Objective: Observational studies suggest that abnormal sleep duration and insomnia are associated with stroke, but residual confounding factors, reverse causal bias, and the nonlinear characteristics of exposure-response relationships limit precise causal inference. This study employed a two-sample Mendelian randomization (MR) approach to systematically investigate the bidirectional causal relationship between sleep duration, insomnia, and cerebral infarction, clarifying their genetic causal effects. Methods: Genome-wide association study (GWAS) summary statistics were retrieved from the IEU OpenGWAS platform for sleep duration (ieu-a-1088; 128,266 participants of European descent), insomnia (ukb-b-3957; 462,341 participants of European descent), and cerebral infarction (ukb-d-I63; 361,194 participants of European descent). The inverse variance weighted (IVW) method was used as the core analytical approach, combined with the maximum likelihood method, MR-Egger regression, weighted median method, and weighted mode method for sensitivity analysis. Cochran’s Q test quantified heterogeneity across genetic instruments, while the MR-Egger intercept test was applied to detect directional horizontal pleiotropy. Results: After data harmonization, 26, 38, 24, and 128 genetic variants were included in the analyses of sleep duration → cerebral infarction, insomnia → cerebral infarction, cerebral infarction → sleep duration, and cerebral infarction → insomnia, respectively. IVW analysis revealed no significant causal effect of genetically predicted sleep duration on cerebral infarction [OR=1.002, 95% confidence interval (CI): 0.998-1.006, P=0.252], nor did genetic susceptibility to insomnia significantly affect the risk of cerebral infarction (OR=0.994, 95% CI: 0.988-1.001, P=0.100). In reverse analyses, genetic susceptibility to cerebral infarction showed no significant causal relationship with sleep duration (β=0.394, 95% CI: -1.620-2.408, P=0.701) or the insomnia phenotype (β=0.057 SD, 95% CI: -0.245-0.360, P=0.711). The results of various supplementary analyses were consistent with the core IVW results, demonstrating stable conclusions. Neither the Cochran’s Q test nor the MR-Egger intercept test detected significant heterogeneity or directional horizontal pleiotropy. Conclusion: This bidirectional MR study indicates that there is currently no reliable genetic evidence supporting a bidirectional causal relationship between sleep duration, insomnia, and cerebral infarction. Their clinical correlation may be largely mediated by non-genetic confounding factors.
With the intensification of population aging and the rapid development of neuroimaging, cerebral small vessel disease (CSVD) has garnered increasing attention. Endovascular thrombectomy (EVT) can significantly improve functional outcomes in patients with intracranial large vessel occlusion and has become the standard treatment for acute large vessel occlusion ischemic stroke. Numerous studies suggest that pre-existing CSVD before acute ischemic stroke may increase the risk of hemorrhagic transformation (HT) after EVT, yet results remain controversial. This article primarily discusses the impact of different subtypes of CSVD and the total burden on magnetic resonance imaging on HT after EVT in patients with acute large vessel occlusion ischemic stroke, aiming to provide a clinical reference.
Objective: The purpose of this study was to evaluate the efficacy and safety of monosialotetrahexosylganglioside (GM1) in patients with acute ischemic stroke (AIS) based on real-world data. Methods: From March 2022 to January 2023, patients with AIS treated with GM1 were included in this study. Functional outcomes were assessed using the modified Rankin Scale (mRS) and the NIH Stroke Scale (NIHSS) at baseline and at 2, 6, and 10 weeks after treatment initiation. Safety was evaluated through adverse event (AE) monitoring. Results: A total of 1772 patients with AIS were collected for analysis after the exclusion of the exclusion criteria. GM1 treatment significantly improved functional outcomes. The mRS score decreased from a baseline of 1.32 to 0.97 at the third follow-up (mean reduction: 0.35 points, P < 0.05). The NIHSS score decreased from 5.14 to 2.32 (mean reduction: 2.82 points, P < 0.05). A total of 128 AEs were reported in 98 patients (5.5%). The majority of AEs were mild to moderate (124 events, 7.0%), with only 4 severe AEs (Grade 3, 0.2%) observed. No life-threatening or fatal AEs occurred. Conclusion: GM1 treatment significantly improves the mRS score and NIHSS score of AIS patients, and the safety is high. AIS patients showed obvious advantages in neurological function recovery after GM1 treatment, and these results provide a clinical basis for GM1 in the real diagnosis and treatment environment of AIS patients.
Temporal lobe epilepsy (TLE) is the most common refractory subtype of epilepsy in clinical practice, with a complex pathogenesis and a lack of precise biomarkers for diagnosis and prognosis evaluation, seriously affecting the quality of life of patients. The hippocampus and amygdala, as the core structures of the limbic system, play a key role in the pathogenesis of TLE. Structural abnormalities in both are considered important pathological bases for the initiation, spread, and progression of epileptic discharges. Although conventional magnetic resonance imaging can detect obvious hippocampal sclerosis, it is difficult to capture microstructural changes and has limited ability to identify hidden damage in areas such as the amygdala, leading to misdiagnosis or missed diagnosis in some patients with hidden TLE. Voxel-based morphological analysis (VBM) can accurately quantify the volume and density changes of the whole brain gray and white matter, providing technical support for analyzing the microstructural damage of the hippocampus and amygdala in TLE patients. Previous studies have suggested that the amygdala is not only a “susceptible area” for epileptic discharges, but may also serve as a “relay station” involved in discharge diffusion. Its structural abnormalities are closely related to the frequency and prognosis of TLE attacks. However, the synergistic effect and specific pathological mechanisms of structural changes in the hippocampus and amygdala still need to be further clarified. Therefore, this study used VBM technology to systematically analyze the magnetic resonance imaging manifestations of the hippocampus and amygdala in TLE patients, aiming to reveal their structural abnormalities and provide imaging evidence for the accurate diagnosis, mechanism research, and prognosis evaluation of TLE.
Objective: To compare and analyze the clinical effects of neuroendoscopic hematoma evacuation (ES) and minimally invasive drilling and drainage (MIDD) in the treatment of spontaneous intracerebral hemorrhage, as well as their impacts on neurological function and serological indicators. Methods: A retrospective analysis was conducted on 77 patients with intracerebral hemorrhage admitted to Gaoyou People’s Hospital and Northern Jiangsu People’s Hospital from January 2020 to December 2024. These patients were grouped according to their treatment methods, with 36 receiving MIDD (control group) and 41 receiving ES (experimental group). Perioperative indicators, neurological function before surgery and at 1 and 3 months postoperatively, and the incidence of complications during hospitalization and follow-up were compared between the two groups. Results: The experimental group had a longer operative time, greater intraoperative blood loss, a higher hematoma evacuation rate, and a shorter drainage tube placement time compared to the control group (P < 0.05). Compared to preoperative values, the Glasgow Coma Scale (GCS) scores of both groups continued to increase at 1 to 3 months postoperatively, with the experimental group showing higher scores; the National Institutes of Health Stroke Scale (NIHSS) scores of both groups continued to decrease, with the experimental group showing lower scores (P < 0.05). During hospitalization and follow-up, the overall incidence of complications was lower in the experimental group compared to the control group, but the difference was not statistically significant (P > 0.05). Conclusion: Endoscopic surgery (ES) for spontaneous intracerebral hemorrhage (ICH) can more thoroughly evacuate hematomas, improve neurological function, and shorten postoperative recovery time. Although it has drawbacks such as prolonged operative time and increased blood loss, its overall safety remains acceptable.
