Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial

静脉注射阿替普酶与口服阿司匹林治疗严重视力丧失4.5小时内急性视网膜中央动脉阻塞的疗效比较（THEIA研究）：一项多中心、双模拟、患者及评估者双盲、随机对照的3期试验

Central retinal artery occlusion (CRAO) is a subtype of ischaemic stroke that results in acute monocular vision loss. Although open-label studies and meta-analyses have suggested that early intravenous thrombolysis might improve visual acuity, no randomised controlled trials have yet confirmed this benefit. We aimed to compare the safety and efficacy of intravenous alteplase with oral aspirin in patients with CRAO treated within 4·5 h of onset of severe vision loss. Intravenous alteplase administered within 4·5 h of CRAO onset was not associated with a significant improvement in visual acuity compared with aspirin, despite a higher rate of improvement in the alteplase group. However, the study was likely underpowered to detect a statistical difference. Although no safety concerns related to alteplase were identified, the overall modest recovery rates underscore the need for individual patient-level data meta-analyses with forthcoming randomised controlled trials to clarify the potential benefit of thrombolysis or aspirin in patients with acute CRAO.

视网膜中央动脉阻塞（CRAO）是缺血性卒中的一种亚型，可导致急性单眼视力丧失。尽管开放标签研究和荟萃分析表明，早期静脉溶栓可能会提高视力，但尚无随机对照试验证实这一益处。我们旨在比较在严重视力丧失发作后4.5小时内接受治疗的CRAO患者中，静脉注射阿替普酶与口服阿司匹林的安全性和有效性。与阿司匹林相比，在CRAO发作后4.5小时内静脉注射阿替普酶并未使视力显著改善，尽管阿替普酶组的改善率更高。然而，该研究可能因样本量不足而未能检测到统计学差异。虽然未发现与阿替普酶相关的安全问题，但总体适度的康复率凸显了有必要结合即将开展的随机对照试验，进行个体患者水平的数据荟萃分析，以明确溶栓治疗或阿司匹林对急性CRAO患者的潜在益处。

REF: Préterre C, Gaultier A, Obadia M, et al. Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial. Lancet Neurol. 2025;24(11):909-919. doi:10.1016/S1474-4422(25)00308-4 PMID: 41109232

High-sensitivity C-reactive protein, LDL cholesterol, lipoprotein(a) and 30-year risk of stroke in healthy women: a prospective, longitudinal cohort study

健康女性高敏 C 反应蛋白、低密度脂蛋白胆固醇、脂蛋白(a)与 30 年卒中风险：一项前瞻性纵向队列研究

Primary stroke prevention guidelines recommend routine screening of individuals for elevated LDL cholesterol from the age of 40 years, but recommendations are ambiguous for high-sensitivity C-reactive protein (hsCRP) and lipoprotein(a). We aimed to examine correlations between hsCRP, LDL cholesterol, and lipoprotein(a) and 30-year risk of stroke in healthy women. Elevated plasma concentrations of hsCRP, LDL cholesterol, and lipoprotein(a), individually and in combination, are associated with 30-year risk of ischaemic stroke. Early screening for these risk factors might facilitate improved lifestyle interventions for the primary prevention of stroke.

原发性卒中预防指南建议从40岁起对个体进行低密度脂蛋白（LDL）胆固醇升高情况的常规筛查，但对于高敏C反应蛋白（hsCRP）和脂蛋白(a)的筛查建议尚不明确。我们旨在研究hsCRP、LDL胆固醇和脂蛋白(a)与健康女性30年卒中风险之间的相关性。血浆hsCRP、LDL胆固醇和脂蛋白(a)浓度升高，无论是单独升高还是联合升高，均与30年缺血性卒中风险相关。早期筛查这些危险因素可能有助于改善生活方式干预措施，以实现卒中的一级预防。

REF: Nordestgaard AT, Moorthy MV, Cook NR, et al. High-sensitivity C-reactive protein, LDL cholesterol, lipoprotein(a) and 30-year risk of stroke in healthy women: a prospective, longitudinal cohort study. Lancet Neurol. 2025;24(11):920-930. doi:10.1016/S1474-4422(25)00306-0 PMID: 41109233

Neuropathological changes and amyloid-related imaging abnormalities in Alzheimer's disease treated with aducanumab versus untreated: a retrospective case–control study

接受阿杜卡玛单抗治疗与未治疗的阿尔茨海默病患者的神经病理学改变及淀粉样蛋白相关影像学异常：一项回顾性病例对照研究

Understanding the neuropathological effects of amyloid β (Aβ)-targeting therapies and amyloid-related imaging abnormalities (ARIA) in Alzheimer's disease is critical for optimising treatment efficacy and patient outcomes. Comparing Aβ PET imaging with neuropathological assessments provides context for evaluating the extent of Aβ clearance and interpreting in-vivo biomarkers. We aimed to assess clinicopathological changes and ARIA-related effects in aducanumab-treated versus untreated Alzheimer's disease. Disproportionate Aβ clearance and ARIA-associated neuropathology localised to superficial cortical layers suggest a distinctive pattern of target engagement by aducanumab. These findings inform understanding and monitoring of similar Aβ-targeting therapies.

了解阿尔茨海默病中靶向淀粉样蛋白β（Aβ）疗法的神经病理学效应以及淀粉样蛋白相关影像学异常（ARIA），对于优化治疗效果和患者预后至关重要。将Aβ正电子发射断层扫描（PET）成像与神经病理学评估进行比较，可为评估Aβ清除程度和解读体内生物标志物提供背景信息。我们旨在评估接受阿杜卡玛单抗治疗与未接受治疗的阿尔茨海默病患者的临床病理变化以及与ARIA相关的效应。Aβ的清除程度不成比例，且与ARIA相关的神经病理学改变局限于皮质表层，这表明阿杜卡玛单抗具有独特的靶点结合模式。这些发现有助于理解和监测类似的靶向Aβ疗法。

REF: Boon BDC, Piura YD, Moloney CM, et al. Neuropathological changes and amyloid-related imaging abnormalities in Alzheimer's disease treated with aducanumab versus untreated: a retrospective case-control study. Lancet Neurol. 2025;24(11):931-944. doi:10.1016/S1474-4422(25)00313-8 PMID: 41109234