The threat of being or becoming overweight or obese to the health of the population in an increasing number of countries is growing rapidly. Elevated body weight is replacing more traditional problems such as malnutrition and infectious diseases as the most important cause of poor health [1]. Although obesity is an established risk factor for cardiovascular disease, studies have shown that many types of cardiovascular disease may have a better prognosis in overweight or obese patients than in normal-weight people [2,3]. This phenomenon is known as "obesity paradox." The finding is well recognized in the cardiometabolic literature but less so in other diseases.

Background: The association between renal impairment (RI) and stroke outcome after endovascular thrombectomy (EVT) remains unclear, which limits the estimation of patient prognosis by clinicians involved in EVT decision-making. Purpose: This study aimed to investigate the association between RI and acute ischemic stroke (AIS) outcomes in patients treated with EVT. Methods: Studies involving the association between RI at admission and AIS outcomes after EVT were retrieved from the PubMed and Embase databases from their inception to 17 January 2022. A fixed-effects model was used to synthesize the data of the included studies. Sensitivity analysis was performed to identify the source of heterogeneity. Results: Overall, 11 studies, including 5053 patients with stroke receiving EVT, were included in the full analysis. In unadjusted analyses, RI was associated with 3-month poor functional outcome and mortality; the odds ratios (ORs) were 2.13 [10 studies; 95% confidence interval (CI), 1.77–2.56; I2 = 45%] and 2.42 (8 studies; 95% CI, 2.02–2.90; I2 = 58%), respectively. In adjusted analyses, the above associations remained significant; the OR of the 3-month poor functional outcome was 1.49 (5 studies; 95% CI, 1.17–1.90; I2 = 58%), and the OR of the 3-month mortality was 1.84 (6 studies; 95% CI, 1.45–2.33; I2 = 74%). Similar results were obtained in sensitivity analyses. Conclusion: Our results suggest that in patients with AIS who underwent EVT, RI at admission was associated with 3-month poor functional outcome and mortality.

Rationale: Remote ischemic conditioning (RIC) combined with intravenous thrombolysis (IVT) may improve functional outcomes in patients with acute ischemic stroke (AIS). Aim: To assess the efficacy and safety of RIC combined with IVT for AIS. Methods and design: SERIC-IVT is a multicenter, randomized, parallel-controlled, blinded endpoint clinical trial. A total of 558 patients with AIS who underwent IVT therapy will be randomly assigned 1:1 to receive RIC or sham-RIC plus standard medical therapy. The cuff pressures of the RIC group and the sham-RIC group will be 200 mmHg and 60 mmHg, respectively, performed twice a day for 7 consecutive days. Study outcomes: The primary efficacy outcome is the proportion of patients with a favorable functional outcome as defined as a modified Rankin Scale ≤ 1 at 90 days. Safety outcomes include mortality and adverse events within 90 days. Sample size estimates: A sample size of 558 patients with AIS (279 in each group) will allow detection of a shift of 13.14% toward favorable functional outcome at 90 days (modified Rankin Scale ≤1) with 5% significance and 80% power. Discussion: RIC is a promising adjuvant treatment for AIS. SERIC-IVT will inform on whether RIC treatment combined with IVT improves functional outcomes in AIS patients and identify any safety issues.

Rationale/Aim: Many patients undergoing successful recanalization after endovascular thrombectomy (EVT) do not have a good outcome; additional neuroprotection might benefit this group. Remote ischemic conditioning (RIC) stimulates endogenous protective mechanisms and may have a neuroprotective in acute brain ischemia. The SERIC-EVT trial is investigating the safety and efficacy of RIC for patients with acute ischemic stroke who underwent EVT due to large vessel occlusion of the anterior circulation. Methods: SERIC-EVT is a multicenter, randomized, parallel-controlled, and blinded endpoint clinical trial. Patients are recruited from 10 hospitals in Jilin Province, Northeast China. Patients with anterior circulation acute ischemic stroke undergoing EVT due to large-vessel occlusion are randomized in a 1:1 ratio to RIC or sham-RIC. Participants will receive standard medical treatment and an inflation pressure of 200 mmHg (RIC group) or 60 mmHg (sham-RIC group) twice daily for seven consecutive days. Study outcomes: The primary outcome is the proportion of patients with mRS score of 0–2 on day 90. Secondary outcome measures include the National Institute of Health Stroke Scale, Barthel Index, and mRS scores obtained at 24 h, 7 days, 30±3 days, and 90±3 days post-EVT, recanalization rate, expanded Thrombolysis in Cerebral Infarction score, and symptomatic intracranial hemorrhage post-EVT. Mortality and all adverse events, including skin changes and pain scores, within the first 90 days will be used as safety outcome measures. Sample size estimates: Based on previous studies, we estimate a 14% difference in functional independence (the modified Rankin Score [mRS]≤2) between RIC and sham-RIC groups. Considering a significance level of 5% and power of 80%, and one-fifth of patients lost to follow-up, the planned sample size is 498 patients (249 per group). Discussion: RIC might be a strategy that improves 3-month clinical outcomes in AIS patients who have undergone EVT due to large vessel occlusion of anterior circulation. SERIC-EVT will determine whether this is the case. Clinical Trial Registration: Clinicaltrials.gov, identifier: NCT04977869.

AimsThis study aimed to investigate changes in dynamic cerebral autoregulation (dCA), 20 stroke‐related blood biomarkers, and autonomic regulation after patent foramen ovale (PFO) closure in severe migraine patients.MethodsPatent foramen ovale severe migraine patients, matched non‐PFO severe migraine patients, and healthy controls were included. dCA and autonomic regulation were evaluated in each participant at baseline, and within 48‐h and 30 days after closure in PFO migraineurs. A panel of stroke‐related blood biomarkers was detected pre‐surgically in arterial‐and venous blood, and post‐surgically in the arterial blood in PFO migraineurs.ResultsForty‐five PFO severe migraine patients, 50 non‐PFO severe migraine patients, and 50 controls were enrolled. The baseline dCA function of PFO migraineurs was significantly lower than that of non‐PFO migraineurs and controls but was rapidly improved with PFO closure, remaining stable at 1‐month follow‐up. Arterial blood platelet‐derived growth factor‐BB (PDGF‐BB) levels were higher in PFO migraineurs than in controls, which was immediately and significantly reduced after closure. No differences in autonomic regulation were observed among the three groups.ConclusionPatent foramen ovale closure can improve dCA and alter elevated arterial PDGF‐BB levels in migraine patients with PFO, both of which may be related to the preventive effect of PFO closure on stroke occurrence/recurrence.