Sleep, Small Vessel Disease, and Cognition in Minor Stroke
METHODOLOGY:
This cross-sectional study analysed 422 patients with TIA or mild stroke from two prospective cohorts (Edinburgh-UK, n = 211 and Hong Kong, n = 211) between 2018 and 2022, with all participants assessed at 1-3 months post-stroke.
Participants underwent brain MRI for assessing markers of SVD (Fazekas white matter hyperintensities [WMHs], lacunes, perivascular spaces, and microbleeds) and the Montreal Cognitive Assessment (MoCA) for evaluating cognition.
Self-reported sleep metrics (in-bed time, nighttime sleep duration, sleep latency, and sleep efficiency) were extracted from an adapted Pittsburgh Sleep Quality Index.
The main outcome was SVD burden; the secondary outcome was the total MoCA score.
TAKEAWAY:
Longer in-bed time was independently associated with increased summary SVD burden (odds ratio [OR], 1.27 per 1-SD increase; false discovery rate-adjusted P = .04) and greater periventricular burden (OR, 1.53 per 1-SD increase; P = .003).
= .04) and greater periventricular burden (OR, 1.53 per 1-SD increase; = .003). Increased sleep duration was not associated with cognitive performance/longer in-bed time was significantly associated with a lower total MoCA score (standardised β, −0.58; P = .02).
= .02). Longer sleep duration was associated with an increased presence of cerebral microbleeds (OR, 1.42 per 1-SD increase; P = .04), although it was not significantly related to other SVD markers.
= .04), although it was not significantly related to other SVD markers. In-bed time (r, 0.52) and sleep efficiency (r, 0.56) were positively correlated with sleep duration; sleep latency was negatively correlated with sleep duration (r, −0.24; P < .001 for all).
IN PRACTICE:
"2 markers of disturbed sleep, longer in-bed time and longer sleep duration, were cross-sectionally associated with greater SVD burden and worse cognitive performance in patients with TIA/mild stroke," the authors wrote.
SOURCE:
This study was led by Dillys Xiaodi Liu, Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, China, and was published online on May 28, 2025, in Neurology .
LIMITATIONS:
The cross-sectional design and visual assessments of WMHs and brain atrophy limited precision. Patients with a history of sleep apnoea were not excluded, and changes in sleep quality over time were not assessed. As only baseline cross-sectional data were analysed, causal relationships cannot be established, and findings may differ in longitudinal contexts.
DISCLOSURES:
This study was supported by the UK Dementia Research Institute, European Union Horizon 2020, Row Fogo Charitable Trust, and other funding agencies. The authors reported having no conflicts of interest.
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Hamilton Spectator
24-07-2025
- Hamilton Spectator
Cabometyx® approved in the EU for previously treated advanced neuroendocrine tumors
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'Advancements like those achieved through the CABINET Phase III study, as recognized by the approval for Cabometyx in a wide range of NET, is offering new treatment opportunities to delay disease progression in patients with well differentiated NET irrespective of the type of neuroendocrine tumor.' The EC approval was based on data from the CABINET Phase III trial which investigated Cabometyx versus placebo in people living with advanced pNETs or epNETs whose disease had progressed after prior systemic therapy. 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Exelixis granted exclusive rights to Takeda Pharmaceutical Company Limited (Takeda) for the commercialization and further clinical development of Cabometyx for all future indications in Japan. Exelixis holds the exclusive rights to develop and commercialize Cabometyx in the U.S. In over 65 countries outside of the United States and Japan, including in the European Union, Cabometyx is currently indicated as:11 About CABINET (Alliance A021602) CABINET (randomized, double-blinded Phase III trial of CABozantinib versus placebo In patients with advanced Neuroendocrine Tumors after progression on prior therapy) is sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health in the U.S., and is being led and conducted by the NCI-funded Alliance for Clinical Trials in Oncology with participation from the NCI-funded National Clinical Trials Network, as part of Exelixis' collaboration through a Cooperative Research and Development Agreement with the NCI's Cancer Therapy Evaluation Program. The multicenter Phase III CABINET pivotal trial enrolled a total of 298 patients in the U.S. at the time of the analysis. 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Such statements involve known and unknown risks and uncertainties that may cause actual results, performance or events to differ materially from those anticipated herein. All of the above risks could affect Ipsen's future ability to achieve its financial targets, which were set assuming reasonable macroeconomic conditions based on the information available today. Use of the words 'believes', 'anticipates' and 'expects' and similar expressions are intended to identify forward-looking statements, including Ipsen's expectations regarding future events, including regulatory filings and determinations. Moreover, the targets described in this document were prepared without taking into account external-growth assumptions and potential future acquisitions, which may alter these parameters. These objectives are based on data and assumptions regarded as reasonable by Ipsen. These targets depend on conditions or facts likely to happen in the future, and not exclusively on historical data. 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There can be no guarantees a medicine will receive the necessary regulatory approvals or that the medicine will prove to be commercially successful. If underlying assumptions prove inaccurate or risks or uncertainties materialize, actual results may differ materially from those set forth in the forward-looking statements. Other risks and uncertainties include but are not limited to, general industry conditions and competition; general economic factors, including interest rate and currency exchange rate fluctuations; the impact of pharmaceutical industry regulation and healthcare legislation; global trends toward healthcare cost containment; technological advances, new medicine and patents attained by competitors; challenges inherent in new-medicine development, including obtaining regulatory approval; Ipsen's ability to accurately predict future market conditions; manufacturing difficulties or delays; financial instability of international economies and sovereign risk; dependence on the effectiveness of Ipsen's patents and other protections for innovative medicines; and the exposure to litigation, including patent litigation, and/or regulatory actions. Ipsen also depends on third parties to develop and market some of its medicines which could potentially generate substantial royalties; these partners could behave in such ways which could cause damage to Ipsen's activities and financial results. Ipsen cannot be certain that its partners will fulfil their obligations. It might be unable to obtain any benefit from those agreements. A default by any of Ipsen's partners could generate lower revenues than expected. Such situations could have a negative impact on Ipsen's business, financial position or performance. Ipsen expressly disclaims any obligation or undertaking to update or revise any forwardlooking statements, targets or estimates contained in this press release to reflect any change in events, conditions, assumptions or circumstances on which any such statements are based, unless so required by applicable law. Ipsen's business is subject to the risk factors outlined in its registration documents filed with the French Autorité des Marchés Financiers. The risks and uncertainties set out are not exhaustive and the reader is advised to refer to Ipsen's latest Universal Registration Document, available on . References 1Pavel M, et al . Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(7):844-860. 2Baudin E, et al. Lung and thymic carcinoids: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Nov;32(11):1453-1455. 3 Chan et al. Phase 3 Trial of Cabozantinib in Previously Treated Advanced Neuroendocrine Tumors. 2024 New England Journal of Medicine. DOI: 10.1056/NEJMoa2403991 4Chan et al. Cabozantinib Versus Placebo for Advanced Neuroendocrine Tumors (NET) after Progression on Prior Therapy (CABINET Trial/Alliance A021602): Updated Results Including Progression Free-Survival (PFS) by Blinded Independent Central Review (BICR) and Subgroup Analyses. As presented at ESMO Congress 2024 during the 'Proffered Paper: NETs and Endocrine Tumors at 2:45 p.m. CEST Barcelona, Spain 5Neuroendocrine tumor (NET). . Accessed July 2025. 6McClellan, K., Chen. E.Y, Kardosh A., et al. Therapy Resistant Gastroenteropancreatic Neuroendocrine Tumors. Cancers. 2022, 14(19), 4769. 7Frilling et al. Neuroendocrine tumor disease: an evolving landscape. 2012. 19:R163-R185 8Singh et al. Patient-Reported Burden of a Neuroendocrine Tumor (NET) Diagnosis: Results From the First Global Survey of Patients With NETs. J Glob Oncol. 2017 Feb; 3(1): 43–53. 9Dueck et al . Health-related quality of life (HRQOL) in the phase 3 trial of cabozantinib vs placebo for advanced neuroendocrine tumors (NET) after progression on prior therapy (CABINET, Alliance A021602). As presented at ASCO Congress 2025. 10El-Khoueiry A. et al., Cabozantinib: An evolving therapy for hepatocellular carcinoma. Cancer Treatment Reviews. 2021 Jul;98:102221. DOI: 10.1016/ 11European Medicines Agency. Cabometyx® (cabozantinib) EU Summary of Product Characteristics. Available from: . Accessed July 2025. 12Yakes M. et al ., Cabozantinib (XL184), a novel MET and VEGFR2 inhibitor, simultaneously suppresses metastasis, angiogenesis, and tumor growth. Mol Cancer Ther. 2011;10:2298–2308. DOI: 10.1158/ 13Hsu et al., AXL and MET in Hepatocellular Carcinoma: A Systematic Literature Review. Liver Cancer 2021 DOI: 10.1159/000520501 Attachment
Newsweek
18-07-2025
- Newsweek
Donald Trump's Vein Disorder, Chronic Venous Insufficiency, Explained
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. The White House announced on Thursday that President Donald Trump has been diagnosed with chronic venous insufficiency (CVI). The announcement followed growing public speculation over visible swelling in the president's legs and bruises on his hands. Why It Matters Trump, who is 79 years old and is the oldest person to serve a second term, has faced intensifying scrutiny over his age and cognitive fitness. While his physician recently declared him "fully fit" after a comprehensive physical that included a perfect score on the Montreal Cognitive Assessment, public concern about his health has persisted. Trump frequently criticized former President Joe Biden over concerns about his health during last year's presidential election, with Biden eventually dropping out of the race. President Donald Trump speaks during a ceremony to sign the "Halt All Lethal Trafficking of Fentanyl Act," in the East Room of the White House on July 16 in Washington, D.C. President Donald Trump speaks during a ceremony to sign the "Halt All Lethal Trafficking of Fentanyl Act," in the East Room of the White House on July 16 in Washington, D.C. Evan Vucci/AP What To Know The White House released a memo from the president's physician, Sean Barbabella, on Thursday which revealed the president was diagnosed with CVI after he noticed swelling in his legs. "The president underwent a comprehensive examination, including diagnostic vascular studies. 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