The early diagnosis of acute ischemic stroke (AIS) can be challenging in cases presenting with a scarcity of clinical signs, normal cerebral imaging in early stages and a lack of specific serum markers. Thrombomodulin has been shown to be associated with cerebrovascular ischemic events and can be considered an important biomarker for the acute onset of ischemic stroke. In our study, we compared the serum levels of thrombomodulin (sTM) between a relevant patient group of 70 AIS patients and a control group of patients without AIS admitted into the neurology department between June 2022 and May 2023. sTM levels were measured at 24 h and 48 h after patients’ admissions into the hospital. There was a significant difference between the two groups (AIS: 23.2 ± 9.17 ng/mL vs. controls: 3.64 ± 1.72 ng/mL; p-value < 0.001). sTM values were correlated with the score of neurological deficits, with gender and dyslipidemia. The association of sTM values with the acute onset of AIS as an end point was significant, which allows rapid therapeutic interventions, even in the absence of a well-defined clinical syndrome (AUC = 0.99). Reanalysis of the patients after propensity score matching increased the power of sTM as a biomarker (AUC = 1). sTM represents a potentially useful biomarker to diagnose the onset of an AIS, even in scarce clinical presentations, which makes thrombomodulin a valuable indicator for early treatment initiation.

Stroke is a leading cause of death and severe disability worldwide. Rapid diagnosis is critical to ensure the timely administration of medical treatment. Given that in some cases CT scans fail to show the classic clinical signs of stroke, we aimed to evaluate the diagnostic capacity of adiponectin levels and their association with the clinical parameters of patients with acute ischemic stroke (AIS). Adiponectin was measured within 24 h (T1) and 48 h (T2) of AIS onset in 70 patients. A total of 68 control cases were included in the study. Adiponectin levels were significantly higher in the AIS patients than in the controls (16.64 (3.79; 16.69) vs. 3.78 (3.79; 16.69); p < 0.001), with an accuracy of 0.98 (AUC = 0.99). Lower levels were seen in males and in AIS patients with obesity. Higher levels of adiponectin at T1 were associated with a moderate/severe NIHSS score at patient discharge. Moreover, higher levels of borderline significance were seen in patients who died within 12 months of their AIS episode (p = 0.054). Adiponectin may be a useful biomarker for the identification of AIS patients who do not present classic CT signs and could be used to stratify severe cases. Further studies are needed to validate these results.

Background and Objectives: Biological correlates of baseline clinical responsiveness remain incompletely characterized in older adults with acute ischemic stroke treated with intravenous thrombolysis. We evaluated associations between admission Glasgow Coma Scale (GCS) and pre-thrombolysis hematologic, inflammatory, iron-status, and micronutrient parameters. Materials and Methods: This retrospective single-center cohort included 95 unique patients aged ≥65 years, all treated with intravenous alteplase between 2020 and 2024. Admission GCS ranged from 11 to 14. Spearman correlations used original GCS scores. Principal proportional odds models used ordered GCS categories of 11–12, 13, and 14, and were adjusted for age, sex, and admission National Institutes of Health Stroke Scale (NIHSS), with false discovery rate corrections. Sensitivity analyses additionally considered clinician-documented aphasia, congestive heart failure, atrial fibrillation, and reperfusion status for 24 h GCS change. Results: Admission GCS correlated most strongly with RDW-CV (rho = −0.843; 95% bootstrap CI, −0.892 to −0.774) and MCV (rho = 0.779; 95% CI, 0.668 to 0.866). Principal adjusted odds ratios per one-SD increase were 5.68 for hemoglobin, 3.01 for log-transformed ferritin, 4.71 for serum iron, 4.71 for log-transformed vitamin B12, 0.20 for C-reactive protein, and 0.019 for RDW-CV (all FDR-adjusted p < 0.001). Association directions remained consistent in sensitivity analyses. MCV showed an exploratory nonlinear association. No biomarker was associated with the direction of 24 h GCS change after FDR correction, including reperfusion-adjusted models. Conclusions: Pre-thrombolysis biological parameters were concurrently associated with baseline GCS within this single-center cohort and restricted GCS range. These associations do not establish causality, independence from unmeasured lesion location or infarct volume, predictive utility, or early neurological recovery. Prospective external validation is required.

Introduction Musculoskeletal disorders represent a major global burden, being the main cause of global disability. Current management of musculoskeletal pain includes medication (non-steroidal anti-inflammatory drugs, opioids, intra-articular injections), physiotherapy, and surgery. A modern approach in musculoskeletal pain physiotherapy is capacitive and resistive energy transfer (TECAR) therapy associated with low-level laser therapy (LLLT). Materials and methods We conducted a prospective, observational, cross-sectional, multicenter clinical study that included a total of 268 patients with clinically and imaging-confirmed musculoskeletal disorders. The collected data were entered and processed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States). Results The repeated-measures ANOVA revealed a statistically significant and progressive reduction in visual analog scale (VAS) scores across the four time points, demonstrating that the combined TECAR and LASER therapy produced a consistent and clinically relevant improvement in pain. The benefits have been observed across multiple pathologies, including knee osteoarthritis, lumbar and cervical disc herniation, spondylosis, and tendinopathies, with consistent clinical responses across subgroups. Conclusion TECAR combined with LLLT represents a non-invasive, effective, and well-tolerated intervention, with the potential to become a central component in the management of chronic musculoskeletal pain. However, further randomized, multicenter studies incorporating functional assessments and long-term follow-up are required to confirm and extend these findings.

Background/Objectives: This study describes symptomatic intracranial hemorrhage (sICH) after intravenous alteplase in older adults with acute ischemic stroke. Methods: This retrospective single-center cohort included 95 unique patients aged ≥65 years treated in Galati, Romania, in 2020–2024. The binary hemorrhage variable was verified against clinical and computed tomography (CT) records. Study-defined sICH required new or increased CT hemorrhage with attributed deterioration, comprising a ≥4-point National Institutes of Health Stroke Scale (NIHSS) increase or other clinically relevant worsening. Comparisons and Firth models were exploratory, with admission NIHSS adjustment. Results: All 14 recorded hemorrhages met this definition (14.7%; 95% CI 9.0–23.2%): 10 met the NIHSS threshold and four had relevant worsening below it. Ten were detected before 24 h and four at the 24–48 h range; morphology included hemorrhagic infarction and parenchymal hematoma. All adjusted intervals included the null. Median hospitalization was five days longer with sICH. The mortality difference was 2.6 percentage points (conservative exact 95% CI range from −31.6 to 45.9). Conclusions: Adjusted association estimates are inconclusive and do not justify altering guideline-based eligibility. Prospective multicenter studies require standardized definitions, stroke-severity measures, reperfusion data, and functional outcomes.

Background and Objectives: Extracranial bleeding after intravenous alteplase is less consistently characterized than symptomatic intracranial hemorrhage. This study describes three site-specific manifestations—gingival bleeding, hematuria, and upper gastrointestinal bleeding—documented after alteplase in older adults with acute ischemic stroke. Materials and Methods: This retrospective single-center cohort included 95 patients aged ≥65 years treated between 2020 and 2024. The analysis was limited to the three site-specific extracranial bleeding variables retained in the analytical dataset; other extracranial sites were not systematically available. Site-specific frequencies were the primary outcomes, while documentation of any of the three manifestations was a secondary summary measure. A positive event required documentation after alteplase during the index hospitalization. Exact event-recognition intervals and standardized severity data were unavailable; therefore, immediate hemorrhagic complications and causality could not be assessed. Frequencies were reported with exact Clopper–Pearson confidence intervals, and three secondary antithrombotic exposure analyses used exact odds ratios. Results: Gingival bleeding was documented in five patients (5.3%; exact 95% confidence interval [CI], 1.7%–11.9%), hematuria in four (4.2%; 1.2%–10.4%), and upper gastrointestinal bleeding in one (1.1%; 0.03%–5.7%). The secondary any-of-three measure occurred in 10 patients (10.5%; 5.2%–18.5%). Odds ratios were 1.30 (95% CI, 0.20–6.37) for oral anticoagulant exposure, 1.29 (0.28–6.08) for antiplatelet exposure, and 1.18 (0.25–5.53) for either class. Twenty-two of the 24 oral anticoagulant users also received antiplatelet therapy. Conclusions: These results represent hospitalization-level documentation of three analyzed sites, not the overall burden of extracranial bleeding or the incidence of immediate alteplase-related complications. The wide confidence intervals can neither confirm nor exclude clinically meaningful associations with pre-stroke antithrombotic exposure.