Acute ischemic stroke (AIS) is one of the leading causes of disability and death among adults worldwide. In recent years, significant advancements have been made in the diagnosis and treatment of AIS, driven by a deeper understanding of its pathophysiological mechanisms and innovations in therapeutic methods. These advancements range from multimodal imaging to the applications of biomarkers, from intravenous thrombolysis to mechanical thrombectomy, from immunomodulation to neuroprotective strategies, and from stem cell therapy to nanomedicine. The field has evolved from drug treatments alone to comprehensive therapeutic models that combine medication with mechanical thrombectomy. The management of AIS is increasingly moving towards individualized, precise, effective, and holistic approaches. Through applying diverse and advanced diagnostic and therapeutic techniques, the early diagnosis level and treatment efficacy of AIS can be enhanced, and ultimately the patients’ outcomes can be improved.

Patent foramen ovale (PFO) exists in about 1/4 of adults and is a recognized risk factor for cryptogenic stroke and migraine. Accurate diagnosis of PFO is crucial for determining the cause and guiding treatment. This article summarized the main diagnostic methods and techniques for PFO, including contrast-enhanced TCD (cTCD), contrast-enhanced transthoracic echocardiography (cTTE), contrast-enhanced transesophageal echocardiography, and cardiac function magnetic resonance imaging. It analyzed the development history, advantages, and disadvantages of each detection method. It also pointed out the important direction of development, which is the combined use of cTTE and cTCD for PFO. The article emphasized the advantages, disadvantages, improvements, and important clinical value of the synchronous multimodal ultrasound contrast examination.

Cerebral autoregulation (CA) is essential for maintaining normal cerebral blood perfusion, which is crucial for ensuring people’s normal daily life and work. CA disorders can occur at any age but are particularly common in patients with cerebrovascular diseases or neurodegenerative diseases. The recumbent-upright test using TCD is a non-invasive and convenient method to assess CA. The key is to monitor the changes in cerebral blood flow velocity and vascular resistance during the transition from supine to upright position. The recumbent-upright test using TCD has significant clinical value in the diagnosis, treatment, and prognostic assessment of cerebrovascular diseases and autonomic dysfunction. However, challenges such as standardized operation, result interpretation, and individual variability hinder its clinical application. In the future, with the advancement of technology and in-depth research, the recumbent-upright test using TCD is expected to play a greater role in individualized treatment and early diagnosis. This paper aims to provide a reference for maximizing its clinical utility.

Acute ischemic stroke is a serious disease that poses a significant threat to human health, with large artery atherosclerotic stroke having more severe symptoms and worse prognosis. Reperfusion therapy can effectively improve the functional outcomes of these patients. In recent years, reperfusion therapy techniques have developed rapidly, yet they also face challenges, such as a low proportion of patients within the treatment time window, reperfusion injury, and hemorrhagic transformation. Addressing these issues requires strategies from multiple aspects, including optimizing emergency procedures, innovating operational techniques, and enhancing injury protection. This article provided a preliminary discussion on the challenges and strategies of reperfusion therapy for large artery atherosclerotic ischemic stroke.

Stroke is a major cause of death and long-term disability among residents in China. Traditional therapeutic drugs are limited by the obstruction of the blood-brain barrier, poor stability, lack of targeting, and low drug loading, which may result in suboptimal treatment outcomes. Nanomaterials, as an emerging, non-invasive, and real-time controllable drug delivery system, have been widely used in the diagnosis and treatment of stroke. Nanomedicines can effectively enhance the biocompatibility, stability, and targeting of drugs, as well as prolong their half-life, thereby significantly improving the efficacy of traditional medications. In recent years, there has been some progress in the application of nanomaterials in the field of ischemic stroke diagnosis and treatment, although challenges in clinical translation remain. This article primarily reviews the research progress and challenges of nanomaterials in the diagnosis and treatment of ischemic stroke, aiming to further promote the research and application of nanomaterials in stroke therapy.

Objective  To investigate and analyze the predictive value of five prehospital stroke screening scales for in-hospital acute large vessel occlusive ischemic stroke.

Methods  All patients admitted to Dongtai People’s Hospital for non-stroke-related diseases who activated the in-hospital stroke green channel due to suspected stroke symptoms during hospitalization from January 2015 to December 2022 were retrospectively included. The ROC curve was used to evaluate the predictive value of the screening scales for in-hospital acute large vessel occlusive ischemic stroke. The five scales included field assessment stroke triage for emergency destination (FAST-ED), rapid arterial occlusion evaluation (RACE), Los Angeles motor scale (LAMS), Cincinnati prehospital stroke severity scale (CPSSS), and prehospital acute stroke severity scale (PASS).

Results  A total of 174 patients were included in this study, of which 54 (31.0%) patients were diagnosed with acute large vessel occlusive ischemic stroke. RACE (AUC 0.888, 95%CI 0.849-0.928) and LAMS (AUC 0.859, 95%CI 0.812-0.905) had the highest predictive efficacy for acute large vessel occlusive ischemic stroke, followed by FAST-ED (AUC 0.820, 95%CI 0.768-0.872), CPSSS (AUC 0.810, 95%CI 0.756-0.863) and PASS (AUC 0.786, 95%CI 0.727-0.844), and there was no significant difference among them.

Conclusions  The prehospital stroke screening scales showed good predictive efficacy in predicting in-hospital acute large vessel occlusive ischemic stroke, and RACE and LAMS showed the highest predictive efficacy.

Objective  To investigate the relationship between eosinophil-to-monocyte ratio (EMR) and the prognosis of patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis .

Methods  The clinical data of 211 patients with AIS who received intravenous thrombolysis were collected from the First Affiliated Hospital of Bengbu Medical University from January 2021 to December 2022. The patients were divided into the good prognosis (mRS score≤2 points) group and the poor prognosis (mRS score>2 points) group according to the mRS score after 3 months. They were divided into the survival group and the death group according to their survival status. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between EMR and the prognosis of patients with AIS receiving intravenous thrombolysis. ROC curve was used to compare the prediction accuracy of EMR, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). According to the optimal cut-off value of the ROC curve, patients were divided into the high EMR group and the low EMR group to analyze the relationship between EMR level and the prognosis.

Results  Multivariate logistic regression analysis showed that EMR (OR 0.406, 95% CI 0.277-0.597, P<0.001) was independently associated with poor prognosis in AIS patients receiving intravenous thrombolysis. The ROC curve showed that the AUC of EMR was 0.773 (95%CI 0.711-0.836, P<0.001), which was superior to NLR and PLR. Its optimal cut-off value was 0.435, the sensitivity was 90.2%, and the specificity was 55.8%. The poor prognosis (P<0.001) and mortality (P=0.009) of the high EMR group (81 cases) were reduced compared to the low EMR group (130 cases).

Conclusions  Lower EMR was independently associated with poor prognosis at 3 months in AIS patients receiving intravenous thrombolysis.

Objective  To study the value of age, blood pressure, clinical features, duration, diabetes, double transient ischemic attack, image (ABCD3-I) score combined with serum cathepsin L (CatL) level in predicting the short-term cerebral infarction in patients with TIA.

Methods  The data of TIA patients admitted to the Northwest University First Hospital from October 2019 to June 2022 were retrospectively and continuously collected. The patients were divided into the cerebral infarction group and the control group according to whether acute cerebral infarction occurred at 90 d follow-up. The differences in ABCD3-I score, serum CatL level, and clinical data between two groups of patients were compared. The independent influencing factors of short-term cerebral infarction in TIA patients were analyzed by multivariate logistic regression. The predictive value of ABCD3-I score and serum CatL level on the occurrence of short-term cerebral infarction in TIA patients was analyzed by the ROC curve.

Results  A total of 115 patients with TIA were enrolled, including 22 patients in the cerebral infarction group and 93 patients in the control group. The ABCD3-I score [7.0 (6.0-7.0) points vs. 5.0 (4.5-6.0) points, P＜0.001], serum CatL level [(6.1±0.9) μg/L vs. (4.8±0.9) μg/L, P＜0.001], and LDL-C level [(3.6±0.5) mmol/L vs. (3.4±0.6) mmol/L, P=0.039] of the cerebral infarction group were higher than those of the control group. Multivariate logistic regression analysis showed that the elevated ABCD3-I score (OR 4.843, 95%CI 2.301-10.193, P＜0.001) and the elevated serum CatL level (OR 2.099, 95%CI 1.332-3.308, P=0.001) were independent risk factors for the occurrence of acute cerebral infarction in TIA patients. ROC curve analysis showed that the AUC value of ABCD3-I score and serum CatL level in predicting acute cerebral infarction of TIA patients were 0.829 (95%CI 0.749-0.909) and 0.867 (95%CI 0.796-0.938), respectively, and the corresponding cutoff value were 7.0 points and 5.3 μg/L, respectively. The AUC value of the combination of the two indicators was 0.911(95%CI 0.848-0.974).

Conclusions  The combination of ABCD3-I score and serum CatL level has good predictive value on the occurrence of short-term cerebral infarction in TIA patients.

Objective  To analyze the current status and research hotspots of research on the correlation between ischemic stroke and sleep from 2013 to 2023.

Methods  A literature search was conducted in the Web of Science core collection for articles related to ischemic stroke and sleep published between January 1, 2013, and December 31, 2023. The bibliometrix package in RStudio and VOSviewer software were utilized to analyze and visualize the number of published studies, contributing countries/regions, institutions, authors, journals, citations, keywords, and research hotspots in this field.

Results  A total of 798 articles were retrieved. An analysis of corresponding authors revealed that China ranked first globally with 199 publications and established collaborations with multiple countries. The United States followed closely with 196 publications. The University of Toronto (Canada) was the leading institution with 34 publications. Among the top ten authors, five were from the University of Michigan (US), and they had close cooperation with each other. American scholar Devin L Brown published 28 articles and was cited 236 times, ranking first in the number of articles published and the frequency of citations. Sleep Medicine published the most articles on ischemic stroke and sleep (74 articles), while Stroke had the highest citation frequency (3542 times). Through the visual analysis of keywords, it was found that stroke and sleep apnea had the highest occurrence frequency. In the research field of the correlation between stroke and sleep, the analysis of research themes suggests that insomnia and depression are fundamental topics crucial to the development of this field. Stroke prevention, functional outcomes, and cerebral blood flow are potential themes that require further exploration.

Conclusions  An increasing number of studies have focused on the correlation between ischemic stroke and sleep. China and the United States have published more literature in this field, and sleep-disordered breathing is the major research hotspot. Future research in the field of stroke and sleep should explore themes such as insomnia, depression, stroke prevention, functional outcomes, and cerebral blood flow.

Objective  To investigate the effects of honokiol on neurological injury and cognitive function in mice with intracerebral hemorrhage (ICH) and its mechanism.

Methods  C57BL/6J mice were randomly grouped into the sham operation group, the model group, the low, medium, and high dose honokiol groups, and the honokiol+inhibitor group. Except for the sham operation group, ICH models were established by injecting autologous blood into the right basal ganglia in other groups. At 15 min before ICH and 1 h after ICH, the low, medium, and high dose honokiol groups were intraperitoneally injected with 10 mg/kg, 20 mg/kg, and 40 mg/kg honokiol, respectively. The honokiol+inhibitor group was intraperitoneally injected with 40 mg/kg honokiol and 5 μg/kg brain derived neurotrophic factor (BDNF)-tyrosine kinase receptor B (TrkB)-cyclic adenosine monophosphate response element binding protein (CREB) signaling pathway inhibitor K252a. The sham operation group and the model group were intraperitoneally injected with equal amounts of dimethyl sulfoxide and physiological saline. The modified neurological severity score (mNSS) was applied to assess the neurological function of mice. The Morris water maze experiment was applied to evaluate the spatial learning and memory abilities of mice by calculating the escape latency, the number of times of crossing the original platform, and the percentage of residence time in the target quadrant. Hematoxylin-eosin (HE) staining was applied to observe the pathological changes in hippocampal neurons. Terminal-deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) staining was applied to detect the apoptotic rate of hippocampal neurons. Enzyme-linked immunosorbent assay (ELISA) was applied to detect serum levels of BDNF and TrkB. Western blot was applied to detect the expression of BDNF, TrkB, CREB, and phosphorylated CREB (p-CREB) proteins in the hippocampus.

Results  Compared with the sham operation group, the mNSS and apoptotic rate of hippocampal neurons in the model group increased, the escape latency prolonged, the number of times of crossing the original platform decreased, the percentage of residence time in the target quadrant decreased, and the levels of BDNF, TrkB in serum and BDNF, TrkB, p-CREB/CREB in the hippocampus decreased (all P<0.001). The structure of hippocampal neurons was blurred, the arrangement was disordered, the number was reduced, the volume was smaller, and the nucleus was shrunk. Compared with the model group, the mNSS (all P<0.01) and apoptotic rate of hippocampal neurons (all P<0.001) in mice in the low, medium, and high dose honokiol groups decreased successively, the escape latency (all P<0.001) shortened successively, the number of times of crossing the original platform (P=0.007, P<0.001, P<0.001) increased successively, the percentage of residence time in the target quadrant (P=0.004, P<0.001, P<0.001) increased successively, and the levels of BDNF (all P<0.001), TrkB (P=0.001, P<0.001, P<0.001) in serum and BDNF (P=0.008, P<0.001, P<0.001), TrkB (P=0.001, P<0.001, P<0.001), p-CREB/CREB (all P<0.001) in the hippocampus increased successively, the damage of hippocampal neurons was improved. Compared with the high dose honokiol group, the mNSS and apoptotic rate of hippocampal neurons in the honokiol+inhibitor group were increased, the escape latency was prolonged, and the number of times of crossing the original platform was decreased, the percentage of residence time in the target quadrant was decreased, and the levels of BDNF, TrkB in serum and BDNF, TrkB, and p-CREB/CREB in the hippocampus were decreased (all P<0.001), and the damage of hippocampal neurons was aggravated.

Conclusions  Honokiol may alleviate hippocampal neuronal apoptosis and damage, and improve cognitive dysfunction in ICH mice by activating the BDNF-TrkB-CREB signaling pathway.

Sneddon syndrome is a rare neurocutaneous syndrome that mainly involves the small and medium arteries. It is clinically characterized by widespread livedo reticularis with recurrent ischemic strokes. This case described a young woman who has suffered multiple minor strokes over the past decade, accompanied by spinal subarachnoid hemorrhage and multiple intracranial aneurysms. Genetic testing revealed a heterozygous mutation in the adenosine deaminase 2 (ADA2) (c.1240G>A). The patient had been treated with clopidogrel for antiplatelet aggregation but later discontinued the therapy. For young patients with a history of recurrent strokes, physicians should closely observe and inquire about the skin lesions in detail and recommend cerebral angiography and genetic testing to more comprehensively assess and manage such cases.

Objective  This study took the training physicians in the green channel of stroke in a medical university-affiliated teaching hospital as the main research object, aiming to improve their learning efficiency and the quality control indicators of clinical work.

Methods  Diversified teaching methods were designed, including case-based collaborative learning, problem-based learning, flipped classroom, one-on-one learning, scenario simulation, and clinical feedback, to assess the teaching effects by collecting multiple quality control indicators and peer feedback for the patients and physicians in the green channel of a teaching hospital’s regional advanced stroke center.

Results  A total of 194 eligible patients from June 2021 to July 2023 were collected. There were 171 (88.14%) cases receiving intravenous thrombolysis, and 23 (11.86%) cases receiving bridging treatment or direct mechanical thrombectomy. The study included 10 junior residents and 5 senior residents. There were 88 (45.36%) patients admitted before training and 106 (54.64%) patients admitted after training. There was no significant difference in demographic baseline characteristics. After training, the median of door-to-needle time (DNT) was shortened by 4 min (44 min vs. 48 min; P=0.150), and the ratios of DNT≤60 min were 73.86% and 65.09% in the two groups (P=0.188). Median informed consent time was shortened by 3.5 min (6.5 min vs. 10 min; P=0.001). Also, thrombolysis-related bleeding events decreased (before training: 1 case of gingival bleeding, 1 case of subdural hematoma, 1 case of gastrointestinal bleeding; after training: no related events), and the proportion of endovascular treatment for large vessel occlusion cases increased significantly (16.98% vs. 5.68%, P=0.015). After training, no significant differences were observed between the senior and junior groups in terms of recognition of the green channel teaching methods of the diversified teaching model, interest in the learning mode of the green channel, satisfaction with the improvement of case quality control, the adaptability of image libraries to problem-solving, the adaptability of literature guide libraries to problem-solving, and the improvement of self-learning ability.

Conclusions  This diversified training program can enhance the learners’ stroke emergency response ability, communication skills, and the level of diagnosis and treatment, improve work quality and teaching satisfaction, and help the clinical learning of both junior and senior residents.