Background/objectives: Cesarean delivery is common, and chronic postsurgical pain (CPSP) may persist, with limited evidence on associated factors and daily-life impact. This study aimed to identify factors associated with CPSP over 48 months of follow-up after cesarean section, to examine whether their associations changed over time, and to assess the impact of CPSP on women’s daily activities. Methods: This was a prospective cohort of 621 women undergoing cesarean section. Participants were assessed preoperatively and followed up at 7 days and 3, 6, 12, 24, 36, and 48 months. Intense acute pain at 7 days (numeric rating scale [NRS] ≥ 7) was assessed as a potential factor associated with CPSP, and CPSP was assessed at each follow-up from 3 to 48 months. Factors associated with CPSP were analyzed using GEE with binomial-logit models, a QIC-selected independent correlation structure, and robust standard errors. Sensitivity analyses addressed missing data, follow-up termination, and the 48-month assessment. Results: The cumulative incidence of CPSP was 25.5% at 3 months, and its prevalence was 5.7% (95% CI: 4.0–8.1) at 48 months. Across the 48 months, factors associated with CPSP included higher preoperative trait anxiety (adjusted OR = 1.06 per point; p = 0.002) and intense pain during the 7-day postoperative period (adjusted OR = 2.28; p < 0.001). These associations did not change over time and were similar in direction in sensitivity analyses. Conclusions: CPSP may persist for years after cesarean section and interfere with women’s activities. Trait anxiety and intense acute postoperative pain were associated with CPSP across the 48-month follow-up.
Background: Cerebral artery dissection is a major cause of stroke in young and middle-aged adults. However, the prevalence of anxiety and depression among patients with cerebral artery dissection, their potential associations with cerebral artery dissection, and the underlying biological mechanisms remain poorly understood. This study aimed to describe anxiety and depression in patients with cerebral artery dissection and to explore potential bidirectional associations and candidate biological processes. Methods: Clinical prevalence and subgroup differences of anxiety and depression in cerebral artery dissection patients were assessed using clinical data. Mendelian randomization (MR) analyses were conducted to evaluate associations between anxiety, depression and cerebral artery dissection. Peripheral-blood RNA sequencing identified cerebral artery dissection-associated differentially expressed genes, which were integrated with anxiety-related genes from GeneCards for enrichment analysis of candidate shared biological processes. Results: Among 726 cerebral artery dissection patients, 315 (43.4%) had anxiety symptoms and 303 (41.7%) had depressive symptoms, with higher proportions in males, ever-smokers, and ever-drinkers. MR analyses provided preliminary evidence of a potential bidirectional association between anxiety and cerebral artery dissection, whereas no consistent evidence of an association was observed between depression and cerebral artery dissection. Integration of cerebral artery dissection-associated differentially expressed genes and anxiety-related genes identified 33 overlapping genes enriched in mitochondrial energy metabolism-related pathways, suggesting candidate systemic transcriptional signatures shared by anxiety and cerebral artery dissection. Conclusions: Anxiety and depression symptoms were frequently observed among patients with cerebral artery dissection. Genetic and transcriptomic analyses suggested potential links between anxiety and cerebral artery dissection, involving candidate mitochondrial energy metabolism-related processes that warrant validation.
Background/Objectives: Prolonged and persistent migraine aura may mimic cerebral ischemia, but its clinical course and neuroimaging features are poorly characterized. We synthesized episode-level evidence on non-motor aura lasting more than 60 min without reported established infarction. Methods: This systematic review (International Prospective Register of Systematic Reviews [PROSPERO] CRD420261461238) followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Scopus, and Google Scholar were searched from inception to August 2026 and the searches were rerun with an extended strategy on 5 October 2026, supplemented by backward and forward citation searching. Eligible reports provided individual-episode clinical data and temporally related neuroimaging. Owing to publication selection, heterogeneous reporting, and clustering, the synthesis was descriptive. Results: Forty-eight studies described 80 episodes in 79 individuals (49 prolonged; 31 persistent). Visual aura occurred in 63/80 episodes. Although magnetic resonance imaging was performed in 77/80 episodes, patient-level informative diffusion imaging was available in only 28/80 and imaging-based perfusion data in 28/80. Five of the 28 episodes with informative diffusion imaging were diffusion-positive (17.9%); the acute apparent diffusion coefficient (ADC) was reduced in 3, non-restricted in 1, and unreported in 1, and all diffusion-weighted imaging (DWI) abnormalities resolved on follow-up. Unusual imaging findings are more likely to be published; this proportion is therefore hypothesis-generating rather than a frequency estimate. In the longer-follow-up stratum, aura improvement was reported in 36/36 prolonged and 18/22 persistent episodes, with complete resolution in 35/35 and 15/22, respectively; a nerve-block series with a fixed 24-h assessment (14 episodes) was analyzed separately. Conclusions: Published cases show heterogeneous phenotypes and cannot support estimates of prognosis or treatment effectiveness. Standardized prospective data collection should incorporate symptom-level duration, imaging timing, DWI/ADC reporting, treatment timing, and protocol-defined follow-up.
Background: Electroencephalographic (EEG) microstates are transient topographic configurations that index large-scale network dynamics at the millisecond scale. Although widely studied clinically, their characterization in healthy subjects remains fragmentary, hindering the separation of normative from pathological dynamics. Methods: Following PRISMA 2020, we searched PubMed, Scopus, Springer, Web of Science and Google Scholar for studies published between June 2019 and June 2025 (PROSPERO CRD420251106374). Of 5052 records, 91 studies were included; risk of bias was assessed with ROBINS-I. Duration, frequency, coverage, topography and transition probabilities were extracted for classes A–F, and the contributing evidence was characterized by clustering solution size (K = 4 vs. K ≥ 5). Results: Microstates D and C showed the longest mean durations (78.14 and 77.04 ms), A and B intermediate values (69.24 and 66.51 ms) and E and F the shortest (59.93 and 58.75 ms); E and F were supported exclusively by solutions with K ≥ 5. The highest transition probabilities (B ↔ F, E → C) rested on only 4–5 studies, whereas the best-evidenced routes were B → A, B → C, B → D and C → D. Conclusions: These findings are a first step toward a normative reference for healthy adults, contingent on standardizing clustering, filtering and transition metrics.
Background: Thyroid dysfunction is a relatively common condition; however, the clinical relevance and long-term effects of subclinical thyroid dysfunction on cardiovascular and cerebrovascular morbidity remain uncertain. This study evaluated the association between subclinical thyroid dysfunction and cerebrovascular disease, focusing on lipid metabolism, carotid atherosclerosis, and stroke severity. Methods: This study included 80 adult patients consecutively admitted with acute ischemic stroke who were newly diagnosed with subclinical thyroid dysfunction. Patients were evaluated over a three-year period (2020–2022). Clinical data, extracranial carotid Doppler ultrasonography, and laboratory parameters (including TSH, FT4, and total cholesterol) were analyzed to establish correlations with stroke characteristics. Results: Subclinical hypothyroidism was identified in 83.75% of patients, while subclinical hyperthyroidism was present in 16.25%. A strong positive linear correlation was observed between serum TSH and total cholesterol levels (r = 0.794, p < 0.001). TSH levels significantly correlated with both the severity of carotid artery stenosis and the National Institutes of Health Stroke Scale (NIHSS) score in patients with anterior circulation stroke. Subclinical hyperthyroidism was identified as a protective factor against moderate or severe carotid atheromatosis (OR = 0.211, p = 0.038); however, 78% of these patients presented with newly diagnosed atrial fibrillation. Conclusions: Subclinical thyroid dysfunction is significantly associated with cerebrovascular pathology through distinct mechanisms. Subclinical hypothyroidism contributes to atherosclerotic vascular disease and greater stroke severity, whereas subclinical hyperthyroidism predisposes predominantly to arrhythmia-mediated embolic events.
