A prediction model for large vessel occlusion in suspected stroke patients based on available prehospital information

Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospital paramedics distinguishing LVO-AIS patients with high efficiency and help to avoid unnecessary and costly delays.The current study aims to develop a screening tool to predict AIS-LVO patients based on prehospital available data.Method:A total of 251 suspected stroke patients who were transported to the emergency department of our hospital via emergency medical services were consecutively enrolled from August,2020 to January,2022.Data including demographic information,medical history,clinical manifestations,and vital signs were collected.A multivariate logistic regression model was developed based on statistically significant variables selected from univariate analysis.Result:Forty-two patients(16.7%)were diagnosed as LVO-AIS based on imaging validation at admission.A comprehensive model was developed with past medical history factors such as atrial fibrillation and coronary heart disease,vital signs such as systolic blood pressure,and prominent symptoms and signs such as gaze palsy,facial paralysis,and dysarthria.The model showed better diagnostic performance in terms of area under the receiver operating characteristic curves(0.884,95%CI,0.830-0.939),which was higher than other common prehospital prediction scales such as the Face,Arm,Speech,Time test(FAST),the Field Assessment Stroke Triage for Emergency Destination(FAST-ED)scale,and the Gaze-Face-Arm-Speech-Time test(G-FAST).Calibration curve analysis,decision curve analysis,and clinical impact curve analysis further validated the reliability,net benefit,and potential clinical impact of the prediction model,respectively.Conclusion:We conducted a prediction model based on prehospital accessible factors including past history of atrial fibrillation and coronary heart disease,systolic blood pressure,and signs such as gaze palsy,facial palsy,and dysarthria.The prediction model showed good diagnostic power and accuracy for identification of the high-risk patients with LVO and may become an effective tool for the LVO recognition in prehospital settings.Future studies are warranted to refine and validate the model further in order to enhance the accuracy and objectivity of clinical judgments.

基于恒河猴脑卒中模型的低温自体血靶向回输系统

几十年来,急性缺血性卒中一直位于我国致死、致残性疾病前列,给患者家庭及社会带来沉重负担[1].其病理特点是血栓阻塞脑血管,形成局部脑组织缺氧.对于急性缺血性卒中,主流的治疗方式是以静脉溶栓及血管内机械取栓术为代表的血管再通疗法[2].但是,仍有50%左右接受再通患者预后仍然较差,究其原因,在于未能得到及时的血管再通以及继发缺血再灌注损伤[3].

Blood-derived factors to brain communication in brain diseases

Brain diseases,mainly including acute brain injuries,neurodegenerative diseases,and mental disorders,have posed a significant threat to human health worldwide.Due to the limited regenerative capability and the existence of the blood–brain barrier,the brain was previously thought to be separated from the rest of the body.Currently,various cross-talks between the central nervous system and peripheral organs have been widely described,including the brain-gut axis,the brain-liver axis,the brain-skeletal muscle axis,and the brain-bone axis.Moreover,several lines of evidence indicate that leveraging systemic biology intervention approaches,including but not limited to lifestyle interventions,exercise,diet,blood administration,and peripheral immune responses,have demonstrated a significant influence on the progress and prognosis of brain diseases.The advancement of innovative proteomic and transcriptomic technologies has enriched our understanding of the nuanced interplay between peripheral organs and brain diseases.An array of novel or previously underappreciated blood-derived factors have been identified to play pivotal roles in mediating these communications.In this review,we provide a comprehensive summary of blood-to-brain communication following brain diseases.Special attention is given to the instrumental role of blood-derived signals,positing them as significant contributors to the complex process of brain diseases.The insights presented here aim to bridge the current knowledge gaps and inspire novel therapeutic strategies for brain diseases.

低温自体血靶向回输对于非人灵长类脑卒中模型的神经保护作用

近几十年来,虽然研究已经证明治疗性低温在啮齿类动物脑卒中模型中有神经保护作用,但其临床转化却未能成功.可能的原因是不同物种之间的生物学差异以及转化研究中治疗性低温诱导难以有效实施.本研究介绍了一种基于非人灵长类动物缺血再灌注模型的选择性治疗性低温疗法,即将自体血于体外循环中冷却,在血管再通后立即通过微导管向缺血区域回输低温自体血.低温自体血将目标脑区迅速冷却至34℃以下,而核心温度可以维持在36℃左右.低温自体血回输减少了梗死面积,保留了白质完整性,改善了神经功能且未引发低温相关并发症.本研究结果表明,在非人灵长类动物脑卒中模型中,通过冷自体输血诱导治疗性低温是一种可行、快速和安全的方法.这提示低温自体血靶向回输是一种具有临床转化潜力的新型低温脑保护疗法.