A Spatial-Temporal Method to Detect Global Influenza Epidemics Using Heterogeneous Data Collected from the Internet

The 2009 influenza pandemic teaches us how fast the influenza virus could spread globally within a short period of time. To address the challenge of timely global influenza surveillance, this paper presents a spatial-temporal method that incorporates heterogeneous data collected from the Internet to detect influenza epidemics in real time. Specifically, the influenza morbidity data, the influenza-related Google query data and news data, and the international air transportation data are integrated in a multivariate hidden Markov model, which is designed to describe the intrinsic temporal-geographical correlation of influenza transmission for surveillance purpose. Respective models are built for 106 countries and regions in the world. Despite that the WHO morbidity data are not always available for most countries, the proposed method achieves 90.26 to 97.10 percent accuracy on average for real-time detection of global influenza epidemics during the period from January 2005 to December 2015. Moreover, experiment shows that, the proposed method could even predict an influenza epidemic before it occurs with 89.20 percent accuracy on average. Timely international surveillance results may help the authorities to prevent and control the influenza disease at the early stage of a global influenza pandemic.

A Novel PhoP/PhoQ Regulation Pathway Modulates the Survival of Extraintestinal Pathogenic Escherichia coli in Macrophages

The extraintestinal pathogenic Escherichia coli (ExPEC) is a typical facultative intracellular bacterial pathogen. Sensing the environmental stimuli and undertaking adaptive change are crucial for ExPEC to successfully colonize in specific extraintestinal niches. The previous studies show that pathogens exploit two-component systems (TCSs) in response to the host environments during its infection. The PhoP/PhoQ is a typical TCS which is ubiquitous in Gram-negative bacteria. However, there is an incompletely understanding about critical regulatory roles of PhoP/PhoQ in ExPEC pathogenesis. Conjugative ColV-related plasmids are responsible for ExPEC virulence, which is associated with ExPEC zoonotic risk. In this study, the molecular characteristics of HlyF, Mig-14 ortholog (Mig-14p), and OmpT variant (OmpTp) encoded by ColV plasmids were identified. Mig-14p and OmpTp played important roles in conferring ExPEC resistance to cationic antimicrobial peptides (CAMPs) during the infection. Moreover, HlyF and Mig-14p acted as intracellular survival factors to promote ExPEC resistance to macrophages killing. The hlyF and Mig-14p formed an operon in ExPEC ColV plasmid, and PhoP acted as a transcriptional activator of hlyF operon by directly binding to the P _hlyF promoter. The acidic pH and CAMPs could additively stimulate ExPEC PhoQ/PhoP activities to upregulate the expression of HlyF and Mig-14p. Our studies revealed that the novel PhoP/PhoQ-HlyF signaling pathway directly upregulates the production of ExPEC outer membrane vesicles. Furthermore, our study first clarified that this PhoP/PhoQ-HlyF pathway was essential for ExPEC intracellular survival in macrophages. It was required to prevent the fusion of ExPEC-containing phagosomes with lysosomes. Moreover, PhoP/PhoQ-HlyF pathway facilitated the inhibition of the phagolysosomal acidification and disruption of the phagolysosomal membranes. In addition, this pathway might promote the formation of ExPEC-containing autophagosome during ExPEC replication in macrophages. Collectively, our studies suggested that PhoP/PhoQ system and CloV plasmids could facilitate ExPEC survival and replication within macrophages.

[Effects of Jinwu Jiangu recipe on IL-17/STAT3 signals in rheumatoid arthritis synoviocytes]

This paper aimed to investigate the effects of Jinwu Jiangu recipe total extract on the IL-17/STAT3 signals in rheumatoid arthritis synovial fibroblasts(RASF). The primary RASFs were cultured by tissue piece method in vitro， and divided into blank control group， Jinwu Jiangu recipe low dose group， Jinwu Jiangu recipe middle dose group， Jinwu Jiangu recipe high dose group， and tripterygium glycosides control group. They were then treated with corresponding serum free medium， different doses of Jinwu Jiangu recipe total extract(0.06， 0.6， 6.0 g·L⁻¹)， and tripterygium glycosides(0.03 g·L⁻¹) respectively for 24 hours. The gene expression levels of RORα， RORγt， and STAT3 mRNA were detected by polymerase chain reaction(PCR)， and the protein activity of IL-17R and pSTAT3 were measured by Western blot assay. The results showed that as compared with blank control group， the expression levels of RORα， RORγt， IL-17R and STAT3 mRNA in RASF were significantly declined(P<0.01). As compared with tripterygium glycosides control group， Jinwu Jiangu recipe total extract middle dose group and high dose group can down-regulate the expression levels of RORα， RORγt， IL-17R and STAT3 mRNA(P<0.05)， and the effect was more obvious in high dose group(P<0.01). As compared with blank control group， the protein expression levels of IL-17R and pSTAT3 in each treatment group were obviously decreased(P<0.01). As compared with tripterygium glycosides control group， Jinwu Jiangu recipe high dose group had more obvious effect in down-regulating the protein expression of pSTAT3(P<0.01). Therefore， Miao medicine Jinwu Jiangu recipe total extract can down-regulate the expressions of RORα， RORγt， and STAT3 mRNA， and inhibit the protein activity of IL-17R and pSTAT3 in RASF.

Prophage phiv142-3 enhances the colonization and resistance to environmental stresses of avian pathogenic Escherichia coli

Bacterial acquisition of prophages reflects natural selection. Phage DNA has been shown to constitute up to 20% if bacterial genomes. However, prophages' role in Avian Pathogenic Escherichia coli (APEC) is unclear. In this study, APEC strain DE142 harboring prophage phiv142-3, was subjected to deletion and the WT and deletion mutant were characterized under a range of conditions. Prophage deletion mutant DE142Δphiv142-3 was constructed and characterized. The DE142Δphiv142-3 colonies were much smaller than those of the wild-type, and the mutant cells were elongated. The mutant showed reduced adherence to DF-1 cells (87.4% reduction) compared to the wild-type (P < 0.001), and showed a significantly decreased resistance to the killing action of serum (P < 0.001). The mutant demonstrated 95.6%, 71.6%, and 99.6% reduced survival under acid, alkaline, and oxidative stress, respectively. In vitro competition assays showed that the cell number of the mutant was about one-tenth that of the wild-type (competitive index (CI) value, 0.1177). In vivo, the mutant showed significantly decreased colonization of chicken tissues compared with the wild-type. Thus phiv142-3 helps DE142 cope with adverse environments and aids bacterial colonization.

Costus root granules improve ulcerative colitis through regulation of TGF-β mediation of the PI3K/AKT signaling pathway

Ulcerative colitis is a chronic nonspecific inflammatory disease that occurs in the colon and rectum. Costus root is a type of traditional Chinese medicine that exhibits antibacterial properties and serves an inhibitory role in the regeneration of gut bacteria. However, the molecular mechanisms underlying Costus root-mediated improvements in ulcerative colitis remain unclear. A complex formula of Costus root granules was created and investigated in the present study for its therapeutic effects in a rat model of ulcerative colitis. Ingredient dissolution into a traditional water decoction was used as a control. The potential mechanism mediated by Costus root granules was also analyzed in colonic epithelial cells isolated from the experimental rats. The results of the present study demonstrated that Costus root granule treatment inhibited inflammation in colonic tissue. Costus root granule treatment also suppressed the apoptosis of colonic epithelial cells isolated from the rat model of ulcerative colitis. Analyses of the underlying mechanisms of these effects indicated that the administration of Costus root granules increased transforming growth factor β expression, which activated the phosphoinositide 3-kinase/RAC-α serine/threonine-protein kinase signaling pathway in colonic epithelial cells. Notably, the administration of Costus root granules improved stomachache, diarrhea and hematochezia in and increased the body weight of, the ulcerative colitis rats. In conclusion, these results indicate that Costus root granules markedly ameliorate inflammation of the colonic epithelium, decrease the apoptosis of colonic epithelial cells and improve colonic function, which suggests that Costus root granules are an efficient agent for the treatment of ulcerative colitis.

Psychological distress and risk for suicidal behavior among university students in contemporary China

BACKGROUND

Psychological distress and suicidal behavior are important mental health problems among university students and warrant research to inform strategies for effective prevention in this young population. The present study aimed to assess psychological distress and suicidal behavior and to unravel their associations among university students.

METHODS

A total of 5972 undergraduate students, randomly selected from six universities in central China, comprised the sample. The Chinese version of the Symptom Checklist-90-revised (SCL-90-R) was used to assess various psychological symptoms. Logistic regression analysis was used to examine the relationship between psychological distress and risk for suicidal behavior.

RESULTS

40.7% of the university students reported positive in a least one of the 9 psychological symptom dimensions assessed by the SCL-90-R. 7.6% of the students reported suicidal behavior in the previous twelve months. The risk of suicidal behavior was significantly associated with psychological symptoms of all types, but there were notable differences by sex. For male students, depression and phobic anxiety increased the risk of suicidal behavior. Meanwhile, depression and obsessive-compulsiveness were positively associated with suicidal behavior in female students. Furthermore, increasing risk of suicidal behavior was associated with increasing positive symptom total (PST) score and a statistically significant trend was observed.

LIMITATIONS

Data collected from a cross-sectional survey does not allow any examination of causal inference.

CONCLUSIONS

Psychological distress and suicidal behavior were both common among university students; and psychological distress was highly associated with suicidal behavior. The findings underscore the importance of mental health care for university students.

Role of free electrons in phosphorescence in n-type wide bandgap semiconductors

Long persistent phosphorescence is generally known as a phenomenon involving carrier traps induced by defects or impurities in crystals. In this paper, phosphorescence sustained for tens of minutes was found in intentionally undoped ZnO and it was proposed to be a universal phenomenon in wide bandgap semiconductors upon satisfying several conditions. A new model was built to understand this attractive phenomenon within the framework of the traditional trapping-detrapping model but it was modified by considering the free electrons in the conduction band as a significant contributor to the long persistent phosphorescence besides the electrons trapped by shallow donors. This model, explicitly expressed as I(t) ∝ [1 + M(1 - Fe^-γt)^-2]e^-γt, is not only capable of giving a quantitative description of the non-exponential decay of phosphorescence in a wide temperature range but also enables one to determine the depth of shallow donors in semiconductors. The participation of free electrons in phosphorescence was further confirmed by another carefully designed experiment. Thus, this study may represent significant progress in understanding phosphorescence.

FePt-Cys nanoparticles induce ROS-dependent cell toxicity, and enhance chemo-radiation sensitivity of NSCLC cells in vivo and in vitro

FePt-Cys nanoparticles (FePt-Cys NPs) have been well used in many fields, despite their poor solubility and stability. We synthetized a cysteine surface modified FePt NPs, which exhibited good solubility, stability and biocompatibility. We explored the insight mechanisms of the antitumor effects of this new nanoparticle system in lung cancer cells. In the in vitro study, FePt-Cys NPs induced a reactive oxygen species (ROS) burst, which suppressed the antioxidant protein expression and induced cell apoptosis. Furthermore, FePt-Cys NPs prevented the migration and invasion of H1975 and A549 cells. These changes were correlated with a dramatic decrease in MMP-2/9 expression and enhanced the cellular attachment. We demonstrated that FePt-Cys NPs promoted the effects of chemo-radiation through activation of the caspase system and impairment of DNA damage repair. In the in vivo study, no severe allergies or drug-related deaths were observed and FePt-Cys NPs showed a synergistic effect with cisplatin and radiation. In conclusion, with good safety and efficacy, FePt-Cys NPs could therefore be potential sensitizers for chemoradiotherapy.

Hexagonally arranged arrays of urchin-like Ag-nanoparticle decorated ZnO-nanorods grafted on PAN-nanopillars as surface-enhanced Raman scattering substrates

Large-scale flexible films with one side consisting of ordered Ag-NPs@ZnO-nanorods/PAN-nanopillar arrays were used as recyclable SERS substrates.

Enhancing tuberculosis patient detection and care through community volunteers in the urban poor, The Philippines

Setting: The Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association Philippines is a local non-governmental organisation (NGO) established in 2008 to improve access to tuberculosis (TB) services. Community health volunteers (CHVs) from NGO referring facilities were engaged to assist in local TB control activities. Objective: To describe the activities of the CHVs and the barriers experienced by patients with presumptive TB in seeking health care to treatment as documented on a master list, and to identify the CHVs' challenges in community TB care implementation. Design: This was a retrospective evaluation with a non-experimental design reviewing the presumptive TB master list and TB reports and conducting a free discussion session (FDS) in 2012. Results: Of the 78% (281/362) of referred presumptive TB patients who accessed a DOTS facility, 69% (194/281) underwent a diagnostic examination and 42% (81/194) were diagnosed with active TB. Of the 93% (75/81) initiated on treatment, 92% (69/75) were successfully treated. The CHVs contributed approximately 3% (75/2534) to the total TB cases diagnosed at the DOTS facilities. In the FDS, barriers evoked in seeking health care for treatment were transfer of residence and lack of interest in seeking a consultation. In 2012, the CHV attrition rate was 55% (80/145). Conclusion: The CHVs assisted in enhancing access to TB care and case detection. Sustainability of the CHVs' efforts should be explored to retain them in the programme.

The protective effects of magnolol on acute trinitrobenzene sulfonic acid‑induced colitis in rats

The present study aimed to investigate the protective effects of magnolol on acute 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis, and its underlying mechanisms. Experimental colitis was induced by intracolonic administration of TNBS/ethanol into rats. The model rats were randomly assigned into groups: TNBS, magnolol (high, medium and low doses), and salazosulfapyridine (positive control). All intervention regimens were administered by oral gavage, once a day for 7 consecutive days, 24 h after colitis induction. Histological and biochemical changes in colonic inflammation were evaluated by hematoxylin and eosin and immunohistochemistry, respectively. Rats treated with all doses of magnolol exhibited decreased colonic myeloperoxidase activity (P<0.05 vs. TNBS), reduced serum levels of proinflammatory cytokines [including interleukin (IL)-6 and IL-17], and downregulated Toll-like receptor-4 (TLR-4) mRNA expression. Histological analysis revealed that medium and high doses of magnolol conferred an anti-inflammatory effect, which was indicated by a decrease in disease activity index, an increase in thymus index, and downregulation of nuclear factor (NF)-κB p65 mRNA and TLR-4 protein expression. However, only high-dose magnolol significantly ameliorated the elevated colon weight/length ratio. The results of the present study indicate that magnolol exerts protective effects against acute TNBS-induced colitis in rats, and the TLR-4/NF-κB signaling pathway-mediated inhibitory effect on inflammatory cascades may contribute to the protective activity of magnolol.

Involvement of upregulation of fibronectin in the pro‑adhesive and pro‑survival effects of glucocorticoid on melanoma cells

Glucocorticoids (GCs) are important stress hormones, which are used as a concomitant medication during malignant tumor chemotherapy. Clinical and preclinical studies have linked GCs to melanoma growth and progression. However, the effects and mechanism of action of GCs on the adhesion and survival of melanoma cells are still unknown. In the present study the effect of dexamethasone (Dex), a synthetic GC, on fibronectin (FN) expression and its roles in regulating the adhesion and survival of melanoma cells were investigated. It was revealed that Dex significantly increased the levels of intracellular and secreted FN in melanoma cell lines by increasing glucocorticoid receptor‑mediated FN protein stability. Additionally, it was demonstrated that Dex (100 nM) significantly promoted the adhesion and survival of melanoma cells. Silencing FN expression abrogated the pro‑adhesive and pro‑survival effects of Dex in melanoma cells. Extracellular FN significantly enhanced melanoma cell adhesion and survival in the presence of cisplatin, whereas partially blocking extracellular FN signaling with a CD44 antibody significantly reduced FN‑enhanced adhesion and survival. This indicated that the upregulation of FN contributed to the pro‑survival effect of Dex by enhancing cell adhesion. It was also observed that activation of the PI3K/AKT signaling pathway by extracellular FN was involved in the FN‑mediated increase in melanoma cell survival. These findings increase understanding of the possible mechanisms by which GCs regulate melanoma cell adhesion and survival.

Research on the correlation of urine calcium integrin binding protein-1 and pro-BNP with ischemic heart failure

OBJECTIVE

To investigate the correlation between the levels of urine calcium integrin binding protein-1 (CIB1) and serum precursor N-terminal brain natriuretic peptide (pro-BNP) and ischemic heart failure.

PATIENTS AND METHODS

30 patients diagnosed as acute ischemic heart failure for the first time in our hospital from January to August 2016 were continuously selected as the observation group 1, 30 patients with chronic stable ischemic heart failure as the observation group 2, and 30 healthy volunteers as the control group. Urine CIB1 level was detected via enzyme linked immunosorbent assay (ELISA) and serum pro-BNP level was detected via radioimmunoassay. The linear correlation between the CIB1 and pro-BNP levels in observation group 1 was observed, and the diagnostic value of CIB1 and pro-BNP levels for chronic stable ischemic heart failure were analyzed using the receiver operating characteristic (ROC) curve.

RESULTS

CIB1 and pro-BNP levels in the observation group 1 were significantly higher than those in the observation group 2. These levels were significantly lower in the control group (p < 0.05). In the observation group 1, CIB1 and pro-BNP levels were positively correlated (p < 0.05). The diagnostic accuracy of CIB1 for chronic stable ischemic heart failure in the observation group 2 (area under the curve, AUC) was 0.854, the sensitivity was 86.6% and the specificity was 82.5%, respectively. The diagnostic accuracy of pro-BNP was 0.823, the sensitivity was 83.5% and the specificity was 85.9%, respectively.

CONCLUSIONS

There is a significant correlation between the urine CIB1 and serum pro-BNP levels in patients with acute ischemic heart failure. In patients with chronic stable ischemic heart failure, the diagnostic value of urine CIB1 outperforms that of serum pro-BNP, which still needs further study.

[Over-expression of mdr1/P-gp is associated with methotrexate resistance in patients with rheumatoid arthritis]

Objective To investigate the relationship between the gene expression of multidrug resisitance 1 (mdr1)/P-glycoprotein (P-gp) in peripheral blood mononuclear cells (PBMCs) and methotrexate (MTX) resistance in patients with rheumatoid arthritis (RA). Methods According to the grades of disease activity score 28 (DAS28) after taking MTX, RA patients were divided into sensitive group and resistant group. In addition, the healthy volunteers were enrolled as a control group. Real-time PCR was adopted to detect the expression of mdrl mRNA, and flow cytometry was used to detect the level and function of P-gp in PBMCs. Using the information obtained from these detections, we compared the expression of mdr1/P-gp between the three groups. Results Compared with the healthy group, the expression of P-gp was higher in the sensitive group and resistant group. Compared with the sensitive group, both mdr1 mRNA and P-gp expressions increased in the resistant group. Conclusion The over-expression of mdr1/P-gp in RA patients is related to the MTX resistance.

SBI0206965, a novel inhibitor of Ulk1, suppresses non-small cell lung cancer cell growth by modulating both autophagy and apoptosis pathways

Lung cancer is a major public health problem worldwide. Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer cases. Autophagy has recently sparked great interest, and it is thought to participate in a variety of diseases, including lung cancer. Uncoordinated (Unc) 51-like kinase 1 (Ulk1), a serine/threonine kinase, plays a central role in the autophagy pathway. However, the role of Ulk1 in NSCLC remains unclear. We report that NSCLC cell lines exhibited high expression of Ulk1 and that Ulk1 was negatively correlated with prognosis in lung cancer patients. Knockdown of Ulk1 or the inhibition of Ulk1 by the selective inhibitor SBI0206965, inhibited cell proliferation, induced cell apoptosis and enhanced the sensitivity of cisplatin against NSCLC cells. Moreover, we demonstrated that Ulk1 exerted oncogenic activity in NSCLC by modulating both autophagy and apoptosis pathways. Inhibition of autophagy by SBI0206965 sensitized NSCLC cells to cisplatin by inhibiting cisplatin induced cell-protective autophagy to promote apoptosis. Furthermore, SBI0206965 promoted apoptosis in NSCLC cells independent of autophagy, which was partly mediated by destabilization of Bcl2/Bclxl. In summary, our results show that inhibition of Ulk1 suppresses NSCLC cell growth and sensitizes NSCLC cells to cisplatin by modulating both autophagy and apoptosis pathways, and that Ulk1 might be a promising target for NSCLC treatment.

Controlled-release mitomycin C-polylactic acid film prevents epidural scar hyperplasia after laminectomy by inducing fibroblast autophagy and regulating the expression of miRNAs

OBJECTIVE

To design a new controlled-release MMC-PLA film and explore whether and how this film could prevent epidural scar hyperplasia and adhesion in a post-laminectomy rat model.

MATERIALS AND METHODS

All procedures were performed under the approval and supervision of the Institutional Animal Care and Use Committee (IACUC) of Nanjing Medical University. A total of 120 Sprague-Dawley (SD) rats were randomly placed into four groups after laminectomy (each group=30 rats). In Group I, the laminectomy area was flushed with saline as a control; in Group II, 25 mg of PLA film was applied to the dura mater in the laminectomy area; in Group III, a cotton pad soaked with 0.01% MMC solution was kept on the laminectomy area; and in Group IV, 25 mg of PLA film containing 0.01% MMC was implanted on the laminectomy area. Magnetic resonance imaging (MRI), hematoxylin-eosin (HE) staining and Masson staining were used to evaluate scar adhesion and collagen deposition one month after the operation. Autophagy-related proteins, including autophagy-related gene 5 (ATG5), beclin 1, light chain-3B-2/1 (LC3B-2/1) and protein 53 (p53), were detected by Western blotting. A microRNA microarray analysis was performed to screen for scar tissue miRNAs, especially those associated with autophagy, and changes in expression were confirmed by reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

A total of 112 rats recovered uneventfully from the surgery. MRI showed that the scar adhesion and scar area of the MMC-PLA group were significantly reduced compared with those of the PLA, MMC, and saline groups. Accordingly, scar adhesion and the deposition of collagen in the rats treated with MMC-PLA were also significantly reduced, as indicated by HE and Masson staining. In the scar tissue, the levels of autophagy-related proteins (ATG5, beclin 1, LC3B-2/1 and p53) were significantly elevated in the MMC-PLA group. Additionally, in the MMC-PLA group, the expression levels of miR-34a, miR-146a and miR-200 were significantly increased, while the levels of miR-16, miR-221 and miR-378a were significantly decreased.

CONCLUSIONS

The controlled-release MMC-PLA film could alleviate epidural scar hyperplasia after laminectomy; this outcome might be associated with increased autophagy and altered expression of miRNAs in the scar tissue.

Association between anxiety and metabolic syndrome: A systematic review and meta-analysis of epidemiological studies

OBJECTIVE

Epidemiological studies have repeatedly investigated the association between anxiety and metabolic syndrome (MetS). However, the results have been inconsistent. We performed a meta-analysis of observational studies to summarize the evidence regarding the relation of anxiety and MetS risk.

METHODS

We performed a systematic literature search of all studies published in PubMed and EMBASE from its inception to June 2016. Cross-sectional and cohort studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratio (OR), and 95% CI were extracted or provided independently by the authors. Random effects model was used to report the pooled OR. The I² statistic was used to assess heterogeneity. Egger's test and Begger's test were used to evaluate the publication bias.

RESULTS

The search yielded 18 cross-sectional studies and two cohort studies. The pooled finding from cross-sectional studies showed that anxiety had a significant positive association with MetS (OR 1.07, 95% CI 1.01-1.12), with moderate heterogeneity (I²=45.7%, P=0.018). Findings from two cohort studies indicated that the association between anxiety and MetS was insignificant.

CONCLUSION

Our results suggest that there is an association between anxiety and MetS. In individuals with MetS anxiety should be detected and managed. Further prospective studies are needed to explore the bidirectional association between anxiety and MetS.

Herpes zoster and the risk of ischemic and hemorrhagic stroke: A systematic review and meta-analysis

Background

Herpes zoster infection and stroke are highly prevalent in the general population; however, reports have presented inconsistent findings regarding the relationship between herpes zoster infection and stroke. In this meta-analysis, we aimed to clarify this association.

Material and methods

The PubMed and Embase databases were searched for studies published from their inception to January 2016. Two investigators independently extracted the data. The pooled relative risk (RR) was calculated using a random effects model.

Results

A total of 8 studies met the inclusion criteria. During the first 1 month after herpes zoster infection, the pooled RRs for ischemic stroke and hemorrhagic stroke were 1.55 (95% CI, 1.46–1.65) and 1.70 (95% CI, 0.73–3.96), respectively, and within 3 months after infection, the corresponding RRs were 1.17 (95% CI, 1.12–1.23) and 2.05 (95% CI, 1.17–3.60), respectively. At 1 year and more than 1 year after herpes zoster infection, a significant relationship was not observed between herpes zoster infection and the incidence of ischemic and hemorrhagic stroke. Publication bias was not observed.

Conclusion

The accumulated evidence generated from this systematic review indicates that an increased risk for ischemic stroke occurred in the short term after herpes zoster infection, whereas a significant relationship was not observed in the long term after infection. With respect to hemorrhagic stroke, the association was not significant. With respect to hemorrhagic stroke, the association between was not significant except within 3 months after a herpes zoster infection.