhile they still have high expectations for personal independence and reintegration into society.The review findings can guide health professionals, survivors and families in optimising care during the hospital‐to‐home transition.PROSPERO [CRD42024522555].ENTREQ.No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Collaterals improve recanalization in acute ischemic stroke patients treated with intravenous thrombolysis, but the mechanisms are poorly understood. To investigate it, an in vitro flow model of the middle cerebral artery was developed with or without collaterals. An occlusion was achieved using human blood clots. Recanalization time, thrombolysis (clot length decrease and red blood cell (RBC) release), pressure gradient across the clot and clot compaction were measured. Results showed that with or without collateral alteplase-treated RBC dominant clots showed recanalization time 98±23 min vs 130±35 min (difference 32 min, 95% CI -6-58 min), relative clot reduction 31.8±14.9% vs 30.3±13.2% (difference 1.5%, 95% CI 10.4–13.4%) and RBC release 0.30±0.07 vs 0.27±0.09 (difference 0.03, 95% CI 0.04–0.10). Similar results were observed with fibrin-dominant clots. In RBC dominant clots, the presence vs absence of collateral caused different pressure gradients across the clot 0.41±0.09 vs 0.70±0.09 mmHg (difference 0.29 mmHg, 95% CI -0.17–0.41 mmHg), and caused the reduction of initial clot compaction by 5%. These findings align with observations in patients, where collaterals shortened recanalization time. However, collaterals did not increase thrombolysis. Instead, they decreased the pressure gradient across the clot, resulting in less clot compaction and easier distal displacement of the clot. [ABSTRACT FROM AUTHOR]

Introduction: After severe ischemic stroke (IS), circulating levels of symmetric dimethylarginine (SDMA) increase. We investigated the early dynamics of SDMA in stroke to potentially aid with prehospital identification of severe IS from hemorrhagic stroke (HS). Methods: We performed targeted mass spectrometry (MS) measurements of SDMA in two sequential acute plasma samples (early and secondary) of 50 IS patients with LVO and 49 HS patients. Secondary samples of 227 IS and 84 HS patients with moderate to severe symptoms (NIHSS ≥ 7) subsequently underwent ELISA validation. Results: The median (IQR) last-known-well (LKW) to sampling times were 43 min (35–67) for early samples in the MS analysis, and 83 min (65–113) for secondary samples in MS and ELISA analyses. No inter-group differences existed in early samples, but IS patients had significantly higher mean (IQR) SDMA levels in secondary samples in both analyses: 5.8 (5.3–6.9) vs. 5.1 (4.2–5.8) A.U. for HS, p < 0.001, with MS; and 0.82 (0.72–1.01) vs. 0.71 (0.58–0.85) nmol/mL for HS, p < 0.001, with ELISA. For IS patients, higher SDMA levels were associated with cardioembolic stroke: 0.84 (0.73–1.09) vs. 0.79 (0.71–0.91) nmol/mL for other etiologies, p = 0.042, and poor outcome: modified Rankin Scale (mRS) 4–6; 0.90 (0.73–1.06) vs. 0.80 (0.72–0.97) nmol/mL for mRS 0–3 (p = 0.045). Conclusion: In a large clinical cohort of stroke patients with moderate to severe symptoms, our data suggest that SDMA can assist in differentiation of IS and HS patients already 1 h and a half after symptom onset. SDMA may prove to have future value in a diagnostic stroke biomarker panel. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The prediction of ischaemic stroke in patients with heart failure with reduced ejection fraction (HFrEF) but without atrial fibrillation (AF) remains challenging. Our aim was to evaluate the performance of machine learning (ML) in identifying the development of ischaemic stroke in this population.We performed a post‐hoc analysis of the WARCEF trial, only including patients without a history of AF. We evaluated the performance of 9 ML models for identifying incident stroke using metrics including area under the curve (AUC) and decision curve analysis. The importance of each feature used in the model was ranked by SAPley Additive exPlanations (SHAP) values.We included 2213 patients with HFrEF but without AF (mean age 58 ± 11 years; 80% male). Of these, 74 (3.3%) had an ischaemic stroke in sinus rhythm during a mean follow‐up of 3.3 ± 1.8 years. Out of the 29 patient‐demographics variables, 12 were selected for the ML training. Almost all ML models demonstrated high AUC values, outperforming the CHA2DS2‐VASc score (AUC: 0.643, 95% confidence interval [CI]: 0.512–0.767). The Support Vector Machine (SVM) and XGBoost models achieved the highest AUCs, with 0.874 (95% CI: 0.769–0.959) and 0.873 (95% CI: 0.783–0.953), respectively. The SVM and LightGBM consistently provided significant net clinical benefits. Key features consistently identified across these models were creatinine clearance (CrCl), blood urea nitrogen (BUN) and warfarin use.Machine‐learning models can be useful in identifying incident ischaemic strokes in patients with HFrEF but without AF. CrCl, BUN and warfarin use were the key features. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Relevance to Clinical Practice To analyse risk factors for early neurological damage in young and middle‐aged stroke cases.Totally 405 young and middle‐aged stroke patients in the neurocritical care unit (NCU) were selected and divided into the developmental (260 patients) and validation (145 patients) sets. The 405 cases were also grouped based on whether early neurological deterioration (END) occurred. The influencing factors of END were analysed by logistic regression, followed by the construction of a nomogram for predicting the risk of END. The Bootstrap method was applied to internally verify the predictive value of the model, using validation set data.Age, type of stroke, diabetes, mechanical ventilation, pulse, initial National Institute of Health stroke scale (NIHSS), Barthel index (BI), haemoglobin, hypersensitive C‐reactive protein (hs‐CRP), triglyceride glucose (TyG) index and CONUT showed statistically significant differences (p < 0.05). Logistic regression analysis revealed type of stroke, initial NIHSS, CONUT, TyG index and hs‐CRP were risk factors for END in young and middle‐aged stroke cases (OR > 1, p < 0.05). The area under the curve (AUC) for the developmental set was 0.842, and internal validation results showed a C‐index of 0.843; the AUC for the validation set was 0.843.The nomogram constructed in this study has good predictive efficacy and can provide reference for early clinical prediction of END in young and middle‐aged stroke cases.The importance of this research lies in shedding light on the significant impact of early neurological deterioration on the health outcomes of young and middle‐aged stroke patients, particularly in the short term. To guide clinical workers to identify risk factors early and improve the prognosis of stroke patients. [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation Carotid intraplaque neovascularization (IPN) detected by contrast‐enhanced ultrasound (CEUS) is a risk factor for recurrent ischemic stroke. However, it is still unclear whether IPN can be used to accurately identify patients with recurrent ischemic stroke in clinical practice. Herein, we investigated the clinical predictive value of IPN for recurrent ischemic stroke in a real‐world setting.We enrolled 200 patients with ischemic stroke and atherosclerotic carotid stenosis who were followed up for 2 years. The endpoint was recurrent ischemic stroke. Cox regression and subgroup analyses were employed to assess whether treatment affected the relationship between IPN and recurrent ischemic stroke. The net classification index (NRI) and integrated discriminant improvement index (IDI) were used to validate the additional clinical value of IPN in identifying recurrent ischemic stroke.During the 2‐year follow‐up, 36 patients experienced recurrent ischemic stroke. Cox regression analyses showed that IPN (grade 2), hypoechoic plaque, high homocysteine levels, and smoking were independent risk factors for recurrent ischemic stroke. Additional IPN evaluation may increase the NRI (0.512; 95% confidence interval [CI]: 0.083–0.624) and IDI (0.151; 95% CI: 0.010–0.213) for identifying high‐risk patients with recurrent ischemic stroke. In addition, in the subgroup undergoing revascularization, the proportion of IPN (grade 2) was significantly higher in patients with recurrent ischemic stroke than in patients with nonrecurrent ischemic stroke (p = 0.001).In clinical settings, IPN, assessed by CEUS, may provide additional clinical value for predicting recurrent ischemic stroke, helping to identify patients with ischemic stroke who require close follow‐up. [ABSTRACT FROM AUTHOR]

Background: Post-stroke delirium affects between 24% and 43% of patients, and negatively impacts patient outcomes. Recently, research attention has been on preventive interventions for delirium, with melatonin receptor agonists and orexin receptor antagonists reported to be effective in preventing delirium in intensive care unit patients. However, the efficacy of these agents in preventing post-stroke delirium remain unclear. This study examined the efficacy of ramelteon, suvorexant, and lemborexant in preventing post-stroke delirium symptoms in patients with stroke. Methods: A retrospective survey of medical records was conducted for patients with stroke aged > 75 years at Kyoto University Hospital from October 2021 to March 2023. Patients who received ramelteon, suvorexant, or lemborexant on admission and the following day were classified into the consecutive administration group, whereas those who did not were classified into the non-consecutive administration group. The primary outcome was an increase in the number of positive items in the delirium screening tool over 7 days. Results: Of the 104 patients, 33 and 71 were in the consecutive and non-consecutive administration groups, respectively. Fewer patients in the consecutive administration group had an increase in the number of positive items than in the other group (6% vs. 21%). Patients in the consecutive administration group significantly less often had an increase in the number of positive items in the delirium screening tool (P = 0.05; hazard ratio, 0.27; 95% confidence interval, 0.10–0.75). Conclusions: This study revealed that early administration of a melatonin receptor agonist or orexin receptor antagonists may effectively prevent post-stroke delirium in older patients. [ABSTRACT FROM AUTHOR]

Background: Post-stroke epilepsy (PSE) is a critical complication that worsens both prognosis and quality of life in patients with ischemic stroke. An interpretable machine learning model was developed to predict PSE using medical records from four hospitals in Chongqing. Methods: Medical records, imaging reports, and laboratory test results from 21,459 ischemic stroke patients were collected and analyzed. Univariable and multivariable statistical analyses identified key predictive factors. The dataset was split into a 70% training set and a 30% testing set. To address the class imbalance, the Synthetic Minority Oversampling Technique combined with Edited Nearest Neighbors was employed. Nine widely used machine learning algorithms were evaluated using relevant prediction metrics, with SHAP (SHapley Additive exPlanations) used to interpret the model and assess the contributions of different features. Results: Regression analyses revealed that complications such as hydrocephalus, cerebral hernia, and deep vein thrombosis, as well as specific brain regions (frontal, parietal, and temporal lobes), significantly contributed to PSE. Factors such as age, gender, NIH Stroke Scale (NIHSS) scores, and laboratory results like WBC count and D-dimer levels were associated with increased PSE risk. Tree-based methods like Random Forest, XGBoost, and LightGBM showed strong predictive performance, achieving an AUC of 0.99. Conclusions: The model accurately predicts PSE risk, with tree-based models demonstrating superior performance. NIHSS score, WBC count, and D-dimer were identified as the most crucial predictors. [ABSTRACT FROM AUTHOR]

Objective: Ginkgo diterpene lactone meglumine (GDLM) could improve the functional outcome after acute ischemic stroke (AIS). This study aimed to investigate the efficacy of GDLM on the quality of life in patients with AIS in China. Methods: This is a post hoc analysis of Efficacy and Safety of Ginkgo Diterpene Lactone Meglumine in Acute Ischemic Stroke trial. The quality of life was measured using the EuroQoL questionnaire, including EQ-5D and EQ visual analogue scale (EQ-VAS). The primary outcomes were changes in EQ-5D and EQ-VAS from baseline to day 14 and day 90 after randomization. Results: A total of 3219 patients with completed data on outcomes were enrolled, with median age of 63 years (interquartile range, 55–70) and 2,067 (64.2%) men. GDLM was associated with a significant decrease in scores of ED-5Q components (from 0 [no problem] to 3[extreme problem]), the mean difference between GDLM and placebo group was -0.14 for mobility, -0.11 for usual activities and self-care, -0.09 for pain/discomfort, and -0.34 for anxiety/depression on day 14, respectively. Similar results were observed on day 90. Additionally, there was statistically significant difference of changes in EQ-VAS between the GDLM group and the placebo group from baseline to day 14 (mean difference, 1.70; 95% confidence interval [CI], 0.78–2.62; P = 0.0003) and to day 90 after randomization (mean difference, 3.29; 95% CI, 2.37–4.22; P < 0.001). Conclusions: In this analysis of Chinese patients with AIS, GDLM could improve the 14-day and 90-day quality of life compared with the placebo. Trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02526225. Registration Date: 2016–02-01. [ABSTRACT FROM AUTHOR]

Numerous studies have suggested that the hemoglobin-to-red blood cell distribution width ratio (HRR) is associated with the onset, progression, and prognosis of various diseases. However, to the best of our knowledge, no research has conducted statistical analyses to determine the association between HRR and stroke. This cross-sectional study was conducted among adults with complete data on hemoglobin-red cell distribution width ratio (HRR) and stroke from the 2005–2018 National Health and Nutrition Examination Survey (NHANES). HRR was calculated by dividing hemoglobin (HGB) in grams per deciliter (g/dL) by the red blood cell distribution width (RDW). Weighted multivariable logistic regression and generalized additive models were employed to investigate the independent and nonlinear relationships between HRR and stroke. Threshold effects were assessed using two-piece linear regression models. Additionally, subgroup analyses and interaction tests were performed. A total of 36,215 participants were included, with 2.92% classified as stroke patients. The prevalence of stroke decreased across increasing tertiles of HRR (Q1: 5.07%; Q2: 2.63%; Q3: 1.69%; P < 0.0001). A negative association between HRR and stroke was observed in both unadjusted and adjusted models. In Model III, each one-unit increase in HRR was associated with a 58% reduction in the likelihood of stroke (Model III: OR = 0.42, 95% CI: 0.29–0.63). Subgroup analyses and interaction tests revealed that the association between HRR and stroke was BMI-dependent (P < 0.05), with the negative association only observed in participants with BMI < = 25 and BMI 25–30, but not in those with BMI > 30. Using a two-piece linear regression model, a threshold effect was identified at a BMI of 30 (K = 1.16). To the left of this breakpoint, there was a negative association between HRR and stroke (OR = 0.55, 95% CI: 0.27–0.97), whereas no such association was detected to the right of the breakpoint (OR = 6.49, 95% CI: 0.75–56.11). HRR is negatively associated with the likelihood of stroke, with a lower risk of stroke in individuals with higher HRR levels. [ABSTRACT FROM AUTHOR]

The utilization of motor imagery-based brain-computer interfaces (MI-BCI) has been shown to assist stroke patients activate motor regions in the brain. In particular, the brain regions activated by unilateral upper limb multi-task are more extensive, which is more beneficial for rehabilitation, but it also increases the difficulty of decoding. In this paper, self-attention convolutional neural network based partial prior transfer learning (SACNN-PPTL) is proposed to improve the classification performance of patients' MI multi-task. The backbone network of the algorithm is SACNN, which accords with the inherent features of electroencephalogram (EEG) and contains the temporal feature module, the spatial feature module and the feature generalization module. In addition, PPTL is introduced to transfer part of the target domain while preserving the generalization of the base model while improving the specificity of the target domain. In the experiment, five backbone networks and three training modes are selected as comparison algorithms. The experimental results show that SACNN-PPTL had a classification accuracy of 55.4%±0.17 in four types of MI tasks for 22 patients, which is significantly higher than comparison algorithms (P < 0.05). SACNN-PPTL effectively improves the decoding performance of MI tasks and promotes the development of BCI-based rehabilitation for unilateral upper limb. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionTo evaluate the cerebellar cognitive affective syndrome scale (CCAS-S) in patients with acute cerebellar stroke (ACS) and examine its relationship with the discharge destination.Patients with first-time ACS admitted to our hospital between April 2021 and April 2023 were included. The CCAS-S, Mini-Mental State Examination (MMSE), and Scale for the Assessment and Rating of Ataxia (SARA) were evaluated 1 week after stroke onset, and Functional Independence Measure (FIM)/Barthel Index (BI) at discharge, duration of hospitalization, and discharge destination were evaluated. The Mann–Whitney U test was used to compare CCAS-S and variables.Thirteen consecutive patients with ACS and age-matched comparison groups were included. The MMSE was within the normal range in all patients; however, patients with stroke had a lower total CCAS-S score (median 72, IQR 66–80) and a higher number of failed tests (median 4, IQR 3–5) than comparison. Significant deficits were observed in semantic fluency (p = 0.008), category switching (p = 0001), and similarity (p = 009). Definite CCAS were diagnosed 10 patients, respectively. Patients discharged home showed better SARA and FIM/BI but similar CCAS-S compared to those discharged to rehabilitation hospitals.In patients with ACS, it is the impairment of motor function, not CCAS, that affects discharge destination. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the prognostic significance of serum inflammatory factor levels in patients with acute ischemic stroke undergoing revascularization therapy.The study included 94 patients with acute ischemic stroke who underwent revascularization therapy at our hospital. The primary outcome was the modified Rankin scale (mRS) score assessed three months post-treatment. Patients were categorized into two groups: those with a poor prognosis (mRS score > 2) and those with a good prognosis (mRS score≤2). The patients were divided into two groups based on the type of revascularization treatment received: thrombus extraction or intravenous thrombolysis. Logistic regression analysis was used to identify independent risk factors associated with the prognosis of patients treated with recanalization for acute ischemic stroke.Among the 94 patients, 59 had a good prognosis, and 35 had a poor prognosis. At admission, the patients in the good prognosis group exhibited lower NIHSS scores, shorter hospital stays, fewer previous cardiac events, lower LDL levels, fasting glucose, IL-6, and TNF-a compared to those in the poor prognosis group (all P < 0.05). Logistic regression analysis identified TNF-a (odd ratio (OD), 1.623; 95% confidence interval (CI), 1.282–1.933; P = 0.035) and IL-6 (OD, 1.055; 95% CI, 1.024–1.088, P = 0.023) as independent risk factors for poor prognosis in patients after revascularization. Additionally, pre-hospital NIHSS scores, IL-6, and TNF-a levels were significantly lower in the good prognosis group compared to the poor prognosis group, with these differences being statistically significant.IL-6 and TNF-α may serve as prognostic markers for outcomes following revascularization therapy in patients with acute ischemic stroke, including those receiving intravenous thrombolysis. [ABSTRACT FROM AUTHOR]

Purpose: To identify Capabilities, Opportunities, and Motivational factors influencing movement behaviour throughout the day in people with stroke who are highly sedentary and inactive to enable intervention development. Methods: A qualitative study was conducted using semistructured interviews with people with stroke. The interview guide was based on the Capabilities, Opportunities, and Motivation Behavioural model. Results: Eleven interviews were conducted. Participants reported a lack of knowledge regarding healthy movement behaviour patterns, a lack of insight into their own movement behaviour, and some physical and cognitive limitations to engage in certain physical activities. Several social and environmental elements affecting movement behaviours were mentioned, their impact on movement behaviour varied among participants. Movement behaviour was mostly driven by habits and daily routine, without conscious regulation. Conclusion: Our findings show that people with stroke are unaware of their own movement behaviour or of the consequences of these behaviours on health. Movement behaviour is, for the most part, based on daily routine and personal habits. This indicates the need for a behaviour change intervention. Such interventions will need to include providing information about healthy movement behaviour, feedback on individual's movement behaviour and individualized support, taking into account the social and environmental context and personal capabilities. Implications for Rehabilitation: There is a need to provide insight and feedback regarding individuals' movement behaviour and information about healthy movement behaviour to enable people with stroke who are highly sedentary and inactive to improve their movement behaviour. Movement behaviour is, for the most part, based on daily routine and personal habits. People need individualised support, and personal capabilities, the social and environmental context need to be taken into account to support sustainable movement behaviour change. These findings can be used in clinical practise and to inform intervention development to support movement behaviour change in people after stroke who are highly sedentary and inactive. [ABSTRACT FROM AUTHOR]

Background: Up to 25% of patients suffering from an acute stroke are diagnosed with delirium during the hospital stay, with older age increasing the risk. Generalized slowing in the electroencephalogram (EEG) supports the diagnosis of delirium. We examined the potential of single-channel EEG (DeltaScan®) as an easy-to-use device on intensive care units for detecting delirium. Our aim was to investigate characteristics of bihemispheric EEG recordings and single-channel EEG in patients suffering from strokes with and without delirium and to analyze the diagnostic accuracy of EEG-based diagnoses. Methods: Within the first five days after stroke onset, patients received single-channel EEG DeltaScan® and a routine 21-channel EEG. The DeltaScan® analyzes right sided fronto-parietal EEG using a proprietary algorithm focusing on polymorphic delta activity (PDA). In routine EEG the power spectral density (PSD) in predefined frequency bands was analyzed based on 2-minute eyes-closed resting state segments. EEG-analyses were conducted in MNE (v1.3.1) in Python (3.10) and RStudio (v4.2.1). Results: In 9 of 53 patients (52–90 years) delirium was diagnosed according to DSM-V criteria. Sensitivity of DeltaScan® was 44% (95% CI = 15.3–77.3%), while specificity was 71% (95% CI = 57–83%). We found patients with right hemispheric stroke having a higher probability to be false positive in DeltaScan® (p = 0.01). The 21-channel EEG based power analysis revealed significant differences in frontal delta and theta power between patients with and without delirium (p < 0.05). Conclusions: When EEG is used in clinical practice to support a delirium diagnosis in stroke patients, bihemispheric recordings are likely preferable over unilateral recordings. Slowing in the delta- or theta-frequency spectrum over the site of stroke may lead to false-positive results in single channel EEG based delirium scoring. [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS‐LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with unfavorable 90‐day functional outcomes despite successful reperfusion. This study investigates the association between PVT and percent change on the National Institutes of Health Stroke Scale (NIHSS) among AIS‐LVO patients who have undergone successful reperfusion.We performed a retrospective analysis of prospectively collected data from consecutive adult AIS‐LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥10 s in the superior sagittal sinus, torcula, or both. The primary outcome was continuous NIHSS percent change and dichotomous NIHSS percent change ≥70%. Regression analyses were performed to assess the effect of PVT on NIHSS percent change.In 119 patients of median (IQR) age 71 (63–81) years, the admission and discharge NIHSS scores were significantly higher in PVT+ patients compared to PVT− patients (17 [14–23.5] vs. 13 [9.5–19], p = 0.011, and 7.5 [4–12] vs. 3 [1–7], p < 0.001, respectively). After adjusting for age, sex, hypertension, diabetes, atrial fibrillation, administration of intravenous thrombolysis (IVT), Alberta Stroke Program Early CT Scores (ASPECTS), mTICI 2c and/or 3, Tmax >6 s volume, and hemorrhagic transformation, PVT+ was significantly associated with lower NIHSS percent change (B = −0.163, 95%CI −0.326 to −0.001, p = 0.049) and was less likely to achieve higher than 70% NIHSS improvement (OR = 0.331, 95% CI 0.127–0.863, p = 0.024).PVT+ was significantly associated with reduced neurological improvement despite successful reperfusion in AIS‐LVO patients, highlighting the critical role of VO impairment in short‐term functional outcomes. These findings further validate PVT as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS‐LVO. [ABSTRACT FROM AUTHOR]

Background: Post-stroke depression (PSD) is a common mood disorder associated with stroke. By investigating the differences in life quality factors among stroke survivors, the results of this study offer insights into how to better prevent and manage the onset and progression of depression. Methods: This study is a cross-sectional study that selected patients receiving treatment in the Department of Rehabilitation Medicine at Hebei University Affiliated Hospital from September 1 to November 30, 2023. The inclusion criteria for this study were as follows: 1. Age ≥ 18 years; 2. Diagnosis of hemorrhagic or ischemic stroke confirmed by imaging examination. The exclusion criteria included: 1. A history of psychiatric disorders such as depression or anxiety prior to the onset of the illness; 2. History of psychiatric medication use before the onset; 3. Functional impairments, such as speech, cognitive, or consciousness disorders, that hinder cooperation with the survey questionnaire. Ultimately, a total of 131 patients were included in the study. Based on the results of the Patient Health Questionnaire-9 (PHQ-9), patients were divided into the PSD group and the non-PSD group. The primary evaluation metrics included the General Self-Efficacy Scale (GSES), Visual Analogue Scale (VAS), modified Rankin Scale (mRS), and Fatigue Assessment Scale (FAS), allowing for a comparison of demographic, clinical data, and evaluation metrics between the two groups. Statistical analysis was performed using SPSS version 25.0, and GraphPad Prism version 9.0 was used for graphical representations. Results: The morbidity rate of PSD in this study was 48%, which was slightly higher than the global statistical data. The demographic data did not show any statistical differences in terms of age, sex, history of smoking and drinking, or occupation, but they did show a significant difference in terms of education level (p < 0.05), which was primarily related to low education level in the PSD group. In contrast, the clinical data did not show any differences in terms of stroke type, pathogenic site, or medical history (p > 0.05). Conclusion: In this study, statistical results indicated no significant difference in the mRS between the two groups. However, the GSES, VAS, and FAS showed significant differences. This suggests a strong correlation between GSES, VAS, and FAS with the occurrence of PSD, indicating that these factors may serve as predictors for PSD. In medical practice, focusing on patients' self-efficacy, pain, and fatigue levels could facilitate recovery. When developing rehabilitation plans, it is crucial to minimize patients' feelings of self-defeat, enhance their self-efficacy, and manage fatigue effectively. Furthermore, reinforcing pain management throughout the rehabilitation process may promote more effective patient recovery. [ABSTRACT FROM AUTHOR]

Background and purpose: Endovascular therapy (EVT) has been used as a standard treatment method for patients with large vessel ischemic stroke within 24 h of the onset. The extent of recanalization after EVT can be assessed using the modified thrombolysis in cerebral infarction (mTICI) scale as an accepted angiographic grading system. In this study, we aimed to investigate whether patients with a mTICI grade of 2b achieve similar outcomes compared to those with complete recanalization (mTICI of 3) following EVT for acute ischemic stroke. Methods: A retrospective analysis was conducted on 196 consecutive patients who underwent EVT in a comprehensive stroke center. In the final study, 176 patients were included based on the inclusion criteria. The primary outcome was the 3-month modified Rankin Scale (mRS) of 0–2 considered as a favorable outcome, while excellent outcomes were defined as mRS scores of 0–1. Results: Our data showed that 59.46% of patients in the mTICI 2b group achieved a favorable outcome, comparable to 58.99% observed in the mTICI 3 group (p = 0.959). Additionally, 54.05% (n = 37) of patients with mTICI 2b achieved an excellent outcome, compared to 51.80% (n = 139) in the mTICI 3 group (p = 0.807). The case fatality rates were also comparable between the groups, with 8.11% in the mTICI 2b group and 10.79% in the mTICI 3 group (p = 0.632). Overall, there were no statistically significant differences between the two groups in terms of 3-month favorable outcomes, excellent outcomes, or mortality. Conclusion: Similar 3-month outcomes can be achieved for ischemic stroke patients undergoing EVT with a mTICI grade of 2b compared to those with a mTICI grade of 3. These data can help clinicians in setting realistic expectations and making informed decisions during EVT procedures. [ABSTRACT FROM AUTHOR]

Background: Post-stroke depression (PSD) is a prevalent psychiatric complication among stroke survivors. The PSD researches focus on pathogenesis, new treatment methods and efficacy prediction. This study explored the electroencephalography (EEG) microstates in PSD and assessed their changes after acupuncture treatment, aiming to find the biological characteristics and the predictors of treatment efficacy of PSD. Methods: A 64-channel resting EEG data was collected from 70 PSD patients (PSD group) and 40 healthy controls (HC group) to explore the neuro-electrophysiological mechanism of PSD. The PSD patients received 6 weeks of acupuncture treatment. EEG data was collected from 60 PSD patients after acupuncture treatment (MA group) to verify whether acupuncture had a modulating effect on abnormal EEG microstates. Finally, the MA group was divided into two groups: the remission prediction group (RP group) and the non-remission prediction group (NRP group) according to the 24-Item Hamilton Depression Scale (HAMD-24) reduction rate. A prediction model for acupuncture treatment was established by baseline EEG microstates. Results: The duration of microstate D along with the occurrence and contribution of microstate C were reduced in PSD patients. Acupuncture treatment partially normalized abnormal EEG microstates in PSD patients. Baseline EEG microstates predicted the efficacy of acupuncture treatment with an area under the curve (AUC) of 0.964. Conclusion: This study provides a novel viewpoint on the neurophysiological mechanisms of PSD and emphasizes the potential of EEG microstates as a functional biomarker. Additionally, we anticipated the therapeutic outcomes of acupuncture by analyzing the baseline microstates, which holds significant practical implication for the PSD treatment. [ABSTRACT FROM AUTHOR]

Background: Intracranial atherosclerotic disease (ICAD) represents a leading cause of ischemic stroke worldwide, conferring increased risk of recurrent stroke and poor clinical outcomes among stroke survivors. Emerging evidence indicates a paradigm shift, pointing towards increasing detection rates of ICAD among White populations and an evolving epidemiological profile across racial and ethnic groups. The present review aims to provide a comprehensive overview of ICAD, focusing on its pathophysiology, diagnostic approach, and evolving epidemiological trends, including underlying mechanisms, advanced neuroimaging techniques for diagnostic evaluation, racial disparities in prevalence, and current and emerging management strategies. Main body: Atherosclerotic plaque accumulation and progressive arterial stenosis of major intracranial arteries comprise the pathophysiological hallmark of ICAD. In clinical practice, the diagnosis of intracranial artery stenosis (ICAS) or high-grade ICAS is reached when luminal narrowing exceeds 50% and 70%, respectively. Advanced neuroimaging, including high-resolution vessel wall MRI (HRVW-MRI), has recently enabled ICAD detection before luminal stenosis occurs. While earlier studies disclosed significant racial disparities in ICAS prevalence, with higher rates among Asians, Hispanics, and Blacks, recent evidence reveals rising detection rates of ICAD among White populations. Genetic, environmental and epigenetic factors have been suggested to confer an increased susceptibility of certain ethnicities and races to ICAD. Nevertheless, with improved accessibility to advanced neuroimaging, ICAD is increasingly recognized as an underlying stroke etiology among White patients presenting with acute ischemic stroke and stroke of undetermined etiology. While conventional management of ICAS entails risk factor modification, pharmacotherapy, and endovascular treatment in selected high-risk patients, substantial progress remains to be made in the management of ICAD at its early, pre-stenotic stages. Conclusion: ICAD remains a critical yet underappreciated risk factor for ischemic stroke across all populations, highlighting the need for increased awareness and improved diagnostic strategies. The emerging epidemiological profile of ICAD across racial groups necessitates a reassessment of risk factors, screening protocols and preventive strategies. Future research should focus on refining the diagnostic criteria and expanding the therapeutic options to cover the full spectrum of ICAD, with the aim of improving patient outcomes and reducing the global burden of intracranial atherosclerosis and stroke. [ABSTRACT FROM AUTHOR]

Real‐time gait estimation is important for the synchrony control of robotic exoskeleton to provide walking assistance. However, for stroke patients with hemiplegic paralysis, the gait pattern is very complex. Accurate and timely gait intention recognition is therefore difficult. To achieve human–robot synchrony control for an unilateral knee exoskeleton, a gait intention recognizer coupling the adaptive frequency oscillator (AFO) and back propagation neural networks (BPNN) is proposed in this paper. The BPNN is trained with gait data of healthy subjects and stroke patients to improve the accuracy of recognized gait pattern, which is then imported into flexible interaction module to provide appropriate assistance. To evaluate the performance of gait intention recognition, three stroke patients were recruited to conduct level ground walking tests. The kinematic and biomechanical data were captured in each test and processed for the evaluation. Experimental results demonstrate the effectiveness of gait intention recognition and movement assistance. [ABSTRACT FROM AUTHOR]

Background: Shared decision-making is recommended for stroke rehabilitation. However, the complexity of the rehabilitation modalities exposes patients to decision-making conflicts, exacerbates their disabilities, and diminishes their quality of life. This study aimed to explore the experiences and needs of older patients with stroke in China during rehabilitation decision-making, providing a reference for developing decision-support strategies. Methods: A qualitative phenomenological design was used to explore the experiences and needs of older patients with stroke in China. Purposive sampling was used to recruit 31 older Chinese patients with stroke. The participants participated in face-to-face, semi-structured, and in-depth interviews. Data were analyzed using inductive thematic analysis. Results: The key themes identified include (1) mixed feelings in shared decision-making, (2) multiple barriers hinder the possibility of participating in shared decision-making, (3) Delegating rehabilitation decisions to surrogates, (4) gaps between reality and expectation, and (5) decision fatigue from lack of continuity in the rehabilitation health care system. Conclusions: Older patients with stroke in China have complex rehabilitation decision-making experiences and needs and face multiple obstacles when participating in shared decision-making. They lack an effective shared decision-making support system to assist them. Providing patients with comprehensive support (such as emotional and informational), strengthening the construction of a continuous rehabilitation system, alleviating economic pressure, and promoting patient participation in rehabilitation decision-making are necessary. [ABSTRACT FROM AUTHOR]