Palliative care for stroke patients: Meeting the Quadruple Aim

中风患者的姑息治疗：实现四重目标

Stroke patients present health care systems with complex clinical and care needs with high costs of care. Prior to 2022, Corewell Health lacked the palliative care infrastructure to reach and serve the diverse needs of this patient population. Corewell Health-West (CH-W) sought to improve end-of-life care for individuals with serious illness. After expanding resources and standardizing the referral and criteria process to palliative care, an increase in palliative care utilization was observed. This effort expanded care dispositions for palliative care services, allowing individuals more opportunities to receive palliative care treatment at home rather than inpatient.

中风患者给医疗保健系统带来了复杂的临床和护理需求，护理成本高昂。2022年之前，科瑞维尔健康（Corewell Health）缺乏姑息治疗基础设施，无法满足这一患者群体的多样化需求。科瑞维尔健康西部（CH - W）力图改善重症患者的临终关怀服务。在增加资源并规范姑息治疗的转诊和评估标准流程后，观察到姑息治疗的使用率有所提高。这一举措拓展了姑息治疗服务的安置方式，让患者有更多机会在家中而非住院接受姑息治疗。

REF: Boone-Sautter KM, Peterson MA, Vermeesch K, Ahmed A. Palliative care for stroke patients: Meeting the Quadruple Aim. J Stroke Cerebrovasc Dis. 2025;34(5):108263. doi:10.1016/j.jstrokecerebrovasdis.2025.108263 PMID: 39984147

Immune checkpoint inhibitor-related CNS vasculitis – A systematic review and report of 6 cases

免疫检查点抑制剂相关的中枢神经系统血管炎——一项系统评价及6例病例报告

Immune checkpoint inhibitors (ICI) represent an important new class of immunotherapy used in cancer treatment. Though effective, immune-related adverse events (irAE) are reported, including cerebral vasculitis (nirVasculitis). In this systematic review, we aim to identify clinical and laboratory features of nirVasculitis and exemplify these in six local clinical cases. There are few clinical reports of nirVasculitis which may be due to underreporting or rarity of complications. Guidelines for diagnostics and reporting may improve awareness and early recognition to initiate important immunosuppressive treatment.

免疫检查点抑制剂（ICI）是一类用于癌症治疗的重要新型免疫疗法。尽管有效，但有免疫相关不良事件（irAE）的报道，包括神经免疫性血管炎（nirVasculitis）。在本系统评价中，我们旨在确定神经免疫性血管炎的临床和实验室特征，并通过六个本地临床病例进行举例说明。关于神经免疫性血管炎的临床报告较少，这可能是由于报告不足或并发症罕见所致。诊断和报告指南可能有助于提高认识和早期识别，以便启动重要的免疫抑制治疗。

REF: Erritzøe-Jervild M, Møller SN, Kruuse C, Stenør C. Immune checkpoint inhibitor-related CNS vasculitis - A systematic review and report of 6 cases. J Stroke Cerebrovasc Dis. 2025;34(5):108265. doi:10.1016/j.jstrokecerebrovasdis.2025.108265 PMID: 39984148

Post-procedural plasma D-dimer level may predict futile recanalization in stroke patients with endovascular treatment

术后血浆D-二聚体水平可预测接受血管内治疗的卒中患者血管再通无效情况

High d-dimer levels may increase the likelihood of unfavorable clinical outcomes in patients with acute ischemic stroke. However, the impacts of serum d-dimer levels on outcomes of reperfusion treatment in patients with acute ischemic stroke have not been evaluated. This study aims to assess a possible relationship between serum d-dimer and functional outcomes in stroke patients with endovascular treatment (EVT). High post-procedural plasma d-dimer levels and a significant increase in d-dimer after EVT may predict futile recanalization in patients with acute ischemic stroke.

D-二聚体水平升高可能会增加急性缺血性脑卒中患者出现不良临床结局的可能性。然而，血清D-二聚体水平对急性缺血性脑卒中患者再灌注治疗结局的影响尚未得到评估。本研究旨在评估接受血管内治疗（EVT）的脑卒中患者血清D-二聚体水平与功能结局之间可能存在的关联。术后血浆D-二聚体水平升高以及EVT后D-二聚体显著升高可能预示着急性缺血性脑卒中患者血管再通无效。

REF: Zhao M, Dai Z, Liu R, Liu X, Xu G. Post-procedural plasma D-dimer level may predict futile recanalization in stroke patients with endovascular treatment. J Stroke Cerebrovasc Dis. 2025;34(5):108248. doi:10.1016/j.jstrokecerebrovasdis.2025.108248 PMID: 39863190

Quality indicators of stroke care in Colombia based on the RES-Q registry

基于RES - Q登记系统的哥伦比亚卒中护理质量指标

This study seeks to outline the epidemiological patterns and quality of care indicators of ischemic stroke in Colombia. It serves as a pioneering effort, offering crucial national-level insights to inform evidence-based stroke policies in Colombia. First study conducted using RES-Q data at the national level in Colombia. A reduction of door-to-needle times by at least 50 % compared to historical levels is evident. Low reperfusion rates persist. Secondary prevention measures are needed with the implementation of national stroke policies.

本研究旨在概述哥伦比亚缺血性中风的流行病学模式和医疗质量指标。这是一项开创性的工作，为哥伦比亚制定基于证据的中风政策提供了至关重要的国家级见解。这是哥伦比亚首次在国家级层面使用RES - Q数据开展的研究。与以往水平相比，从入院到溶栓治疗的时间明显缩短了至少50%。再灌注率仍然较低。需要通过实施国家中风政策来采取二级预防措施。

REF: Bayona H, Amaya P, Bustos JL, et al. Quality indicators of stroke care in Colombia based on the RES-Q registry. J Stroke Cerebrovasc Dis. 2025;34(5):108249. doi:10.1016/j.jstrokecerebrovasdis.2025.108249 PMID: 39921199

Evaluating the strengths and limitations of structured modified rankin scale validation studies – A systematic review

评估结构化改良Rankin量表验证研究的优势与局限性——一项系统评价

Variations in performance of structured modified Rankin Scale (mRS) questionnaires in people with stroke within different cultural and language settings have not been systematically assessed. We systematically reviewed all studies of structured mRS questionnaires compared to in-person unstructured mRS evaluation scores. While structured mRS questionnaire validation studies have generally displayed good agreement with in-person unstructured outcomes, significant discrepancies exist for patients with very poor and very good outcomes. Future studies should limit time between mRS assessments and better understand reasons for differences in structured and unstructured assessments. Further, data on validity of structured mRS tools are lacking from much of the world, especially Africa.

在不同文化和语言环境下，针对中风患者使用结构化改良Rankin量表（mRS）问卷进行评估的效果差异尚未得到系统评估。我们系统回顾了所有将结构化mRS问卷评估结果与面对面非结构化mRS评估得分进行对比的研究。虽然结构化mRS问卷验证研究总体显示与面对面非结构化评估结果具有良好的一致性，但对于预后极差和预后极好的患者，仍存在显著差异。未来的研究应缩短mRS评估的时间间隔，并更好地探究结构化评估与非结构化评估结果存在差异的原因。此外，世界上很多地区，尤其是非洲，缺乏关于结构化mRS工具有效性的数据。

REF: Nair S, Hurly J, Saylor D. Evaluating the strengths and limitations of structured modified rankin scale validation studies - A systematic review. J Stroke Cerebrovasc Dis. 2025;34(5):108242. doi:10.1016/j.jstrokecerebrovasdis.2025.108242 PMID: 39922249

Stroke severity influences correlation of fibrinogen with early neurological deterioration after thrombolytic therapy

卒中严重程度影响溶栓治疗后纤维蛋白原与早期神经功能恶化的相关性

To investigate the relationships between fibrinogen levels at baseline and 24 hours after intravenous thrombolysis (IVT) and early neurological deterioration (END); and to investigate whether stroke severity influences the correlation between fibrinogen and END. Fibrinogen after IVT but not on admission was independently associated with END. And stroke severity influenced the correlation between fibrinogen after IVT and END.

探讨静脉溶栓（IVT）基线及溶栓后24小时纤维蛋白原水平与早期神经功能恶化（END）的关系；并探讨卒中严重程度是否影响纤维蛋白原与END的相关性。静脉溶栓后而非入院时的纤维蛋白原水平与END独立相关。且卒中严重程度影响静脉溶栓后纤维蛋白原水平与END的相关性。

REF: Yu S, Shi J, Guo S, Guo Z, Xiao G. Stroke severity influences correlation of fibrinogen with early neurological deterioration after thrombolytic therapy. J Stroke Cerebrovasc Dis. 2025;34(5):108264. doi:10.1016/j.jstrokecerebrovasdis.2025.108264 PMID: 39988003

Elevated initial blood kynurenine is associated with increased odds of post-stroke infection

初始血液犬尿氨酸水平升高与中风后感染几率增加相关

Post-stroke infection is a leading cause of acute ischemic stroke mortality. Tryptophan metabolites can modulate the immune response. This study assesses the association between tryptophan metabolism and post-stroke infection. Increasing circulating kynurenine within 72 hours of ischemic stroke onset is associated with increased odds of developing a post-stroke infection within 30 days of emergency department admission. Understanding the causal mechanism of kynurenine promoting post-stroke infection may yield targeted therapeutics that reduce the morbidity and mortality of ischemic stroke.

卒中后感染是急性缺血性卒中死亡的主要原因。色氨酸代谢产物可调节免疫反应。本研究评估了色氨酸代谢与卒中后感染之间的关联。缺血性卒中发病后72小时内循环犬尿氨酸水平升高与急诊科就诊后30天内发生卒中后感染的几率增加有关。了解犬尿氨酸促发卒中后感染的因果机制可能会产生针对性疗法，以降低缺血性卒中的发病率和死亡率。

REF: Dylla L, Reisz JA, Poisson SN, Herson PS, Sansing LH, Monte AA. Elevated initial blood kynurenine is associated with increased odds of post-stroke infection: Kynurenine and post-stroke infection. J Stroke Cerebrovasc Dis. 2025;34(5):108268. doi:10.1016/j.jstrokecerebrovasdis.2025.108268 PMID: 40015349 PMCID: PMC11970113

Residual inflammatory risk is associated with leukoaraiosis in patients with ischemic stroke

缺血性中风患者的残余炎症风险与脑白质疏松症相关

Emerging evidence has highlighted the clinical significance of residual inflammation risk (RIR) in cardiovascular and cerebrovascular diseases, with studies demonstrating its association with disease recurrence and poor prognosis. This study aimed to investigate the relationship between RIR and leukoaraiosis (LA) severity in patients with ischemic stroke. These findings suggest that RIR may serve as an independent risk factor for LA in patients with ischemic stroke, particularly among those with a BMI ≥25.0.

越来越多的证据凸显了残余炎症风险（RIR）在心血管和脑血管疾病中的临床意义，多项研究表明其与疾病复发和预后不良相关。本研究旨在探讨缺血性中风患者残余炎症风险与脑白质疏松症（LA）严重程度之间的关系。这些研究结果表明，残余炎症风险可能是缺血性中风患者发生脑白质疏松症的一个独立危险因素，尤其是在体重指数（BMI）≥25.0的患者中。

REF: Gong X, Gang Y, Lu Z, et al. Residual inflammatory risk is associated with leukoaraiosis in patients with ischemic stroke. J Stroke Cerebrovasc Dis. 2025;34(5):108261. doi:10.1016/j.jstrokecerebrovasdis.2025.108261 PMID: 39988002

Multimorbidity in acute ischemic stroke and its impact on short-term mortality: A Chilean nationwide database analysis

急性缺血性卒中的多病共存现象及其对短期死亡率的影响：一项智利全国性数据库分析

Multimorbidity predicts a worse prognosis for various diseases but its impact in people after an acute ischemic stroke (AIS) in developing societies is not well established. We aimed to characterize the pattern of multimorbidity and determine its association with in-hospital mortality after AIS in the nationwide Chilean database. Multimorbidity is common in patients with AIS and its components vary by age and sex. Cardiometabolic multimorbidity increases the likelihood of in-hospital mortality. Adopting a multimorbidity-focused approach to stroke care could improve outcomes.

多病共存预示着多种疾病的预后更差，但在发展中社会，其对急性缺血性卒中（AIS）患者的影响尚不明确。我们旨在描绘多病共存的模式，并在全国性的智利数据库中确定其与AIS患者住院死亡率的关联。多病共存现象在AIS患者中很常见，且其构成因年龄和性别而异。心脏代谢性多病共存会增加住院死亡率。采用以多病共存为重点的卒中护理方法可能会改善预后。

REF: González F, Allende MI, Nuñez M, et al. Multimorbidity in acute ischemic stroke and its impact on short-term mortality: A Chilean nationwide database analysis. J Stroke Cerebrovasc Dis. 2025;34(5):108267. doi:10.1016/j.jstrokecerebrovasdis.2025.108267 PMID: 40023349